Prognostic importance of atypical endometriosis with architectural hyperplasia versus cytologic atypia in endometriosis-associated ovarian cancer

Isabel Ñiguez, Francisco Machado Linde, M. Sánchez, Pilar Marín-Sánchez, Julián J. Árense-Gonzalo, Julián Jesús Arense, Amparo Torroba, Aníbal Nieto Díaz, María Luisa Sánchez-Ferrer
Journal of gynecologic oncology · 2019 · vol. 30(4) , pp. e63 · doi:10.3802/jgo.2019.30.e63 · PMID:31074246 · PMC6543102 · W2922233609
article OA: gold CC0 ⤵ 29 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that architectural atypia in endometriosis, unlike cellular atypia, is associated with ovarian cancer and may be a precursor lesion.

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

This prospective observational study evaluated surgical pathology from 266 women undergoing surgery with histologic diagnoses of endometriosis, ovarian cancer, or endometriosis-associated ovarian cancer (EAOC), assessing the prevalence and immunohistochemical markers (Ki-67, BAF250a, COX-2) of atypical endometriosis subtypes. It found that atypical endometriosis occurred in 12.43% of cases, with architectural atypia (endometriosis with architectural hyperplasia) appearing predominantly in patients with ovarian cancer, while cytologic (cellular) atypia was more common in patients without neoplasm; Ki-67 was significantly higher in architectural atypia than in cytologic atypia. The paper’s limitation is that the reported analysis focuses on histologic/immunohistologic differences rather than providing outcome-based prognostic measures. This paper is centrally about endometriosis—specifically whether architectural hyperplasia-type atypical endometriosis versus cytologic atypia is more relevant as a precursor lesion for endometriosis-associated ovarian cancer.

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Abstract

OBJECTIVE: Patients with endometriosis are at increased risk of ovarian cancer. It has been suggested that atypical endometriosis is a precursor lesion of endometriosis-associated ovarian cancer (EAOC). The aim of this study is to evaluate if cytologic (cellular) atypia and architectural atypia (hyperplasia), histologic findings described as atypical endometriosis, play a different role in patients with EAOC. METHODS: A prospective study was conducted between January 2014 and April 2017 at our institution with patients undergoing surgery with a histologic diagnosis of endometriosis, ovarian cancer, or EAOC. The prevalence and immunohistologic study (Ki-67, BAF250a, COX-2) of cases of cellular and architectural atypia in endometriosis were analyzed. RESULTS: Two hundred and sixty-six patients were included: the diagnosis was endometriosis alone in 159 cases, ovarian cancer in 81, and EAOC in 26. Atypical endometriosis was reported in 23 cases (12.43%), 39.13% of them found in patients with EAOC. Endometriosis with cellular atypia was found mainly in patients without neoplasm (71.4%), and endometriosis with architectural atypia was seen in patients with ovarian cancer (88.9%) (p=0.009). Ki-67 was significantly higher in endometriosis patients with architectural atypia than those with cellular atypia. CONCLUSION: The diagnosis of endometriosis with architectural atypia is important because it may be a precursor lesion of ovarian cancer; therefore, pathologists finding endometriosis should carefully examine the surgical specimen to identify any patients with hyperplasia-type endometriosis, as they may be at higher risk of developing EAOC.

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Condition tags

endometriosis

MeSH descriptors

Endometrial Hyperplasia Endometriosis Ovarian Neoplasms Biomarkers, Tumor DNA-Binding Proteins Endometrial Hyperplasia Endometrial Hyperplasia Endometriosis Endometriosis Female Humans Ki-67 Antigen Ovarian Neoplasms Ovarian Neoplasms Precancerous Conditions Precancerous Conditions Prospective Studies Transcription Factors

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