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Malignant transformation of residual endometriosis after hysterectomy: a case series
Vrunda C Karanjgaokar1, Damian J Murphy, Jagbir S Samra
1Department of Gynaeoncology, New Cross Hospital, Wolverhampton, West Midlands, Wolverhampton, United Kingdom. vrnkar@aol.com
Objective:
To explore the role of long-standing hormone replacement therapy (HRT) in the malignant transformation of endometriosis.
Design:
Short case series. Three cases of women with pelvic clearance receiving long-standing HRT studied in detail.
Setting:
Teaching hospital in the United Kingdom (Gynaecological Cancer Centre) (Institutional Review Board approval was not obtained as it was not deemed necessary, this being a case series).
Patient(S):
Women with a history of pelvic clearance for endometriosis and longstanding HRT.
Intervention(S):
HRT.
Main Outcome Measure(S):
Malignant transformation of endometriosis.
Result(S):
Long-standing HRT in all three women with pelvic clearance for endometriosis resulted in malignant transformation of residual endometriosis many years after the initial surgery. All cases presented with a new pelvic lesion.
Conclusion(S):
The diagnosis of malignant transformation needs to be considered in women with a history of endometriosis and with long-term HRT use in whom a new pelvic lesion is detected. The risk of malignant transformation in women with endometriosis after pelvic clearance receiving HRT needs to be explored further. Surveillance with CA-125 and imaging in such cases to predict recurrence or malignant transformation needs to be studied further in a research setting.
