Endometriose und Malignom

Zusammenfassung

Maligne Tumoren auf dem Boden einer Endometriose sind selten. Sie treten in etwa 1 % der Fälle auf, wovon 80 % auf das Ovar und 20 % auf extragonadale Manifestationen entfallen. Häufigste extragonadale Manifestationen sind das Rektosigmoid und das Septum rectovaginale. Die Therapie von extragonadalen Endometriose-assoziierten Karzinomen besteht in der Resektion möglichst im Gesunden mit postoperativer Radiatio, ggf. mit adjuvanter Gestagengabe. Endometriose- assoziierte Ovarialkarzinome präsentieren sich häufiger in früheren Stadien und häufiger mit G1-und G2-Differenzierung. Sie werden wie Ovarialkarzinome behandelt, wobei ein schlechteres Ansprechen auf eine Chemotherapie angenommen wird. Da eine Östrogenmonotherapie ein potenzieller Risikofaktor für das Auftreten von Endometriose-assoziierten Malignomen ist, wird sie bei positiver Anamnese für Endometriose als Hormonersatz in der Peri- und Postmenopause nicht empfohlen. Heterozygotieverlust und Mutationen des PTEN Tumorsuppressorgens könnten frühe Ereignisse der Malignisierung sein. Möglicherweise sind die Endometriose und ihre maligne Transformation ein geeignetes Modell zum Studium der Krebsentstehung. Endometriose ist nach aktuellen Studien mit einem etwas erhöhten relativen Risiko, an einem Non-Hodgkin-Lymphom zu erkranken, assoziiert.

Abstract

Malignant tumors arising from endometriosis are rare. A frequency of about 1 % has been reported with in 80 % the ovary, and in 20 % extragonadal sites being affected. The most common extragonadal manifestations are the rectosigmoid and the rectovaginal septum. For extragonadal malignant tumors arising from endometriosis, complete resection followed by post-operative radiotherapy, possibly plus adjuvant progestin therapy, is the treatment of choice. Endometriosis-associated ovarian carcinomas are likely to present with lower stage disease and predominantly lower grade tumors. While their treatment follows that of common ovarian cancer, a poorer response to chemotherapy must be considered. As unopposed estrogen replacement therapy has been identified as a risk factor for the development of endometriosis-associated cancer, it is not recommended for hormone replacement therapy in women with a history of endometriosis. Loss of heterozygosity and mutations of the PTEN tumor suppressor gene may be early events of tumorigenesis. Endometriosis and its malignant transformation, perhaps, may serve as a suitable model in this regard. According to recent studies, endometriosis is associated with an increased relative risk of non-Hodgkin lymphoma.

Endometriose - Kanzerisierung endometriose-assoziiert - Ovarialkarzinom - PTEN Tumorsuppressorgen - Non-Hodgkin-Lymphom

Endometriosis - tumorigenesis - ovarian cancer - PTEN tumor supressor gene - non-Hodgkin lymphoma

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