Malignant transformation of ovarian endometrioma and pelvic abscesses: a case report and literature review

doi:10.3877/cma.j.issn.1673-5250.2023.06.011

Objective

To explore the clinical characteristics and risks of ovarian endometrioma (OMA) malignancy complicated with pelvic abscess in pregnant women after in vitro fertilization-embryo transfer (IVF-ET) treatment.

Methods

A retrospective analysis was conducted on a case of a 31-year-old pregnant woman with malignant transformation of right OMA complicated with pelvic abscess after IVF-ET assisted reproduction (patient 1) admitted to the Obstetrics and Gynecology Department of Tianjin Medical University General Hospital in January 2017. The medical history, diagnosis and treatment process, and prognosis of patient 1 were analyzed. The relevant research literature on OMA malignancy complicated with pelvic abscess in pregnant women was retrieved using the keywords " malignant transformation of ovarian endometrioma" " in vitro fertilization and embryo transfer" " pelvic abscesses" and " reproductive age", in both Chinese and English in the CNKI, Wanfang Data Knowledge Service Platform, and PubMed database. This study complied with the ethical standards formulated by the Ethics Committee of Tianjin Medical University General Hospital (Approval No. IRB2023-WZ-156). Informed censent was obtained from patient 1.

Results

① After undergoing total hysterectomy + bilateral salpingo-oophorectomy + omentectomy + pelvic and para-aortic lymph node dissection, Patient 1 was diagnosed with malignant transformation of right OMA (endometrioid adenocarcinoma stage ⅡB) and pelvic abscess. Patient 1 developed complications such as incomplete intestinal obstruction, moderate anemia, hypoalbuminemia, and drug-induced liver injury after surgery, and was discharged from the hospital after 7 weeks of treatment. Patient 1 received six cycles of chemotherapy with docetaxel + carboplatin after surgery, and follow-up for 6.5 years showed no recurrence of right ovarian endometrioid adenocarcinoma. ② According to the literature retrieval strategy developed in this study, no literature reports were found on the study of OMA malignancy complicated with pelvic abscess in women of reproductive age.

Conclusions

Clinicians should be alert to the possibility of OMA malignancy in women of reproductive age, and early diagnosis of OMA should be made to avoid the occurrence of OMA malignancy complicated with pelvic abscess after patients enter the IVF-ET cycle. Patients with OMA should actively prevent the risk of pelvic abscess after IVF-ET assisted reproduction. Multidisciplinary team collaboration plays an active role in the diagnosis and treatment of these patients.

Key words: Endometriosis, Ovarian endometrioma, Reproductive age, Pelvic abscesses, Fertilization in vitro, Embryo transfer, Multi-disciplinary team, Female

图1　患者1影像学检查结果[图1A：IVF-ET前经阴道超声示右附件区多房囊性包块，大小为5.7 cm×7.1 cm×6.3 cm；图1B：盆腔MRI结果显示宫旁右侧多房囊性包块(红色箭头所示)]　图2　患者1盆腔病灶照片图[图2A：右侧卵巢肿物(6.0 cm×6.0 cm×6.0 cm)，与子宫紧密黏连(红色箭头所示)；图2B：右侧卵巢切面为多房分隔，其内为黄色脓性恶臭液体，右侧卵巢内可见部分区域呈实性，组织糟脆，并发出血及坏死]　图3　患者1右侧卵巢内实性区域组织病理学检查结果(右侧卵巢子宫内膜异位囊肿恶变，呈高分化子宫内膜样癌)(HE染色，低倍) 注：患者1为右侧卵巢子宫内膜异位囊肿恶变并发盆腔脓肿，31岁，女性，G₁P₁。IVF-ET为体外受精-胚胎移植，HE为苏木精-伊红

[1]	Murakami K, Kotani Y, Nakai H, et al. Endometriosis-associated ovarian cancer: the origin and targeted therapy [J]. Cancers (Basel), 2020, 12(6): 1676. DOI: 10.3390/cancers12061676.
[2]	Sampson JA. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ [J]. Arch Surg, 1925, 10(1): 1-2. DOI: 10.1001/archsurg.1925.01120100007001.
[3]	Scott RB. Malignant changes in endometriosis [J]. Obstet Gynecol, 1953, 2(3): 283-289.
[4]	Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease：clinical challenges and novel innovations [J] Lancet, 2021, 397(10276): 839-852. DOI：10.1016/S0140-6736(21)00389-5.
[5]	Park H, Kim CH, Kim EY, et al. Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severe endometriosis [J]. Obstet Gynecol Sci, 2015, 58(6): 481-486. DOI: 10.5468/ogs.2015.58.6.481.
[6]	Vercellini P, Somigliana E, Daguati R, et al. The second time around: reproductive performance after repetitive versus primary surgery for endometriosis [J]. Fertil Steril, 2009, 92(4): 1253-1255. DOI: 10.1016/j.fertnstert.2009.04.037.
[7]	中国医师协会妇产科医师分会，中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症诊治指南(第三版)[J]．中华妇产科杂志，2021, 56(12): 812-824. DOI: 10.3760/cma.j.cn112141-20211018-00603.
[8]	Younis JS, Izhaki I. At what age endometriosis-associated ovarian cancer is diagnosed? The implications for women in the reproductive age [J]. Front Oncol, 2023, 13: 1193123. DOI: 10.3389/fonc.2023.1193123.
[9]	钱欢欢，林明娟，朱姝，等．育龄期女性卵巢子宫内膜异位囊肿恶变的高危因素研究 [J]．南京医科大学学报(自然科学版)[J]. 2021, 41(9): 1396-1399. DOI: 10.7655/NYDXBNS20210922.
[10]	Cai Y, Yin J, Jin Y, et al. Endometriosis-associated ovarian cancer is not a distinct clinical entity among young patients: a 12-year cohort study [J]. Eur J Surg Oncol, 2020, 46(5): 876-882. DOI: 10.1016/j.ejso.2019.11.517.
[11]	Melin A, Sparén P, Persson I, et al. Endometriosis and the risk of cancer with special emphasis on ovarian cancer [J]. Hum Reprod, 2006, 21(5): 1237-1242. DOI: 10.1093/humrep/dei462.
[12]	山东省妇幼保健协会妇科肿瘤综合防治专业委员会，中国医师协会微无创医学专业委员会妇科肿瘤学组. 子宫内膜异位症相关卵巢癌的诊断及治疗山东专家共识(2022)[J]．山东医药，2022, 62(18): 1-6. DOI: 10.3969/j.issn.1002-266X.2022.18.001.
[13]	Kobayashi H, Sumimoto K, Kitanaka T, et al. Ovarian endometrioma--risks factors of ovarian cancer development [J]. Eur J Obstet Gynecol Reprod Biol, 2008, 138(2): 187-193. DOI: 10.1016/j.ejogrb.2007.06.017.
[14]	Terzic M, Aimagambetova G, Kunz J, et al. Molecular basis of endometriosis and endometrial cancer: current knowledge and future perspectives [J]. Int J Mol Sci, 2021, 22(17): 9274. DOI: 10.3390/ijms22179274.
[15]	王玉，盛洁，靳灵鸽，等. 不同止血方式对腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响 [J/OL]. 中华妇幼临床医学杂志(电子版), 2021, 17(4): 420-424. DOI: 10.3877/cma.j.issn.1673-5250.2021.04.007.
[16]	马晓欣，向阳，狄文，等. 卵巢子宫内膜样癌临床诊治中国专家共识(2023年版)[J]．中国实用妇科与产科杂志，2023, 39(4): 445-451. DOI: 10.19538/j.fk2023040113.
[17]	Benson AB, D′Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2021, 19(5): 541-565. DOI: 10.6004/jnccn.2021.0022.
[18]	El-Shawarby S, Margara R, Trew G, et al. A review of complications following transvaginal oocyte retrieval for in-vitro fertilization [J]. Hum Fertil(Camb), 2004, 7(2): 127-133. DOI: 10.1080/14647270410001699081.
[19]	Chen MJ, Yang JH, Yang YS, et al. Increased occurrence of tubo-ovarian abscesses in women with stage Ⅲ and Ⅳ endometriosis [J]. Fertil Steril, 2004, 82(2): 498-499. DOI: 10.1016/j.fertnstert.2004.01.032.
[20]	苏悦，马志松，尹香花，等. 腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术后卵巢储备功能评估的临床研究 [J/OL]. 中华妇幼临床医学杂志(电子版)，2017，13(1): 93-98. DOI: 10.3877/cma.j.issn.1673-5250.2017.01.017.

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