Clinicopathological Features Of Ovarian Endometriosis-related Neoplasms

BackgroundEndometriosis(EM)refers to the presence of endometrial glands and stroma outside the uterine body(including the cervix).Tumors originating from EM are collectively referred to as endometriosis related tumors,the most common of which is endometriosis-associated ovarian carcinoma(EAOC),including ovarian endometrioid carcinoma(OEC)and ovarian clear cell carcinoma(OCCC),as well as other rare tumors such as mesonephric-like adenocarcinoma(MLA).The ovarian EM and atypical endometriosis(AEM)are precursor lesions of ovarian EAOC and studies have shown that EAOC has earlier stages and better prognosis than non-EAOC.This article investigates the clinicopathological features of tumors associated with endometriosis,analyzes their correlation with the histomorphology of endometriosis and atypical endometriosis,and explores the pathological diagnostic significance of related atypical lesions in endometriosis.The aim of this study is to provide a theoretical basis for guiding early clinical management of endometriosis in the ovaries,and preventing malignant transformation.Materials and methodsWe collected 939 0 cases of ovarian endometriosis related diseases diagnosed in our hospital from March 2009 to February 2023,and counted the proportion of different histopathological types of diseases.Among them,we collected clinicopathological data on 81 cases of EAOC and 384 cases of non-EAOC,and performed immunohistochemical staining.After evaluating the differences in clinicopathological characteristics between the two groups,we then selected 37 cases of EAOC with detailed information and histological sections for histopathological evaluation and follow-up to analyze the relationship between prognosis and clinicopathological characteristics.Results1.Analysis of histological types of EM related ovarian diseases and its incidence ratio: 9390 cases of EM related ovarian diseases,9211 cases of benign ovarian EM(98.1%),69 cases of EM related borderline ovarian tumors(0.7%)(including 51 borderline endometrioid tumors and 18 borderline seromucinous tumors),110 cases of EAOC(1.2%)(including 65 cases of OCCC(59.1%),42 cases of EAC(38.2%),and3 cases of MLA(2.7%)).2.There were differences between the EAOC group and the non-EAOC group in terms of age,tumor differentiation,histological type,and FIGO stage(P<0.05),with the average age of the EAOC group being lower than that of the non-EAOC group(P=0.001),the proportion of high differentiation in the EAOC group being higher in histological grade(P=0.009);the proportion of OCCC in EAOC group being higher than that in non-EAOC group in histological type(P<0.001);the proportion of early tumors in FIGO stage in EAOC group being higher than that in non-EAOC group(P=0.033).3.The analysis of immunophenotypes between EAOC and non-EAOC groups showed that there was no statistically significant difference in the expression of commonly used immunohistochemical markers between the EAOC and non-EAOC groups,between OEC in EAOC group and OEC in non-EAOC groups,between OCCC in EAOC group and OCCC in non-EAOC group.4.3 7 cases of EAOC with sufficient histological sections and follow-up data were reviewed and analyzed for detailed clinicopathological,histomorphological,and immunohistochemical characteristics.Among them,FIGO stages I and II accounted for the majority(78.3%),with the histological type being mainly OCCC and poorly differentiated carcinoma.Compared with the tumor infiltrating lymphocyte negative group,the tumor infiltrating lymphocyte positive EAOC group had a significantly lower onset age(P=0.001),and there was no difference in other clinicopathological characteristics between the two groups(P>0.0 5).Comparing the clinicopathological information of cases with typical EM and AEM with those of EAOC with and without transition,there was no difference in each index between the two groups(P>0.05).A follow-up study of 3 7 patients showed that the total survival time of patients with poorly differentiated cancer was significantly shorter than that of patients with highly differentiated and moderately differentiated cancer(68.49 ± 9.45 months vs.118.00 ±0.00 months).There was no significant correlation between other clinicopathological features and prognosis.5.Detailed histopathological characteristics of 37 EAOC patients with sufficient histopathological sections were analyzed.The results showed that most of the tumors were cystic or cystic-solid masses with solid and papillary growth on the inner wall.The common morphological changes of metaplasia in EAOC include eosinophilic metaplasia in 16 cases(34.8%),followed by ciliated metaplasia in 13 cases(28.3%),squamous and mulberry-like metaplasia in 13 cases(28.3%),and mucinous metaplasia in 4 cases(8.7%).6.Detailed immunohistochemically microscopic observation of OCCC transitional lesions showed that in the same case,from EM to AEM,and then to the transitional region of cancer,the expression of ER,PR,Napsin A,HNF1-β has also changed.The expression of endometrioid carcinoma markers such as ER and PR was absent,while the expression of Napsin A and HNF1-β was positive.7.Three cases of MLA were accompanied by EM or AEM,and there was a transitional region between EM or AEM and cancer.Conclusion1.The majority of EM related ovarian diseases are benign EM,and the incidence rate of borderline tumors and cancers is 1.9%.The most common histological type of EAOC is OCCC.2.EAOC has a younger onset age,higher tumor differentiation,and earlier FIGO staging than non-EAOC.3.The most common EAOC related metaplasia is eosinophilic metaplasia,which is closely related to AEM and carcinogenesis.4.MLA may originate from EM and also belong to one of EAOC.