Namık Kemal Tıp Dergisi (Mar 2024)
Relationship Between Endometriosis, Borderline Adnexal Tumors and Malignant Tumors: A Retrospective Case Study
Abstract
Aim: The main purpose of this study is to investigate the relationship between ovarian endometriosis and borderline ovarian tumor (BOT) and malignant ovarian tumor. Materials and Methods: Data were retrospectively collected from patients with BOT or malignant adnexal tumor and endometriosis in the surrounding tissue (in the same piece) in the pathology after gynecological surgery at the tertiary center Obstetrics and Gynecology Clinic, between 2017 and May 2023. Patient age, gravidity, body mass index, family history of cancer, clinical complaints, ultrasound and magnetic resonance imaging (MRI) features of the detected mass, preoperative tumor markers and pathological stages were recorded. Results: A total of 49 BOTs were diagnosed in this 5.5-year period. 19 of them were serous, 22 of them were mucinous, 7 of them were seromucinous, and 1 of them was endometrioid BOT. In 9 BOT cases, there was pathologically confirmed endometriosis in the same ovary or pelvic tissue remaining in the surgical area. There were 37 malignant epithelial ovarian cancer diagnoses in 5.5 years. Of these, 11 had endometrioid ovarian cancer (1 had endometrioid and clear cell cancer), 25 had serous ovarian cancer and 1 had mucinous ovarian cancer. Endometriosis was associated with 4 cases of serous adenocarcinoma and 4 cases of endometrioid ovarian cancer. Among these patients, BOT patients with endometriosis were younger. Tumor markers were slightly elevated in 3 cases in the BOT group. In women having endometriosis with malignant pathology, preoperative tumor markers were slightly elevated in 3 patients, and tumor markers were normal in the other cases. Infertility was more common in the malignant patient group. MRI findings were more consistent with the pathological diagnosis in the malignant group. All but 1 patient in the malignant group had peroperative frozen pathology and complementary surgery in a single session. Frozen pathology was not performed in all patients in the BOT group, and some patients underwent cystectomy only. Conclusion: Endometriosis can be associated with malignancies and borderline adnexal tumors with or without endometrioma. We believe that when an adnexal mass is seen in patients who have undergone surgery for the diagnosis of endometriosis, the possibility of malignancy should be considered and per-operative frozen pathology should be performed.
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