Endometrial Cancer Arising in Adenomyosis (EC-AIA): A Systematic Review

Abstract

Endometrial cancer arising in adenomyosis (EC-AIA) is a rare uterine disease characterized by the malignant transformation of the ectopic endometrium within the adenomyotic foci. Clinicopathological and survival data are mostly limited to case reports and a few cohort studies. We aimed to assess the clinicopathological features and survival outcomes of women with EC-AIA through a systematic review of the literature. Six electronic databases were searched, from 2002 to 2022, for all peer-reviewed studies that reported EC-AIA cases. Thirty-seven EC-AIA patients from 27 case reports and four case series were included in our study. In our analysis, EC-AIA appeared as a rare disease that mainly occurs in menopausal women, shares symptoms with endometrial cancer, and is challenging to diagnose preoperatively. Differently from EC, it shows a higher prevalence of the non-endometrioid histotype, advanced FIGO stages, and p53-signature, which might be responsible for its worse prognosis. Future studies are necessary, to confirm our findings and further investigate this rare condition.

Keywords: adenomyo*; carcinoma; endometr* malignancy; tumors; tumours.

Figure 1

Flow diagram of the studies identified in the systematic review (Prisma template (preferred reporting item for systematic reviews and meta-analyses)).

Figure 2

Kaplan–Meier curve for the risk of recurrence in women with endometrial carcinoma arising in adenomyosis (EC-AIA).

Figure 3

Assessment of the risk of bias. Summary of the risk of bias for each study. Plus sign: low risk of bias; minus sign: high risk of bias; question mark: unclear risk of bias.