paywalled - Unravelling the two entities of endometrioid ovarian cancer: A single center clinical experience

Unravelling the two entities of endometrioid ovarian cancer: A single center clinical experience

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Abstract

Objective

Due to the increasing prevalence of the benign condition, ovarian carcinoma arising from endometriosis is emerging as a relevant clinical entity with an unclear biological signature. We have investigated clinical and histologic features of endometriosis-associated endometrioid ovarian cancer using an institutional retrospective database.

Methods

Patients diagnosed with endometrioid ovarian cancer at our institution were divided into two groups according to the fulfillment or not of Sampson's and Scott's criteria for the detection of endometriosis-associated ovarian cancer. Clinical and histological data were reported and compared. Survival analysis was obtained using the log-rank test in an unadjusted Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression model to establish independent factors associated with endometriosis-associated endometrioid ovarian cancer and to identify predictors of survival.

Results

Patients with endometriosis-associated endometrioid ovarian cancer were significantly younger, had a lower disease stage (77% vs 38%; p = 0.003), a less prevalent high grade tumor (38% vs 82%; p = 0.002) and a higher prevalence of squamous and mucinous metaplasia. 

The rate of endometrial cancer diagnosis was significantly higher in women with endometriosis-associated endometrioid ovarian cancer (33%) than in other patients (11%) (p = 0.04) with a 92% concordance between ovarian and endometrial histologic tumor grade. A significant difference in survival rate could not be demonstrated between patients with or without endometriosis.

Conclusions

The analysis of a retrospective endometrioid ovarian cancer database may allow to suggest a molecular, morphological and clinical parallelism between endometrial and endometrioid ovarian cancer.

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Highlights

► Endometriosis-associated endometrioid ovarian tumors possess a different biologic signature when compared to cancers not associated with the disease.
► Clinical course and molecular alterations of type I and type II endometrial tumors are similar to those detected respectively in endometriosis-associated and non-associated endometrioid ovarian tumor.

open access (pdf): Endometrial cancer genomics and genetics (of interest to Lynch Syndrome women/dual malignancies eg. ovarian/uterine cancers)

Endometrial cancer genomics and genetics


Abstract: (click on pdf for full file)

Most sporadic endometrial cancers (ECs) can be histologically classified as endometrioid, serous, or clear cell.

Each histotype has a distinct natural history, clinical behavior, and genetic etiology. Endometrioid ECs have an overall favorable prognosis.

They are typified by high frequency genomic alterations affecting PIK3CA, PIK3R1, PTEN, KRAS, FGFR2, ARID1A (BAF250a), and CTNNB1 (β-catenin), as well as epigenetic silencing of MLH1 resulting in microsatellite instability.

Serous and clear cell ECs are clinically aggressive tumors that are rare at presentation but account for a disproportionate fraction of all endometrial cancer deaths. Serous ECs tend to be aneuploid and are typified by frequent genomic alterations affecting TP53 (p53), PPP2R1A, HER-2/ERBB2, PIK3CA, and PTEN; additionally, they display dysregulation of E-cadherin, p16, cyclin E, and BAF250a.  

The genetic etiology of clear cell ECs resembles that of serous ECs, but it remains relatively poorly defined. A detailed discussion of the characteristic patterns of genomic alterations that distinguish the three major histotypes of endometrial cancer is reviewed herein.

Ovarian Endometrioid Adenocarcinoma: Incidence and Clinical Significance of the Morphologic and Immunohistochemical Markers of Mismatch Repair Protein Defects and Tumor Microsatellite Instability

"Ovarian cancer, particularly endometrioid (cell type)adenocarcinoma, is also associated with Lynch syndrome.....Overall, 10% of tumors had abnormal MMR protein status, defined as complete immunohistochemical loss of expression of MLH1, MSH2, MSH6, and/or PMS2.....Concurrent uterine tumor was present in 5/7 patients whose ovarian tumor had abnormal MMR/MSI.......Although abnormal MMR/MSI did not carry prognostic value in this study, it did predict the involvement of the uterus by the tumor. Thus, in patients with ovarian endometrioid adenocarcinoma who undergo uterus-sparing surgery, abnormal MMR/MSI should prompt further diagnostic evaluation of the endometrium for tumor."

 

abstract: CA 125 normalization with chemotherapy is independently predictive of survival in advanced endometrial cancer

Abstract

OBJECTIVE: Changes in CA 125 with chemotherapy predict outcome for epithelial ovarian cancer. There is no such data for advanced endometrial cancer.
CONCLUSION: As with epithelial ovarian cancer, changes in CA 125 are highly predictive of outcome for advanced, chemotherapy treated endometrial cancer.

Uterine cancer screening effective, but not yet recommended – The Chart - CNN.com Blogs (Lynch Syndrome)

"..However Smith notes many postmenopausal women receive a late diagnosis because they overlook a very important warning sign. "The American Cancer Society places a great deal of emphasis of being aware that postmenopausal bleeding is not normal and if it occurs, contact a doctor immediately," he advises."