Clinicopathologic Manifestations Of Endometriosis-Associated Ovarian Carcinoma

Background:Studies have suggested that endometriosis(EM) is associated with ovarian epithelium cancer (EOC) especially ovarian clear cell cancer(CCC) and endometrioid adenocarcinoma(EAC). Thus, we call those who came from malignancy of endometriosis endometriosis-associated ovarian cancer(EAOC).Objective:The objective of this study was to describe the clinicopathologic features of EAOC in ovarian clear cell carcinoma and endometrioid adenocarcinoma.Methods:In this retrospective study,27cases of CCC and82cases of EAC were selected according to the following selection criteria:①treated between Jan,2000and Feb,2013for the first time of surgery in Qilu Hospital of Shandong university;②no neoadjuvant chemotherapy before surgery;③postoperative pathology proved CCC or EAC.According to whether it was EAOC, subjects were classified into4groups:group A(CCC-EM):EAOC in CCC,12cases; group B(CCC-NEM):CCC without evidence of EAOC,15cases; group C(EAC-EM):EAOC in EAC,19cases; group D(EAC-NEM):EAC without evidence of EAOC,63cases.Compare their common features, clinical symptoms and signs, laboratary examinations, pathological characteristics, treatment and prognosis. Results were performed using X2test, Fish exact test and parametic student t test of SPSS17.0, the probability values of0.05or less were considered to be statistically significant.Results:Among27cases of CCC,12(44.4%) were EAOC. The mean age in the CCC-EM group was51.17, which was7years younger than CCC-NEM group(P<0.05). Algomenorrhea was more frequent in CCC-EM group(54.5%vs23.1%). Both had high proportions of elvated CA-125level and mixed echos in ultrasound findings. In comparison with CCC-NEM, the CCC-EM patients were tend to found in the early stages (FIGO Ⅰ and Ⅱ)(91.7%vs53.3%, P<0.05) and larger in size(14.42cm vs9.84, P <0.05). And also there was a common left-sided predominance(50%vs33.3%, P>0.05).Only22.7%(19/82) of EAC were EAOC. The mean age in the EAC-EM group was50.6, which was3years younger than EAC-NEM group(P>0.05). Algomenorrhea was also more frequent in EAC-EM group(52.6%vs25.4%). The level of CA-125was much higher in EAC than CCC, while EAC-NEM had the highest levels among all. EAC-EM patients were also more likely to found in the early stages (FIGO Ⅰ and Ⅱ)(73.7%vs31.7%, P<0.05) and had low-grade(27.8%vs6.7%, P<0.05). Still, it had a common left-sided predominance(57.9%vs25.4%, P<0.05).The treatment among these four groups had no significant differences, either did the prognosis.Conclusion:EAOC has significant differences in some of the clinicopathologic features when compared with the others. They are much younger and usually have algomenorrhea. In pathology, they are likely to have low grade and low-stage tumors. But the treatment and the prognosis are the same. Whether treatment should be changed still need further studies. We should pay more attention to EM to prevent it from malignant transformation by now.