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

• Published in: Journal of gynecologic oncology Vol. 30; no. 4; p. e63
• Main Authors: Ñiguez Sevilla, Isabel, Machado Linde, Francisco, Marín Sánchez, Maria Del Pilar, Arense, Julián Jesús, Torroba, Amparo, Nieto Díaz, Anibal, Sánchez Ferrer, Maria Luisa
• Format: Journal Article
• Language: English
• Published: Korea (South) Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 01.07.2019; 대한부인종양학회
• Subjects: Biomarkers, Tumor; DNA-Binding Proteins; Endometrial Hyperplasia - diagnosis; Endometrial Hyperplasia - pathology; Endometriosis - diagnosis; Endometriosis - pathology; Female; Humans; Ki-67 Antigen; Original; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - pathology; Precancerous Conditions - pathology; Prospective Studies; Transcription Factors; 산부인과학; Ovarian Cancer; Endometriosis; Hyperplasia
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2019.30.e63

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. 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. 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. 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.