Abstract:
Endometriosis associated ovarian carcinoma (EAOC) is currently receiving attention due to the controversy about its biological behavior. It is not clear
whether tumors with demonstrable transition of benign to malignant lining of ovarian endometriosis differ from ovarian carcinomas with associated
endometriosis in cases where direct transition is not evident. This study examined the association between the relationship of endometriosis and ovarian cancer and histopathologic characteristics, p53 status and outcome.
Methods:
140 patients with EAOC with available tissue met the inclusion criteria. Patients were categorized as EAOC type I when direct transition of benign to
malignant lining was identified in ovarian endometriosis and EAOC type II when ovarian endometriosis was present but no direct transition to carcinoma
was demonstrated. Age, histologic type, FIGO stage and disease free survival were compared between the groups. P53 status was determined by
immunohistochemistry using tissue microarray.
Results:
Seventy one (51.07%) patients had EAOC type I while 69 (49.6%) patients had EAOC type II. There was a significant difference in cell type composition
between the groups. The most common histologic type in EAOC type I was endometrioid carcinoma (35, 49.3%) followed by clear cell carcinoma (29,
40.8%) and serous carcinoma (7, 9.9%). The most common histologic type in EAOC type II was serous carcinoma (35, 50.7%) followed by endometrioid
carcinoma (20, 29%), clear cell carcinoma (9, 13%) and mucinous carcinoma (5, 7.2%), P < 0.001. Of 140 patients with EAOC, 139 tumor tissue
specimens were identified on the TMAs. Mutant p53, either overexpressed or null phenotype, was detected in 16/71 (22.5%) patients with EAOC type I
vs. 33/68 (48.5%) patients with type II, P=0.003. However when p53 status was compared in the two groups by tumor histology and grade, there was no
significant difference between EAOC type and P53 status. EAOC type I cases were more likely to present at a lower stage. DFS was not associated with
EAOC type but was significantly decreased in cases with mutant p53.
Conclusion:
In this single institution cohort, the outcome of patients with ovarian carcinoma was related to the histological type and stage. However, the type of
EAOC was not independently predictive of outcome. Biological differences such as in p53 status, stage at diagnosis and outcome reflect the higher
proportion of serous and high grade endometrioid carcinoma in EAOC type II.
Author(s): Dina R. Bassiouny, Mahmoud A. El-Baz, Tawakol M. Gamil, Nazem Shams, Nadia Ismiil, Valerie Dube, Guangming
Han, Matthew Cesari, Fang-I Lu, Elzbieta Slodkowska, Sherine Salama, Hak Fai Chiu, Magda Naeim, Nim Li,
Hadas Moshonov, Sharon Nofech-Mozes, Mahmoud Khalifa