Takagi Hiroaki, Takata Emi, Sakamoto Jinichi, Fujita Satoko, Takakura Masahiro, Sasagawa Toshiyuki
Department of Obstetrics and Gynecology, Kanazawa Medical University, School of Medicine, Japan.
Case Rep Obstet Gynecol. 2018 Sep 4;2018:6210172. doi: 10.1155/2018/6210172. eCollection 2018.
Dienogest (DNG) is considered to be effective against ovarian endometrioma (OMA). We report a rare case of OMA transformation to ovarian cancer during long-term endometriosis treatment with a periodic administration of a gonadotropin-releasing hormone agonist (Gn-RH agonist) and DNG. The patient was a 41-year-old Japanese woman. OMA and adenomyosis of the uterus were revealed via computed tomography. Consequently, she underwent conservative treatment without undergoing surgery because her overall status was poor. She received cyclic therapy (Gn-RH agonist and DNG) for approximately eight years. However, she reported lumbago and underwent close medical examination at our hospital after about eight years of treatment. Under the suspicion of malignant transformation, she underwent surgery. The pathological diagnosis was clear cell carcinoma of the right ovary (stage 2B). After surgery, she received six courses of chemotherapy (conventional TC). No evidence of disease was observed after chemotherapy. Our findings suggest that malignant transformation of OMA can occur during DNG treatment. Since the delayed detection of ovarian cancer greatly affects the prognosis, women older than 40 with OMA are encouraged to undergo regular check-ups every few months.
地诺孕素（DNG）被认为对卵巢子宫内膜异位囊肿（OMA）有效。我们报告了1例罕见病例，该患者在长期使用促性腺激素释放激素激动剂（Gn-RH激动剂）和DNG周期性治疗子宫内膜异位症期间，OMA转变为卵巢癌。患者为一名41岁的日本女性。通过计算机断层扫描发现了OMA和子宫腺肌病。由于她的整体状况较差，因此未接受手术而是接受了保守治疗。她接受了约8年的周期治疗（Gn-RH激动剂和DNG）。然而，她报告有腰痛症状，并在治疗约8年后到我院进行了详细的医学检查。在怀疑发生恶性转化后，她接受了手术。病理诊断为右卵巢透明细胞癌（2B期）。术后，她接受了6个疗程的化疗（传统TC方案）。化疗后未发现疾病迹象。我们的研究结果表明，OMA的恶性转化可能发生在DNG治疗期间。由于卵巢癌的延迟检测会极大地影响预后，因此鼓励40岁以上患有OMA的女性每隔几个月进行定期检查。
