Portal de Periódicos da CAPES

Malignant transformation of ovarian endometriosis. Nature, treatment and report of two cases.

1970; National Institutes of Health; Volume: 36; Issue: 3 Linguagem: Inglês

Stevenson Cs,

Endometriosis Research and Treatment

It is noted that in the published literature up to 1950 only 11 true cases of ovarian cancer arising in ovarian endometriosis were reported. In 1965 out of 120 cases of ovarian carcinoma 21 had some pelvic endometriosis also present. Of these 21 there were 3 with carcinoma developing in endometriotic ovarian cysts while in 7 cases the carcinoma appeared to be related to endometrioses. In 1966 there were 8 cases reported in which carcinoma arose in endometriosis of the ovary. Some may have originated from the germinal epithelial cells of the ovary. The author reports 2 cases in which the carcinoma originated in ovarian endometiosis cysts. In the first case symptoms and pelvic findings indicated that extensive ovarian endometriosis had been present before the malignant growth began. The second patient apparently had a normal uterus and adnexa 5 years previously but had not been seen in the interval. The histologic pattern of these ovarian malignancies resembled ovarian metastases of endometrial adenocarcinoma. The ovarian tumors in both cases were probably secreting estrogen as was indicated by the pre and postoperative vaginal cell maturation indices. The opposite ovary in each case was atrophic. In both cases the endometrium showed hyperplasia and adenomyosis. Some irritating substance elaborated by the ovarian tumors affected adjacent surfaces and caused edematous adhesions to form. In the second case a sterile inflammatory process was generated in the adherent portion of the omentum. The same effect was seen in adherent serosa surfaces in the first case. Both patients had had basal cell carcinoma of the facial skin. These facial carcinoma had developed 4 and 7 years respectively before the beginning growth of their ovarian adenocarcinomas. Others have reported the association of skin cancer without metastases followed by primary carcinoma of an internal organ in greater frequency than expected. Since estrogen is secreted by the ovaries and not by the endometrium the secretion by these 2 ovarian tumors suggests that the endometriosis in them is of ovarian germinal tissue origin and not retrograde by way of the fallopian tubes. Treatment of these tumors is the same as for any malignant tumor of the ovary. If possible rupture of any part of the tumor should be avoided. In 1 case a locule of the friable tumor was already ruptured at the time of the operation. In the other case a part of the tumor was torn in separating it from adhesions. Radoactive chemical solution in the peritoneal cavity and deep colbalt therapy were inadequate for a cure. Massive doses of progestational hormones in 1 case had a temporary beneficial effect. The first patient survivied her original laparotomy for 33 months (death caused by emboli in the brain arteries) and the other for 10 months (death related to the carcinoma).