title: Endometriosis-associated ovarian carcinoma: differential expression of vascular endothelial growth factor and estrogen/progesterone receptors.
abstract: BACKGROUND
  Multiple epidemiologic and histologic studies have suggested that ovarian endometriosis can give rise to malignant ovarian tumors, primarily those of epithelial origin. The progression of endometriosis to endometriosis-associated ovarian carcinoma (EAOC) has not been investigated thoroughly and is poorly understood at best. Using immunohistochemical methods, we compared the differential expression patterns of various cytokines and growth factors in atypical endometriosis (AE) and EAOC.
  
  
  METHODS
  Using the Johns Hopkins Pathology Data Bank, tissue blocks from patients diagnosed with EAOC or AE were identified. Tissue blocks were stained for 4 markers: vascular endothelial growth factor (VEGF), Ki-67, estrogen receptor (ER), and progesterone receptor (PR).
  
  
  RESULTS
  Seventeen cases of EAOC and 8 cases of AE were identified. Staining for VEGF was documented in 16 of 17 (94%) EAOC tissue blocks and in only 1 of 8 (12.5%) AE tissue blocks (P < 0.0001). Only 4 of the 17 (23%) EAOC tissue blocks exhibited positive staining for ER, compared with 8 of 8 (100%) AE tissue blocks (P = 0.0005). Positive staining for PR was noted in only 6 of 17 (35%) EAOC samples but was present in 8 of 8 (100%) AE samples (P = 0.003). Seventy percent of EAOC samples exhibited positive staining for Ki-67, compared with 37.5% of AE samples (P = 0.19).
  
  
  CONCLUSIONS
  EAOC appears to be associated with overexpression of VEGF and reduced expression of both ER and PR. Variations in VEGF expression may be associated with the malignant transformation of endometriosis and may present both diagnostic and therapeutic options for the treatment of ovarian malignancies.
authors.affiliation: Department of Gynecology and Obstetrics/Department of Oncology, The Johns Hopkins Hospital and Medical Institutions, Baltimore, Maryland, USA. mdelcar1@jhmi.edu
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Del Carmen
authors.forename: Anne E
authors.initials: AE
authors.lastname: Smith Sehdev
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Michael
authors.initials: M
authors.lastname: Richardson
authors.forename: John P
authors.initials: JP
authors.lastname: Fruehauf
authors.forename: F J
authors.initials: FJ
authors.lastname: Montz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D004715:Endometriosis / Q000150:complications*; D016228:Endothelial Growth Factors / Q000032:analysis*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D036341:Intercellular Signaling Peptides and Proteins / Q000032:analysis*; D019394:Ki-67 Antigen / Q000032:analysis; D008222:Lymphokines / Q000032:analysis*; D010051:Ovarian Neoplasms / Q000737:chemistry*; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
chemical_list: D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D019394:Ki-67 Antigen; D008222:Lymphokines; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors