Heaps J M, Nieberg R K, Berek J S
Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine.
Obstet Gynecol. 1990 Jun;75(6):1023-8.
Ten cases of malignant tumors arising in foci of gonadal and extragonadal endometriosis are reported and added to 195 previously reported cases from the English literature. The ovary was the primary site in 165 (78.7%) of the cases, whereas extragonadal sites represented 44 (21.3%). Endometrioid adenocarcinomas accounted for 69% of the lesions, clear-cell carcinomas 13.5%, sarcomas 11.6%, and rare cell types 6%. Extragonadal lesions were mostly endometrioid tumors (66%) and sarcomas (25%). Tumors arising in endometriosis were predominantly low grade and confined to the site of origin. Radiation therapy was often able to control completely tumors limited to the pelvis, but was not beneficial in metastatic disease. Only one patient had a response to chemotherapy. Fourteen patients received postoperative progestin therapy, with a 77% 5-year survival. Follow-up has been reported in 86 patients. The tumor was either confined to the ovary (57), confined to the extragonadal site of origin (11), or spread throughout the peritoneal cavity (18). With each of these situations, the 5-year survival was 65, 100, and 10%, respectively. Fourteen patients had malignant transformation in endometriosis associated with presumed estrogenic stimulation; most lesions (69%) were well differentiated and the 5-year survival was 82%. After surgical resection, we recommend that progestin therapy be included in the treatment of cancer arising in endometriosis. The actual frequency of malignancy arising in endometriosis may be higher than reported.
本文报告了10例性腺和性腺外子宫内膜异位症病灶中发生的恶性肿瘤，并将其加入英文文献中先前报告的195例病例。卵巢是165例（78.7%）病例的原发部位，而性腺外部位占44例（21.3%）。子宫内膜样腺癌占病变的69%，透明细胞癌占13.5%，肉瘤占11.6%，罕见细胞类型占6%。性腺外病变大多为子宫内膜样肿瘤（66%）和肉瘤（25%）。子宫内膜异位症中发生的肿瘤主要为低级别，且局限于起源部位。放射治疗通常能够完全控制局限于盆腔的肿瘤，但对转移性疾病无益。只有1例患者对化疗有反应。14例患者接受了术后孕激素治疗，5年生存率为77%。已报告86例患者的随访情况。肿瘤要么局限于卵巢（57例），局限于性腺外起源部位（11例），要么扩散至整个腹腔（18例）。在这三种情况下，5年生存率分别为65%、100%和10%。14例患者在与推测的雌激素刺激相关的子宫内膜异位症中发生了恶性转化；大多数病变（69%）分化良好，5年生存率为82%。手术切除后，我们建议将孕激素治疗纳入子宫内膜异位症相关癌症的治疗中。子宫内膜异位症中发生恶性肿瘤的实际频率可能高于报告的频率。
