Yin Dan, Jiang Yan-Jiao
The Second Clinical College of Zhejiang Chinese Medical University, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou, Zhejiang, People's Republic of China.
Int J Womens Health. 2023 Oct 24;15:1611-1619. doi: 10.2147/IJWH.S418135. eCollection 2023.
Endometriosis-associated ovarian cancer (EAOC) is rare, occurring approximately in 1% of women with ovarian endometriosis. The main histological types are endometrioid adenocarcinoma and clear cell carcinoma (CCC), with the latter being the least common.
In our hospital, we recently summarized two patients with ovarian clear cell carcinoma with similar characteristics. They all had endometriosis for a long time and had undergone ovarian cyst removal due to a chocolate cyst. Unfortunately, the cyst recurred after surgery, and the histological diagnosis was clear cell carcinoma. In case 1, the expression of P53 was found in the tumor by regular examination, and the stage was IIB. In Case 2, we found it in intraoperative freezing; the stage was IA. Case 1 has been treated with the TP regimen six times, and the survival period has reached one year. Case 2 had a survival period of 6 years after completing six TP regimen treatments. Clinicians should pay attention to patients with a long history of endometriosis and postoperative recurrence of ovarian cysts accompanied by serum CA-125 of more than 200U/mL. Imaging examination has a good prospect in diagnosing malignant transformation of endometriosis, especially PET-CT.
This case report highlights the risk factors related to the formation of ovarian clear cell carcinoma and suggests that the follow-up of patients with ovarian endometriosis is essential because of its recurrence characteristics. Radical surgery and postoperative platinum-containing chemotherapy are the primary treatment methods at present.
子宫内膜异位症相关的卵巢癌(EAOC)较为罕见,约占卵巢子宫内膜异位症患者的1%。主要组织学类型为子宫内膜样腺癌和透明细胞癌(CCC),后者最为少见。
我院近期总结了两名具有相似特征的卵巢透明细胞癌患者。她们均长期患有子宫内膜异位症,因巧克力囊肿接受过卵巢囊肿切除术。遗憾的是,术后囊肿复发,组织学诊断为透明细胞癌。病例1经定期检查发现肿瘤中有P53表达,分期为IIB期。病例2在术中冰冻检查时发现,分期为IA期。病例1已接受6次TP方案治疗,生存期达1年。病例2完成6次TP方案治疗后生存期为6年。临床医生应关注有长期子宫内膜异位症病史且卵巢囊肿术后复发伴有血清CA-125超过200U/mL的患者。影像学检查在诊断子宫内膜异位症恶变方面前景良好,尤其是PET-CT。
本病例报告突出了与卵巢透明细胞癌形成相关的危险因素,并表明由于卵巢子宫内膜异位症的复发特征,对其患者进行随访至关重要。根治性手术和术后含铂化疗是目前的主要治疗方法。