National Taiwan University Hospital, Yunlin Branch, Yunlin county, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
J Ovarian Res. 2022 Jul 14;15(1):84. doi: 10.1186/s13048-022-01019-8.
Ovarian clear cell carcinoma (OCCC) is the most common endometriosis-associated ovarian cancer. Ovarian endometriosis may present with atypical or malignant sonographic features and interfere with clinical judgment about whether definitive surgical intervention is required.
To compare the characteristics of endometrioma with atypical features and OCCC.
This study enrolled patients with pathologic diagnoses of either endometrioma or OCCC. For patients with endometrioma, only those with atypical features, defined as the presence of at least one of the following sonographic characteristics: cyst diameter of 10 ± 1 cm, multi-cystic lesions, any solid component or papillary structure, and blood flow of any degree, were included.
Sixty-three patients had endometriomas with atypical features, while 57 patients had OCCC. Patients with endometriomas were younger (39.33 ± 7.04 years vs. 53.11 ± 9.28 years, P < 0.01), had smaller cysts (7.81 ± 2.81 cm vs. 12.68 ± 4.60 cm, P < 0.01), and had smaller solid components (0.93 ± 1.74 cm vs. 4.82 ± 3.53 cm, P < 0.01). In contrast, OCCCs were associated with loss of ground-glass echogenicity (6.3% vs 68.4%, P < 0.01). In multivariate analysis, advanced age (> 47.5 years), large cysts (> 11.55 cm), large solid components (size > 1.37 cm), and loss of ground-glass echogenicity were independent factors suggestive of malignancy.
Advanced age, larger cyst sizes, larger solid component sizes, and loss of ground-glass echogenicity are major factors differentiating endometriomas from malignancies. For women in menopausal transition who have finished childbearing who present with endometrioma with atypical features, removal of the adnexa intact could be considered.
卵巢透明细胞癌（OCCC）是最常见的子宫内膜异位症相关卵巢癌。卵巢子宫内膜异位症可能表现出非典型或恶性的超声特征，并干扰临床判断是否需要明确的手术干预。
比较具有非典型特征的卵巢子宫内膜异位囊肿和 OCCC 的特征。
本研究纳入了病理诊断为卵巢子宫内膜异位囊肿或 OCCC 的患者。对于卵巢子宫内膜异位囊肿患者，仅纳入具有以下至少一种超声特征的非典型特征的患者：囊肿直径为 10±1cm、多房性病变、任何实性成分或乳头状结构、以及任何程度的血流。
63 例患者的卵巢子宫内膜异位囊肿具有非典型特征，而 57 例患者患有 OCCC。具有卵巢子宫内膜异位囊肿的患者年龄更小（39.33±7.04 岁 vs. 53.11±9.28 岁，P<0.01），囊肿更小（7.81±2.81cm vs. 12.68±4.60cm，P<0.01），实性成分更小（0.93±1.74cm vs. 4.82±3.53cm，P<0.01）。相比之下，OCCC 与玻璃样回声丢失有关（6.3% vs 68.4%，P<0.01）。多因素分析显示，年龄较大（>47.5 岁）、较大的囊肿（>11.55cm）、较大的实性成分（大小>1.37cm）和玻璃样回声丢失是提示恶性的独立因素。
年龄较大、较大的囊肿大小、较大的实性成分大小和玻璃样回声丢失是区分卵巢子宫内膜异位囊肿和恶性肿瘤的主要因素。对于处于绝经过渡阶段、已完成生育且具有非典型特征的卵巢子宫内膜异位囊肿患者，可以考虑完整切除附件。
