Absence Of Myometrial Invasion Research Articles

Serous endometrial intraepithelial carcinoma: A clinico-pathological study of 48 cases and its association with endometrial polyps – A tertiary care oncology centre experience

BackgroundEndometrial serous carcinoma (ESC) is an aggressive neoplasm wherein the recent studies have shown that it arises from its putative precursor namely the serous endometrial intraepithelial carcinoma (SEIC). SEIC usually arises in inactive/ atrophic endometrium but surprisingly is frequently associated endometrial polyps (EPs). The aim of this study was to assess the incidence of SEIC with or without invasion, its clinical behaviour and association with endometrial polyp. Materials and MethodsAfter Institutional review board approval, a total of 205 samples (belonging to 120 patients); diagnosed as ESC from January 2009 to December 2015 were retrieved and reviewed for presence of in situ carcinoma and also for associated endometrial polyp. ResultsThe mean age at diagnosis was 62.40 years with postmenopausal bleeding being the most common presenting symptom. The incidence of SEIC with or without invasive tumor was 40% (48/120). Of these 48 cases; 25 cases were associated with in-situ carcinoma arising in the EPs which amounted to 52% of the total cases. The overall three year survival and disease free survival in SEIC with or without invasion were 1.9% and 0.25%, indicating the aggressive nature of the disease. ConclusionSEIC is a difficult histopathological diagnosis and one should carefully look for these lesion, especially in the EPs which are frequently associated with them. Extensive sampling of the EP will be helpful to pick up in-situ carcinoma arising in EP. SEIC is an aggressive disease on its own with a propensity to develop distant metastasis even in the absence of myometrial invasion and hence should be treated with optimum surgical staging and if indicated aggressive adjuvant treatment protocols.

Tumor size loses prognostic significance for progression free survival in the absence of myometrial invasion in grades 1-2 endometrioid endometrial adenocarcinoma

Objective: Endometrial adenocarcinoma is the most common gynecologic malignancy in Western society. Prognosis and recommendations for adjuvant therapy are based on pathologic findings including tumor size, depth of invasion, lymphovascular space invasion, and extrauterine disease. Size and depth of invasion are regarded as independent factors of prognosis, but the interaction between tumor size and depth of invasion has not been evaluated. The objective of this study was to evaluate tumor size in relation to depth of invasion of grade 1–2 endometrioid tumors as a factor determining PFS.

Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study.

ObjectiveTo assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy.MethodsA multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected.ResultsA total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060).ConclusionExtra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.

Fertility Preservation in Patients with Endometrial Cancer

Endometrial carcinoma (EC) is the most common gynaecological cancer, with 2-14% of cases occurring in women <40 years of age. When considering the increase in the delay of pregnancy in developing countries, the incidence of EC in nulliparous women is likely to increase. Younger women with EC have a chance to preserve their fertility due to the probability of being diagnosed with early-stage and low- grade endometrioid carcinomas. However, it should be noted that the most important step of fertility preservation in patients with EC is patient selection. The appropriate clinical criteria should include: a) well-differentiated histology; b) absence of myometrial invasion; c) absence of extrauterine or pelvic and pre-aortic lymphatic spread; and d) absence of synchronous ovarian tumour. There is no consensus regarding endometrial suppression therapy or the follow-up period for fertility preservation in women with EC. Therefore, this review aims to evaluate the current literature.

Fertility Preservation in Patients with Endometrial Cancer

Endometrial carcinoma (EC) is the most common gynaecological cancer, with 2-14% of cases occurring in women <40 years of age. When considering the increase in the delay of pregnancy in developing countries, the incidence of EC in nulliparous women is likely to increase. Younger women with EC have a chance to preserve their fertility due to the probability of being diagnosed with early-stage and low- grade endometrioid carcinomas. However, it should be noted that the most important step of fertility preservation in patients with EC is patient selection. The appropriate clinical criteria should include: a) well-differentiated histology; b) absence of myometrial invasion; c) absence of extrauterine or pelvic and pre-aortic lymphatic spread; and d) absence of synchronous ovarian tumour. There is no consensus regarding endometrial suppression therapy or the follow-up period for fertility preservation in women with EC. Therefore, this review aims to evaluate the current literature.

Accuracy of frozen-section examination for myometrial invasion and grade in endometrial cancer

To evaluate the accuracy of frozen section (FS) analysis in endometrial cancer. The medical records of 816 patients with stage IA-IVB endometrial carcinoma were evaluated. Concordance of the frozen section examination and postoperative evaluation in terms of the depth of myometrial invasion (MI) and grade was assessed. The mean age of the patients was 58.1 years. Postoperative pathology revealed endometrioid type tumor in 756 patients. Concordance of intraoperative and postoperative pathology results in terms of grade was 89%. This rate was 96.8% for grade 1, 86% for grade 2 and 91.3% for grade 3 tumors. Sensitivity and specificity of intraoperative evaluation for grade 1, grade 2 and grade 3 were 89.3%, 91.2%, 77.8% and 93.1%, 96.1%, 99.5%, respectively. Intraoperative and postoperative determination of MI was consistent in 85.4% of patients. MI was assessed accurately in 78.5% of patients with no involvement of myometrium and in 90.5% and 95.3% of patients with myometrial invasion <1/2 and ≥1/2, respectively. Sensitivity and specificity of FS in prediction of the absence of MI, MI<1/2 and ≥1/2 were 60%, 91.5%, 88.8% and 96.6%, 88.3%, 98.3%, respectively. The accuracy of myometrial invasion was affected by the postoperative grade. Concordance was higher in grade 2 and 3 than grade 1 tumors. The accuracy of intraoperative pathologic evaluation in endometrial cancer is reasonably high. For that reason, results of the intraoperative pathologic examination should be taken into consideration primarily in the management for lymphadenectomy.

MR Imaging of Uterine Malignant Mixed Mullerian Tumor: Comparison with Endometrial Carcinoma

Background: Generally, it is difficult to differentiate uterine malignant mixed M llerian tumor(MMMT) from endometrial carcinom in radiological and clinical aspects. Our purpose is to investigate MR findings that distinguishes MMMT from endometrial carcinoma. Materials and Methods: We retrogradely evaluated the magnetic resonance imaging findings of pathologically proven 5 cases of malignant mixed Mllerian tumor(MMMT) and 14 endometrial carcinomas to know the differential points of these two tumors originating in the endometrial cavity. The size of the mass, presence or absence of myometrial or uterine cervical invasion, growth pattern of the mass, signal intensity and degree and pattern of contrast enhancement were analyzed and compared. Results: The length of the long axis of the MMMT was 1.5-9.0cm(average, 5.7cm) but that of the endometrial carcinoma was 0.5-6.0cm(average, 2.5cm). Invasion of uterine cervix which was found in 3 MMMT cases, dilated the endometrial cavity and the lumen of the uterine cervix and showed the pattern of growing into the external os. Invasion of uterine cervix was found in only one case of endometrial carcinoma. The presence or absence of myometrial invasion, the signal intensity and homogeneity on T1- and T2-weighted images, and the degree and patterns of contrast enhancement showed no significant difference. Conclusion: Any specific finding to differentiate MMMT from endometrial carcinoma was not ascertained. However, MMMT can be suspected if the size of the endometrial mass is greater than 5cm and if the mass dilates the enocervical canal and invades the uterine cervix.

Stage IA uterine serous carcinoma: a study of 13 cases.

Although in endometrioid type endometrial carcinoma depth of invasion is a powerful predictor of extrauterine disease and survival, in serous carcinoma its importance is unclear. Recurrences and death in patients with serous tumors confined to the endometrium or an endometrial polyp have been reported. In other studies, however, the absence of myometrial invasion was correlated with a more favorable course. In an attempt to clarify this issue, we reviewed 13 completely staged, stage IA serous carcinomas with follow-up from 10 to 93 months (median 38), in which extensive histologic examination had been performed. Serous carcinoma was identified in an endometrial polyp in six cases, in an endometrial polyp and associated endometrium in four, and solely in the endometrium in three cases. No other histologic types of endometrial carcinoma were present, and there was no myometrial invasion. Multifocal serous intraepithelial carcinoma was also seen in 12 cases. Two of the patients died of disease with intraabdominal carcinomatosis at 10 and 14 months after presentation. The overall estimated survival was 83%, showing a relatively favorable prognosis. In conclusion, although the absence of histologically detected myometrial invasion may be associated with recurrences and death in serous carcinoma, an accurately assessed stage based on a careful histologic examination appears to be, at present, the most reliable predictor of survival.

Endometrioid endometrial adenocarcinoma with psammoma bodies.

Since the wide acceptance of serous carcinoma as a distinct subtype of endometrial carcinoma, almost all endometrial carcinomas with psammoma bodies have been classified as such. We describe eight cases of endometrioid endometrial adenocarcinoma with psammoma bodies and discuss their clinicopathologic features. The patients ranged in age from 37 to 79 years. Psammoma bodies were present in the curettage material in three and in the hysterectomy specimens in all cases. The tumors were well to moderately differentiated with at least focal squamous metaplasia. Four of eight cases also showed a focal villoglandular architecture. Inflammation and necrosis were present in all cases, and four had features of pyometra. Deep myometrial invasion was present in six cases. Diffuse lymphatic invasion was present in six, and one showed perivascular lymphocytic infiltrate in the absence of myometrial invasion. The tumors metastasized to lymph nodes in four of eight cases. One case showed intranodal psammoma bodies in the absence of endosalpingiosis or tumor. Intra-abdominal recurrence was present in only one case and was endometrioid with rare psammoma bodies. All patients are alive, six with no evidence of disease, one with stable periaortic lymphadenopathy, and one with progressive disease. This report suggests that endometrioid endometrial carcinoma may rarely be associated with psammoma bodies, the formation of which is most likely due to inflammation and necrosis. It also suggests that endometrioid carcinoma with psammoma bodies has a higher surgical stage and is more likely to have lymphatic invasion and lymph-node metastases and hence require surgical staging. The pattern of spread appears to be different from uterine papillary serous carcinoma, and the rate of survival is similar to stage-matched endometrioid carcinoma without psammoma bodies.

Endometrial carcinoma in situ in postmenopausal women.

In a review of 518 nonirradiated hysterectomy specimens with endometrial carcinoma and 39 with carcinosarcoma, 86 cases were identified in which there were microscopic foci of malignant epithelium that failed to alter the architecture of an otherwise thin atrophic or weakly proliferative endometrium or endometrial polyp. These changes were interpreted to be endometrial carcinoma in situ (ECIS). This change was present on the surface (SCIS), in isolated glands (GCIS), and in small (three to five) groups of glands (thin AH). For these three subtypes, neither papillations, stromal reaction, nor glandular epithelial bridging were present. When they were present and there was either no stromal reaction or the reaction was limited to one or two glands in the absence of myometrial invasion or endometrial architectural alteration, they were designated as thin carcinoma (thin CA), a fourth subtype of ECIS. For these patients the age range was 50-90 years, with mean and median ages of 66 and 65 years, respectively. All but one patient was known to be postmenopausal. In 66% of cases the endometrial malignancy either was uterine papillary serous/clear cell carcinoma (UPS) or contained an element of UPS. Foci of ECIS were present adjacent to the tumor in 86%, isolated from the tumor in 59%, and diffuse in 16% of cases. It is proposed that in many postmenopausal women, either surface epithelium or individual glands undergo malignant transformation and then progress to an invasive malignancy without an intervening phase of atypical hyperplasia, particularly in cases with an element of UPS.