High risk for neoplastic transformation of endometriosis in a carrier of Lynch syndrome

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A Lynch syndrome carrier with MLH1 deficiency exhibited endometrial intraepithelial neoplasia and ovarian endometriosis, highlighting endometriosis's malignant potential and the need for lesion management.

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This paper reports a case of a healthy woman with Lynch syndrome carrying a germline MLH1 mutation who developed endometrial intra-epithelial neoplasia alongside ovarian endometriotic lesions. The authors used immunohistochemical and molecular evidence to show loss of MLH1 protein expression in the endometriotic-associated ovarian lesions, supporting malignant potential for endometriosis in this high-risk genetic context. As a single case report, the study’s main limitation is that it cannot establish incidence or causality, and it provides limited generalizability beyond the individual described. This paper is centrally about endometriosis—specifically, it describes neoplastic transformation risk of endometriosis-associated ovarian lesions in a Lynch syndrome (MLH1 carrier) context.

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Abstract

Lynch syndrome is an autosomal dominant cancer-susceptibility disorder caused by mutations in DNA mismatch repair genes. Women with Lynch syndrome have an increased lifetime risk for endometrial and ovarian cancers. While there is evidence of efficacy for prophylactic surgery, no standard recommendations have been developed to support screening for premalignant endometrial and ovarian epithelial lesions in high-risk women. Here, we report a case of a healthy woman carrying a germline mutation in MLH1 gene with endometrial intra-epithelial neoplasia and ovarian endometriotic lesions exhibiting a loss of MLH1 protein expression. This case report illustrates the malignant potential of endometriosis, and highlights the need for a meticulous management of gynecologic premalignant precursor lesions in reducing cancer risk among related Lynch syndrome women.
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Abstract

Lynch syndrome is an autosomal dominant cancer-susceptibility disorder caused by mutations in DNA mismatch repair genes. Women with Lynch syndrome have an increased lifetime risk for endometrial and ovarian cancers. While there is evidence of efficacy for prophylactic surgery, no standard recommendations have been developed to support screening for premalignant endometrial and ovarian epithelial lesions in high-risk women. Here, we report a case of a healthy woman carrying a germline mutation in MLH1 gene with endometrial intra-epithelial neoplasia and ovarian endometriotic lesions exhibiting a loss of MLH1 protein expression. This case report illustrates the malignant potential of endometriosis, and highlights the need for a meticulous management of gynecologic premalignant precursor lesions in reducing cancer risk among related Lynch syndrome women. Similar content being viewed by others Abbreviations - HNPCC: - Hereditary non-polyposis colorectal cancer - MMR: - DNA mismatch repair system - MSI: - Microsatellite instability

References

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Condition tags

endometriosis

MeSH descriptors

Carcinoma in Situ Cell Transformation, Neoplastic Colorectal Neoplasms, Hereditary Nonpolyposis Endometrial Neoplasms Endometriosis Adaptor Proteins, Signal Transducing Adaptor Proteins, Signal Transducing Carcinoma in Situ Carcinoma in Situ Cell Transformation, Neoplastic Colorectal Neoplasms, Hereditary Nonpolyposis Colorectal Neoplasms, Hereditary Nonpolyposis Endometrial Neoplasms Endometrial Neoplasms Endometriosis Endometriosis Female Genetic Predisposition to Disease Heterozygote Humans

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