Endometrioides Adenokarzinom in einer Endometriose des Ureters

In: Geburtshilfe und Frauenheilkunde · 2002 · vol. 62(5) , pp. 490–494 · doi:10.1055/s-2002-32283 · W2042097318
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This paper details a rare case of malignant transformation of an extragonadal endometriosis focus, specifically an endometrioid adenocarcinoma arising in a ureteral endometriosis implant.

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Abstract

Die maligne Entartung extragonadaler Endometrioseherde ist selten. Karzinome in ektopen Endometrioseherden bereiten aufgrund der Vielfalt der Implantationen und assoziierten Symptome häufig erhebliche diagnostische Schwierigkeiten.
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Abstract

Background Malignant transformation of endometriosis is very rare and implies considerable diagnostic difficulties. Depending on the implantation site, it may present various symptoms. The ovary is the most common site, followed by the pelvic peritoneum and the rectovaginal septum. The following report describes a case of endometrioid adenocarcinoma in endometriosis of the ureter. Case Report A 57-year-old patient presented herself in our clinic with a weight loss of 8 kg in 3 months, abdominal pain and hematuria. 13 years before, an abdominal hysterectomy and right-sided adnectomy because of endometriosis and uterus myomatosus had been performed, followed by hormone replacement therapy with oral estrogens. Computer tomography and abdominal sonography showed a hydronephrotic right kidney. Scintigraphy showed loss of function of the right kidney. Surgery was performed and the tumor, including the right kidney and the right ureter, was removed. Histopathological examination showed malignant transformation of ureteral endometriosis. Radiation therapy of the pelvic region and the draining lymphatic system was applicated. 18 months after operation and adjuvant radiotherapy, the patient was free of symptoms, and there was no evidence of disease.

Conclusion

After diagnosis of endometriosis and especially after longterm hormone replacement therapy with estrogens alone, in patients with unclear abdominal symptoms, the possibility of malignant transformation of endometriosis should be taken into consideration. Literatur - 1 Berkowitz R S, Ehrmann R L, Knapp R C. Endometrial stromal sarcoma arising from vaginal endometriosis. Obstet Gynecol. 1978; 51 (Suppl) 34-37 - 2 Brunson G L, Barclay D L, Sanders M, Araoz C A. Malignant extraovarian endometriosis: two case reports and review of literature. Gynecol Oncol. 1988; 30 123-130 - 3 Casper F, Petri E. Ureteral endometriosis. Geburtsh Frauenheilk. 1985; 45 789-791 - 4 Favre Y, Keller K, Schreiner W E. Obstructive endometriosis of the efferent urinary tract. Geburtsh Frauenheilk. 1986; 46 23-26 - 5 Fishman A, Demirel D, Laucirica R, Ramzy Y, Klima T, Lyzak J, Kaplan A L. Malignant tumors arising in endometriosis: clinical-pathological study and flow cytometry analysis. Eur J Obstet Gynecol Reprod Biol. 1996; 70 69-74 - 6 Heaps J M, Nieberg R K, Bertek J S. Malignant neoplasms arising in endometriosis. Obstet Gynecol. 1990; 75 1023-1028 - 7 Jick H, Watkins R N, Hunter J R, Dinan B J, Madsen S, Rothman K J, Walker A M. Replacement estrogens and endometrial cancer. N Engl J Med. 1979; 300 218-222 - 8 Jimenez R E, Tiguert R, Hurley P, An T, Grignon D J, Lawrence D, Triest J. Unilateral hydronephrosis resulting from intraluminal obstruction of the ureter by adenosquamous endometrioid carcinoma arising from disseminated endometriosis. Urology. 2000; 56 331 - 9 Judson P L, Temple A M, Fowler W C, Novotny D B, Funkhouser W K. Vaginal adenosarcoma arising from endometriosis. Gynecol Oncol. 2000; 76 123-125 - 10 Kapadia S B, Russak R R, O'Donnell W F, Harris R N, Lecky J W. Postmenopausal ureteral endometriosis with atypical adenomatous hyperplasia following hysterectomy, bilateral oophorectomy, and long-term estrogen therapy. Obstet Gynecol. 1984; 64 (Suppl) 60-63 - 11 Lauslahti K. Malignant external endometriosis. Acta Pathol Immunol Microbiol Scand. 1972; 223 (Suppl) 98-102 - 12 Mostoufizadeh M, Scully R E. Malignant tumours arising in endometriosis. Clin Obstet Gynecol. 1980; 23 951-963 - 13 Roß M, Oehler M K, Lange W, Dietl J. Harnstau durch Ureterendometriose. Geburtsh Frauenheilk. 1998; 58 324-327 - 14 Sampson J A. Endometrial carcinoma of the ovary arising in endometrial tissue in that organ. Arch Surg. 1925; 10 1-72 - 15 Shamsuddin A KM, Umberto V S, Mohamed N C. Adenocarcinoma arising from extragonadal endometriosis 14 years after hysterectomy and bilateral salpingo-oophorectomy for endometriosis: report of a case with ultrastructural studies. Am J Obstet Gynecol. 1979; 133 585-586 - 16 Stern R C, Dash R, Bentley R C, Snyder M J, Haney A F, Robboy S J. Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol. 2001; 20 133-139 - 17 Vercellini P, Pisacreta A, Pesole A, Vincentini S, Stellato G, Crosignani P G. Is ureteral endometriosis an asymmetric disease?. Br J Obstet Gynecol. 2000; 107 559-561 - 18 Vercellini P, Aimi G, De Giorgi O, Maddalena S, Carinelli S, Crosignani P. Is cystic ovarian endometriosis an asymmetric disease?. Br J Obstet Gynecol. 1998; 105 1018-1021 Dr. Mandana Motamedi Universitätsfrauenklinik Würzburg Josef-Schneider-Straße 4 97080 Würzburg Email: [email protected]

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