Habiba Marwan, Pluchino Nicola, Petignat Patrick, Bianchi Paola, Brosens Ivo A, Benagiano Giuseppe
Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom.
Department of Obstetrics and Gynaecology, University Hospital of Geneva, Geneva, Switzerland and Division of Obstetrics, Gynaecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA.
Gynecol Obstet Invest. 2018;83(4):313-328. doi: 10.1159/000487320. Epub 2018 Jun 6.
To confirm the origin of cancer found in both the endometrium and the myometrium is difficult. Cancer may spread from the endometrium into adenomyotic foci or vice versa. Also, premalignant changes may arise at either or both sites. Investigating disease origin enhances our understanding of pathophysiology and prognosis. Additional critical questions are whether women with adenomyosis have a higher risk of endometrial cancer; whether the invasive properties and prognosis of cancer in adenomyosis differ from those arising in the eutopic endometrium and whether the ectopic glandular tissue in adenomyosis becomes altered in the presence of eutopic endometrial cancer. A final question is whether cancer arising within adenomyosis carries a worse prognosis because of its location within the myometrium and the possibility that the presence of adenomyosis facilitates invasion of cancer arising in the eutopic endometrium. The present review explores currently available literature in an attempt to answer these questions and to examine clinical presentations, diagnostic criteria, pathogenesis and prognosis.
要确定同时在子宫内膜和子宫肌层发现的癌症的起源很困难。癌症可能从子宫内膜扩散到子宫腺肌病病灶，反之亦然。此外，癌前病变可能出现在任一部位或两个部位。研究疾病起源有助于我们理解病理生理学和预后。其他关键问题包括：患有子宫腺肌病的女性患子宫内膜癌的风险是否更高；子宫腺肌病中的癌症的侵袭特性和预后与在位子宫内膜中产生的癌症是否不同；以及在在位子宫内膜癌存在的情况下，子宫腺肌病中的异位腺组织是否会发生改变。最后一个问题是，由于子宫腺肌病中的癌症位于子宫肌层内，且子宫腺肌病的存在可能促进在位子宫内膜癌的侵袭，那么子宫腺肌病内发生的癌症预后是否更差。本综述探讨了当前可得的文献，试图回答这些问题，并研究临床表现、诊断标准、发病机制和预后。
