{"paper_id":"836c7ffd-b7b3-4c67-a74c-07a81d87e283","body_text":"Abstract\nThe transformation of benign endometriosis into endometriosis-associated cancers is rare. The physiopathology of this phenomenon is still complex and remains controversial, but atypical endometriosis has been described as a precursor to endometriosis-associated ovarian cancer, especially in endometrioid and clear-cell ovarian carcinomas.\nThis chapter explores the pivotal role of imaging in the diagnosis of atypical endometriosis and endometriosis-associated cancers. Radiologic techniques, such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), play a crucial role in the early detection, characterization, and monitoring of atypical endometriosis and endometriosis-associated ovarian and extra-ovarian cancers. The chapter also highlights the challenges in accurately diagnosing atypical endometriosis and emphasizes the significance of imaging modalities in distinguishing benign from potentially malignant tumors.\nA comprehensive understanding of the imaging features associated with atypical endometriosis and endometriosis-associated cancer is fundamental as it aids clinicians in making informed decisions regarding treatment strategies, contributing to improved patient outcomes.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nAnglesio MS, Yong P. Endometriosis-associated ovarian cancers. Clin Obstet Gynecol. 2017;60(4):711–27. https://doi.org/10.1097/GRF.0000000000000320.\nBarnard ME, Farland LV, Yan B, Wang J, Trabert B, Doherty JA, et al. Endometriosis Typology and Ovarian Cancer Risk. JAMA. 2024;332(6):482–9. Published online July 17, 2024.\nBartiromo L, Schimberni M, Villanacci R, Mangili G, Ferrari S, Ottolina J, et al. A systematic review of atypical endometriosis-associated biomarkers. Int J Mol Sci. 2022;23(8):4425. https://doi.org/10.3390/ijms23084425.\nBazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, et al. European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27(7):2765–75. https://doi.org/10.1007/s00330-016-4673-z.\nDias JL, Gomes FV, Lucas R, Cunha TM. The shading sign: is it exclusive of endometriomas? Abdom Imaging. 2015;40(7):2566–72. https://doi.org/10.1007/s00261-015-0465-1.\nForstner R, Thomassin-Naggara I, Cunha TM, Kinkel K, Masselli G, Kubik-Huch R, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 2017;27(6):2248–57. https://doi.org/10.1007/s00330-016-4600-3.\nGrandi G, Toss A, Cortesi L, Botticelli L, Volpe A, Cagnacci A. The association between endometriomas and ovarian cancer: preventive effect of inhibiting ovulation and menstruation during reproductive life. Biomed Res Int. 2015;2015:751571. https://doi.org/10.1155/2015/751571.\nHuang KJ, Li YX, Wu CJ, Chang WC, Wei LH, Sheu BC. Sonographic features differentiating early-stage ovarian clear cell carcinoma from endometrioma with atypical features. J Ovarian Res. 2022;15(1):84. https://doi.org/10.1186/s13048-022-01019-8.\nKido A, Himoto Y, Moribata Y, Kurata Y, Nakamoto Y. MRI in diagnosis of endometriosis and related diseases. Korean J Radiol. 2022;23(4):426–45. https://doi.org/10.3348/kjr.2021.0405.\nKobayashi H, Ooi H, Yamada Y, Sakata M, Kawaguchi R, Kanayama S, et al. Serum CA125 level before the development of ovarian cancer. Int J Gynaecol Obstet. 2007;99(2):95–9. https://doi.org/10.1016/j.ijgo.2007.06.003.\nLi X, Ye Z. Clear cell carcinoma of the ovary: multi-slice computed tomography findings. World J Surg Oncol. 2015;13:133. https://doi.org/10.1186/s12957-015-0546-1.\nMcDermott S, Oei TN, Iyer VR, Lee SI. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics. 2012;32(3):845–63. https://doi.org/10.1148/rg.323115736.\nMelin A, Sparen P, Persson I, Bergqvist A. Endometriosis and the risk of cancer with special emphasis on ovarian cancer. Hum Reprod. 2006;21(5):1237–42. https://doi.org/10.1093/humrep/dei462.\nMikami Y. Endometriosis-related ovarian neoplasms: pathogenesis and histopathologic features. Diagn Histopathol. 2014;20(9):357–63. https://doi.org/10.1016/j.mpdhp.2014.07.002.\nNezhat F, Datta MS, Hanson V, Pejovic T, Nezhat C, Nezhat C. The relationship of endometriosis and ovarian malignancy: a review. Fertil Steril. 2008;90(5):1559–70. https://doi.org/10.1016/j.fertnstert.2008.08.007.\nRadzynski L, Boyer L, Kossai M, Mouraire A, Montoriol PF. Pictorial essay: MRI evaluation of endometriosis-associated neoplasms. Insights Imaging. 2023;14:144. https://doi.org/10.1186/s13244-023-01485-8.\nRobinson KA, Menias CO, Chen L, Schiappacasse G, Shaaban AM, Caserta MP, et al. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol. 2020 Jun;45(6):1762–75. https://doi.org/10.1007/s00261-019-01914-7.\nRodrigues S, Braga M, Félix A, Cunha TM. Clear cell carcinoma of the ovary: clues for radiologists to perform a correct diagnosis. Curr Probl Diagn Radiol. 2023;53(2):271–9. https://doi.org/10.1067/j.cpradiol.2023.10.003.\nSampson JA. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ. Arch Surg. 1925;10(1):1–72. https://doi.org/10.1001/archsurg.1925.01120100007001.\nScott RB. Malignant changes in endometriosis. Obstet Gynecol. 1953;2(3):283–9.\nTran-Harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, et al. Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging. 2018;52:163–71. https://doi.org/10.1016/j.clinimag.2018.07.017.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2025 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nPaixão, H., Cunha, T.M. (2025). Atypical Endometriosis and Malignant Transformation. In: Thomassin-Naggara, I. (eds) Imaging of Endometriosis: A Comparative Guide of US, MRI and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-82750-1_4\nDownload citation\nDOI: https://doi.org/10.1007/978-3-031-82750-1_4\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-031-82749-5\nOnline ISBN: 978-3-031-82750-1\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}