Ovarian carcinomas, especially clear cell and endometroid adenocarcinomas, are highly associated with endometriosis. Atypical endometriosis shows proliferation activity intermediate to those of typical endometriosis and ovarian carcinoma, suggesting it is a precancerous status¹. Histopathological studies show the transformation/progression of endometriosis to clear call carcinomas.

Patients diagnosed ovarian clear cell carcinoma with pelvic endometriosis exhibited a better prognosis than those without endometriosis, especially those patients with stage I cancer².

What is not so clear is that should all demonstrable macroscopic endometriosis in women be removed even if asymptomatic given this relationship of endometriosis with pelvic clear cell cancer?  What features would advocate excision? Size or site of disease? Should a hysterectomy and bilateral salpingo-oophrectomy be recommended at menopause if a patient is known to have unexcised macroscopic endometriosis pre-menopausally?  Are there any guidelines?

Limited existing evidence will be reviewed and the presentation will attempt to extrapolate some “guidelines”, which will no doubt create controversies.