Abstract
Malignant transformation and particularly malignant mixed mullerian tumor arising in extragenital endometriosis is extremely rare and occurs in the majority of cases after estrogen replacement therapy. We present a case of a 75-year-old woman who developed a ureteral malignant mullerian carcinosarcoma in a context of florid endometriosis. The patient had a history of total hysterectomy with bilateral salpingo-oophorectomy 30 years earlier for extensive endometriosis. Since 5 years, the patient has been on phytoestrogen supplementation consisting of 72 mg/day of superconcentrated soy isoflavones. This is the first case of ureteral mullerian carcinosarcoma arising in endometriosis foci after extensive phytoestrogen supplementation. Our data suggest that phytoestrogens at least in concentrated form may play a role not only in maintenance of endometriosis but also in its malignant transformation. Given the extraordinary popularity and availability of these dietary supplements, several studies are indispensable regarding their safety particularly in women with extensive endometriosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Antonelli A, Simeone C, Frego E, Minimi G, Bianchi U, Cunico SC (2004) Surgical treatment of ureteral obstruction from endometriosis: our experience with thirteen cases. Int Urogynecol J Pelvic Floor Dysfunct 15:407–412
Booth C, Zahn CM, McBroom J, Maxwell GI (2004) Retroperitoneal mullerian carcinosarcoma associated with endometriosis: a case report. Gynecol Oncol 93:546–549
Brunson GL, Barclay DL, Sanders M, Araoz CA (1988) Malignant extraovarian endometriosis: two case reports and review of the literature. Gynecol Oncol 30:123–130
Bulun SE, Lin Z, Imir G, Amin S, Demura M, Yilmaz B, Martin R, Utsunomiya H, Thung S, Gurates B, Tamura M, Langoi D, Deb S (2005) Regulation of aromatase expression in estrogen-responsive breast and uterine disease: from bench to treatment. Pharmacol Rev 57:359–383
Burton JL, Wells M (2002) The effect of phytoestrogens on the female genital tract. J Clin Pathol 55:401–407
Chang HY, Changchien CC, Chen HH, Lin H, Huang CC (2005) Extrauterine mullerian adenosarcoma associated with endometriosis and rectal villotubular adenoma: report of a case and review of the literature. Int J Gynecol Cancer 15:361–365
Chumas JC, Thanning L, Mann WJ (1986) Malignant mixed mullerian tumor arising in extragenital endometriosis: report of a case and review of the literature. Gynecol Oncol 23:227–233
Comiter CV (2002) Endometriosis of the urinary tract. Urol Clin North Am 29:625–635
Cotroneo MS, Lamartiniere CA (2001) Pharmacologic, but not dietary, genistein supports endometriosis in a rat model. Toxicol Sci 61:68–75
Donnez J, Nisolle M, Squifflet J (2002) Ureteral endometriosis: a complication of rectovaginal endometriotic (adenomyotic) nodules. Fertil Steril 77:32–37
Frohlich EP, Koller AB, van Blerk PJ, Margolius KA (1988) Adenocarcinoma from endometriosis causing urinary tract obstruction in a patient on oestrogen replacement therapy after hysterectomy. A case report. S Afr Med J 74:638–639
Goodman MT, Wilkens LR, Hankin JH, Lyu LC, Wu AH, Kolonel LN (1997) Association of soy and fiber consumption with the risk of endometrial cancer. Am J Epidemiol 146:294–306
Hasiuk AS, Petersen RO, Hanjani P, Griffin TD (1984) Extragenital malignant mixed Mullerian tumor. Case report and review of the literature. Am J Clin Pathol 81:102–105
Jimenez RE, Tiguert R, Hurley P, An T, Grignon DJ, Lawrence D, Triest J (2000) Unilateral hydronephrosis resulting from intraluminal obstruction of the ureter by adenosquamous endometrioid carcinoma arising from disseminated endometriosis. Urology 56:331
Johnson EB, Muto MG, Yanushpolsky EH, Mutter GL (2001) Phytoestrogen supplementation and endometrial cancer. Obstet Gynecol 98:947–950
Leiserowitz GS, Gumbs JL, Oi R, Dalrymple JL, Smith LH, Ryn J, Scudder S, Russell AH (2003) Endometriosis-related malignancies. Int J Gynecol Cancer 13:466–471
Muthyala RS, Ju YH, Sheng S, Williams LD, Doerge DR, Katzenellenbogen BS, Helferich WG, Katzenellenbogen JA (2004) Equol, a natural estrogenic metabolite from soy isoflavones: convenient preparation and resolution of R- and S-equols and their differing binding and biological activity through estrogen receptors alpha and beta. Bioorg Med Chem 12:1559–1567
Nezhat C, Nezhat F, Nezhat C, Nasserbakht F, Rosati M, Seidman DS (1996) Urinary tract endometriosis treated by laparoscopy. Fertil Steril 66:920–924
Salerno MG, Masciullo V, Naldini A, Zannoni GF, Vellone V, Scambia G (2005) Endometrioid adenocarcinoma with squamous differentiation arising from ureteral endometriosis in a patient with no history of gonadal endometriosis. Gynecol Oncol 99(3):749–752
Seidman JD (1996) Prognostic importance of hyperplasia and atypia in endometriosis. Int J Gynecol Pathol 15:1–9
Shook TE, Nyberg LM (1988) Endometriosis of the urinary tract. Urology 31:1–6
Staar S, Richter DU, Makovitzky J, Briese V, Bergemann C (2005) Stimulation of endometrial glandular cells with genistein and daidzein and their effects on ER alpha- and ER beta-mRNA and protein expression. Anticancer Res 25:1713–1718
Stern RC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ (2001) Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol 20:133–139
Zanetta GM, Webb MJ, Li H, Keeney GL (2000) Hyperestrogenism: a relevant risk factor for the development of cancer from endometriosis. Gynecol Oncol 79:18–22
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Noel, JC., Anaf, V., Fayt, I. et al. Ureteral mullerian carcinosarcoma (mixed mullerian tumor) associated with endometriosis occurring in a patient with a concentrated soy isoflavones supplementation. Arch Gynecol Obstet 274, 389–392 (2006). https://doi.org/10.1007/s00404-006-0188-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-006-0188-1