Clear cell cancer of the ovary developing within an advanced postmenopausal endometriosis. Case report and review of the literature

Oddział Ginekologii Onkologicznej, Gdyńskie Centrum Onkologii, Szpital Morski im. PCK w Gdyni, Aleksandra Myszewska, Mirosław Dudziak, B Kadylak, Zakład Patomorfologii, Szpital Morski im. PCK w Gdyni, Jacek Jan Sznurkowski
In: Current Gynecologic Oncology · 2013 · vol. 11(1) , pp. 82–88 · doi:10.15557/cgo.2013.0008 · W31957498
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This case report describes a clear cell ovarian cancer developing within an advanced postmenopausal endometriosis and provides a review of relevant literature on this rare occurrence.

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This case report and literature review describes endometriosis-associated ovarian cancer in a 54-year-old postmenopausal woman who had an adnexal tumor detected by sonography and markedly elevated CA-125. Surgery found advanced endometriosis with multiple endometrial implants and bilateral endometrial cysts, and histology identified grade 2 ovarian clear cell carcinoma with an area of transition from endometriosis through atypical endometriosis. The authors interpret the findings as evidence that malignant transformation can occur in an endometrial cyst after menopause, despite active endometriosis usually being estrogen-dependent and rare postmenopause; they also discuss the ongoing debate about whether ovarian cancer arises from malignant transformation of pre-existing endometriosis or develops synchronously. This paper is centrally about endometriosis — it presents rare clear cell ovarian cancer developing within advanced postmenopausal endometriosis and reviews prior cases supporting malignant transformation from atypical endometriosis.

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Abstract

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Clear cell cancer of the ovary developing within an advanced postmenopausal endometriosis. Case report and review of the literature Aleksandra Myszewska1, Mirosław Dudziak1, Bogdan Kadylak2, Jacek Jan Sznurkowski3 Endometriosis has a multifactorial etiology and its association with ovarian cancer is known since the beginning of the past century. As has been well documented, endometriosis possesses all the features of cancer phenotype, but a matter of debate remains whether ovarian cancer develops as a result of malignant transformation of pre-existing endometriosis or both conditions develop synchronously on a common basis. Active endometriosis is estrogen-dependent and rarely develops in postmenopausal women. Endometriosis-associated ovarian cancer (EAOC) is a distinct clinical entity, differing by age at diagnosis, histological type, clinical stage and prognosis. EAOC may develop both before and after menopause and the commonest histological types are clear cell and endometrioid. The purpose of this paper was to present a rare case of EAOC developing within the wall of an endometrial cyst, 7 years after menopause in a slim woman, not presenting features of estrogenization. A 54 years old female, on long-term oral anticoagulant (Sintrom) after mitral valve surgery, was admitted for surgical treatment due to an adnexal tumor on the right detected by sonography with CA-125 level of 354.7 U/ml. Intraoperative inspection revealed advanced endometriosis manifesting by numerous endometrial implants to the pelvic parietal peritoneum, visceral peritoneum and greater omentum as well as endometrial cysts within both ovaries. Intraoperative histological study revealed grade 2 clear cell carcinoma (CCC), while final histological study showed the area of transition from endometriosis to CCC with an intermediate stage of atypical endometriosis. The patient’s FIGO stage was defined as IA and her TNM stage – as T1aN0M0 G2. Conclusion: Active endometriosis resulting in presence of endometrial implants and endometrial cysts may manifest at postmenopausal age. Endometrial cyst may undergo malignant transformation, as suggested by documented evolution of endometriosis to clear cell ovarian cancer with intermediate stage of atypical endometriosis

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endometriosis

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