Gynecology Department, IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milan, Italy.
Med Hypotheses. 2018 Jan;110:80-82. doi: 10.1016/j.mehy.2017.11.006. Epub 2017 Nov 13.
Endometriosis is a risk factor for type I epithelial ovarian cancer but an issue to be clarified is the site of origin of endometriosis associated ovarian cancer. Here we proposed that the uterus may be the organ of origin of ovarian endometrioid cancer associated with endometriosis. Thus, the first neoplastic transformation would characterize the uterine cells migrating in the pelvis via retrograde menstruation and they would implant secondarily on the ovary. Supporting this hypothesis, an higher incidence of synchronous precancerous and cancerous endometrial pathology in patients affected by ovarian endometrioid cancer associated with endometriosis was showed. Moreover, uterine endometrial type I carcinoma resembles endometriosis associated endometrioid ovarian cancer in behavior and prognosis. This hypothesis is also supported by epidemiologic evidence showing a protective effect for tubal ligation and oral contraceptive use for endometriosis associated endometrioid ovarian cancer. Endometriosis and endometrioid ovarian carcinoma might represent two distinct biological entities characterized by the same organ of origin (the uterus), the same pathogenetic mechanism (transtubal reflux) and the same target organ (the ovary). By shifting the early events of ovarian carcinogenesis to the endometrium, prevention approaches as salpingectomy/tubal ligation and intervention at uterine corpus level may play an important role.
子宫内膜异位症是 I 型上皮性卵巢癌的一个危险因素，但仍需阐明的问题是与子宫内膜异位症相关的卵巢子宫内膜样癌的起源部位。在这里，我们提出子宫可能是与子宫内膜异位症相关的卵巢子宫内膜样癌的起源器官。因此，第一次肿瘤转化将表现为通过逆行月经迁移到骨盆中的子宫细胞，并在卵巢上继发性地种植。支持这一假说，在患有与子宫内膜异位症相关的卵巢子宫内膜样癌的患者中，同时存在癌前和癌症子宫内膜病理的发生率更高。此外，子宫内Ⅰ型癌在行为和预后上类似于与子宫内膜异位症相关的子宫内膜样卵巢癌。这一假说也得到了流行病学证据的支持，这些证据表明输卵管结扎和口服避孕药对与子宫内膜异位症相关的子宫内膜样卵巢癌具有保护作用。子宫内膜异位症和子宫内膜样卵巢癌可能代表两种不同的生物学实体，它们具有相同的起源器官（子宫）、相同的发病机制（输卵管逆流入腹腔）和相同的靶器官（卵巢）。通过将卵巢癌发生的早期事件转移到子宫内膜，输卵管切除术/结扎和子宫体水平的干预可能会发挥重要作用。
