Abstract
Endometriosis-associated ovarian malignancies have been well documented. Although these malignancies also occur as extraovarian lesions, little is known about them. Thus, this literature review aimed to further explore these rarely experienced tumors. A total of 257 published cases between April 1990 and April 2020 were found using PubMed, and 212 cases were included in the analysis considering Sampson’s criteria and the history of endometriosis. We classified these cases as follows: intestine, abdominal scar, vagina and vulva, peritoneum and deep endometriosis, urinary tract, uterine cervix, and others. Age of patients, history of endometriosis, types of past hormonal therapy, symptoms, histological types, and treatment were identified. The most common tumor site was the intestine. Endometrioid carcinoma was the dominant histological type. Contrary to the ovary, clear cell carcinoma was rare in extraovarian sites. On the other hand, clear cell carcinoma represented the largest number of abdominal scars. This difference may help us to understand the development of endometriosis-related malignancies. Hormonal treatment was mentioned in 67 cases and estrogen replacement therapy in 33 cases. Although risks of estrogen therapy are still controversial, the highly differentiated histological types and hormone-dependent characteristics of endometriosis-associated malignancy should be considered. Physicians should be careful about estrogen monotherapy after hysterectomy and long-term hormone replacement therapy in patients with a history of endometriosis.
Highlights
Endometriosis is defined as the presence of endometrial lesions outside the uterine corpus, affecting 6–10% of women of reproductive age [1]
Out of the identified 258 cases, 45 cases were excluded as follows: detail was not described about each cases (15 cases in 1 case series) [24]; benign diseases (11 cases: 8 cases including 2 case series, mesothelial tumor [25,26,27,28,29]; 1 case, abscess [30]; 1 case, adenofibroma [31]; 1 case, endosalpingiosis was suspected by histological image [32]); no history or coexistence of endometriosis (7 cases) [33,34,35,36,37,38,39]; histological types that were not associated with endometriosis (3 cases) [40,41,42]; coexisting intestinal cancer (2 cases) [43,44]; dissemination of ovarian tumor (2 cases) [45,46]; tumor derived from adenomyosis (2 cases) [47]; primary peritoneal borderline tumor (1 case) [48]; malignancy from endosalpingiosis (1 case) [42]; review from other papers (1 case) [49]
Three cases had surgical history of endometriosis [62,63], one case of myomectomy [64], and one case of uterine perforation [65]. These results indicate that various surgeries that expose endometriotic tissues or endometrial tissues increase risks of malignancy arising in scar endometriosis
Summary
Endometriosis is defined as the presence of endometrial lesions outside the uterine corpus, affecting 6–10% of women of reproductive age [1]. Endometriosis in the ovary, uterine serosa, cul-de-sac, and uterine ligament is often experienced. Irving and Clement classified endometriosis into three categories: common site, less common site, and rare site [2]. Less and rare sites might variously include the intestine, skin, urinary tract, uterine cervix, and vagina. The common issues in endometriosis are infertility and chronic pelvic pain. The prevalence of endometriosis is 21–50% in infertile women and 82% in women who have chronic pelvic pain [3,4]. Malignant transformation is the most serious problem in perimenopausal women
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