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Understanding malignant transformation of endometriosis: imaging features with pathologic correlation

  • Special Section: Endometriosis
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Transformation of benign endometriosis to endometriosis-associated ovarian carcinoma (EAOC) is rare; however, women with endometriosis are four times more likely to develop EAOC which can present 20 years earlier than de novo ovarian cancer. Presenting symptoms are often vague and the radiologist’s role in recognizing EAOC is critical for early detection and treatment. Histopathologic evaluation remains the mainstay for definitive diagnosis.

Methods

Using a case-based approach, this article will review the sonographic, CT, and MRI features of EAOC with an emphasis on MRI. Histopathologic correlation of benign and malignant endometriosis will be reviewed.

Results

Multiple factors contribute to the malignant transformation of endometriosis including genetic alterations, hormonal influences, oxidative stress, and inflammation. Malignancy most often occurs in ovarian endometriomas with less common sites involving the rectovaginal septum, rectosigmoid colon, and abdominal wall scars. The most common pathologic subtypes are endometrioid adenocarcinoma and clear cell carcinoma. MRI is the most specific imaging modality for evaluating EAOC. Key MR features include solid enhancing nodules (accentuated by subtraction imaging), nodular septations, loss of T2 shading within the endometrioma, and diffusion restriction.

Conclusions

EAOC is a distinct disease that affects women with benign endometriosis at younger ages than classic ovarian cancer. Understanding the imaging features of malignant transformation of endometriosis is essential for early diagnosis and timely definitive treatment.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA

    Kristin A. Robinson

  2. Department of Diagnostic Radiology, Abdominal Division, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA

    Christine O. Menias

  3. Department of Pathology, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA

    Longwen Chen

  4. Facultad de Medicina Clínica Alemana - UDD, Av. Vitacura 5951, Vitacura, Santiago, Chile

    Giancarlo Schiappacasse

  5. Department of Diagnostic Radiology, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA

    Akram M. Shaaban

  6. Department of Diagnostic Radiology, Ultrasound Division, Mayo Clinic Hospital, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Melanie P. Caserta

  7. Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Khalid M. Elsayes

  8. Department of Diagnostic Radiology, Ultrasound Division, Mayo Clinic Hospital, 200 First Street SW, Rochester, MN, 55905, USA

    Wendaline M. VanBuren

  9. Department of Diagnostic Radiology, Abdominal Division, Mayo Clinic Hospital, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Candice W. Bolan

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  1. Kristin A. Robinson
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Robinson, K.A., Menias, C.O., Chen, L. et al. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol 45, 1762–1775 (2020). https://doi.org/10.1007/s00261-019-01914-7

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