PDF(Pubmed)
Abstract：
Although adenomyosis is a benign uterine disease, it can turn malignant in rare instances. Cystic adenomyosis is a rare variation of adenomyosis, arising from which 8 cases of clear cell carcinoma have been reported. However, to the best of our knowledge, there have been no previous reports describing the mechanism by which clear cell carcinoma develops from cystic adenomyosis. The present report documents a case of a 73-year-old woman who was referred to Kanazawa University Hospital (Kanazawa, Japan) because of cystic adenomyosis, with a solid part inside the cyst. The patient was diagnosed with cystic adenomyosis at Shonan Obstetrics and Gynecology Hospital (Hakusan, Japan) 17 years prior; however, the size of the cyst increased after menopause. Therefore, malignant transformation was suspected, which warranted simple abdominal hysterectomy and bilateral salpingo-oophorectomy. The final diagnosis of the present case was uterine corpus cancer, clear cell carcinoma, stage IA. Immunohistochemical staining revealed that the normal and transitional atypical epithelial cells lining the cyst wall, in addition to the clear cell carcinoma cells (which were inside mural nodules located on the cyst wall), were positive for 8-hydroxy-20-deoxyguanosine. This observation suggested the presence of chronic oxidative stress around the cystic adenomyosis. Therefore, the present case suggests the possible involvement of chronic oxidative stress in the malignant transformation of cystic adenomyosis to clear cell carcinoma. This mechanism of malignant transformation of cystic adenomyosis appears to be similar to that of the malignant transformation of endometriotic cysts. Therefore, if the size of the cystic adenomyosis increases after menopause or if the solid part appears in the cyst in future cases, then the possibility of malignant transformation should be considered.
摘要：
虽然子宫腺肌病是一种良性子宫疾病，在极少数情况下会变成恶性。囊性子宫腺肌病是子宫腺肌病的一种罕见变异，已报道8例透明细胞癌。然而,据我们所知,以前没有报道描述透明细胞癌从囊性子宫腺肌病发展的机制。本报告记录了一名73岁妇女被转诊到金泽大学医院(金泽，日本）因为囊性子宫腺肌病，囊肿里面有一个坚实的部分。该患者在湘南妇产科医院（Hakusan，日本)17年前；然而，绝经后囊肿的大小增加。因此,怀疑是恶性转化，这需要简单的腹部子宫切除术和双侧附件卵巢切除术。本病例最终诊断为子宫体癌,透明细胞癌,IA阶段。免疫组织化学染色显示，正常和过渡非典型上皮细胞衬里的囊肿壁，除了透明细胞癌细胞（位于囊肿壁上的壁结节内），8-羟基-20-脱氧鸟苷阳性。这一观察表明囊性子宫腺肌病周围存在慢性氧化应激。因此,本病例提示慢性氧化应激可能参与囊性子宫腺肌病向透明细胞癌的恶性转化。囊性子宫腺肌病的恶性转化机制似乎与子宫内膜异位囊肿的恶性转化机制相似。因此,如果绝经后囊性子宫腺肌病的大小增加，或者如果在未来的病例中囊肿中出现实性部分，那么应该考虑恶性转化的可能性。
