title: Ovarian endometriosis associated with ovarian carcinoma: a clinicopathological and immunohistochemical study.
abstract: OBJECTIVE
  The purpose of this study was to demonstrate the incidence, the histopathological characteristics, and the proliferation activity of endometriosis and atypical endometriosis associated with ovarian carcinoma.
  
  
  METHODS
  Microscopic slides of primary lesions from 127 patients with primary ovarian carcinoma were reviewed. The presence or absence of endometriosis and the transitions from typical endometriosis to atypical endometriosis and from atypical endometriosis to carcinoma were also histologically evaluated. Ki-67 immunoreactivity of typical and atypical endometriosis and carcinoma was examined. In addition, endometrial metaplasias were also evaluated.
  
  
  RESULTS
  Of the 127 patients, 37 had endometriosis: 70% (30/43) had clear cell adenocarcinoma, 43% (3/7) had endometrioid adenocarcinoma, 7% (4/60) had serous adenocarcinoma, and none (0/17) had mucinous adenocarcinoma. Thirty-three cases showed typical endometriosis and 29 cases had atypical endometriosis (25 cases had both). Tufting and the stratification of the lining epithelium were observed in 25 and 23 cases, respectively. The transition from typical endometriosis to atypical endometriosis was observed in 22 cases, and the transition from atypical endometriosis to carcinoma, in 23 cases. Only one case showed a direct transition from typical endometriosis to carcinoma. The mean Ki-67 indices were as follows: ovarian carcinoma, 23.1; atypical endometriosis, 9.9; typical endometriosis, 2.7. In 18 cases with metaplasia in endometriosis, eosinophilic metaplasia and ciliated metaplasia were the most common types. Five cases had two types of metaplasia.
  
  
  CONCLUSIONS
  Ovarian carcinomas, especially clear cell and endometrioid adenocarcinomas, are highly associated with endometriosis. Atypical endometriosis shows proliferation activity intermediate to those of typical endometriosis and ovarian carcinoma, suggesting it is a precancerous status.
authors.affiliation: Department of Obstetrics and Gynecology, School of Health Sciences, Second Department of Pathology, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka City, 812-8582, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Kaku
authors.forename: S
authors.initials: S
authors.lastname: Amada
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Hirakawa
authors.forename: K
authors.initials: K
authors.lastname: Ariyoshi
authors.forename: T
authors.initials: T
authors.lastname: Kamura
authors.forename: H
authors.initials: H
authors.lastname: Nakano
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000150:complications* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002455:Cell Division; D018293:Cystadenoma, Serous / Q000150:complications* / Q000473:pathology; D004715:Endometriosis / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008875:Middle Aged; D010049:Ovarian Diseases / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D010051:Ovarian Neoplasms / Q000150:complications* / Q000473:pathology
chemical_list: D019394:Ki-67 Antigen