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Review
. 2024 Mar 27;13(7):1933.
doi: 10.3390/jcm13071933.

Endometriosis-Related Ovarian Cancer: Where Are We Now? A Narrative Review towards a Pragmatic Approach

Gabriele Centini  1 , Giorgia Schettini  1 , Emilio Pieri  1 , Matteo Giorgi  2 , Lucia Lazzeri  1 , Francesco Giuseppe Martire  1   3 , Virginia Mancini  4 , Diego Raimondo  5 , Renato Seracchioli  5   6 , Nassir Habib  7 , Francesco Fedele  8 , Errico Zupi  1
Affiliations
Review

Endometriosis-Related Ovarian Cancer: Where Are We Now? A Narrative Review towards a Pragmatic Approach

Gabriele Centini et al. J Clin Med. .

Abstract

Background: Endometriosis affects more than 10% of reproductive-aged women, causing pelvic pain and infertility. Despite the benign nature of endometriosis, ovarian endometriomas carry a higher risk of developing endometrioid carcinomas (EnOCs) and clear cell ovarian carcinomas (CCCs). Atypical endometriosis, defined as cytological atypia resembling intraepithelial cancer, is considered the precursor of endometriosis-associated ovarian cancer (EAOC). This narrative review aims to provide an overview of EAOC, proposing a practical approach to clinical and therapeutic decision making.

Methods: An electronic literature search was conducted from inception up to January 2023, using the MEDLINE database via PubMed to evaluate the existing literature on EAOC, including its pathogenesis, the diagnostic process, and the therapeutic possibilities, with articles not relevant to the topic or lacking scientific merit being excluded.

Results: Eighty-one articles were included in the review to present the current state of the art regarding EAOC. A pragmatic clinical flowchart is proposed to guide therapeutic decisions and improve patient outcomes.

Conclusions: Endometriosis patients may have an increased risk of developing EAOC (either EnOC or CCC). Despite not being fully accepted, the concept of AE may reshape the endometriosis-ovarian cancer relationship. Further research is needed to understand the unaddressed issues.

Keywords: ARID1A mutations; PI3K/AKT/mTOR pathway; atypia; atypical endometriosis; biomarkers; clear cell ovarian carcinoma; endometrioid ovarian carcinoma; endometrioma; treatment; ultrasound.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Microscopic view of different grades of endometrioma atypia (50–100 μm): (A) typical endometrioma is lined by endometrioid epithelium with no endometrial stroma beneath it; (B) endometrioma with atypia showing nuclear pleomorphism, an inverted nucleus-to-cytoplasmatic ratio, and abundant eosinophilic cytoplasm with epithelial stratification and tufting; (C) endometrioma with foci of atypia (green arrow) and foci of clear cell carcinoma (blue arrow).
Figure 2
Figure 2
Ultrasound images of (a) a typical endometrioma, (b) an atypical endometrioma, (c) a clear cell carcinoma, and (d) an endometrioid carcinoma. The ultrasonographic diagnosis was confirmed by pathological examination, and patients provided informed consent for the use of their images.
Figure 3
Figure 3
Flowchart for surgical management of ovarian atypical endometriosis. Abbreviations: MRI, magnetic resonance imaging; HC, hormonal contraceptive; US, ultrasound.
See this image and copyright information in PMC

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