Chang Yi-Ting, Lu Ting-Fang, Sun Lou, Shih Yu-Hsiang, Hsu Shih-Tien, Liu Chin-Ku, Hwang Sheau-Feng, Lu Chien-Hsing
Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Food and Nutrition, Providence University, Taichung, Taiwan.
Front Oncol. 2024 Jan 31;14:1338472. doi: 10.3389/fonc.2024.1338472. eCollection 2024.
Endometriosis is a benign disease, which is also regarded as a precursor to ovarian malignancy. Dienogest is a progestin treatment for endometriosis with efficacy and tolerability. A 35-year-old Taiwanese lady with ovarian endometrioma had taken dienogest for the last 5 years. During sonographic follow-up, surgery was suggested owing to suspicious of malignant transformation of ovarian endometrioma. While she hesitated and turned to receive two cycles of oocyte retrieval because of nulliparity. Meanwhile, more papillary growth in the ovarian endometrioma with intratumor flow was found during follow-up. Laparoscopic enucleation was performed later, and pathology revealed clear cell carcinoma with peritoneal involvement, at least FIGO stage IIB. She then underwent debulking surgery to grossly no residual tumor and received adjuvant chemotherapy with no tumor recurrence in post-operative 17-months follow-up. Considering fertility preservation, conservative treatment of ovarian endometrioma is typically indicated for those women who have not yet completed childbearing. However, malignant transformation may still occur despite long-term progestin treatment. Therefore, careful image follow-up is still indispensable.
子宫内膜异位症是一种良性疾病，也被视为卵巢恶性肿瘤的前驱病变。地诺孕素是一种用于治疗子宫内膜异位症的孕激素，具有疗效和耐受性。一名35岁患有卵巢子宫内膜异位囊肿的台湾女性在过去5年一直服用地诺孕素。在超声随访期间，由于怀疑卵巢子宫内膜异位囊肿发生恶变，建议进行手术。然而，由于未生育，她犹豫不决，转而接受了两个周期的取卵。同时，随访期间发现卵巢子宫内膜异位囊肿内出现更多乳头样生长且有瘤内血流信号。随后进行了腹腔镜剥除术，病理显示为透明细胞癌伴腹膜受累，至少为国际妇产科联盟（FIGO）IIB期。她随后接受了肿瘤减灭术，术后大体无残留肿瘤，并接受了辅助化疗，术后17个月随访无肿瘤复发。考虑到保留生育功能，对于尚未完成生育的女性，卵巢子宫内膜异位囊肿通常采用保守治疗。然而，尽管长期使用孕激素治疗，仍可能发生恶变。因此，仔细的影像随访仍然不可或缺。
