La endometriosis atípica como lesión precursora del cáncer de ovario asociado a endometriosis un estudio prospectivo

espanolEn la presente tesis hemos estudiado la probable transformacion maligna de la en cancer de ovario asociado a (COAE). Nuestra hipotesis de trabajo se basa en el potencial papel que juega la en la patogenesis del COAE, fundamentalmente en los histotipos, adenocarcinoma de celulas claras (AcCC) y el adenocarcinoma endometrioide (AcE). Exploramos la posibilidad de que represente una etapa evolutiva entre la tipica y el COAE. Ademas, nos planteamos si la atipia celular (EAC) y la hiperplasia o atipia arquitectural (EAA), los dos hallazgos histologicos globalmente referidos como atipica (EA), tienen un significado diferente en la etiopatogenia del COAE. OBJETIVOS Objetivo Principal: Establecer la Prevalencia de EA y de sus subtipos histologicos: EAC y EAA en las pacientes con Endometriosis y COAE. Objetivos secundarios: Objetivo 1.- Establecer las diferencias en la prevalencia de los subtipos histologicos AcCC y AcE en las pacientes con COAE vs CO. Objetivo 2.- Comparar las caracteristicas clinico-epidemiologicas y Factores de riesgo y pronosticos de los grupos de estudio: pacientes con diagnostico postquirurgico de Endometriosis, COAE y CO. MATERIAL Y METODO: Estudio observacional prospectivo de serie de casos desde Enero 2014 hasta Abril de 2017 en pacientes asistidas en el Servicio de Ginecologia y Obstetricia del Hospital Clinico Universitario Virgen de la Arrixaca, con el diagnostico de y/o cancer de ovario sometidas a cirugia. Se realizo un analisis anatomopatologico e inmunohistoquimico de las piezas quirurgicas de los diferentes grupos (EN, CO y COAE). RESULTADOS: Se incluyeron 266 pacientes. Se confirmo en 185 pacientes, de las cuales, 159 casos tenian aislada y 26 presentaban COAE. Del total de los 107 canceres de ovario registrados (COT), 26 (24,3%) eran COAE y 81 (75,7%) cancer de ovario sin asociada (CO). El 53,1% de los CO el tipo histologico fue el seroso frente al 15,4% observado en los COAE. Asi mismo, el 23,1% de los COAE fueron AcCC y el 42,3% eran AcE, versus el 6,2% y 14,8% respectivamente de los encontrados en CO (p CONCLUSIONES: 1. Existe una asociacion significativa entre Endometriosis Atipica y Cancer de Ovario Asociado a Endometriosis. ? 2. Los tipos histologicos de Cancer de Ovario asociados de forma significativa a Endometriosis fueron el Adenocarcinoma de Celulas Claras y el Adenocarcinoma Endometrioide, ambos incluidos en el tipo I del modelo de Kurman y Shild. ? 3. Nuestros datos sugieren que el Cancer de Ovario Asociado a Endometriosis podria presentar un mejor pronostico dentro del Cancer de Ovario. ? 4. Existe una asociacion significativa entre Endometriosis Atipica Arquitectural y Cancer de Ovario Asociado a Endometriosis. ? 5. Nuestros datos apoyan la hipotesis de que la Endometriosis Atipica Arquitectural o Hiperplasica podria constituir una lesion precursora en la patogenesis del Cancer de Ovario Asociado a Endometriosis. ? Endometriosis atipica, Cancer de ovario, Atipia celular, Atipia arquitectural, BAF250a. EnglishIn this thesis we have studied the possible malignant transformation of in endometriosis-associated ovarian cancer (EAOC). Our hypothesis is based on the potential role played by endometriosis in the pathogenesis of EAOC, mainly in histotypes, clear cell adenocarcinoma (CCAc) and endometrioid adenocarcinoma (EAc). We have explored the possibility that it represents an evolutionary stage between typical and EAOC. In addition, we have considered whether cellular atypia (ECA) and architectural atypia or hyperplasia (EAA), the two histological findings globally referred to as atypical (AE), have a different meaning in the etiopathogenesis of EAOC. OBJETIVES Main objetive: To establish the prevalence of AE and its histological subtypes: ECA and EAA in patients with Endometriosis and EAOC. Other objetives: Objetive 1.- To establish differences in prevalence of histological subtypes CCAc and EAc between patients with EAOC and ovarian cancer (OC). Objetive 2.- To compare the clinical and epidemiological characteristics, risk factors and prognoses of the study groups: patients with postoperative diagnosis of Endometriosis, EAOC and OC. MATERIAL AND METHOD: Prospective observational study of case series from January 2014 to April 2017 in patients assisted in the Gynecology and Obstetrics Service of the Virgen de la Arrixaca Clinical Universitary Hospital, with the diagnosis of and / or OC undergoing surgery. An anatomopathological and immunohistochemical analysis of the surgical pieces of the different groups (Endometriosis, OC and EAOC) was performed. RESULTADOS: 266 patients were included. Endometriosis was confirmed in 185 patients, of whom 159 had isolated and 26 had EAOC. Of the total of 107 registered ovarian cancers (TOC), 26 (24.3%) were EAOC and 81 (75.7%) ovarian cancer without associated (OC). The 53.1% of the OC were serous carcinomas, compared to the 15.4% seen in the EAOC. Likewise, 23.1% of the EAOC were CCAc and 42.3% were EAc, versus 6.2% and 14.8% respectively of those found in OC (p CONCLUSIONS: 1. There is a significant association between Atypical Endometriosis and Endometriosis-associated Ovarian Cancer. 2. The histological types of Ovarian Cancer significantly associated with Endometriosis were Clear Cell Adenocarcinoma and Endometrioid Adenocarcinoma, both included in type I of the Kurman and Shild model. 3. Our data suggest that ovarian cancer associated with could present a better prognosis in ovarian cancer. 4. There is a significant association between Atypical Architectural Endometriosis and Endometriosis-associated Ovarian Cancer. 5. Our data support the hypothesis that Hiperplasia or Atypical Architectural Endometriosis could constitute a precursor lesion in the pathogenesis of Endometriosis-Associated Ovarian Cancer.