Ivanov S, Ivanov S
Akush Ginekol (Sofiia). 1998;37(3):29-30.
The endometriosis can undergo estrogen-dependent changes similar to endometrium and may carry a risk for developing hyperplasia and carcinoma during unopposed estrogen stimulation. We reviewed the existing literature to analyze the potential of malignancy arising from extraovarian endometriosis by estrogen stimulation. Our two cases are also discussed. According to our study there are 21 cases published in the literature of malignant transformation of endometriosis after estrogen stimulation. The most common place for malignant trans formation is the vagina. The most common hystological type is adenocarcinoma in 13 cases. Our two cases were with adenocarcinoma and adenosquamous carcinoma. The incidence of malignant transformation of the endometriosis can not be estimated based upon these cases. There is a need for randomised clinical trials.
The estrogen stimulation may lead to premalignant or malignant transformations of the residual foci of endometriosis. That is why addition of progestins to the estrogen substitutional therapy should be considered in women with endometriosis after total hysterectomy with oophorectomy, especially if a residual foci are present or suspected. With our study we think we can make more clear the way an endometriosis is transformed into a malignancy.
子宫内膜异位症可发生类似于子宫内膜的雌激素依赖性变化，在无对抗性雌激素刺激时可能有发生增生和癌变的风险。我们回顾了现有文献，以分析雌激素刺激引起的卵巢外子宫内膜异位症发生恶性肿瘤的可能性。我们的两个病例也进行了讨论。根据我们的研究，文献中发表了21例雌激素刺激后子宫内膜异位症恶变的病例。恶变最常见的部位是阴道。最常见的组织学类型是腺癌，共13例。我们的两个病例分别为腺癌和腺鳞癌。基于这些病例无法估计子宫内膜异位症恶变的发生率。需要进行随机临床试验。
雌激素刺激可能导致子宫内膜异位症残留病灶发生癌前或恶性转化。这就是为什么对于全子宫切除加卵巢切除术后患有子宫内膜异位症的女性，尤其是存在或怀疑有残留病灶时，应考虑在雌激素替代治疗中加用孕激素。通过我们的研究，我们认为可以更清楚地了解子宫内膜异位症转变为恶性肿瘤的方式。
