Carcinoma Of Endometrium Research Articles

Evaluation of positron emission tomography and contrast-enhanced computed tomography scan in nodal staging of early operable uterine cancers

Introduction:In early operable stages of cervical an endometrial malignancies, surgical staging of lymph nodes is advocated as contrast-enhanced computed tomography (CECT) has limited sensitivity and accuracy. Although fluorine-18 (F-18) fluorodeoxyglucose (FDG)/positron emission tomography (PET)-CT has potential to identify subcentimeter-sized nodal metastases, higher prevalence of pelvic inflammatory disease in developing countries could result in lower accuracy. The present study was undertaken to assess the incremental value of PET scan over CECT for nodal staging before radical surgery.Methods:Forty-four patients with the International Federation of Gynecology and Obstetrics (FIGO) Stage IA2–IIb carcinoma cervix and 28 patients of FIGO Stage I–II carcinoma endometrium underwent F-18 FDG-PET-CECT scan. A SUVmax value >2.5 g/ml based on body weight was considered as positive. An enhancing node with >1 cm size in the shortest dimension, with loss of fatty hilum was considered positive on CT images. The histological findings were considered the gold standard against which the two modalities were compared.Results:All 1226 pelvic nodes were dissected, of which 65 were found to be metastatic (i.e., 5.3%). Of the 72 patients, 15 (20.83%) had pelvic nodal metastases. The overall accuracy of PET and CECT for assessment of pelvic nodal metastases was comparable (i.e., 86% vs. 85%).Conclusion:PET and CECT scans have similar accuracy in pelvic nodal staging of operable uterine malignancies. Granulomatous inflammation may not be a major cause of false-positive results. The sensitivity and negative predictive values are not high enough to obviate need of surgical nodal staging.

The role of syndecan-1 during endometrial carcinoma progression.

Syndecan-1 (CD138) has most extensively been studied and correlated with many types of cancers. CD138 is mainly expressed in epithelial cells and plasma cells. Quite a few previous studies have called attention to the expression status of CD138 in EC. We aimed to determine the location of CD138 in the hyperplasia and endometrial carcinoma progression scale, and its relation with proliferation via Ki67, and to identify a new criterion in the differential diagnosis of hyperplasia-carcinoma. A total of 120 endometrial curettage materials with proliferative and secretory phase endometrium, hyperplasia without atypical, atypical hyperplasia, and endometrium carcinoma examined in the pathology laboratory between 1995 and 2016 were included in the study. Samples were subjected to immunostaining for CD138 and Ki67 using antibody. Statistical analysis revealed a significant and negative correlation between histopathological progression and CD138 (P < 0.01). Statistical analysis revealed a significant and positive correlation between histopathological progression and Ki67 (P < 0.01) and a significant negative correlation between Ki67 and CD138 (P < 0.01). CD138 may be helpful in diagnostic difficulties, and benign pathologies should be considered due to the increase in staining density. Furthermore, we believe that CD138 will be an important criterion in determining the risk of malignancy in hyperplasia, and the risk of malignancy progression may increase in cases, of which intensity of staining decreases in accordance with the normal endometrium.

Role of Positron Emission Tomography/Computed Tomography in Preoperative Assessment of Carcinoma Endometrium-a Retrospective Analysis.

PET/CT has made significant inroads into routine oncological practice in recent times. In our study, we aim to determine its value in preoperative assessment of endometrial carcinoma. A retrospective study between January 2011 and March 2016 was conducted; we included all cases of carcinoma endometrium with a preoperative PET/CT scan. PET/CT images were analyzed and correlated with histological findings after surgical staging. A total of 46 cases were analyzed, mean age was 59.8years, BMI 30.8kg/m2, and most common histology endometrioid type (69.5%). We correlated PET/CT findings with histopathology as reference standard. PET/CT had a sensitivity of 40%, moderate specificity (75%) and accuracy (71.7%), good NPV (91.2%), but poor PPV (16.7%) for lymph node involvement. A total of 10 (21.7%) cases were detected to have distant metabolically active lesions on PET/CT, seven out of these were positive for malignancy. And 90% of them were either non-endometrioid type or grade two and higher. We found that SUV of primary tumor was significantly higher in patients with deep myometrial invasion (p = 0.018), and high-risk histological type of tumor (p = 0.022), though not statistically significant when lymph nodal involvement (p = 0.9), cervical involvement (p = 0.56), or histological grade (p = 0.84) were considered. Sensitivity and specificity of PET/CT in staging endometrial cancer is not high enough to reliably tailor lymphadenectomy. Although SUV of the primary tumor was significantly higher in patients with deep myometrial invasion and high-risk histological type, it's usefulness in classifying patients into predefined risk groups seems to be limited. However, it is useful in detecting distant metastasis especially in high-grade and non-endometrioid type of tumors. Thus, implementation of PET/CT as a surrogate for surgical staging of endometrial cancer remains enigmatic and is open to further research.

Activity of steroid receptors in the ovaries in women with and without adenomyosis and hyperplastic processes of the endometrium in menopause.

Background. Adenomyosis (AM) is a relevant problem in modern medicine. Manifestations of AM do not subside against the background of hypoestrogens. Some studies indicate local hyperteriogenicity and autonomous growth of AM foci. However, there are no reliable data on the activity and effect of the steroid hormones of the ovaries on the pathogenesis of AM. Of especial importance is this problem in women in menopause. It is of interest to study immunohistochemical (IHC) features of the ovarian tissue cells in women in the presence of AM and associated pathology of the endometrium. Objective. Investigation of IHC activity of the steroid receptors in the ovaries of women with AM and hyperplastic endometrial processes (endometrial hyperplasia (HPE) and endometrioid endometrium carcinoma (ECE)) without menopause and its role in the pathogenesis of this existence. Materials and methods. The material included removed ovaries of 30 patients (52-73 years) diagnosed with AM in combination with and without hyperplastic processes of the endometrium. The IHC studies were conducted for markers ER, PR and AR. Results. IHC studies have found that there was no reaction to ER markers with IHC among most women. On assessing the expression of ovarian cancer in women with AM and HPE a weak intensity level and moderate - the prevalence of coloration was more often revealed. The similar situation was observed in other groups of women. The analysis of IHC of the reaction with AR showed that in cases of AM and HPE the intensity of 1 point and the prevalence of coloration in 2 points, in contrast to the group of ECE was more frequent, where the most common were 2 and 4 points, respectively. Intermediate position was occupied by women with age-related changes in the endometrium. Conclusions. In postmenopausal women, due to the noticeable decrease in estrogen synthesizing function, the ovaries do not affect the pathogenesis of AM as a source of hyperestrogenism. The ability of the ovaries to develop progesterones indicates its need as one of the elements of AM development. In postmenopause, the preservation of the androgene-producing ovarian function plays a leading role in the pathogenesis of AM as a source of further synthesis of estrogen.

Simultaneous TLC-densitometric determination of tamoxifen citrate and medroxyprogesterone acetate and UV-degradation kinetic study of medroxyprogesterone acetate.

Coadministration of tamoxifen citrate (TMC) and medroxyprogesterone acetate (MPA) is preferred to increase the response rate and the percentage recovery in patients with endometrial carcinoma. Administration of TMC and MPA and their combination affects estrogen and progestin receptor concentrations in advanced endometrium carcinoma by affecting 17β-hydroxyl steroid dehydrogenase activity and serum hormone concentrations. A sensitive, accurate and robust thin-layer chromatography method has been established for simultaneous analysis of TMC and MPA. Method development was carried out on silica gel F254 using butanol-acetic acid-water (6:0.5:0.5, v/v/v) as mobile phase. Densitometric scanning was carried out at 241 nm for simultaneous detection of TMC and MPA. Retardation factor (Rf ) values for TMC and MPA were 0.21 and 0.85, respectively. The method was validated according to ICH guidelines. Regression plots revealed linear relationships in the concentration range of 50-500 and 25-250 ng/band for TMC and MPA, successively. Accuracy was ≥99.60 and 98.72% for TMC and MPA, respectively. Forced degradation studies using UV photodegradation was applied on MPA after exposure to UV light for different times and applying a kinetic study for calculating the degradation rate constant (k) and half-life time (t1/2 ).

Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

Objective: To define recurrence pattern of endometrioid type endometrium cancer performed adjuvant radiotherapy.Study Design: 351 patients who underwent at least total abdominal hysterectomy with bilateral salpingo-oophorectomy and followed by adjuvant radiotherapy (vaginal brachytherapy or pelvic radiotherapy or both) for endometrioid type endometrium carcinoma were included. The patients who received systemic adjuvant treatment after surgery were excluded from the study except for 18 patients who received concomitant chemo-radiotherapy. Recurrence was categorized as pelvic recurrence included areas distal to the pelvic inlet, as abdominal recurrence included areas between pelvic inlet and diaphragm and findings such as ascites and peritonitis carcinomatosa, and the rest of recurrences including lung, cutaneous, liver parenchyma and bone as extra-abdominal recurrence.Results: The median age was 57 years (range; 29-82). 236 patients had stage I, 25 had stage II, 63 had stage III and 14 had stage IV disease (by FIGO 2009). Lymph node metastasis was determined in 21.8% of patients who underwent lymphadenectomy (n: 289). The median follow-up time was 46 months (range; 1-190). Throughout follow-up, recurrence was developed in 55 (15.7%) patients. Only pelvic recurrence was determined in 11 (3.1%) patients. There was recurrence beyond the pelvis in 44 (80%) of the recurrent patients. Thirty-five (%63.6) of recurrent patients had extra-abdominal recurrence. Twenty-three (41.8%) of recurrent patients had stage IB disease. The recurrence developed in 10% of patients with stage I&amp;II, whereas it was occurred in 31% of patients with stage III&amp;IV (p&lt;0.0001).Conclusion: Radiotherapy provides local control of the disease, but recurrence is likely to be extra-pelvic and extra-abdominal in this patient group.

Utility of three dimensional (3-D) ultrasound and power Doppler in identification of high risk endometrial cancer at a tertiary care hospital in southern India: A preliminary study

ObjectiveThe study was conducted to find the utility of three dimensional (3-D) ultrasound and Doppler sonography in differentiating benign and malignant endometrial lesions and to ascertain the association of sonology parameters with type, grade and stage of endometrial cancer. Materials and methodsWomen attending the gynaecology department of a tertiary care hospital, with a provisional diagnosis of carcinoma endometrium were subjected to three dimensional power Doppler ultrasound evaluation and assessment of vascular patterns. VOCAL (Virtual Organ Computer-aided Analysis) software was used to assess volume, Vascularisation Index (VI), Flow Index (FI) and Vascularisation Flow Index (VFI). Ultrasound parameters were compared with histologic diagnosis to evaluate the diagnostic performance using Receiver Operating Characteristic (ROC) Curve. ResultsSixty-four women were included in the study, 33 with benign and 31 with malignant endometrial lesions. Larger endometrial volume and higher Doppler indices correlated with malignant lesions. The variables with good discriminatory potential between benign and malignant status were VI and VFI, having a sensitivity of 90.3% and specificity of around 80%. VFI (adjusted odds ratio of 40.4; (95% CI – 8.46–192.88), p value < 0.001) was the only significant variable identified by multivariate logistic regression, when adjusted for age and post-menopausal status. Multiple global and focal vessel pattern was seen predominantly in malignant cases (specificity 93.9%), although the sensitivity was low (61.2%). Higher stages and grades of tumour and non-endometrioid types had higher Doppler indices, and requires further evaluation. Conclusions3-D ultrasound has good discrimination potential between benign and malignant endometrial lesions and could be useful as a screening tool. However, utility of 3-D tool for differentiation between tumour characteristics needs further validation.

Abstract 4566: PD-L1 and B7-H3 expression in serous carcinoma of endometrium

Abstract Endometrial cancer keeps increasing in Japan explosively. In endometrial cancer, the prognosis of serous carcinoma is very poor, because of early progression to abdominal cavity. Remedy for endometrial cancer is limited, so new therapy has been required for a long time. Immunotherapy is very promising in various cancers recently. PD-L1 (programmed cell death ligand 1) and B7-H3 are factors of immunoresponse between cancer cells and lymphcyte. Purpose: The purpose of this study is to investing the expression of PD-L1 and B7-H3, moreover, relationship with clinicopathological factors in serous carcinoma of endometrium. We immunohistochemically evaluated PD-L1 and B7-H3 expression in 21 serous carcinoma. The result was graded as positive in case stained more than 10% area. Result: 2/21(9.5%) for PD-L1 and 10/21(47.6%) for B7-H3 were positive. There was no correlation with tumor diameter, lymphnode metastasis, advanced stage and recurrence in PD-L1, however, B7-H3 expression had trend node metastasis, 3/10 in positive cases vs 0/11 in negative cases (p=0.05). In 4 recurrent cases treated with taxane and carboplatin as second line therapy, one case with B7-H3 negative got complete remission, however 3 cases with B7-H3 positive got partial improvement once, but finally got progression. Conclusion: PD-L1 expression was limited in serous carcinoma, so immunotherapy targeted for PD-1 and PD-L1 may be limited. The expression of B7-H3 is related to chemotherapy resistance. B7-H3 may be a biomarker for chemotherapy and target of new immunotherapy for serous carcinoma of endometrium. Citation Format: Masato Nishimura, Ayuka Mineda, Akiko Abe, Minoru Irahara. PD-L1 and B7-H3 expression in serous carcinoma of endometrium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4566.

Clinicopathologic and survival results in serous endometrium carcinoma and subgroup analysis for mixed serous and pure serous histology.

Objective:To review the clinicopathologic and survival outcomes of patients with serous endometrial cancer (EC) and to investigate subgroup analysis based on pure serous and mixed serous EC subtypes.Material and Methods:Patients who underwent EC surgery between 2002 and 2014 and who were reported as serous EC were enrolled in the study. All patients were diagnosed as having serous EC or mixed serous EC with serous component higher than 10% based on the postoperative pathology report.Results:A total of 93 patients were analyzed. The median disease-free and overall survival (OS) durations were 49.6 and 32.2 months, respectively. Forty-three patients (46.2%) relapsed and 35 patients (37.6%) died. The histologic type was pure serous EC in 52 (55.9%) and mixed EC in 41 (44.9%) patients. There was no statistical difference between the pure serous and mixed serous groups in terms of age, International Federation of Gynecology and Obstetrics stage, lymphadenectomy, lymph node metastasis or adjuvant therapy combinations. Twenty-nine (55.8%) patients in the pure serous group and 14 (34.1%) in the mixed serous group hade recurrence (p=0.038). Twenty-five (48.1%) patients in the pure serous group and 10 (24.4%) in the mixed serous group died (p=0.034). In the pure serous group, the mean disease-free and OS durations were shorter than in the mixed serous group (59 vs. 81 months and 73 vs. 95 months, log-rank p=0.055 and 0.041, respectively). Histologic type was a significant prognostic factor on recurrence and OS in the univariate analysis (Hazard ratio: 2.404, 95% Confidence interval: 1.01-5.71; 2.027, respectively), but not in the multivariate analysis, which included disease stage and age of the patients.Conclusion:Compared with pure serous and mixed serous endometrium cancer groups, primary surgical treatments, clinicopathologic features and adjuvant treatments were similar, but there was a survival difference. Patients with pure serous cancer had a worse prognosis. However histology was not an independent factor for survival.

Histopathological Pattern of Endometrium: Hospital Based Study in Teaching Hospital, Batticaloa, Srilanka

Introduction: Abnormal uterine bleeding, either due to organic or be dysfunctional cause, is a common gynaecological problems. Methods: A retrospective, cross sectional, hospital-based study was done for a period of five and a half years included 1884 samples which were taken by endosampling as well as by curetting for the evaluation of several gynaecological symptoms. Results: The age distribution ranges from 16 to 83 years. 12.8% of (242/1884) samples were inadequate for a comprehensive diagnosis. The functional cause was the predominant in 1263 samples and organic causes were found in 379 sample. The menorrhagia is the commonest one and it is followed by post-menopausal bleeding and polymenorrhoea. Endometrial polyp was the predominant organic (46.9%) cause followed by (26.1%) simple endometrial hyperplasia without atypia. Most of the simple hyperplasia without atypia (49/99) and complex hyperplasia (10/28) also occurred in the same age group. Total 29 (1.5%) cases of carcinoma of endometrium were found and it was common (13/29) in 50 - 59 years of age. It was noted that (5/29) carcinoma occurred in less than 39 years of age. Conclusion: This study shows that most of the patients fall in the age group of 40 - 49 years. As the organic causes mostly found in this age group, endometrial cavity evaluation should be done more than 40 years of age. Further endometrial hyperplasia and carcinoma of the endometrium also occurs in less than 40 years of age. Therefore, clinical risk factors should be assessed and need of endometrial cavity should be individualised for better outcome.

Fertility preservation in endometrial carcinoma: Case series of 11 patients

Introduction: Endometrial cancer comprises 7.1% of all new cancer cases in females. Carcinoma of the endometrium is one of the long-term complications of polycystic ovarian syndrome (PCOS) due to unopposed estrogen action due to chronic anovulation. The standard treatment involves hysterectomy and bilateral salpingo-oophorectomy, due to its hormonal sensitivity. In endometrial cancer without infiltration to the myometrium and no extrauterine involvement, conservative treatment can be offered to women who wish to preserve fertility. Results: We report 11 cases of endometrial carcinoma either diagnosed during workup for infertility or referred for fertility preservation (FP) before definitive treatment. About 72.7% (7/11) of patients had PCOS, it becomes important for clinicians to suspect and rule out endometrial carcinoma by regular endometrial surveillance which, includes transvaginal ultrasound and/or endometrial biopsy in all PCOS women who have abnormal uterine bleeding, prolonged amenorrhea, unopposed estrogen exposure, and thick endometrium especially on day 3 of the menstrual cycle. About 36.36% (4/11) of our patients were not convinced for FP and were either lost to follow-up or underwent definitive therapy. Thus, it is important that all patients with endometrial carcinoma should be counseled not only by the oncologist but also by a reproductive endocrinologist and a psychosocial counselor, both together and separately. This will enable the patient to make a right choice of the treatment modality. Conclusion: Conservative treatment with progestogen therapy in selected young patients with well-differentiated carcinoma limited to the endometrium helps in preserving fertility. If they fail to conceive in the first attempt of in vitro fertilization, it is mandatory to monitor them for recurrence till a definitive treatment is planned. If definitive treatment is required fertility can be preserved either by oocyte or embryo freezing. Some women with low risk of ovarian involvement can benefit by ovarian tissue cryopreservation.

Combined external beam radiotherapy and vaginal brachytherapy versus vaginal brachytherapy in stage I, intermediate- and high-risk cases of endometrium carcinoma.

PurposeRandomized trials on the effect of external beam radiotherapy (EBRT) with or without vaginal brachytherapy (VBT) for endometrial carcinoma are very few. In view of this, the current study was conducted with the hypothesizes: whether the escalated dose of 26 Gy (VBT alone) in comparison with various major international trials (PORTEC-2) has any difference in rates of disease-free and overall survival with fewer adverse effects in low resource setting like India.Material and methodsAn open-labeled, non-inferiority, randomized control trial was undertaken at a regional cancer center among patients with stage IA or IB high-intermediate risk endometrial carcinoma. A total of 50 patients were divided equally among two arms of combined EBRT with VBT (arm I) and VBT alone (arm II). A dose of 50-50.4 Gy in 25-28 fractions of EBRT with 2 fractions of VBT 6.5 Gy each were delivered to patients in arm I and 4 fractions of VBT 6.5 Gy each to patients in arm II, and were followed up for 60 months.ResultsDuring the median follow-up of 36.5 months, two patients developed loco-regional recurrence in arm II, three (arm II), and one (arm I) developed distant metastasis. The 5-year survival rates for arms I and II were 96.0% vs. 92.0% overall, and 88.0% vs. 84.0% disease-free, respectively, and were not found to be statistically significantly different. Dermatological, gastro-intestinal toxicities, and cystitis were lower in the VBT group compared to combined group.ConclusionsVBT alone is as effective as EBRT+VBT in ensuring loco-regional control and achieving comparable survival rates, with fewer toxic effects for patients with stage I intermediate- and high-risk endometrial carcinoma. The dose escalation did not make a difference in the survival rates and was like in the other major trials (PORTEC-2).

A Histomorphological Study of Carcinoma Endometrium Conducted in a Tertiary Care Centre

A Histomorphological Study of Carcinoma Endometrium Conducted in a Tertiary Care Centre

Clinical comparison between double primary carcinoma of ovary or endometrium and ovarian metastasis in endometrial cancer

Objective To investigate the clinical and pathologic features, and prognosis of patients with double primary carcinoma of ovary or endometrium and ovarian metastasis in endometrial cancer. Methods The clinical pathological data of 23 female patients with double primary carcinoma of ovary or endometrium (group A), and 25 female patients with ovarian metastasis in endometrial cancer (group B) from Shanxi Province Tumor Hospital from January 2008 to January 2015 were analyzed retrospectively. Chi-square test was used to compare the count data. Results The results showed significant differences in the morbidity before and after menopause, the primal symptom, the type and grade of pathology, the invasion of myometrium, seroperitoneum and lymphatic metastasis between the two groups (P 0.05). There was no obvious advantage of CA125 and HE4 in identifying the double primary carcinoma of ovary or ovarian metastasis in endometrial cancer (P > 0.05). The significant difference was not found in the involvement of cervix of both groups. Conclusions The significant difference in the clinical and pathologic features between the two groups plays a key role in the preoperation diagnosis and treatment guiding. The prognosis of double primary carcinoma of ovary or endometrium is better than that of ovarian metastasis in endometrial cancer. Key words: Endometrial neoplasms; Ovarian neoplasms; Neoplasms, multiple primary

Inadequately Staged Endometrial Cancer: a Clinical Dilemma.

A retrospective case series of 20 women with postoperative diagnosis of endometrial cancer, who had undergone completion staging. A gynaecologic oncology unit in a tertiary level hospital in Tamil Nadu, India. Electronic medical records of patients who underwent completion staging between January 2011 and December 2014 for endometrial cancer were reviewed. Two hundred and sixty four women with endometrial cancer were evaluated during this period. Twenty women with carcinoma endometrium, with a mean age of 53 (range 31-67) who were previously inadequately staged, were found to be at risk of extrauterine disease, following histopathological review, consented to undergo completion staging over an average of 57days (range 30-91) following the initial surgery. Forty-five percent (9/20) had a BMI of more than 30, and 40% (8/20) had metabolic syndrome. The most common indications for the initial surgery were perimenopausal abnormal uterine bleeding and postmenopausal bleeding. Only eight patients had a pre-hysterectomy endometrial sampling/biopsy (40%) of whom, one had a pre-operative diagnosis of carcinoma endometrium. Sixteen (80%) had pathological risk factors for lymph nodal involvement and in the others, besides histological grading, surgicopathological details for risk assessment were unavailable. Adnexae were retained in 11, and uterus was bisected/cored during surgery in three women. Following completion staging, 5/20 (25%) patients were upstaged, 9 (45%) required no adjuvant treatment, 5 required vaginal brachytherapy therapy alone and 5 were advised chemotherapy and radiation. Two patients during the study period of 48months had disease recurrence, and two women died of disease progression. Complications of surgery included the following: iliac vein injury (1) and bladder injury (1). Patients with incidental diagnosis of endometrial cancer following hysterectomy after clinical and radiological assessment and histopathological review, should be offered completion staging, if at risk for extrauterine disease. Completion staging permits appropriate prognostication of disease and thereby allows tailoring of adjuvant treatment, avoiding risks of overtreatment and undertreatment.

Role of Intraoperative Frozen Section in Defining the Extent of Surgery in Endometrial Carcinoma: An Indian Experience

Purpose The role of frozen section in the intraoperative decision making about the extent of surgical staging is controversial. The study was undertaken to evaluate the role of the frozen section and its agreement to histopathology in determining the tumor grade and depth of the tumor invasion in carcinoma endometrium at our center.

Abstract 4482: Osteopontin, p53 and PTEN isoforms expression patterns in endometrium carcinoma cell lines

Abstract Total osteopontin (OPN) is overexpressed in endometrium carcinoma (EC) and modifications at TP53 and PTEN genes correspond to major genetic alterations in these tumors. Althought total OPN expression has been correlated to p53 and PTEN expression, no data is available regarding OPN splice variants and their association to p53 and PTEN isoforms expression. OPN has three splicing isoforms (OPN-SI), named OPNa, OPNb and OPNc, while p53 has at least 12 variants, such as p53 (full lenght), p53β, p53γ, Δ40p53, Δ133p53 and Δ160p53. Moreover, PTEN splicing isoforms (PTEN-SI) are named vs-fl (full lenght variant), vs-3a-3c, vs-5a-5d, and vs-D6. We aimed to evaluate the expression profile of OPN, p53 and PTEN isoforms as a first approach to establish their presumptive associations and functional interactions in endometrial tumoral and non tumoral cells. Total RNA has been extracted from endometrial non-tumoral (E6/E7 and EM42) and tumoral (Ishikawa, RL95-2, AN3CA and KLE) cell lines, followed by cDNA synthesis. Transcriptional and protein expression patterns have been evaluated for OPN, p53 or PTEN isoforms, using quantitative real time PCR, immunoblot or immunofluorescence. OPNa is overexpressed in tumoral and non-tumoral cell lines in relation to OPNb and OPNc. Regarding p53, the full lengh isoform is overexpressed, followed by Δ40p53, in relation to other variants in EC cells. Conversely, Δ40p53 it is the major expressed transcript in both EM42 and E6/E7 non-tumoral cells. Otherwise, in EC and endometrial non-tumoral cells, PTEN vs-fl isoform is overexpressed in relation to the other splice variants. Specifically in E6/E7 cells, all PTEN-SI, except vs-3b e vs-D6, are overexpressed in relation to EC cell lines. At the protein level, both p53 and PTEN isoforms are overexpressed in E6/E7 cells, when compared to EC cells. Of note, distinct isoforms for most of these variant transcripts have not been detected at the protein level. Our data demonstrate that full lenght OPN, p53 and PTEN are the major expressed variants in EC tumor cell lines. However, most of these transcript variants display differential expression between endometrial tumor and non-tumoral cells and also among distinct EC cell lines. These data provide early evidence that these variants can differently modulate the expression and functional roles of their full length couterparts. Further work should investigate the impact of OPNa overerexpression on p53 and PTEN isoforms and their putative cellular and molecular roles on modulating p53 and PTEN tumor supressive roles. Citation Format: Vanessa F. Franco, Nataly dos Santos Melo, Iaci N. Soares, Ya-Ting Hsu, Ya-Ting, Tim H. Huang, Wallace M. Araujo, José A. Morgado-Diaz, Jerson L. Silva, Etel Rodrigues Pereira Gimba. Osteopontin, p53 and PTEN isoforms expression patterns in endometrium carcinoma cell lines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4482. doi:10.1158/1538-7445.AM2017-4482

Diagnostic hysteroscopy in abnormal uterine bleeding: a five years study in Kathmandu university hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Abnormal uterine bleeding is the cause of concern, inconvenience and discomfort to many ladies, this affects millions of women in both developed and developing world. Until recent times, dilatation and curettage was the usual method of evaluation .This detects the cause of bleeding in less than 50% of the cases, but hysteroscopy is a better diagnostic modality and prompt treatment can be provided in the same setting.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was carried out in the Department of Obstetrics and Gynecology at Dhulikhel hospital, Kathmandu University Hospital, Kavre, Nepal from January 2010 to January 2016. Two hundred and eighteen cases were enrolled in this study. Patients with abnormal uterine bleeding above the age of 18 years were enrolled. Hysteroscopic examination was done in all patients after the pregnancy was ruled out with urine pregnancy test and ultrasonology. The patients then underwent hysteroscopic guided endometrial sampling and endometrium was sent for histopathologic examination. The correlation between findings on hysteroscopy and histopathologic examination was tabulated. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Following were the findings on hysteroscopy: proliferative endometrium was in 59%, secretary endometrium was in 14%,endometrial hyperplasia in 12%, atrophic in 2 %, endometrial polyp in 7%, submucous myoma in 5% and carcinoma of endometrium in 1%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In patients with abnormal uterine bleeding, hysteroscopy provides more accurate diagnosis than dilatation and curettage&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;

Synchronous Primary Carcinoma of Cervix and Endometrium

Introduction: Synchronous primary tumours in the female genital tract are rare. Even rarer are the synchronous tumours involving the cervix and endometrium . We describe a rare case of cervical squamous cell carcinoma and endometrial endometrioid adenocarcinoma in a 62-year-old woman . Case report A 62-year-old female presented with post menopausal bleeding for 4 months duration. Per vaginal examination showed a cervical growth . Magnetic resonance imaging revealed a mass in the cervical region and extension into the body and fundus of the uterine cavity. Radical hysterectomy(Type III hysterectomy) was done. The pathology revealed synchronous occurrence of primary neoplasms of squamous cell carcinoma of the cervix and adenocarcinoma of the endometrium. Conclusion Synchronous malignancies of endometrium and cervix are rare. Surgical treatment is radical surgery- Type 3 hysterectomy with bilateral pelvic lymph node dissection. The knowledge of occurrence of synchronous primaries is needed to plan appropriate adjuvant treatment. DOI: 10.21276/APALM.1073

Immunohistochemical expression of galectin-3 is significantly associated with grade, stage and differentiation of endometrial carcinomas

This study describes galectin-3 immunohistochemical phenotype and its association with clinicopathological factors in the carcinoma of endometrium. Seventy one cases of endometrial carcinoma and 30 cases of benign and normal endometrium were employed for the detection of galectin-3 protein using tissue microarrays and immunohistochemistry staining. Thirty nine (55%) cases, including 54.2% of endometrioid adenocarcinomas and 55.5% serous carcinomas, were positively stained for galectin-3. Brown granular expression of this glycoprotein was detected in transformed epithelial cells of 36 cases including 28 cases with membranous and cytoplasmic staining and 8 cases with only cytoplasmic staining; nuclear expression was present in stromal cells of the remaining 3 cases. Twenty-four (80%) control cases showed granular cytoplasmic and membranous expression, and six control cases were negative. Tumor grade, stage and differentiation were significantly associated with galectin-3 immunoreactivity (p-values are 0.043, 0.016, and 0.044 respectively), cases with membranous and cytoplasmic staining is significantly associated with grade I and stage II, while cases with loss of staining are more frequent in grade II, III and poorly differentiated tumors. No significant association of galectin-3 staining was observed with age, diagnosis, recurrence and alive status. The current study supports the tumor suppression role of galectin-3 in endometrial carcinoma. Greater galectin-3 immunostaining has been found in control endometrial tissues compared to endometrial tumors. Loss or decreased galectin-3 immunoexpression gives a sign for poor prognoses in endometrial carcinoma patients.