Malignant transformation of residual endometriosis after hysterectomy: a case series

Objective: To explore the role of long-standing hormone replacement therapy (HRT) in the malignant transformation of endometriosis. Design: Short case series. Three cases of women with pelvic clearance receiving long-standing HRT studied in detail. Setting: Teaching hospital in the United Kingdom (Gynaecological Cancer Centre) (Institutional Review Board approval was not obtained as it was not deemed necessary, this being a case series). Patient(s): Women with a history of pelvic clearance for endometriosis and longstanding HRT. Intervention(s): HRT. Main Outcome Measure(s): Malignant transformation of endometriosis. Result(s): Long-standing HRT in all three women with pelvic clearance for endometriosis resulted in malignant transformation of residual endometriosis many years after the initial surgery. All cases presented with a new pelvic lesion. Conclusion(s): The diagnosis of malignant transformation needs to be considered in women with a history of endometriosis and with long-term HRT use in whom a new pelvic lesion is detected. The risk of malignant transformation in women with endometriosis after pelvic clearance receiving HRT needs to be explored further. Surveillance with CA-125 and imaging in such cases to predict recurrence or malignant transformation needs to be studied further in a research setting. (Fertil Steril (R) 2009; 92: 2037.e19-e21. (C) 2009 by American Society for Reproductive Medicine.)