{"paper_id":"2eea30e8-d685-4d2e-86b8-4ac23f1409a4","body_text":"Abstract\nMalignant transformation and particularly malignant mixed mullerian tumor arising in extragenital endometriosis is extremely rare and occurs in the majority of cases after estrogen replacement therapy. We present a case of a 75-year-old woman who developed a ureteral malignant mullerian carcinosarcoma in a context of florid endometriosis. The patient had a history of total hysterectomy with bilateral salpingo-oophorectomy 30 years earlier for extensive endometriosis. Since 5 years, the patient has been on phytoestrogen supplementation consisting of 72 mg/day of superconcentrated soy isoflavones. This is the first case of ureteral mullerian carcinosarcoma arising in endometriosis foci after extensive phytoestrogen supplementation. Our data suggest that phytoestrogens at least in concentrated form may play a role not only in maintenance of endometriosis but also in its malignant transformation. Given the extraordinary popularity and availability of these dietary supplements, several studies are indispensable regarding their safety particularly in women with extensive endometriosis.\nSimilar content being viewed by others\nReferences\nAntonelli A, Simeone C, Frego E, Minimi G, Bianchi U, Cunico SC (2004) Surgical treatment of ureteral obstruction from endometriosis: our experience with thirteen cases. Int Urogynecol J Pelvic Floor Dysfunct 15:407–412\nBooth C, Zahn CM, McBroom J, Maxwell GI (2004) Retroperitoneal mullerian carcinosarcoma associated with endometriosis: a case report. Gynecol Oncol 93:546–549\nBrunson GL, Barclay DL, Sanders M, Araoz CA (1988) Malignant extraovarian endometriosis: two case reports and review of the literature. Gynecol Oncol 30:123–130\nBulun SE, Lin Z, Imir G, Amin S, Demura M, Yilmaz B, Martin R, Utsunomiya H, Thung S, Gurates B, Tamura M, Langoi D, Deb S (2005) Regulation of aromatase expression in estrogen-responsive breast and uterine disease: from bench to treatment. Pharmacol Rev 57:359–383\nBurton JL, Wells M (2002) The effect of phytoestrogens on the female genital tract. J Clin Pathol 55:401–407\nChang HY, Changchien CC, Chen HH, Lin H, Huang CC (2005) Extrauterine mullerian adenosarcoma associated with endometriosis and rectal villotubular adenoma: report of a case and review of the literature. Int J Gynecol Cancer 15:361–365\nChumas JC, Thanning L, Mann WJ (1986) Malignant mixed mullerian tumor arising in extragenital endometriosis: report of a case and review of the literature. Gynecol Oncol 23:227–233\nComiter CV (2002) Endometriosis of the urinary tract. Urol Clin North Am 29:625–635\nCotroneo MS, Lamartiniere CA (2001) Pharmacologic, but not dietary, genistein supports endometriosis in a rat model. Toxicol Sci 61:68–75\nDonnez J, Nisolle M, Squifflet J (2002) Ureteral endometriosis: a complication of rectovaginal endometriotic (adenomyotic) nodules. Fertil Steril 77:32–37\nFrohlich EP, Koller AB, van Blerk PJ, Margolius KA (1988) Adenocarcinoma from endometriosis causing urinary tract obstruction in a patient on oestrogen replacement therapy after hysterectomy. A case report. S Afr Med J 74:638–639\nGoodman MT, Wilkens LR, Hankin JH, Lyu LC, Wu AH, Kolonel LN (1997) Association of soy and fiber consumption with the risk of endometrial cancer. Am J Epidemiol 146:294–306\nHasiuk AS, Petersen RO, Hanjani P, Griffin TD (1984) Extragenital malignant mixed Mullerian tumor. Case report and review of the literature. Am J Clin Pathol 81:102–105\nJimenez RE, Tiguert R, Hurley P, An T, Grignon DJ, Lawrence D, Triest J (2000) Unilateral hydronephrosis resulting from intraluminal obstruction of the ureter by adenosquamous endometrioid carcinoma arising from disseminated endometriosis. Urology 56:331\nJohnson EB, Muto MG, Yanushpolsky EH, Mutter GL (2001) Phytoestrogen supplementation and endometrial cancer. Obstet Gynecol 98:947–950\nLeiserowitz GS, Gumbs JL, Oi R, Dalrymple JL, Smith LH, Ryn J, Scudder S, Russell AH (2003) Endometriosis-related malignancies. Int J Gynecol Cancer 13:466–471\nMuthyala RS, Ju YH, Sheng S, Williams LD, Doerge DR, Katzenellenbogen BS, Helferich WG, Katzenellenbogen JA (2004) Equol, a natural estrogenic metabolite from soy isoflavones: convenient preparation and resolution of R- and S-equols and their differing binding and biological activity through estrogen receptors alpha and beta. Bioorg Med Chem 12:1559–1567\nNezhat C, Nezhat F, Nezhat C, Nasserbakht F, Rosati M, Seidman DS (1996) Urinary tract endometriosis treated by laparoscopy. Fertil Steril 66:920–924\nSalerno MG, Masciullo V, Naldini A, Zannoni GF, Vellone V, Scambia G (2005) Endometrioid adenocarcinoma with squamous differentiation arising from ureteral endometriosis in a patient with no history of gonadal endometriosis. Gynecol Oncol 99(3):749–752\nSeidman JD (1996) Prognostic importance of hyperplasia and atypia in endometriosis. Int J Gynecol Pathol 15:1–9\nShook TE, Nyberg LM (1988) Endometriosis of the urinary tract. Urology 31:1–6\nStaar S, Richter DU, Makovitzky J, Briese V, Bergemann C (2005) Stimulation of endometrial glandular cells with genistein and daidzein and their effects on ER alpha- and ER beta-mRNA and protein expression. Anticancer Res 25:1713–1718\nStern RC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ (2001) Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol 20:133–139\nZanetta GM, Webb MJ, Li H, Keeney GL (2000) Hyperestrogenism: a relevant risk factor for the development of cancer from endometriosis. Gynecol Oncol 79:18–22\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nNoel, JC., Anaf, V., Fayt, I. et al. Ureteral mullerian carcinosarcoma (mixed mullerian tumor) associated with endometriosis occurring in a patient with a concentrated soy isoflavones supplementation. Arch Gynecol Obstet 274, 389–392 (2006). https://doi.org/10.1007/s00404-006-0188-1\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-006-0188-1","source_license":"CC0","license_restricted":false}