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Clinical Management of Selected Precancerous Lesions of the Uterus, Fallopian Tube, and Ovary

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Abstract

The vast majority of precancerous lesions of the gynecologic tract are diagnosed post hoc. Often the surgery by which the lesion was diagnosed is sufficient treatment. However, a few exceptions exist. The most notable is endometrial hyperplasia, which is usually diagnosed on an endometrial biopsy or curettage and definitively treated with hysterectomy. Nonsurgical treatment of endometrial hyperplasia can be considered in select patients. The role of surgical staging (lymphadenectomy, omentectomy, etc.) for the majority of precancerous lesions of the fallopian tube and ovary is unclear. In the absence of upstaged and confirmed invasive carcinoma, adjuvant chemotherapy is not recommended.

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References

  1. Marra C, Penati C, Ferrari L, Cantu MG, Bargossi L, Fruscio R. Treatment of simple and complex endometrial non-atypical hyperplasia with natural progesterone: response rate to different doses. Gynecol Endocrinol. 2014;30(12):1–3.

    Google Scholar 

  2. Niwa K, Tagami K, Lian Z, Onogi K, Mori H, Tamaya T. Outcome of fertility-preserving treatment in young women with endometrial carcinomas. BJOG. 2005;112:317–20.

    Article  CAS  PubMed  Google Scholar 

  3. Yu M, Yang JX, Wu M, Lang JH, Huo Z, Shen K. Fertility-preserving treatment in young women with well-differentiated endometrial carcinoma and severe atypical hyperplasia of endometrium. Fertil Steril. 2009;92:2122–4.

    Article  PubMed  Google Scholar 

  4. Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke II JJ, Alberts D, Curtin J. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer. 2006;106:812–9.

    Article  PubMed  Google Scholar 

  5. Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol. 2005;106:693–9.

    Article  PubMed  Google Scholar 

  6. Evans-Metcalf ER, Brooks SE, Reale FR, Baker SP. Profile of women 45 years of age and younger with endometrial cancer. Obstet Gynecol. 1998;91:349–54.

    Article  CAS  PubMed  Google Scholar 

  7. Lee TS, Kim JW, Kim TJ, Cho CH, Ryu SY, Ryu HS, Kim BG, Lee KH, Kim YM, Kang SB, Korean Gynecologic Oncology G. Ovarian preservation during the surgical treatment of early stage endometrial cancer: a nation-wide study conducted by the Korean Gynecologic Oncology Group. Gynecol Oncol. 2009;115:26–31.

    Article  PubMed  Google Scholar 

  8. Richter CE, Qian B, Martel M, Yu H, Azodi M, Rutherford TJ, Schwartz PE. Ovarian preservation and staging in reproductive-age endometrial cancer patients. Gynecol Oncol. 2009;114:99–104.

    Article  PubMed  Google Scholar 

  9. Zheng W, Schwartz PE. Serous EIC as an early form of uterine papillary serous carcinoma: recent progress in understanding its pathogenesis and current opinions regarding pathologic and clinical management. Gynecol Oncol. 2005;96:579–82.

    Article  PubMed  Google Scholar 

  10. Hou JY, McAndrew TC, Goldberg GL, Whitney K, Shahabi S. A clinical and pathologic comparison between stage-matched endometrial intraepithelial carcinoma and uterine serous carcinoma: is there a difference? Reprod Sci. 2014;21:532–7.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Sherman ME, Bitterman P, Rosenshein NB, Delgado G, Kurman RJ. Uterine serous carcinoma. A morphologically diverse neoplasm with unifying clinicopathologic features. Am J Surg Pathol. 1992;16:600–10.

    Article  CAS  PubMed  Google Scholar 

  12. Soslow RA, Pirog E, Isacson C. Endometrial intraepithelial carcinoma with associated peritoneal carcinomatosis. Am J Surg Pathol. 2000;24:726–32.

    Article  CAS  PubMed  Google Scholar 

  13. Baergen RN, Warren CD, Isacson C, Ellenson LH. Early uterine serous carcinoma: clonal origin of extrauterine disease. Int J Gynecol Pathol. 2001;20:214–9.

    Article  CAS  PubMed  Google Scholar 

  14. Zheng W, Xiang L, Fadare O, Kong B. A proposed model for endometrial serous carcinogenesis. Am J Surg Pathol. 2011;35:e1–14.

    Article  PubMed  Google Scholar 

  15. Jia L, Liu Y, Yi X, Miron A, Crum CP, Kong B, Zheng W. Endometrial glandular dysplasia with frequent p53 gene mutation: a genetic evidence supporting its precancer nature for endometrial serous carcinoma. Clin Cancer Res. 2008;14:2263–9.

    Article  CAS  PubMed  Google Scholar 

  16. Zheng W, Liang SX, Yu H, Rutherford T, Chambers SK, Schwartz PE. Endometrial glandular dysplasia: a newly defined precursor lesion of uterine papillary serous carcinoma. Part I: morphologic features. Int J Surg Pathol. 2004;12:207–23.

    Article  PubMed  Google Scholar 

  17. Lim S, Kim HS, Lee KB, Yoo CW, Park SY, Seo SS. Does the use of a uterine manipulator with an intrauterine balloon in total laparoscopic hysterectomy facilitate tumor cell spillage into the peritoneal cavity in patients with endometrial cancer? Int J Gynecol Cancer. 2008;18:1145–9.

    Article  CAS  PubMed  Google Scholar 

  18. Sonoda Y, Zerbe M, Smith A, Lin O, Barakat RR, Hoskins WJ. High incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy. Gynecol Oncol. 2001;80:378–82.

    Article  CAS  PubMed  Google Scholar 

  19. Eltabbakh GH, Mount SL. Laparoscopic surgery does not increase the positive peritoneal cytology among women with endometrial carcinoma. Gynecol Oncol. 2006;100:361–4.

    Article  PubMed  Google Scholar 

  20. Olivier RI, van Beurden M, Lubsen MA, Rookus MA, Mooij TM, van de Vijver MJ, van’t Veer LJ. Clinical outcome of prophylactic oophorectomy in BRCA1/BRCA2 mutation carriers and events during follow-up. Br J Cancer. 2004;90:1492–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Wethington SL, Park KJ, Soslow RA, Kauff ND, Brown CL, Dao F, Otegbeye E, Sonoda Y, Abu-Rustum NR, Barakat RR, Levine DA, Gardner GJ. Clinical outcome of isolated serous tubal intraepithelial carcinomas (STIC). Int J Gynecol Cancer. 2013;23:1603–11.

    Article  PubMed  Google Scholar 

  22. Powell CB, Swisher EM, Cass I, McLennan J, Norquist B, Garcia RL, Lester J, Karlan BY, Chen L. Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy. Gynecol Oncol. 2013;129:364–71.

    Article  CAS  PubMed  Google Scholar 

  23. Gilks CB, Irving J, Kobel M, Lee C, Singh N, Wilkinson N, McCluggage WG. Incidental nonuterine high-grade serous carcinomas arise in the fallopian tube in most cases: further evidence for the tubal origin of high-grade serous carcinomas. Am J Surg Pathol. 2015;39:357–64.

    Article  PubMed  Google Scholar 

  24. Moll UM, Chumas JC, Chalas E, Mann WJ. Ovarian carcinoma arising in atypical endometriosis. Obstet Gynecol. 1990;75:537–9.

    CAS  PubMed  Google Scholar 

  25. Chalas E, Chumas J, Barbieri R, Mann WJ. Nucleolar organizer regions in endometriosis, atypical endometriosis, and clear cell and endometrioid carcinomas. Gynecol Oncol. 1991;40:260–3.

    Article  CAS  PubMed  Google Scholar 

  26. Tanase Y, Furukawa N, Kobayashi H, Matsumoto T. Malignant transformation from endometriosis to atypical endometriosis and finally to endometrioid adenocarcinoma within 10 years. Case Rep Oncol. 2013;6:480–4.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Fukunaga M, Nomura K, Ishikawa E, Ushigome S. Ovarian atypical endometriosis: its close association with malignant epithelial tumours. Histopathology. 1997;30:249–55.

    Article  CAS  PubMed  Google Scholar 

  28. Bell KA, Kurman RJ. A clinicopathologic analysis of atypical proliferative (borderline) tumors and well-differentiated endometrioid adenocarcinomas of the ovary. Am J Surg Pathol. 2000;24:1465–79.

    Article  CAS  PubMed  Google Scholar 

  29. Uzan C, Berretta R, Rolla M, Gouy S, Fauvet R, Darai E, Duvillard P, Morice P. Management and prognosis of endometrioid borderline tumors of the ovary. Surg Oncol. 2012;21:178–84.

    Article  CAS  PubMed  Google Scholar 

  30. Bell DA, Scully RE. Benign and borderline clear cell adenofibromas of the ovary. Cancer. 1985;56:2922–31.

    Article  CAS  PubMed  Google Scholar 

  31. Snyder RR, Norris HJ, Tavassoli F. Endometrioid proliferative and low malignant potential tumors of the ovary. A clinicopathologic study of 46 cases. Am J Surg Pathol. 1988;12:661–71.

    Article  CAS  PubMed  Google Scholar 

  32. Roth LM, Emerson RE, Ulbright TM. Ovarian endometrioid tumors of low malignant potential: a clinicopathologic study of 30 cases with comparison to well-differentiated endometrioid adenocarcinoma. Am J Surg Pathol. 2003;27:1253–9.

    Article  PubMed  Google Scholar 

  33. Uzan C, Dufeu-Lefebvre M, Fauvet R, Gouy S, Duvillard P, Darai E, Morice P. Management and prognosis of clear cell borderline ovarian tumor. Int J Gynecol Cancer. 2012;22:993–9.

    Article  PubMed  Google Scholar 

  34. Zhao C, Wu LS, Barner R. Pathogenesis of ovarian clear cell adenofibroma, atypical proliferative (borderline) tumor, and carcinoma: clinicopathologic features of tumors with endometriosis or adenofibromatous components support two related pathways of tumor development. J Cancer. 2011;2:94–106.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Vasilakaki T, Skafida E, Arkoumani E, Grammatoglou X, Firfiris N, Manoloudaki K. Borderline clear cell adenofibroma of the ovary associated with ovarian endometriosis: a case report. Eur J Gynaecol Oncol. 2012;33:230–2.

    CAS  PubMed  Google Scholar 

  36. Katsube Y, Fujiwara H, Tanioka Y, Imajo M, Fujiwara A. Ovarian clear cell adenofibroma of borderline malignancy. A case report. Hiroshima J Med Sci. 1989;38:87–90.

    CAS  PubMed  Google Scholar 

  37. Suzuki A, Shiozawa T, Mori A, Kimura K, Konishi I. Cystic clear cell tumor of borderline malignancy of the ovary lacking fibromatous components: report of two cases and a possible new histological subtype. Gynecol Oncol. 2006;101:540–4.

    Article  PubMed  Google Scholar 

  38. Narese F, Virzi G, Narese D, Orlando AA, Vinti D, Virzi V. MR imaging of a bilateral ovarian clear cell borderline adenofibromatous tumor. Clin Ter. 2014;165:249–51.

    CAS  PubMed  Google Scholar 

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Correspondence to Xiaomang B. Stickles MD, FACOG .

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Stickles, X.B. (2016). Clinical Management of Selected Precancerous Lesions of the Uterus, Fallopian Tube, and Ovary. In: Fadare, O. (eds) Precancerous Lesions of the Gynecologic Tract. Springer, Cham. https://doi.org/10.1007/978-3-319-22509-8_4

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  • DOI: https://doi.org/10.1007/978-3-319-22509-8_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22508-1

  • Online ISBN: 978-3-319-22509-8

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