Case report: Malignant transformation of ovarian endometrioma during long term use of dienogest in a young lady

Yi-Ting Chang, Yi‐Ting Chang, Ting-Fang Lu, Lou Sun, Yu-Hsiang Shih, Yu‐Hsiang Shih, Shih‐Tien Hsu, Shih-Tien Hsu, Chin-Ku Liu, Sheau-Feng Hwang, Chien-Hsing Lu, Chien‐Hsing Lu
Frontiers in oncology · 2024 · vol. 14 , pp. 1338472 · doi:10.3389/fonc.2024.1338472 · PMID:38357201 · PMC10864460 · W4391397072
case-report OA: gold CC0 ⤵ 3 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 35-year-old woman who developed clear cell carcinoma in her ovarian endometrioma after five years of dienogest treatment, necessitating surgery and chemotherapy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 35-year-old nulliparous Taiwanese woman with an ovarian endometrioma treated continuously with dienogest for about 5 years, whose cyst initially decreased from 6 cm to ~3 cm but later enlarged with developing suspicious mural nodules and intra-tumor flow. Despite normal tumor markers and staged imaging surveillance, laparoscopic enucleation ultimately showed clear cell carcinoma with peritoneal involvement (at least FIGO stage IIB), followed by definitive debulking surgery and adjuvant chemotherapy, with no recurrence at 17 months. The authors review prior literature noting malignant transformation of endometrioma during shorter dienogest exposure and highlight that malignant change may occur even after prolonged progestin treatment; they also note the initial absence of cytologic or pathologic confirmation of the presumed benign endometrioma. This paper is centrally about endometriosis — it documents malignant transformation of an ovarian endometrioma during long-term dienogest therapy.

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Abstract

Endometriosis is a benign disease, which is also regarded as a precursor to ovarian malignancy. Dienogest is a progestin treatment for endometriosis with efficacy and tolerability. A 35-year-old Taiwanese lady with ovarian endometrioma had taken dienogest for the last 5 years. During sonographic follow-up, surgery was suggested owing to suspicious of malignant transformation of ovarian endometrioma. While she hesitated and turned to receive two cycles of oocyte retrieval because of nulliparity. Meanwhile, more papillary growth in the ovarian endometrioma with intratumor flow was found during follow-up. Laparoscopic enucleation was performed later, and pathology revealed clear cell carcinoma with peritoneal involvement, at least FIGO stage IIB. She then underwent debulking surgery to grossly no residual tumor and received adjuvant chemotherapy with no tumor recurrence in post-operative 17-months follow-up. Considering fertility preservation, conservative treatment of ovarian endometrioma is typically indicated for those women who have not yet completed childbearing. However, malignant transformation may still occur despite long-term progestin treatment. Therefore, careful image follow-up is still indispensable.

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endometriosisendometrioma

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