Endometriosis associated ovarian clear cell carcinoma

Introduction: Endometriosis is a benign condition and ovary is one of the common site affected by endometriosis. Malignant transformation associated with endometriosis is a rare complication. Sampson et al in 1925, first describe histological criteria to link ovarian endometriosis and malignancy. For ovarian endometriosis the commonest type of malignancy seen is clear cell carcinoma. Case report: A 43-year-old lady presented with dysmenorrhea. Radiological examination reveals a bilateral complex ovarian cyst with malignant features. She undergoes total abdominal hysterectomy with bilateral salpingo-oophorectomy and staging laparotomy. Grossly, the uterus and the left ovary are enlarged. The left ovary exhibits solid cystic tumour with an intact capsule. The right ovary, cervix and the endometrium are unremarkable. Microscopically, the left ovarian solid tumour shows clear cell carcinoma. with stromal and capsular invasion. Whereas, the cystic left ovarian tumour is composed of an endometriotic cyst.Endometriotic foci are also seen at the right ovary, both parametrium and the right fallopian tube. A final diagnosis of left ovarian clear cell carcinoma with endometriosis and adenomyosis is made. Discussion: Endometriosis is common involving woman in reproductive age group. Majority presents with dysmenorrhea, pelvic pain and infertility.Previous studies have shown link between ovarian endometriosis and malignancy. It is found that patients with longstanding ovarian endometriosis have a high relative risk of ovarian cancer. An intermediary lesion i.e atypical endometriosis may play a role in endometriosis malignant transformation. Oxidative stress, inflammation and hyperoestrogenism have been implicated in the carcinogenic pathways. Conclusion: Biopsy of endometriosis should be considered establishing the diagnosis and to exclude underlying malignant disease.