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

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

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.

Keywords: Endometriosis; Hyperplasia; Ovarian Cancer.

Publication types

  • Observational Study

MeSH terms

  • Biomarkers, Tumor
  • DNA-Binding Proteins
  • Endometrial Hyperplasia / diagnosis
  • Endometrial Hyperplasia / pathology*
  • Endometriosis / diagnosis
  • Endometriosis / pathology*
  • Female
  • Humans
  • Ki-67 Antigen
  • Ovarian Neoplasms / diagnosis
  • Ovarian Neoplasms / pathology*
  • Precancerous Conditions / pathology
  • Prospective Studies
  • Transcription Factors

Substances

  • ARID1A protein, human
  • Biomarkers, Tumor
  • DNA-Binding Proteins
  • Ki-67 Antigen
  • Transcription Factors