Malignant transformation of adenomyosis: literature review and meta-analysis

Purpose To review and analyze risk factors and the pathology of malignant transformation of adenomyosis.

In this paper, the relevant research on current risks factors and the pathology of malignant transformation of adenomyosis was reviewed and analyzed by metaanalysis. All studies included were retrieved from the PUBMED.

Analysis of existing studies revealed that most malignant transformation of adenomyosis occurs in elderly or postmenopausal patients. Adenomyosis with uterine leiomyoma or benign endometrial hyperplasia and other benign diseases appears to be more prone to malignancy, but there is currently no strong evidence to confirm this finding.

At present, the malignant transformation of adenomyosis is thought to be due to its endometrial epithelium transition to monolayer tumor cells before malignant transformation, which eventually develops to varying degrees of cancer. However, the specific molecular mechanism of adenomyosis is not yet clear. Because of its low incidence of malignant transformation, lack of large-sample, multi-center clinical trials, and large heterogeneity of the existing research, the evidence based on the high-risk factors of malignant transformation of adenomyosis is weak. Similar content being viewed by others

Koike N, Tsunemi T, Uekuri C, Akasaka J, Ito F, Shigemitsu A, Kobayashi H (2013) Pathogenesis and malignant transformation of adenomyosis (review). Oncol Rep 29:861–867 (Published online EpubMar (10.3892/or.2012.2184)) Taran FA, Stewart EA, Brucker S (2013) Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe und Frauenheilkunde 73:924–931 (Published online EpubSep (10.1055/s-0033-1350840)) Hong SC, Khoo CK (2016) An update on adenomyosis uteri. Gynecol Min Invas Ther 5:106–108. https://doi.org/10.1016/j.gmit.2015.08.003 Ismiil ND, Rasty G, Ghorab Z, Nofech-Mozes S, Bernardini M, Thomas G, Ackerman I, Covens A, Khalifa MA (2007) Adenomyosis is associated with myometrial invasion by FIGO 1 endometrial adenocarcinoma. Int J Gynecol Pathol 26:278–283. https://doi.org/10.1097/01.pgp.0000235064.93182.ec Mori M, Furusawa A, Kino N, Uno M, Ozaki Y, Yasugi T (2015) Rare case of endometrioid adenocarcinoma arising from cystic adenomyosis. J Obstet Gynaecol Res 41:324–328 (Published online EpubFeb 10.1111/jog.12513) Kazandi M, Zeybek B, Terek MC, Zekioglu O, Ozdemir N, Oztekin K (2010) Grade 2 endometrioid adenocarcinoma arising from adenomyosis of the uterus: report of a case. Eur J Gynaecol Oncol 31:719–721 Hsu MI, Chou SY, Lin SE, Liang SJ, Chiu HC, Hsu CS (2006) Very early stage adenocarcinoma arising from adenomyosis in the uterus. Taiwan J Obstet Gynecol 45:346–349 (Published online EpubDec (10.1016/s1028-4559(09)60258-8)) Matsuo K, Moeini A, Machida H, Scannell CA, Casabar JK, Kakuda M, Adachi S, Garcia-Sayre J, Ueda Y, Roman LD (2016) Tumor characteristics and survival outcome of endometrial cancer arising in adenomyosis: an exploratory analysis. Ann Surg Oncol 23:959–967 (Published online EpubMar (10.1245/s10434-015-4952-y)) Ismiil N, Rasty G, Ghorab Z, Nofech-Mozes S, Bernardini M, Ackerman I, Thomas G, Covens A, Khalifa MA (2007) Adenomyosis involved by endometrial adenocarcinoma is a significant risk factor for deep myometrial invasion. Annals of diagnostic pathology 11:252–257 (Published online epubaug (10.1016/j.anndiagpath.2006.08.011)) Koshiyama M, Okamoto T, Ueta M (2004) The relationship between endometrial carcinoma and coexistent adenomyosis uteri, endometriosis externa and myoma uteri. Cancer Detect Prev 28:94–98. https://doi.org/10.1016/j.cdp.2003.12.008 Taneichi A, Fujiwara H, Takahashi Y, Takei Y, Machida S, Saga Y, Takahashi S, Suzuki M (2014) Influences of uterine adenomyosis on muscle invasion and prognosis of endometrioid adenocarcinoma. Int J Gynecol Cancer 24:1429–1433 (Published online EpubOct (10.1097/IGC.0000000000000243)) Genc M, Genc B, Cengiz H (2015) Adenomyosis and accompanying gynecological pathologies. Arch Gynecol Obstet 291:877–881 (Published online EpubApr (10.1007/s00404-014-3498-8)) Baba A, Yamazoe S, Dogru M, Ogawa M, Takamatsu K, Miyauchi J (2016) Clear cell adenocarcinoma arising from adenomyotic cyst: A case report and literature review. The journal of obstetrics and gynaecology research 42:217–223 (Published online EpubFeb (10.1111/jog.12866)) Lu B, Chen Q, Zhang X, Cheng L (2016) Serous carcinoma arising from uterine adenomyosis/adenomyotic cyst of the cervical stump: a report of 3 cases. Diagn Pathol 11:46 (Published online EpubJun 04 (10.1186/s13000-016-0496-0)) Izadi-Mood N, Samadi N, Sarmadi S, Eftekhar Z (2007) Papillary serous carcinoma arising from adenomyosis presenting as intramural leiomyoma. Arch Iran Med 10:258–260 (Published online EpubApr (07102/aim.0026)) Matsuo K, Cahoon SS, Gualtieri M, Scannell CA, Jung CE, Takano T, Paulson RJ, Muderspach LI, Roman LD (2014) Significance of adenomyosis on tumor progression and survival outcome of endometrial cancer. Ann Surg Oncol 21:4246–4255 (Published online EpubDec (10.1245/s10434-014-3880-6)) Goumenou AG, Arvanitis DA, Matalliotakis IM, Koumantakis EE, Spandidos DA (2000) Loss of heterozygosity in adenomyosis on hMSH2, hMLH1, p16Ink4 and GALT loci. International journal of molecular medicine 6:667–671 (Published online EpubDec) Jones RK, Searle RF, Bulmer JN (1998) Apoptosis and bcl-2 expression in normal human endometrium, endometriosis and adenomyosis. Hum Reprod (Oxford, England) 13:3496–3502 (Published online EpubDec) Jichan N, Xishi L, Guo SW (2010) Promoter hypermethylation of progesterone receptor isoform B (PR-B) in adenomyosis and its rectification by a histone deacetylase inhibitor and a demethylation agent. Reprod Sci 17:995–1005 (Published online EpubNov (10.1177/1933719110377118)) Sampson JA (1925) Endometrial carcinoma of the ovary arising in endometrial tissue of that organ. Arch Surg 10:1–72 Colman HI, Rosenthal AH (1959) Carcinoma developing in areas of adenomyosis. Obset Gynecol 14:342–348 Gizzo S, Patrelli TS, Dall’asta A, DI Gangi S, Giordano G, Migliavacca C, Monica M, Merisio C, Nardelli GB, Quaranta M, Noventa M, Berretta R (2016) Coexistence of adenomyosis and endometrioid endometrial cancer: role in surgical guidance and prognosis estimation. Oncol Lett 11(2):1213–1219 (Epub 2015 Dec 15) Author information Authors and Affiliations Contributions HY Data Collection, Manuscript writing. SZ Data Collection, Manuscript writing Corresponding author Ethics declarations Conflict of interest Hang Yuan declares that she has no conflict of interest. Shiqian Zhang declares that he has no conflict of interest. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Rights and permissions About this article Cite this article Yuan, H., Zhang, S. Malignant transformation of adenomyosis: literature review and meta-analysis. Arch Gynecol Obstet 299, 47–53 (2019). https://doi.org/10.1007/s00404-018-4991-2 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-018-4991-2