Nezhat Farr, Datta M Shoma, Hanson Veneta, Pejovic Tanja, Nezhat Ceana, Nezhat Camran
Department of Obstetrics, Mount Sinai Medical Center, New York, New York 10019, USA.
Fertil Steril. 2008 Nov;90(5):1559-70. doi: 10.1016/j.fertnstert.2008.08.007.
To review the malignant potential of endometriosis based on epidemiologic, histopathologic, and molecular data.
Literature review.
RESULT(S): The pathogenesis of endometriosis remains unclear. The histopathologic development of endometriosis has undergone long-term investigation. Studies have confirmed histologic transition from benign endometriosis to ovarian malignancy, including malignant transformation of extraovarian endometriosis. The prevalence of endometriosis in patients with epithelial ovarian cancer, especially in endometrioid and clear cell types, has been confirmed to be higher than in the general population. Ovarian cancers and adjacent endometriotic lesions have shown common genetic alterations, such as PTEN, p53, and bcl gene mutations, suggesting a possible malignant genetic transition spectrum. Furthermore, endometriosis has been associated with a chronic inflammatory state leading to cytokine release. These cytokines act in a complex system in which they induce or repress their own synthesis and can cause unregulated mitotic division, growth and differentiation, and migration or apoptosis similar to malignant mechanisms.
CONCLUSION(S): The malignant potential of endometriosis holds serious implications for management, such as the need for earlier and more meticulous surgical intervention for complete disease treatment.
基于流行病学、组织病理学和分子数据，综述子宫内膜异位症的恶性潜能。
文献综述。
子宫内膜异位症的发病机制仍不清楚。子宫内膜异位症的组织病理学发展已经历了长期研究。研究已证实从良性子宫内膜异位症到卵巢恶性肿瘤的组织学转变，包括卵巢外子宫内膜异位症的恶性转化。上皮性卵巢癌患者中子宫内膜异位症的患病率，尤其是在子宫内膜样癌和透明细胞癌类型中，已被证实高于一般人群。卵巢癌和相邻的子宫内膜异位病变已显示出常见的基因改变，如PTEN、p53和bcl基因突变，提示可能存在恶性遗传转变谱。此外，子宫内膜异位症与导致细胞因子释放的慢性炎症状态有关。这些细胞因子在一个复杂的系统中起作用，在这个系统中它们诱导或抑制自身的合成，并可导致与恶性机制类似的不受调控的有丝分裂、生长和分化以及迁移或凋亡。
子宫内膜异位症的恶性潜能对治疗具有严重影响，例如需要更早、更细致的手术干预以彻底治疗疾病。
