Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Adenomyosis in endometrial cancer: protective factor or prognostic marker? A narrative review
1Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, Henan, China
DOI: 10.22514/ejgo.2025.115 Vol.46,Issue 9,September 2025 pp.11-16
Submitted: 25 January 2025 Accepted: 14 March 2025
Published: 15 September 2025
*Corresponding Author(s): Liping Han E-mail: fcchanlp@zzu.edu.cn
The co-occurrence of adenomyosis and endometrial cancer (EC) has garnered increasing attention due to its potential impact on tumor progression and patient outcomes. Adenomyosis, characterized by ectopic endometrial tissue within the myometrium, creates a unique inflammatory and hormonal microenvironment that may influence endometrial tumor biology. This review synthesizes findings from studies conducted in the last decade, focusing on tumor stage, histopathological characteristics, and prognostic outcomes in patients with coexisting adenomyosis and EC. Evidence suggests that adenomyosis is associated with favorable tumor characteristics, such as reduced deep myometrial invasion and lymphovascular space invasion and may correlate with improved survival outcomes. However, conflicting findings highlight the need for further research to elucidate these interactions and their underlying mechanisms.
Endometrial cancer; Adenomyosis; Prognostic factors; Disease progression
Vinita Shiwali,Xintong Cai,Liping Han. Adenomyosis in endometrial cancer: protective factor or prognostic marker? A narrative review. European Journal of Gynaecological Oncology. 2025. 46(9);11-16.
[1] Buyuksahin LG, Ibanoglu MC, Ozturk AC, Korkmaz V, Altinbas SK, Engin-Ustun Y. Does coexistence of endometrial cancer and adenomyosis affect survival outcomes? A retrospective cohort study. European Journal of Gynaecological Oncology. 2024; 45: 118–126.
[2] Makker V, MacKay H, Ray-Coquard I, Levine DA, Westin SN, Aoki D, et al. Endometrial cancer. Nature Reviews Disease Primers. 2021; 7: 88.
[3] Markowska A, Chudecka-Głaz A, Pityński K, Baranowski W, Markowska J, Sawicki W. Endometrial cancer management in young women. Cancers. 2022; 14: 1922.
[4] Mahdy H, Vadakekut ES, Crotzer D. Endometrial cancer. StatPearls Publishing: Treasure Island (FL). 2024.
[5] Clontz AD, Gan E, Hursting SD, Bae-Jump VL. Effects of weight loss on key obesity-related biomarkers linked to the risk of endometrial cancer: a systematic review and meta-analysis. Cancers. 2024; 16: 2197.
[6] Bassette E, Ducie JA. Endometrial cancer in reproductive-aged females: etiology and pathogenesis. Biomedicines. 2024; 12: 886.
[7] Saglam O. Uncommon morphologic types of endometrial cancer and their mimickers: how much does molecular classification improve the practice for challenging cases? Life. 2024; 14: 387.
[8] Kalampokas E, Giannis G, Kalampokas T, Papathanasiou AA, Mitsopoulou D, Tsironi E, et al. Current approaches to the management of patients with endometrial cancer. Cancers. 2022; 14: 4500.
[9] Bourdon M, Santulli P, Marcellin L, Maignien C, Maitrot-Mantelet L, Bordonne C, et al. Adenomyosis: an update regarding its diagnosis and clinical features. Journal of Gynecology Obstetrics and Human Reproduction. 2021; 50: 102228.
[10] Selntigia A, Molinaro P, Tartaglia S, Pellicer A, Galliano D, Cozzolino M. Adenomyosis: an update concerning diagnosis, treatment, and fertility. Journal of Clinical Medicine. 2024; 13: 5224.
[11] Khan KN, Fujishita A, Mori T. Pathogenesis of human adenomyosis: current understanding and its association with infertility. Journal of Clinical Medicine. 2022; 11: 4057.
[12] Gunther R, Walker C. Adenomyosis. StatPearls Publishing: Treasure Island (FL). 2024.
[13] Bordonné C, Puntonet J, Maitrot-Mantelet L, Bourdon M, Marcellin L, Dion E, et al. Imaging for evaluation of endometriosis and adenomyosis. Minerva Obstetrics and Gynecology. 2021; 73: 290–303.
[14] Moawad G, Youssef Y, Fruscalzo A, Khedhri S, Faysal H, Pirtea P, et al. Effects of pretreatment strategies on fertility outcomes in patients with adenomyosis. Frontiers in Reproductive Health. 2024; 6: 1484202.
[15] Moraru L, Mitranovici MI, Chiorean DM, Moraru R, Caravia L, Tiron AT, et al. Adenomyosis and its possible malignancy: a review of the literature. Diagnostics. 2023; 13: 1883.
[16] Steen EH, Wang X, Balaji S, Butte MJ, Bollyky PL, Keswani SG. The role of the anti-inflammatory cytokine interleukin-10 in tissue fibrosis. Advances in Wound Care. 2020; 9: 184–198.
[17] Kasius JC, Pijnenborg JMA, Lindemann K, Forsse D, van Zwol J, Kristensen GB, et al. Risk stratification of endometrial cancer patients: FIGO stage, biomarkers and molecular classification. Cancers. 2021; 13: 5848.
[18] Raimondo D, Raffone A, Travaglino A, Maletta M, Casadio P, Ambrosio M, et al. Impact of adenomyosis on the prognosis of patients with endometrial cancer. International Journal of Gynecology & Obstetrics. 2022; 157: 265–270.
[19] Szubert M, Kozirog E, Wilczynski J. Adenomyosis as a risk factor for myometrial or endometrial neoplasms-review. International Journal of Environmental Research and Public Health. 2022; 19: 2294.
[20] Zhang H, Li C, Li W, Xin W, Qin T. Research advances in adenomyosis-related signaling pathways and promising targets. Biomolecules. 2024; 14: 1402.
[21] Hong IS. Endometrial stem cells: orchestrating dynamic regeneration of endometrium and their implications in diverse endometrial disorders. International Journal of Biological Sciences. 2024; 20: 864–879.
[22] Cheng WX, Wei SB, Zhou Y, Shao Y, Li MY. Exosomes: potential diagnostic markers and drug carriers for adenomyosis. Frontiers in Pharmacology. 2023; 14: 1216149.
[23] Ulger G, Gokulu SG, Akay K, Yildiz H, Yildizbakan A, Ilhan TT, et al. Does adenomyosis influence tumor characteristics and survival in endometrioid-type endometrial cancer?? BMC Women’s Health. 2025; 25: 237.
[24] Mitranovici MI, Chiorean DM, Moraru L, Moraru R, Caravia L, Tiron AT, et al. Shared pathogenic and therapeutic characteristics of endometriosis, adenomyosis, and endometrial cancer: a comprehensive literature review. Pharmaceuticals. 2024; 17: 311.
[25] Ghalehbandi S, Yuzugulen J, Pranjol MZI, Pourgholami MH. The role of VEGF in cancer-induced angiogenesis and research progress of drugs targeting VEGF. European Journal of Pharmacology. 2023; 949: 175586.
[26] Hermens M, van Altena AM, Velthuis I, van de Laar DCM, Bulten J, van Vliet HAAM, et al. Endometrial cancer incidence in endometriosis and adenomyosis. Cancers. 2021; 13: 4592.
[27] Liu F, Liu L, Zheng J. Expression of annexin A2 in adenomyosis and dysmenorrhea. Archives of Gynecology and Obstetrics. 2019; 300: 711–716.
[28] Bulun SE, Yildiz S, Adli M, Wei JJ. Adenomyosis pathogenesis: insights from next-generation sequencing. Human Reproduction Update. 2021; 27: 1086–1097.
[29] Hossain MM, Nakayama K, Shanta K, Razia S, Ishikawa M, Ishibashi T, et al. Establishment of a novel in vitro model of endometriosis with oncogenic KRAS and PIK3CA mutations for understanding the underlying biology and molecular pathogenesis. Cancers. 2021; 13: 3174.
[30] MacLean JA 2nd, Hayashi K. Progesterone actions and resistance in gynecological disorders. Cells. 2022; 11: 647.
[31] Oală IE, Mitranovici MI, Chiorean DM, Irimia T, Crișan AI, Melinte IM, et al. Endometriosis and the role of pro-inflammatory and anti-inflammatory cytokines in pathophysiology: a narrative review of the literature. Diagnostics. 2024; 14: 312.
[32] Yu W, Tu Y, Long Z, Liu J, Kong D, Peng J, et al. Reactive oxygen species bridge the gap between chronic inflammation and tumor development. Oxidative Medicine and Cellular Longevity. 2022; 2022: 2606928.
[33] Casadio P, Raffone A, Maletta M, Travaglino A, Raimondo D, Raimondo I, et al. Clinical characteristics of patients with endometrial cancer and adenomyosis. Cancers. 2021; 13: 4918.
[34] Boonlak S, Aue-Aungkul A, Kietpeerakool C, Kleebkaow P, Chumworathayi B, Luanratanakorn S, et al. Impact of coexisting uterine adenomyosis on the survival outcome of patients with endometrial cancer: a retrospective cohort study. Asian Pacific Journal of Cancer Prevention. 2019; 20: 1185–1190.
[35] Habiba M, Pluchino N, Petignat P, Bianchi P, Brosens IA, Benagiano G. Adenomyosis and endometrial cancer: literature review. Gynecologic and Obstetric Investigation. 2018; 83: 313–328.
[36] Musa F, Frey MK, Im HB, Chekmareva M, Ellenson LH, Holcomb K. Does the presence of adenomyosis and lymphovascular space invasion affect lymph node status in patients with endometrioid adenocarcinoma of the endometrium? American Journal of Obstetrics and Gynecology. 2012; 207: 417.e1–e6.
[37] Hertlein L, Rath J, Zeder-Göss C, Fürst S, Bayer D, Trillsch F, et al. Coexistence of adenomyosis uteri and endometrial cancer is associated with an improved prognosis compared with endometrial cancer only. Oncology Letters. 2017; 14: 3302–3308.
[38] Gizzo S, Patrelli TS, Dall’asta A, DI Gangi S, Giordano G, Migliavacca C, et al. Coexistence of adenomyosis and endometrioid endometrial cancer: role in surgical guidance and prognosis estimation. Oncology Letters. 2016; 11: 1213–1219.
[39] Wang DG, Ji LM, Jia CL, Shao MJ. Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: a systematic review and meta-analysis. Taiwanese Journal of Obstetrics and Gynecology. 2023; 62: 640–650.
[40] Matsuo K, Cahoon SS, Gualtieri M, Scannell CA, Jung CE, Takano T, et al. Significance of adenomyosis on tumor progression and survival outcome of endometrial cancer. Annals of Surgical Oncology. 2014; 21: 4246–4255.
[41] Hermens M, van Altena AM, van der Aa M, Bulten J, van Vliet HAAM, Siebers AG, et al. Endometrial cancer prognosis in women with endometriosis and adenomyosis: a retrospective nationwide cohort study of 40 840 women. International Journal of Cancer. 2022; 150: 1439–1446.
[42] Celik E, Goksever Celik H, Sozen H, Onder S, Tosun OA, Topuz S, et al. The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study. Journal of Obstetrics and Gynaecology. 2022; 42: 158–165.
[43] Aslan K, Sarı ME, Yalçın HR, Yalçın İ, Cüylan ZF, Özdal B. Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer. Irish Journal of Medical Science. 2020; 189: 835–842.
[44] Raffone A, Seracchioli R, Raimondo D, Maletta M, Travaglino A, Raimondo I, et al. Prevalence of adenomyosis in endometrial cancer patients: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics. 2021; 303: 47–53.
[45] Hirai M, Hirono M, Oosaki T, Hayashi Y, Yoshihara T, Matsuzaki O. Prognostic factors relating to survival in uterine endometrioid carcinoma. International Journal of Gynecology & Obstetrics. 1999; 66: 155–162.
[46] Zouzoulas OD, Tsolakidis D, Efstratiou I, Pervana S, Pazarli E, Grimbizis G. Correlation between adenomyosis and endometrial cancer: 6-year experience of a single center. Facts, Views and Vision in ObGyn. 2018; 10: 147–152.
[47] Zhang Z, Yang B, Zhang W, Gao X, Zhao C, Zhang X, et al. Clinicopathological characteristics and survival outcomes of patients with coexistence of adenomyosis and endometrial carcinoma. International Journal of Clinical and Experimental Pathology. 2018; 11: 956–962.
[48] Mao X, Zheng W, Mao W. Malignant changes in adenomyosis in patients with endometrial adenocarcinoma: a case series. Medicine. 2017; 96: e8336.
[49] An M, Duan H, Zhang Y. Prognostic significance of co-existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: a meta-analysis. Journal of Obstetrics and Gynaecology Research. 2020; 46: 1851–1863.
[50] Machida H, Maeda M, Cahoon SS, Scannell CA, Garcia-Sayre J, Roman LD, et al. Endometrial cancer arising in adenomyosis versus endometrial cancer coexisting with adenomyosis: are these two different entities? Archives of Gynecology and Obstetrics. 2017; 295: 1459–1468.
[51] Chao X, Wu M, Ma S, Tan X, Zhong S, Bi Y, et al. The clinicopathological characteristics and survival outcomes of endometrial carcinoma coexisting with or arising in adenomyosis: a pilot study. Scientific Reports. 2020; 10: 5984.
[52] Şimşek E, Yıldız Ş, Karakaş S, Gündüz S, Yıldız ÖA, Özdemir İA, et al. Effect of adenomyosis on prognosis of patients with endometrial cancer. Revista da Associação Médica Brasileira. 2023; 69: e20221720.
[53] Yilmaz A, Cokmez H, Gulbahar A. Effect of coexisting adenomyosis on patients with endometrioid adenocarcinoma: determination of intraoperative risk factors for tumor metastasis and estimation of prognosis. Journal of Cancer Research and Therapeutics. 2022; 18: 599–602.
[54] Yetimalar MH, Kilic D, Bezircioglu I, Yigit S. The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma. Journal of Obstetrics and Gynaecology. 2022; 42: 2213–2219.
[55] Taneichi A, Fujiwara H, Takahashi Y, Takei Y, Machida S, Saga Y, et al. Influences of uterine adenomyosis on muscle invasion and prognosis of endometrioid adenocarcinoma. International Journal of Gynecological Cancer. 2014; 24: 1429–1433.
[56] Koshiyama M, Okamoto T, Ueta M. The relationship between endometrial carcinoma and coexistent adenomyosis uteri, endometriosis externa and myoma uteri. Cancer Detection and Prevention. 2004; 28: 94–98.
[57] Aydin HA, Toptas T, Bozkurt S, Pestereli E, Simsek T. Impact of coexistent adenomyosis on outcomes of patients with endometrioid endometrial cancer: a propensity score-matched analysis. Tumori Journal. 2018; 104: 60–65.
[58] Johnatty SE, Stewart CJR, Smith D, Nguyen A, O’Dwyer J, O’Mara TA, et al. Co-existence of leiomyomas, adenomyosis and endometriosis in women with endometrial cancer. Scientific Reports. 2020; 10: 3621.
[59] El Sabeh M, Afrin S, Singh B, Miyashita-Ishiwata M, Borahay M. Uterine stem cells and benign gynecological disorders: role in pathobiology and therapeutic implications. Stem Cell Reviews and Reports. 2021; 17: 803–820.
[60] Laganà AS, Garzon S, Götte M, Viganò P, Franchi M, Ghezzi F, et al. The pathogenesis of endometriosis: molecular and cell biology insights. International Journal of Molecular Sciences. 2019; 20: 5615.
[61] Frąszczak K, Barczyński B. Characteristics of cancer stem cells and their potential role in endometrial cancer. Cancers. 2024; 16: 1083.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Top