Abstract
Adenomyosis is a common benign gynecological condition, defined as an extension of endometrial tissue into the myometrium. Some studies suggest that adenomyosis could be a favorable prediction factor associated with survival outcomes in endometrial cancer. The aim of our systematic review was to investigate the current knowledge regarding adenomyosis and a possible molecular mechanism of carcinogenesis in adenomyotic lesions. In addition, the long-term prognosis for patients with endometrial cancer and coexisting adenomyosis (and endometriosis) was a key point of the research. The current literature was reviewed by searching PubMed, using the following phrases: “adenomyosis and endometrial cancer” and “malignant transformation of adenomyosis”. According to the literature, genetic mutations, epigenetic changes, and inactivation of specific tumor suppressor genes in adenomyosis are still poorly understood. Data regarding the influence of adenomyosis on survival outcomes in endometrial cancer seem to be contradictory and require further clinical and molecular investigation.
Highlights
Adenomyosis, endometriosis, and gynecological cancers, such as endometrial, ovarian endometroid, and clear cell cancers, may have common pathogenetic mechanisms that, amongst others, include hormonal factors, genetic predisposition growth factors, inflammation, altered function of the immune system, environmental factors, and oxidative stress
endometrial cancer (EC)-AIA, which accounts for less than 1% of EC, should be diagnosed only if some important histopathological features are acknowledged: EC must not be present in the eutopic endometrium or other places in the pelvis; cancer must arise from the epithelium of adenomyotic foci found between the uterus muscle; and the diagnosis of adenomyosis should be confirmed by the presence of endometrial stromal cells surrounding the ectopic endometrial glands
A comparison of Endometrial Cancer Arising In Adenomyosis (EC-AIA) and EC-A leads to the conclusion that endometrial cancer arising in adenomyosis is associated with poor survival outcomes compared to EC-A
Summary
Adenomyosis, endometriosis, and gynecological cancers, such as endometrial, ovarian endometroid, and clear cell cancers, may have common pathogenetic mechanisms that, amongst others, include hormonal factors, genetic predisposition growth factors, inflammation, altered function of the immune system, environmental factors, and oxidative stress. While an irregular endometrium layer or junctional zone typical of adenomyosis may imitate endometrial cancer, thickening of the myometrium may be a symptom for both adenomyosis and the spread of cancer. These confounding features may lead, in our opinion, to the early recognition of EC associated with adenomyosis. ADENOMYOSIS IN ULTRASOUND globally enlarged uterus asymmetric thickness anterior and posterior wall = pseudo-widening sign cystic myometrium (cystic anechoic spaces) junctional zone (JZ) not clearly visible, JZ interrupted, irregular, thickened; with anechoic cysts, hyperechoic dots heterogeneous echogenicity of the myometrium ill-defined lesion (difficult to delineate) focal disturbances in myometrium layer sometimes focal form diagnosed as intramural myoma anechoic cysts or cysts of ground-glass appearance absence of blood flow in lesions
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