Malignant Transformation from Endometriosis to Atypical Endometriosis and Finally to Endometrioid Adenocarcinoma within 10 Years

Abstract

Atypical endometriosis is reported to possess a precancerous potential attributed to premalignant changes characterized by cytological atypia and architecture proliferation. Moreover, the coexistence of atypical endometriosis and neoplasms had been reported. However, cases of atypical endometriosis transformation to carcinoma are rarely reported. We describe the case of a 33-year-old woman who had a long therapeutic history of endometriosis. Three laparoscopic surgeries were performed to treat endometriosis. After the third surgery, she was diagnosed as having grade 1 endometrioid adenocarcinoma. The histological review of the previous surgery confirmed the diagnosis of atypical endometriosis based on the second specimen. The patient's disease progressed from a benign endometriotic cyst to atypical endometriosis and finally to endometrioid adenocarcinoma within 10 years. When we encounter cases of atypical endometriosis, it is necessary to consider the possibility of ovarian cancer and carefully follow the patients for long periods.

Keywords: Atypical endometriosis; Endometriosis; Malignant transformation.

Fig. 1

Pathological finding of the third specimen for her left ovarian cyst (H&E staining; a ×40, b ×400). a Grade 1 endometrioid adenocarcinoma was observed. b The transition between the carcinoma and the benign endometriosis was detected.

Fig. 2

Pathological finding of the second specimen for her right ovarian cyst (H&E staining; ×400). Atypical features were observed, including eosinophilic cytoplasm, large hyperchromatic or pale nuclei with moderate pleomorphism, an increased nuclear to cytoplasmic ratio, cellular crowding and stratification.