{"paper_id":"09ddb446-aca2-4a91-a819-cea0cd97f6c7","body_text":"406  © 2020 Indian Journal of Medical and Paediatric Oncology | Published by Wolters Kluwer - Medknow\nIntroduction\nThe ovary is a common site for \nendometriosis. Endometriosis is the \npresence of endometrium glands and \nstroma outside the uterus. [1] It is well \nrecognized that malignant transformation \ncan occurs in endometriosis. Nishida \net al . reported 18 cases of atypical \nendometriosis and one case of ovarian \ncarcinoma in 147 cases of ovarian \nendometriosis, thus the incidence of \nmalignancy in ovarian endometriosis \nis 0.7%. [2] However, among the \nmalignancies, clear cell adenocarcinoma \nand endometrioid adenocarcinoma are \nthe common malignancies associated \nwith endometriosis. Serous and mucinous \ntumors are infrequently seen with \nendometriosis. [3] Here, we present a \ncase report of a 40‑year‑old female who \nclinically presented with abnormal uterine \nbleeding (AUB) and ovarian mass. On \nhistopathological examination, it was \ndiagnosed as a borderline serous tumor \nwith endometriosis.\nCase Report\nA 40‑year‑old female presented to \nthe outpatient setting with AUB and \nabdominal mass. On ultrasonography \nexamination, it was diagnosed as an \nAddress for correspondence:  \nDr. Seema Dayal, \nDepartment of Pathology, \nUttar Pradesh University \nof Medical Sciences, Saifai, \nEtawah, Uttar Pradesh, India.  \nE-mail: seemadayal5@gmail.\ncom\nAccess this article online\nWebsite: www.ijmpo.org\nDOI: 10.4103/ijmpo.ijmpo_209_18\nQuick Response Code:\nAbstract\nEndometriosis is the presence of endometrial glands outside the endometrium, and ovary is the \ncommon site for endometriosis. Endometriosis can also transform into malignant tumors. When \nendometriosis is present within the tumors, the term endometriosis‑derived tumor applies, whereas \nwhen endometriosis is recognized adjacent to the tumor, it is called as endometriosis‑associated \ntumor. Borderline serous tumor is surface epithelial ovarian tumor. The endometriosis‑associated \novarian malignancies are clear cell adenocarcinoma and endometrioid adenocarcinoma, whereas \nserous and mucinous are rare malignancies with endometriosis. Here, we are presenting a case report \nin which endometriosis was associated with borderline serous tumor.\nKeywords: Borderline serous tumor, endometriosis, ovary\nOvarian Endometriosis with Borderline Serous Tumor- Association or \nCoincidence – A Case Report and Review of Literature\nCase Reports and Review of Literature\nSeema Dayal\nDepartment of Pathology, \nUttar Pradesh University \nof Medical Sciences, Saifai, \nUttar Pradesh, India\nHow to cite this article:  Dayal S. Ovarian \nendometriosis with borderline serous tumor- \nassociation or coincidence – A case report and \nreview of literature. Indian J Med Paediatr Oncol \n2020;41:406-8.\nThis is an open access journal, and articles are \ndistributed under the terms of the Creative Commons \nAttribution-NonCommercial-ShareAlike 4.0 License, which allows \nothers to remix, tweak, and build upon the work non-commercially, \nas long as appropriate credit is given and the new creations are \nlicensed under the identical terms.\nFor reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com\novarian cyst. Hysterectomy with bilateral \nsalpingo‑oophorectomy was performed, \nand the specimen was sent in 10% formal \nsaline for histopathological analysis. \nGrossly, hysterectomy with bilateral \nsalpingo‑oophorectomy measured \n12 cm × 9 cm × 6 cm, on further \nsectioning, multiple leiomyomas measuring \n1 to 1.5 cm in size were also seen in the \nmyometrium, [Figure 1] whereas, the left \nsided ovary showed hemorrhagic luteal \ncyst and right sided ovary measured \n8 cm × 6 cm × 4 cm, which on cutting was \nuniloculated, with papillary architecture \nand filled with serous fluid [Figure 2]. \nOn histopathology examination, right \nsided ovary showed a borderline serous \ntumor, and associated endometriosis \n[Figures 3 and 4].\nDiscussion\nOvarian tumors are common tumors \nof the female genital tract. The WHO \nclassification of ovarian tumor includes \nsurface epithelial tumor, germ cell tumor, \nsex cord stromal tumour, miscellaneous \nand metastatic tumors. [4,5] Surface epithelial \ntumor constitutes 60%–70% of all ovarian \nneoplasms and 90% of malignant ovarian \ntumors. The common epithelial tumors \nare serous, mucinous, and endometrioid. \nSerous tumors are divided into benign, \nborderline, and malignant. [5] Endometriosis \nSubmitted: 20‑Sep‑2018 \nRevised: 24‑Oct‑2019 \nAccepted: 10‑Nov‑2019 \nPublished: 27‑Jun‑2020\nArticle published online: 2021-06-28\n\nDayal: Ovarian endometriosis association with serous tumor\nIndian Journal of Medical and Paediatric Oncology | Volume 41 | Issue 3 | May-June 2020 407\nis defined as heterotopic presence of endometrium, \nthat is, endometrial glands with its stroma outside the \nendometrium. Exact pathology is not known, but some \ntheories believe that reflux of endometrial tissue through \nfallopian tube at the time of menstruation, coelomic \nmetaplasia, embryonic cell rest lymphatic and vascular \ndissemination have been proposed to explain the theory \nof endometriosis. [6] The pathogenesis is multifactorial \nincluding genetic, hormonal, environment, and role of \nimmune system. [7] The ovary is the most common site of \nendometriosis followed by pelvic structures. In 1925, for \nthe first time, Sampson explained the association between \nendometriosis and ovarian carcinoma. [8] Stern et al.  \nreported that ovarian malignancies were associated with \nendometriosis in 3.2%–10% of cases. [9] Histologically, \nin majority of the patients with ovarian epithelial tumors \nand associated endometriosis, the ovarian tumor is of \nendometrioid (53%) or clear cell lineage (22%); and \nin most cases with associated endometriosis serous \nor mucinous ovarian epithelial tumors, it was more \nfrequently borderline, which also justifies the better \nprognosis of ovarian epithelial tumors associated with \nendometriosis. [10] The present case also confirms the \nborderline nature of serous ovarian tumor with associated \nendometriosis.\nThe significance of endometriosis arises because of its \nmalignant potential, pathology might be high estrogen \nconcentration which leads to malignant proliferation of \nendometriotic cyst or due to mutation in the AR1D1A gene \nand consequent loss of BAF250a expression, similarly, iron \nproduced in endometriotic cyst promotes oxidative stress, \nwhich causes genetic mutation and malignant progression \nof ovarian cyst. [11]\nConclusion\nIt is uncommon to find an association of borderline \nserous tumor with endometriosis, because the incidence \nis higher with clear cell and endometrioid carcinoma, but \nstill possibilities are always there. Thus, histopathological \nevaluation of every ovarian mass must be carried out to \ndetermine the ovarian tumor along with the endometriosis, \nespecially to analyze the malignant potential of \nendometriosis.\nFigure 3: Borderline serous cystadenoma with benign endometriosis, \nH and E (×40)\nFigure 4: Endometrial glands and its stroma lying in ovarian stroma, \nH and E (×100)\nFigure 1: Gross examination of hysterectomy showing subserosal and intra \nmural-leiomyoma, whereas right-sided ovary having borderline serous \ncystadenoma with endometriosis\nFigure 2: Gross picture of right-sided ovary showing borderline serous \ncystadenoma with endometriosis\n\n\nDayal: Ovarian endometriosis association with serous tumor\n408 Indian Journal of Medical and Paediatric Oncology | Volume 41 | Issue 3 | May-June 2020\nFinancial support and sponsorship\nNil.\nConflicts of interest\nThere are no conflicts of interest.\nReferences\n1. Rosai J, editor. Uterus‑Corpus. 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