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Endometrioseassoziierte maligne Tumoren

Endometriosis-associated malignant tumors

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Auf dem Boden einer Endometriose können maligne Tumoren entstehen; dabei fallen etwa 80 % auf Ovarialkarzinome und etwa 20 % auf extragonadale Manifestationen. Diese maligne Transformation kann jedes Gewebe betreffen, in dem auch Endometriose vorkommt. Eine direkte Kanzerisierung benigner Endometriose über Atypien erscheint möglich. Histologisch handelt es sich bei den endometrioseassoziierten Malignomen überwiegend um endometrioide oder klarzellige Karzinome, seltener um andere histologische Typen, wie seromuzinöse Bordeline-Tumoren, endometriale Stromasarkome, Adenosarkome u. a. Das Risiko einer malignen Transformation von Endometriosegewebe bzw. deren Prävalenz wurde in älteren Arbeiten mit insgesamt 1 % angegeben, bei ovariellen Endometriomen mit 2,5 % bei einer Breite zwischen 2 und 17 %. Molekularbiologisch wurden PTEN- und ARID1a-Mutationen sowie Heterozygotieverlust gefunden. Klinisch wird eine bessere Prognose dieser Tumoren im Vergleich mit high-grade serösen Ovarialkarzinomen diskutiert. Insgesamt liegen in der Literatur nur wenige systematische Studien zu diesen Malignomen vor. Die Stiftung Endometrioseforschung führt gemeinsam mit den Kommissionen Ovar und Uterus der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) aktuell eine retrospektive Studie zur Charakterisierung endometrioseassoziierter Malignome durch (EAM-Studie); ihr Herzstück ist die histopathologische Zweitbegutachtung in einem Referenzlabor.

Abstract

Malignant tumors can arise from endometriosis with 80 % presenting as ovarian cancer and 20 % as extragonadal manifestations. This malignant transformation may basically affect every tissue that could potentially harbor endometriosis. A direct cancerous transformation of benign endometriosis through atypias seems to be possible. Histologically, endometriosis-associated malignancies mostly present as endometrioid or clear cell carcinomas, rarely as seromucinous borderline lesions, endometrial stromal sarcomas, adenosarcomas and others. The overall risk of malignancy of endometriosis tissue has been estimated as 1 % and 2.5 % for ovarian endometriomas with a range between 2 % and 17 %. PTEN and ARID1A mutations as well as loss of heterozygosity have been reported as molecular genetic findings. Clinically, a more favorable prognosis of these tumors compared to high-grade serous ovarian cancers is being discussed. There are only few systematic studies concerning these tumors. The Endometriosis Research Foundation together with the study groups on ovarian and uterine tumors of the working group for gynecological oncology (AGO) are currently conducting a retrospective study to characterize endometriosis-associated tumors (EAM study). The core component of the study is the expert histopathological second opinion in a reference laboratory.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Ulrich gibt an, dass kein Interessenkonflikt besteht. A. Wunschel, V. M. Reichert, S. Darb-Esfahani, D. Denschlag, L.-C. Horn, F. Noack, S. P. Renner, M. Sillem, K.-W. Schweppe, E. Wardelmann, D. Schmidt haben keine Angaben gemacht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Caspar-Theyß-Str. 27–31, 14193, Berlin, Deutschland

    U. Ulrich, A. Wunschel & V.M. Reichert

  2. Institut für Pathologie, Charité Campus Mitte, Universitätsmedizin Berlin, Berlin, Deutschland

    S. Darb-Esfahani

  3. Frauenklinik, Hochtaunus-Kliniken, Bad Homburg, Deutschland

    D. Denschlag

  4. Institut für Pathologie, Abteilung für Mamma, Gynäko- und Perinatalpathologie, Universitätsklinikum, Leipzig, Deutschland

    L.-C. Horn

  5. Institut für Pathologie, Martin-Luther-Krankenhaus, Berlin, Deutschland

    F. Noack

  6. Frauenklinik, Universitätsklinikum, Erlangen, Deutschland

    S.P. Renner

  7. Praxisklinik am Rosengarten, Mannheim, Deutschland

    M. Sillem

  8. Frauenklinik, Ammerland Klinik, Westerstede, Deutschland

    K.-W. Schweppe

  9. Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum, Münster, Deutschland

    E. Wardelmann

  10. Pathologie Mannheim GmbH, synlab MVZ, Mannheim, Deutschland

    D. Schmidt

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  1. U. Ulrich
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Correspondence to U. Ulrich.

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Ulrich, U., Wunschel, A., Reichert, V. et al. Endometrioseassoziierte maligne Tumoren. Gynäkologe 48, 221–227 (2015). https://doi.org/10.1007/s00129-014-3424-y

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