Learning objectives
Review of malignant degeneration arising in an ovarian endometriosic cyst,
deep pelvic or parietal endometriosis lesions.
All mural nodule in a endometrioma is not malignant (blood clot,
decidualization,
ectopic endometrial proliferation and borderline Müllerian sero-mucinous tumors).
Differential diagnosis of atypical parietal endometriosis remains the sarcomatous or desmoid tumor pathology.
Background
Endometriosis is a common benign pathology (affecting about 10% of women)but discussed as a risk factor for epithelial ovarian cancer.
Ovarian cancer is the 7th female cancer (cumulative risk from 0 to 74 years about 1%) and at 5th rank of cancer deaths in women1.
Malignant transformation of an endometriotic cyst is rare (0,7-1,6%) and some risk factors (age > 50 years,
endometrioma diameter > 9 cm) are reported2,3,4,5,6. Fig. 1
MRI is usually recommanded for characterization a complex pelvic mass (adnexal masses MRI scoring...
Findings and procedure details
Review of endometriosis-associated cancers MRI findings and pathologic correlation in:
Endometrioma : enhancing mural nodules in an ovarian endometriosic cyst hyperintense on fat-sat T1-weighted images is suspicious,
with or without shading on T2.
Subtraction images can help,
like hyperintensity on DWI with restricted ADC.
Often no adenopathy neither peritoneal carcinomatosis.
Impact of the size of cyst (>10 cm) / mural nodule (>2 cm),
suspicious MRI signal and age (>40-50 yo).Fig. 3 Fig. 4 Fig. 5Fig. 6 Fig. 8Fig. 9Fig. 10Fig. 11Fig. 12
Parietal endometriosis :...
Conclusion
Endometriosis-associated ovarian and extra-ovarian cancer is rare,
but it must be recognized in pelvic MRI (whether adnexal,
parietal or deep pelvic endometriosis lesions).
Ovarian cancer (frequently endometrioid or clear cell tumors) should be excluded in case of endometrioma > 9 cm in post-menopausal woman (frequently endometrioid or clear cell tumors).
Fig. 17,
Fig. 18
Malignant degeneration may also involve extra-ovarian endometriosis (deep pelvic endometriosis or parietal lesions).
Personal information
Gwendoline LEVY,
MD.
email :
[email protected]
• CHRU Nice,
L'Archet 2 Hospital - Department of Radiology and
Multidisciplinary PreNatal Diagnosis Center.
151 Route de Saint-Antoine,
06200 Nice
FRANCE
+334 92 03 77 77
References
http://invs.santepubliquefrance.fr//publications/2009/estimation_ cancer_1980_2005/estimation_cancer_1980_2005.pdf
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Endometriosis and the development of malignant tumours of the pelvis.
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Brinton LA and al.
Cancer risk after a hospital discharge diagnosis of endometriosis.
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Kobayashi H and...