Atypical Endometriosis

[Objectives]Endometriosis(EMs)acount for a large proportion in gynecological disease,and atypical endometriosis(AEMs)take an important position in endometriosis and endometriosis-associated ovary carcinoma(EAOC).However, the study about AEMs is not enough up to now.The incidence rate of AEMs in reports varied greatly,and the role of AEMs played in the spectrum from EMs to EAOC is unclear.We choose AEMs to investigate and the focus is its incidence, pathological features,and immunoprofile including the protein expression of oncogene/tumor suppressor genes,cell proliferation activity and hormone receptor. The histological changes of AEMs are compared with the immunophenotype of EMs-associated lesions.The purpose of our study is to characterize the histological features of AEMs,try to probe its roles or malignant potential in the transformation from EMs to EAOC and supply some important informations for clinical therapy and follow-up.[Methods]1.A retrospective analysis was performed on 3724 cases of EMs and EMs associated with neoplasms and their clinical and pathologic datas in our hospital during the period 2004 January to 2006 December.Total of 6820 foci were revalued under microscop.A clincopathological study were performed on AEMs and neoplasms associated with EMs/AEMs.2.Immunohistochemisty staining of PTEN,p53,ki67,ER,PR were performed on four groups of total 82 cases,which were from our pathological files from 2006 to 2007,including 20cases of EMs,17 cases of reactive hyperplasia,25 cases of AEMs and 20 cases of EAOC.3.Statistical analysis were performed using Kruskal-Wallis test and Wilcoxon test were used to compare groups.[results]1.The incidence of AEMs:163 cases of AEMs were found in 3724 cases of EMs.The incidence of AEMs is 4.38%and the frequency of AEMs in the ovaries is 6.81%in our group.2.Details of AEMs associated with tumor:AEMs associated with a tumor in the same ovary were found in 27 ovaries(15.7%)of 26 patients(15.95%).All neoplasms associated with AEMs were epithelial types,which include 15 cases that were malignant,9 cases that were borderline,and 3 cases of cystoadenoma.Bordline and malignant tumors account for 1.01%(24/2363)of ovary endometrisis and 14.9% (24/161)of ovary AEMs.3.Pathological features:Besids the microscopic features described by other authors,we found AEMs often showed eosinophilic changes and obvious papillary structures.88%of the AEM lesions had only endometrioid surface epithelial,with non or a few gland components found underneath it.There were many fibroticcollagen and scar in the stroma and the inflammary background was not prominent.4.The expression of immunohistochemistry:the immunohistochemistry results in EMs,reactive hyperplasia,AEMs and EAOC were showed as follows:(1)PTEN:none of the EMs cases showed PTEN loss,but the other three groups had PTEN loss in some degree.There are statistical significance of PTEN loss between the reactive hyperplasia,AEMs,EAOC and EMs. (2)p53:all of the four groups present with different extent of p53 expression.But the expression of p53 in AEMs and EAOC were higher than in EMs.(3)ki67:all of the four groups present with high level of ki67expression,but the expression intensity was obviously different;EMs and reactive hyperplasia showed mild intensity,AEMs mainly low and moderate intensity and EAOC mainly moderate and high intensity.(4)ER and PR:we found a descending tendency both of ER and PR expression;ER expression in EAOC was lower than in other groups and PR exprssion in EMs was higher than other groups.We summarized immunohistochemistry results as follows:(1)EMs:none cases showed PTEN loss,minority overexpression of p53,mildly increased expression of ki67,high expression of ER and PR.(2)Reactive hyperplasia:PTEN begun to loss.There were minority overexpression of p53,mildly increaed of ki67,high expression of ER.PR expression begun to decreased.(3)AEMs:PTEN begun to loss,the high expression ratio of p53 increased,ki67 expression moderately increased,ER were highly expressed and PR expression decreased.(4)EAOC:There were obvious loss of PTEN,majority overpression of p53,high grade expression of ki67,both ER and PR expression decreased.[conclusions]1.We found the ratio of AEMs in EMs and ovary EMs is 4.3 8% and 6.81%respectively,which is the largest sample in the reports up to now.Our study proved the theory that the AEMs is not rare in EMs lesions.2.EMs and AEMs have close relation with neoplasms.In our study,bordline and malignant neoplasms accouted for 14.9%of AEMs,which was more than 10 times as the malignancy rate of EMs.AEMs have a relatively higher potential for tumorigenesis and canceration.3.Pathologic features of AEMs:AEMs lesions have some features which are similar and also differ from both of the tumor and EMs.The phenomena.of hormonal inactivity,significant cellular atypia,and scarring presentasion in AEMs indicate that EMs have experienced damage,repair and scarring changes over a long period of time,which may be invoved in the process that EMs develop into neoplasms through AEMs.4.Immunohistochemistry results of the spectrum of EMs-AEMs-EAOC indicated:with the development of lesions,PTEN loss and p53 expression increased;ER and PR expression decreased;the intensity of ki67 expression showed different staging;PTEN loss begun from reactive hyperplasia;increasing of p53 expression from AEMs;decreasing of ER expression from EAOC and PR from reactive hyperplasia.5.The study about the histological changes and immunophenotype in different EMs associated lesions indicate:the development of EMs-AEMs-EAOC is a consecutive process;histological changes and immunophenotype are conformity;AEMs have hold some features of EMs and tumor not only in histology but also in immunophenotype.AEMs showed PTEN loss,increased p53 expression,high cell hyperplasia activity and decreased expression of hormon receptor.These features suggest AEMs have a relatively higher potential for tumorigenesis and canceration.