J Gynecol Oncol.  2019 Jul;30(4):e63. 10.3802/jgo.2019.30.e63.

Prognostic importance of atypical endometriosis with architectural hyperplasia versus cytologic atypia in endometriosis-associated ovarian cancer

• Ñiguez Sevilla I
• Machado Linde F
• Marín Sánchez MdP
• Arense JJ
• Torroba A
• Nieto Díaz A
• Sánchez Ferrer ML

• KMID: 2450242
• DOI: http://doi.org/10.3802/jgo.2019.30.e63

Abstract

OBJECTIVE
Patients with endometriosis are at increased risk of ovarian cancer. It has been suggested that atypical endometriosis is a precursor lesion of endometriosis-associated ovarian cancer (EAOC). The aim of this study is to evaluate if cytologic (cellular) atypia and architectural atypia (hyperplasia), histologic findings described as atypical endometriosis, play a different role in patients with EAOC.
METHODS
A prospective study was conducted between January 2014 and April 2017 at our institution with patients undergoing surgery with a histologic diagnosis of endometriosis, ovarian cancer, or EAOC. The prevalence and immunohistologic study (Ki-67, BAF250a, COX-2) of cases of cellular and architectural atypia in endometriosis were analyzed.
RESULTS
Two hundred and sixty-six patients were included: the diagnosis was endometriosis alone in 159 cases, ovarian cancer in 81, and EAOC in 26. Atypical endometriosis was reported in 23 cases (12.43%), 39.13% of them found in patients with EAOC. Endometriosis with cellular atypia was found mainly in patients without neoplasm (71.4%), and endometriosis with architectural atypia was seen in patients with ovarian cancer (88.9%) (p=0.009). Ki-67 was significantly higher in endometriosis patients with architectural atypia than those with cellular atypia.
CONCLUSION
The diagnosis of endometriosis with architectural atypia is important because it may be a precursor lesion of ovarian cancer; therefore, pathologists finding endometriosis should carefully examine the surgical specimen to identify any patients with hyperplasia-type endometriosis, as they may be at higher risk of developing EAOC.

Keyword

Endometriosis; Ovarian Cancer; Hyperplasia

MeSH Terms

Diagnosis
Endometriosis*
Female
Humans
Hyperplasia*
Ovarian Neoplasms*
Prevalence
Prospective Studies