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Malignant neoplasms arising in endometriosis.
J M Heaps1, R K Nieberg, J S Berek
1Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine.
Obstetrics and Gynecology
|June 1, 1990
Summary
Malignant tumors in endometriosis, primarily ovarian endometrioid adenocarcinomas, show better survival with progestin therapy post-surgery. Early-stage disease confined to the pelvis has a good prognosis.
Area of Science:
- Gynecologic Oncology
- Reproductive Medicine
- Pathology
Background:
- Malignant transformation in endometriosis is a rare but significant clinical event.
- Endometriosis, characterized by endometrial tissue outside the uterus, can occur in gonadal and extragonadal sites.
- Understanding the characteristics and outcomes of these rare malignancies is crucial for effective management.
Purpose of the Study:
- To report ten new cases of malignant tumors arising in endometriosis.
- To analyze a cumulative series of 205 cases from the English literature.
- To evaluate the impact of treatment modalities, including radiation, chemotherapy, and hormonal therapy, on survival.
Main Methods:
- Retrospective review of ten cases of malignant tumors in endometriosis.
- Literature search and meta-analysis of 195 previously reported cases.
- Analysis of tumor types, primary sites, treatment regimens, and patient survival outcomes.
Main Results:
- Ovary was the primary site in 78.7% of cases; extragonadal sites in 21.3%.
- Endometrioid adenocarcinomas (69%) and clear-cell carcinomas (13.5%) were most common.
- Progestin therapy showed a 77% 5-year survival rate; chemotherapy had limited efficacy.
Conclusions:
- Malignant tumors in endometriosis are often low-grade and confined to the site of origin.
- Progestin therapy, in addition to surgical resection, is recommended for treating cancer arising in endometriosis.
- The incidence of malignancy in endometriosis may be underestimated.