Association between ovarian or extra-ovarian endometriosis and cancer in pelvic MRI : clinical cases.

Congress:

ECR 2019

Poster Number:

C-3718

Type:

Educational Exhibit

Keywords:

Pathology, Education and training, Cancer, eLearning, Education, Diagnostic procedure, MR-Functional imaging, MR-Diffusion/Perfusion, MR, Pelvis, Oncology, Genital / Reproductive system female

Authors:

G. Levy¹, S. Taieb², A.-S. Lemaire², F. Narducci², E. Leblanc², L. Ceugnart ³; ¹Nice/FR, ²Lille/FR, ³Lille Cedex/FR

DOI:

10.26044/ecr2019/C-3718

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-3718

Fig. 1: Lancet Oncol (2012) doi: 10.1016:S1470-2045(11)70404-1

Fig. 2: Oncology Letters (2012) doi.org/10.3892/ol.2012.690

Fig. 3: Pelvic pains in a 42 year old nulliparous woman with a RIGHT ovary multilocular...

Fig. 16: 52 year-old woman, OMS 0, menopausis with history of treated NST breast...

Fig. 18: Radiographics (2012) DOI: http://dx.doi.org/10.1148/rg.32311573

Fig. 17: AJR American Journal Roentgenol (2010) DOI :10.2214/AJR.09.2985

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 Pearce CL and al. Ovarian Cancer Association Consortium. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol. 2012 Apr;13(4):385-94. doi: 10.1016/S1470-2045(11)70404-1. Epub 2012 Feb 22. Van Gorp T and al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Pract Res Clin Obstet Gynaecol. 2004 Apr;18(2):349-71. Brinton LA and al. Cancer risk after a hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol. 1997;176:572–579. Kobayashi H and...