MRI Features of Malignant Transformation of Pelvic Endometriosis: A Systematic Review

Behnaz Moradi, Masoumeh Gity, Sara Hassani, Mobin Azami, Maryam Rahmani, Fahimeh Azizi Nik, Arash Khameneh Bagheri, Shirin Yaghoobpoor, Hamed Ghorani
In: Basic & Clinical Cancer Research · 2025 · doi:10.18502/bccr.v15i4.18745 · W4410717760
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This systematic review found that MRI features like larger lesion size, loss of T2 shading, and mural nodules with contrast enhancement and acute angle protrusions suggest malignant transformation of pelvic endometriosis.

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This systematic review analyzed existing literature to identify magnetic resonance imaging characteristics associated with the malignant transformation of pelvic endometriosis. The authors synthesized data from various studies to delineate specific radiological features that may indicate cancerous changes within endometriotic lesions. The paper highlights the importance of recognizing these MRI patterns for early detection and improved clinical management of this rare complication. This paper is centrally about endometriosis — specifically focusing on the malignant transformation of pelvic endometriosis lesions as visualized through MRI.

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Abstract

Background: Endometriosis is a benign gynecologic condition that is estrogen-de-pendent. Malignant transformation is one of the complications of endometriosis; it canaffect the woman`s ovarian and extra-ovarian regions. Diagnosing endometriosis-asso-ciated cancers has an essential role in treatment.Purpose: Our study aimed to review magnetic resonance imaging (MRI) features ofmalignant transformation of pelvic endometriosis. Material and Methods: We searched three online databases including Web of Sci-ence, Scopus, and PubMed, applying relevant keywords up to May 2022. We includedEnglish observational studies using MRI for endometriosis patients and comparing theMRI features of malignant pelvic endometriosis with non-malignant ones or studiesreporting the MRI features of malignant pelvic endometriosis. Finally, a comprehen-sive systematic review of the included studies was conducted. The small number ofqualifying studies was the most significant limitation. Also, the eligible studies wereinsufficient for conducting a meta-analysis. Results: A total of eight papers were included as they matched our inclusion require-ments. Eighty-seven individuals were included finally. Studies were published between1992 and 2021. The larger size of the lesion, loss of T2-weighted images shading, muralnodules, mural nodules contrast enhancement, and mural nodules protruding fromthe cyst wall at acute angles were the main MRI features suggesting potential malig-nant transformation of pelvic endometriosis. Conclusion: The endometriosis›s malignant changes can be observed on MRI. Thepredominant MRI findings are a large cyst, loss of shading on T2-weighted imaging,mural nodules enhancement, and acutely angled protrusion of mural nodules fromthe cyst wall.
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Publication Basic & Clinical Cancer Research Record type Journal article Published 25 May 2025 Authors Behnaz Moradi | Masoumeh Gity | Sara Hassani | Mobin Azami | Maryam Rahmani | Fahimeh Azizi Nik | Arash Khameneh Bagheri | Shirin Yaghoobpoor | Hamed Ghorani The publisher of this work supports multiple resolution. The work is available from the following locations: {'doi': '10.18502/bccr.v15i4.18745', 'member_id': '7770', 'member': 'Knowledge E DMCC', 'container-title': 'Basic & Clinical Cancer Research', 'primary-resource': 'https://publish.kne-publishing.com/index.php/bccr/article/view/18745', 'tld': 'kne-publishing.com', 'clearbit-logo': '/static/no_logo.svg', 'coaccess': [], 'multiple-resolution': [{'url': 'https://bccr.tums.ac.ir/index.php/bccrj/article/view/516', 'tld': 'tums.ac.ir', 'clearbit-logo': '/static/no_logo.svg'}], 'type': 'JOURNAL ARTICLE', 'published_date': '25 May 2025', 'publication': 'Basic & Clinical Cancer Research', 'title': 'MRI Features of Malignant Transformation of Pelvic Endometriosis: A Systematic Review', 'name': None, 'id': None, 'location': None, 'display_doi': 'https://doi.org/10.18502/bccr.v15i4.18745', 'grant_info': None, 'grant_info_funders': None, 'grant_info_funder_ids': '', 'grant_info_type': None, 'multiple_lead_investigators': [], 'multiple_co_lead_investigators': [], 'multiple_investigators': [], 'finances': [], 'project_description': None, 'award_amount': None, 'award_start': None, 'funding_scheme': None, 'internal_award_number': None, 'editors': None, 'authors': 'Behnaz Moradi | Masoumeh Gity | Sara Hassani | Mobin Azami | Maryam Rahmani | Fahimeh Azizi Nik | Arash Khameneh Bagheri | Shirin Yaghoobpoor | Hamed Ghorani', 'chairs': None, 'supplementary_ids': None} https://doi.org/10.18502/bccr.v15i4.18745 JSON XML

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