Kobayashi Hiroshi
Department of Gynecology, Ms.Clinic MayOne, Kashihara, Nara 634-0813, Japan.
Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan.
Exp Ther Med. 2023 Apr 24;25(6):279. doi: 10.3892/etm.2023.11978. eCollection 2023 Jun.
Endometriosis is a benign gynecological disease that affects women of reproductive age. Although malignant transformation of endometriosis is rare, physicians must be aware of this due to the high incidence of clear cell carcinoma of the ovary (CCC) in Japan. The most prevalent histological subtype of ovarian cancer is CCC (~70%) followed by endometrioid carcinoma (30%). The present review discusses the clinicopathological and molecular features of endometriosis-associated ovarian cancer (EAOC) as well as prospects for novel diagnostic strategies. Papers published between 2000 and 2022 in the PubMed and Google Scholar databases were included. Contents of the endometriotic cyst fluid may be involved in carcinogenesis, although the underlying mechanisms are largely unknown. Some studies have proposed a possible mechanism wherein excessive hemoglobin, heme and iron could cause an imbalance in intracellular redox homeostasis in endometriotic cells. Combined with DNA damage and mutations, the imbalances may induce the development of EAOC. Endometriotic cells evolve to adapt to the prolonged unfavorable oxidative microenvironmental stress. On the other hand, macrophages enhance the antioxidative defense mechanism and protect endometriotic cells against oxidative damage through intercellular crosstalk and signaling pathways. Therefore, changes in redox signaling, energy metabolism and the tumor immune microenvironment could be the key elements in the malignant transformation of certain endometriotic cell clones. Additionally, non-invasive bioimaging (i.e., magnetic resonance relaxometry) and biomarkers (i.e., tissue factor pathway inhibitor 2) may be promising tools for early-stage detection of the disease. In conclusion, the present review summarizes the latest advancements in research on the biological characteristics and early diagnosis of malignant transformation of endometriosis.
子宫内膜异位症是一种影响育龄女性的良性妇科疾病。尽管子宫内膜异位症的恶性转化很少见，但由于日本卵巢透明细胞癌（CCC）的高发病率，医生必须对此有所警惕。卵巢癌最常见的组织学亚型是CCC（约70%），其次是子宫内膜样癌（30%）。本综述讨论了子宫内膜异位症相关卵巢癌（EAOC）的临床病理和分子特征以及新型诊断策略的前景。纳入了2000年至2022年在PubMed和谷歌学术数据库中发表的论文。尽管其潜在机制 largely unknown，但子宫内膜异位囊肿液的成分可能参与致癌过程。一些研究提出了一种可能的机制，即过量的血红蛋白、血红素和铁可能导致子宫内膜异位细胞内氧化还原稳态失衡。再加上DNA损伤和突变，这些失衡可能会诱导EAOC的发生。子宫内膜异位细胞不断进化以适应长期不利的氧化微环境压力。另一方面，巨噬细胞通过细胞间串扰和信号通路增强抗氧化防御机制，保护子宫内膜异位细胞免受氧化损伤。因此，氧化还原信号、能量代谢和肿瘤免疫微环境的变化可能是某些子宫内膜异位细胞克隆恶性转化的关键因素。此外，非侵入性生物成像（即磁共振弛豫测量）和生物标志物（即组织因子途径抑制剂2）可能是早期检测该疾病的有前景的工具。总之，本综述总结了子宫内膜异位症恶性转化的生物学特性和早期诊断研究的最新进展。
