Cases Of Endometrial Carcinoma Research Articles

Expression of neurotensin receptor 1 in endometrial adenocarcinoma is correlated with histological grade and clinical outcome.

The promalignant effects of neurotensin (NTS) are sustained in many solid tumors, including hormone-dependent cancers. As the endometrium is also subjected to hormonal regulation, we evaluated the contribution of NTS to endometrial carcinogenesis. Neurotensin receptor 1 (NTSR1) expression and NTSR1 promoter methylation (HM450) were analyzed in 385 cases of endometrial carcinoma from The Cancer Genome Atlas (TCGA). Additionally, from a series of 100 endometrial carcinomas, and 66 benign endometrium samples, NTS and NTSR1 labeling was evaluated by immunohistochemistry. Using TCGA series, NTSR1 messenger RNA (mRNA) level was negatively correlated with overall survival (OS) and progression-free survival (PFS) (p=0.0012 and p=0.0116, respectively), and positively correlated with the grade (p=0.0008). When including only endometrioid carcinomas, NTSR1 mRNA level continued to be negatively correlated with OS (log-rank: p<0.0001) and PFS (log-rank: p=0.002). A higher NTSR1 mRNA level was significantly associated with a loss of NTSR1 promoter methylation. Immunohistochemical expression of NTS and NTSR1 was significantly increased in adenocarcinoma (n=100), as compared to benign endometrium (p<0.001). NTSR1 expression was positively correlated with grade (p=0.004). High immunohistochemical expression of cytoplasmic NTSR1 was significantly correlated with a shorter OS and PFS (p<0.001 and p=0.001, respectively). This correlation remained significant when excluding non-endometrioid subtypes (p=0.04 and p=0.02, respectively). In multivariate analysis, the expression of NTSR1 was an independent prognostic factor (p=0.004). NTSR1 overexpression is a poor prognostic factor in endometrial cancer, highlighting the contribution of NTS in endometrial cancer progression and its uses as a prognostic marker, and as a potential therapeutic target.

Tamoxifen gynecological side effects

Prospective comparative study done in basrah maternity and child hospital over a period of two years from 2002- 2004 , on breast cancer patients treated with tamoxifen which is estrogen receptors modulators with paradoxical effects ( agonist on some tissue and antagonist on others. This study aimed To compare side effect of tamoxifen on both studied groups Premenopausal and postmenopausal.This study included96 Symptomatic pre and postmenopausal breast cancer treated patients with tamoxifen assassed by history and then examination was performedThen endometrium assessed by transabdominal ultrasound to check thickness then almost all patients subjected to endometrial biopsy under general anesthesia, about 45.8% of patients between 50-60 years of age 41.6% of patients had advanced stages of cancer , vaginal bleeding which is the most common symptom symptoms presented in 68.7% ,while 22.8% , 8.28% had vaginal discharge and pain respectively.ultrasound findings showed 22.9% endometrial thickness less than 6mm , 41.6% endometrial thickness 1 cm and more ,10.3% showed polyps and fibroid . no statistical difference between pre and postmenopausal inUSS findings with p value = 7.81, x2= 13.7, df=321.2% showed atrophic endometrium, 16.9% showed endometrial hyperplasia , bulk 44.6% showed non secretory ( proliferative) , with no cases of endometrial carcinoma . No, statistical difference between pre and postmenopausal findingsP value = 9.49 , x2 8.652 , df= 4 .In conclusion the main sharing symptoms in both groups was vaginal bleeding, USS had a poor predictive value in detecting changes in both studied groupOur study did not confirm risk of endometrial carcinoma , with no statistical difference in risk of hyperplasia between pre and postmenopausal studied groups.

Assessment of DNA Ploidy in the ProMisE molecular subgroups of endometrial cancer

ObjectiveWe sought to determine whether DNA ploidy correlates with the four molecular subgroups of endometrial carcinoma (EC) as determined using ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer). Methods90 cases of EC previously characterized by clinicopathological parameters, outcomes, and ProMisE molecular subgroup (POLE EDM, MMR-D, p53 wt or p53 abn) were assessed for DNA ploidy using image cytometry. Associations of ploidy with traditional clinicopathological parameters were also tested. ResultsAbnormal DNA ploidy status differed amongst the ProMisE groups (p<0.001) and was found in 80.9% (17/21) of p53 abn, 37.0% (10/27) of p53 wt, 28.6% (4/14) of POLE EDM and 14.3% (4/28) of MMR-D. Abnormal DNA content was significantly associated with lower BMI (p=0.034) and grade 3 tumors (p=0.001). In the entire cohort, abnormal DNA content was significantly associated with worse progression free survival (p=0.0094) but not disease specific survival (p=0.249) or overall survival (p=0.187). When examining ploidy within each of the ProMisE groups, abnormal DNA content correlated with worse overall survival (p=0.041) and progression free survival (p=0.011) in the MMR-D group. No statistically significant relationship was seen in the remaining 3 groups. ConclusionAbnormal DNA ploidy status did correlate with the molecular subgroups of EC; abnormal DNA content was seen in the large majority of p53 abn cases. Abnormal ploidy however was also seen in smaller numbers in the p53 wt, POLE EDM and MMR-D groups; therefore abnormal DNA content was not a specific marker for any one molecular group. The addition of ploidy to the ProMisE molecular categories conferred additional prognostic value within the MMR-D group, which merits further study.

Altered PTEN expression as a diagnostic marker for the earliest endometrial precancerous changes

Introduction: Study was planned to investigate PTEN gene expression in endometrial hyperplasia and carcinoma as analyzed by immunohistochemistry. Material and Method: This study was conducted on 80 endometrial samples in the Department of Pathology, Gandhi Medical College, Bhopal (January 2012 to August 2016) Results: 5 out of 5 cases of proliferative endometrium, 3 out of 5 cases of secretory endometrium, 37 [84%] out of 44 cases of simple and complex endometrial hyperplasia without atypia, 8 out of 15 cases of simple and complex endometrial hyperplasia with atypia and 3 out of 11 cases of endometrial carcinoma showed positive PTEN expression. Conclusion: PTEN is a major gene involved in the pathogenesis of endometrial carcinoma. Our data suggest that decreased PTEN expression was a marker of earliest endometrial pre-cancer lesion and we propose that use of PTEN immunostaining in a clinical setting may be informative in identifying premalignant lesions that are likely to progress to carcinoma.

Advanced Ultrasound Technology and Its Application to Gynecologic Practice [11P

INTRODUCTION: In 2015, the American Journal of Obstetrics and Gynecology published an opinion supporting ultrasound as the first-line imaging choice in obstetrics and gynecology. Recent advances in 3D gynecologic ultrasound, which includes volumetric calculation and Power Doppler Angiography (PDA) have expanded the practical functionality and diagnostic ability for complex gynecologic conditions. The authors seek to demonstrate this with a case series, comparing the imaging results and the clinical value obtained. METHODS: The described case series includes: 1) Case of missing/broken/embedded IUD complication: located and characterized with 3D gynecologic ultrasound; 2) Case of deeply invasive endometriosis: characterized with 3D gynecologic ultrasound; 3) Improved mapping of uterine fibroids for definitive surgical treatment: characterized by 3D gynecologic ultrasound; 4) Case of endometrial cancerous polyp in a 28 year old, identified with 3D, PDA, volumetric calculation, histogram and Vascularity Index (VI); 5) Case of endometrial carcinoma after negative biopsies: diagnosed via 3D gynecologic ultrasound; 6) Case of an intramural ectopic pregnancy: diagnosed and managed with 3D, PDA, volumetric calculation, histogram and VI. RESULTS: Our case series demonstrates the substantial clinical benefit this modality offers over traditional 2D ultrasound, as well as CT and MRI. Each case shows a unique application of advanced ultrasound technique in gynecologic practice. CONCLUSION: Advances in gynecologic ultrasound are underutilized in current practice. Gynecologists should be aware of the availability and benefits that can result from the use of these advances.

Risk of Occult Endometrial Cancer During Hysterectomy for Benign Indications [14H

INTRODUCTION: Recent attention regarding the use of power morcellation highlighted concerns regarding occult uterine sarcomas. However, sarcomas comprise only 3% of uterine cancers. The vast majority of malignancies are endometrial in origin and are more reliably diagnosed preoperatively than sarcomas. We sought to estimate the frequency of occult endometrial cancer in women undergoing benign hysterectomies. METHODS: We performed a retrospective review of all patients undergoing hysterectomies for benign indications at our institution from 2006‒2014. A departmental database was used to identify all hysterectomies performed, and institutional tumor registry was used to identify cases of endometrial carcinoma. Occult carcinomas were defined as cases with no suspicion preoperatively and histopathologic diagnosis of endometrial cancer postoperatively. RESULTS: A total of 6,981 hysterectomies were performed. Thirteen patients (0.19%) were found to have occult endometrial cancer, with an overall rate of 1 in 537 patients (95% confidence interval 1:314‒1:1,008). Twelve patients had stage IA and one had stage IB disease. Median age of women with endometrial cancer was 50 years (range 35-72 years). The mean Body Mass Index was 32.6 ± 9.2 kg/m2. Most common indication for hysterectomy were abnormal bleeding (47%), then postmenopausal bleeding (15%). Cases included nine abdominal hysterectomies, two laparoscopic hysterectomies, and two vaginal hysterectomies. One specimen was manually morcellated during vaginal hysterectomy. CONCLUSION: This is one of the largest single institution cohorts to examine occult malignancy. Occult endometrial carcinomas are more common than occult uterine sarcomas, and were found to occur in 1:537 (0.19%) hysterectomies for benign indications in our population.

Hypermethylation of WIF1 and its inhibitory role in the tumor growth of endometrial adenocarcinoma.

Endometrial carcinoma is the most common malignancy of the female genital tract and is the fourth most common malignancy among women worldwide. Endometrial adenocarcinoma (EAC) accounts for ~80% of endometrial carcinoma cases. Numerous critical genetic events have been determined to serve an essential role in EAC progression; however, the precise molecular mechanisms underlying EAC progression remain unclear. Pyrosequencing and methylation-specific PCR were used to detect the methylation status of Wnt inhibitory factor 1 (WIF1). Immunohistochemistry and western blot were used to detect the expression of WIF1, Wnt family member 1 and other related pathways. The anticancer role of WIF1 in EAC was investigated in vitro and in vivo. Two of the three EAC cases exhibited significantly high methylation in five CpG sites, and the WIF1 methylation rate in EAC and endometrial tissues was 43.4 and 8%, respectively (P<0.05). The kappa consistency coefficient was −0.369 between methylation and mRNA expression (P<0.05) and WIF1 expression levels were significantly downregulated in EAC tissues compared with non-tumorous tissues (P<0.01). The 5-year overall survival rates were significantly lower for patients with tumors that negatively expressed WIF1 when compared with the 77.9% exhibited by those with positive WIF1 expression. Furthermore, the proliferation rate of KLE cells was significantly reduced following 5-aza-20-deoxycytidine treatment or WIF1 overexpression in vitro and in vivo, which may be associated with downregulated c-Myc and phosphorylated-extracellular signal-regulated kinase expression. These results demonstrated the important role of WIF1 in EAC tumorigenesis, and suggested that WIF1 may be a potential drug target in EAC treatment.

Histo-Pathological Study of Endometrial Biopsies in Patients With Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding is a common sign of a number of different uterine disorders ranging from dysfunctional (non organic) abnormalities or complications of pregnancy to organic lesions such as polyps, hyperplasia or carcinoma. Methods: This is a retrospective study conducted at Hospital of 2nd author during a period of 5 years (Jan 2008-Dec 2013). Histopathology records were retrieved and searched for cases of abnormal uterine bleeding. Relevant histopathological findings and clinical data were recorded and analyzed. The aim of the study was to determine the causes for abnormal uterine bleeding in women presenting to the hospital and to compare the histopathological findings at various age groups.Results: The age of patients ranged from 17 to 71 years with an average of 43 years. The most common cause of uterine bleeding was found to be proliferative phase endometrium; that were 649 cases (56.43%). Out of the pathological causes, the most common cause was found to be endometrial hyperplasia- 44 cases (3.82%). Endometrial carcinoma was found to be more common in the elderly postmenopausal women. A total of 6 cases (0.5%) of endometrial carcinoma were present.Conclusion: Endometrial hyperplasias and malignancies are common in increasing age group, especially in perimenopausal and postmenopausal women. So, a thorough work-up and diagnostic endometrial biopsy is therefore mandatory without delay in these patients to rule out malignancies.

Cyclin D1 is significantly associated with stage of tumor and predicts poor survival in endometrial carcinoma patients.

Cyclin D1 overexpression has been described to have oncogenic role and association with diagnosis, prognosis and survival in various tumors. This study will describe the immunohistochemical phenotype of cyclin D1, and investigate the correlation between these patterns of expression and clinicopathological parameters of endometrial carcinomas, to conclude the clinical relevance of cyclin D1 expression in the evolution of endometrial neoplasms. This study employed 101 endometrial tissue samples which include 71 endometrial carcinomas and thirty normal and benign endometrium cases. All these tissue samples were used in the assembly of tissue microarrays which have been utilized afterward in immunohistochemistry staining to detect cyclin D1 expression. Forty (56.3%) cases of endometrial carcinomas showed brown nuclear expression of cyclin D1 including 36 (61%) cases of endometrioid carcinomas, and 3 (33.3%) cases of serous carcinomas. Twenty three (76.6%) cases of control group demonstrated nuclear expression. High score cyclin D1 immunohistochemical staining has been significantly linked with patient age (P=0.0001). Large proportion of high score cyclin D1 immunohistochemical staining was observed in females who are <40years of age while high proportions of negative staining were observed in older age groups. Histologic type of tissue was also significantly related to cyclin D1 immunohistochemical staining (P-value=0.0001), high staining is more common in normal proliferative and secretory endometrium while serous carcinoma is more prevalent with negative staining. Stage of tumor was significantly associated with cyclin D1 immunohistochemical staining (P-value=0.029), proportion of stage III and IV are higher in negative cyclin D1 immunostaining. Significantly higher proportion of high score cyclin D1 immunostaining is observed in controls while higher proportion of negative cyclin D1 immunostaining is observed among carcinoma cases (P-value=0.0001). No significant associations between cyclin D1 immunohistochemical staining and grade, recurrence and alive status were observed. Significant different survival distributions were observed (P-value=0.011) and poor survival behavior was correlated with negative cyclin D1 immunohistochemical staining. In conclusion, greater frequency of cyclin D1 expression was revealed in normal endometrial tissues in comparison with carcinomas. The distribution pattern of cyclin D1 immunoexpression suggests poor prognoses in endometrial carcinoma patients.

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.

Immunohistochemical Study of ER, PR, Ki67 and p53 in Endometrial Hyperplasias and Endometrial Carcinomas.

Endometrial carcinoma is the second most common gynecologic malignancy in the developing countries. Endometrial Hyperplasia (EH) is a precursor to Endometrioid Adenocarcinoma (EMAC). A 23% of Atypical Hyperplasias (AEH) progress to EMAC. This study was undertaken to analyse ER, PR, p53 and Ki67 in EH and endometrial carcinomas and attempt correlation with clinical and histopathological findings. The present study was conducted over a period of seven years. A manual tissue array technique was employed for cases subjected to IHC. Analysis of the expression of IHC markers (ER, PR, p53, Ki67) in EH and endometrial carcinoma was attempted. Results were subjected to statistical analysis. The results were considered to be significant when the p-value <0.05. A total of 85 cases of EH and 28 cases of endometrial carcinoma were included in the study. EH (75.22%) was more common than endometrial carcinoma (24.78%). Among 28 cases of endometrial carcinomas, EMAC was most common (78.57%) followed by Clear Cell Carcinoma (CCC) (14.28%), and Uterine Serous Carcinoma (USC) (7.14%). ER and PR expression decreased as lesion progressed from EH to EMAC. ER and PR expression was negative in USC and CCC. The p53 expression and mean Ki67 labelling index increased as the severity of lesion increased from EH to endometrial carcinoma. The ER, PR, p53, Ki67 IHC markers may be included in every case of endometrial carcinoma to understand the tumour biological behavior which in turn could help individual treatment strategies.

Value of H-TERT and CD10 in differentiating endometrial carcinoma from atypical endometrial hyperplasia: an immunohistochemical study

Context The histopathological differentiation between atypical endometrial hyperplasia and well-differentiated conventional endometrial carcinoma is sometimes tricky, particularly in endometrial dilatation and curettage specimens, to the extent that a differentiating marker is sought. Aim This study was devoted to evaluate the immunohistochemical expression of CD10 and human telomerase reverse transcriptase (H-TERT) in atypical endometrial hyperplasia and endometrial carcinoma to determine their role in differentiating both lesions. Patients and methods Thirty paraffin blocks of endometrial biopsy distributed as 15 cases of atypical endometrial hyperplasia and 15 cases of conventional endometrial carcinoma were studied immunohistochemically using antibodies against CD10 and H-TERT. Data were represented as mean, SD, and percentage. The Fisher exact test was used to compare immunoexpression between atypical endometrial hyperplasia and endometrial carcinoma. The Mann–Whitney U-test and the Kruskal–Wallis test were used to compare between the two marker expressions in both lesions. The one-way analysis of variance test was used to determine whether the difference was significant. A P-value of less than 0.05 was considered significant. Results A statistically significant difference was observed between CD10 and H-TERT expression in both lesions, but only H-TERT significantly correlated with international federation of gynecology and obstetrics (FIGO) tumor grades in endometrial carcinoma cases. Although H-TERT labeling index upregulates with CD10 weaker expression, the relation between the two markers was not significant. Conclusion Both CD10 and H-TERT may be involved in the progression from the atypical endometrial hyperplasia to endometrial carcinoma as well as to differentiate between the two lesions. However, only H-TERT may be associated with the prognosis of endometrial carcinoma.

Postablation Endometrial Carcinoma.

Background:Many women have undergone both resectoscopic and nonresectoscopic (or global) endometrial ablation (EA) during the past 20 years. These women are now approaching their sixth and seventh decades of life, a time frame in which endometrial carcinoma (EC) is most frequently diagnosed.Database:In several reports, surgeons have expressed concern that endometrial ablation may leave a sequestered island of EC that may escape detection, possibly delaying its diagnosis or causing it to appear at an advanced stage. Others suggest that EA artifact does not hinder the evaluation and treatment planning in the presence of EC. Data bases used are from Medline and PubMed.Discussion:We introduce 6 new cases of postablation endometrial carcinoma (PAEC), 4 of which occurred after the introduction of global endometrial ablation (GEA) techniques. In addition, we examine several key questions regarding the impact of EA on the subsequent development of EC, including the manner in which PAEC presents, the efficacy of traditional diagnostic modalities, the ablation-to-cancer interval, and the stage of PAEC at the time of diagnosis. Finally, we explore the use of reoperative hysteroscopic surgery (RHS) as a diagnostic modality and address the possible role ultrasound surveillance as a screening method for women at risk of EC.

Morphometric and DNA Image Analysis of Endometrial Hyperplasia and Carcinoma.

Endometrial hyperplasia is believed to increase the risk of endometrial carcinoma and represents a spectrum of morphologic and biological alterations of endometrial glands and stroma ranging from an exaggerated physiological state to carcinoma in situ. Considering the overlap between the various entities, it is not surprising that the morphologic assessment of endometrial lesions is particularly challenging. This work aimed to evaluate endometrial lesions according to their nuclear and glandular morphometric parameters, their D score, and their DNA ploidy, which help in making an accurate diagnosis. In this study, 50 endometrial biopsy specimens were stained with hematoxylin and eosin for their histopathologic and morphometric study and Feulgen stain for DNA analysis. The cases were classified into 20 cases of simple hyperplasia, 10 cases of atypical hyperplasia, and 20 cases of endometrial carcinoma. Morphometric analysis of nuclear, glandular, and stromal parameters was performed using the Leica Qwin 500 image analysis system. In the studied cases, a significant difference was found in the mean values of the morphometrical parameters of endometrial lesions, including the nuclear area and the nuclear roundness, and all glandular measurements including their complexity, area, volume percentage of stroma, and D score were significantly different. The DNA index and diploid and aneuploid values could differentiate significantly between endometrial lesions. We conclude that nuclear morphometric evaluation of the hyperplastic and carcinomatous endometrium may be used as an ancillary technique in the diagnosis of atypical changes occurring in precancerous endometrial lesions. In addition, DNA and D score assessment may be a reproducible and accurate predictor of the outcome of endometrial hyperplasia and may add some objective criteria for the correct diagnosis of difficult cases.

Association of the hormonal receptor status of endometrial carcinomas with the markers of tumor aggression: A comparison with similar studies in developed nations

Background: Endometrial carcinomas (EC) are the most common gynecological malignancy in developed nations, but in developing nations, it follows cervical cancer. Estrogen and progesterone receptor (ER and PR) status is important prognostic indicators in EC. With this in background, we intended to compare the hormonal receptor status of our cases with markers of tumor aggression and compare our results with that of developed nations. Aims: The present retrospective study aims to check the association of ER and PR status of cases of EC with markers of tumor aggression-tumor grade, MIB-1 score (proliferative index), depth of myometrial invasion, and incidence of nodal metastasis and to also compare status of our cases in developing nation with the studies of similar nature in the developed countries. Materials and Methods: The cases diagnosed in this tertiary care center over the past 2 years were evaluated. ER and PR status of cases in this retrospective observational study was performed using immunohistochemistry. The hormonal status of the cases was checked for its association with markers of tumor aggression. Results: A total of 34 cases were evaluated during the period of the study. The age of the cases ranged from 35 to 85 years. Mean age being 60.36 years. Twenty-four out of 34 (70.6%) cases were ER and PR positive. Significant association of positive hormonal status was found with lower histological grade (P = 0.01) and low MIB-1 score (P = 0.0009) while no association of hormonal status was found with depth of myometrial invasion and incidence of nodal metastasis. Conclusion: We conclude that positive ER and PR status is associated with lower histological grade and low MIB-1 score; however, our study in contrast to previous studies done in developed nations did not find any association with depth of myometrial invasion and incidence of nodal metastasis likely due to late access to treatment in our country when the disease had already advanced.

Histomorphological profile of uterine corpus malignancies: a single unit experience

Introduction Primary uterine malignancy (PUM) is a common malignancy amongst females worldwide. According to the National Cancer Incidence data (2007), the age- specific incidence rate of uterine corpus malignancy is 2.7 per 100 000 population in Sri Lanka. The aim of this study was to describe the frequency, clinicopathological and prognostic parameters of PUM. Methodology Hysterectomy specimens (49) and biopsies (05) of PUM received over two years were retrieved to collect demographic and morphological data. The tumours were categorized as epithelial, mesenchymal or mixed. Histological subtypes of epithelial tumours were classified as type 1(T1) or type 2 (T2). Prognostic markers including grade (1-3), stage (FIGO I-IV) and vascular invasion were recorded. The concomitant pathological changes such as endometrial hyperplasia and intra epithelial neoplasia were assessed. Results Fifty four PUM were included. The mean age at presentation was 59 years. There were 45 (83.3%) endometrial carcinomas (EC), 5(9.3%) uterine sarcomas, 2(3.7%) carcinosarcomas (CS) and 2(3.7%) choriocarcinomas. Of the EC, 86.6 % (39/45) were T1 and 11.1% (6/45) were T2. The majority of T1 EC was endometrioid adenocarcinoma (37/45), while 5/45 T2 tumours were serous papillary adenocarcinomas. Ten cases of T1 EC had associated simple (6/10) and complex (4/10) endometrial hyperplasia and 2 cases of T2 EC had intraepithelial carcinoma. Of the endometrioid carcinomas, 13.5% (5/37), 64.8% (24/37) and 21.6% (8/37) were grade 1, 2 and 3 respectively. 3/5 cases of uterine sarcomas were low grade. Of all resection tumours, 63.2% (31/49), 22.4% (11/49) and 14.2% (7/49)) were FIGO stage I, II and III respectively. Of the resected tumours 51.02%(25/49) had more than 50% of myometrial invasion and 46.93% (23/49) had vascular invasion. Conclusion T1 endometrial carcinoma was the commonest primary uterine malignancy. Overall, although the patients present at an early stage, they had unfavourable prognostic factors such as deep myometrial invasion, vascular invasion and high histological grade.

Factores de riesgo para carcinoma de endometrio de alto grado

Endometrial carcinoma (EC) has traditionally been divided into 2groups: type I, considered to have a good prognosis and to be oestrogen-dependent and type II, with a poorer prognosis and oestrogen-independent. The aim of the study is to analyse the risk factors associated with high-grade EC. Material and MethodsRetrospective multicentre cohort study in 3Spanish reference hospitals: Hospital Universitario Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Seville. We studied the presence of risk factors associated with high grade EC: G3 endometrioid (G3EC), serous carcinoma (SC), clear cell carcinoma (CCC) and malignant mixed mesodermal tumours (MMMT). Differences between subtypes were analysed depending on whether the EC was type I or II. A total of 373 cases of high-grade EC were included, of which 135 were G3EC or type I and 238 were type II (96 SC, 64 CCC and 78 MMMT). ResultsDiabetes, obesity, nulliparity and use of hormonal replacement therapy showed no significant difference between subtypes. MMMT was less frequently associated with hypertension and conversely it showed greater association with the use of tamoxifen. ConclusionsRisk factors associated with high-grade EC are similar in type I and II.

The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities.

BackgroundEven in the face of a substantial increase in the numbers of endometrial cancer cases and in the numbers of women who have risk factors, there is no clear agreement about the indications for assessing the endometria of women with abnormal bleeding or about the tools to use in that assessment. This study sought to determine in a group of high risk women with abnormal uterine bleeding, the probability that an outpatient endometrial aspiration would identify significant pathology.MethodsRetrospective cohort study of the histology from endometrial aspirations performed from 2001 to 2008 for abnormal uterine bleeding at Harbor-UCLA Medical Center and its satellite public health clinics. Medical records were reviewed in detail to assess risk factors, descriptions of bleeding abnormalities and histologic results.ResultsThe charts of 1601 women who underwent 1636 endometrial biopsies for a wide variety of abnormal uterine bleeding patterns yielded 73 (4.6 %) cases of endometrial carcinoma, 43 cases of atypical endometrial hyperplasia (2.7 %), for an overall yield of significant pathology of 7.2 %. Hyperplasia without atypia was found in another 83 cases (5.2 %). Obesity, diabetes and postmenopausal age are associated with an increased risk of significant pathology. Bleeding patterns were so poorly documented that analysis of yield by this factor should be viewed with caution.ConclusionsThe probability of detecting significant uterine pathology is greatest among obese, diabetic postmenopausal women with diabetes (26.3 %). Conversely, the probability of identifying significant pathology in younger women without risk factors is less than 2 %. For women who perceive their individualized risk estimate to be too small to justify an endometrial biopsy, it may be possible to offer oral higher dose progestin therapy on the condition that persistent abnormal bleeding will require more intensive evaluation. These estimates of absolute risk of being diagnosed with significant pathology on endometrial biopsy may be helpful to patients as they consider giving informed consent for the procedure.

Vaginal implantation metastasis of endometrial carcinoma: A case report.

Endometrial cancer is the most common malignancy of the female reproductive system. The three common spread patterns of endometrial cancer are local invasion, lymphatic spread and hematogenous spread. Vaginal metastasis occurs by submucosal lymphatic or vascular metastases in ~10% of patients with clinical stage I disease. Vaginal implantation metastasis of endometrial cancer is extremely rare. Here we present a case of endometrial carcinoma (International Federation of Gynecology and Obstetrics stage IA) spread to the vagina by implantation metastasis as opposed to any of the methods mentioned above. This conclusion was confirmed mainly from pathological examination. This case highlights the occurrence of vaginal implantation metastasis of endometrial carcinoma. Certain changes may be applied during surgery to prevent implantation metastasis in patients with endometrial cancer.

Paired boxed gene 1 expression: A single potential biomarker for differentiating endometrial lesions associated with favorable outcomes in patients with endometrial carcinoma.

Paired boxed gene 1 (PAX1) has previously been reported to be a methylation-silenced gene in cases of cervical and ovarian cancers. We evaluated the expression of PAX1 in normal endometrium, endometrial hyperplasia and endometrial carcinoma (EC), and investigated the prognostic value of PAX1 expression in patients with EC. We conducted a hospital-based retrospective review of PAX1 distribution immunohistochemically in 201 samples of endometrium from biopsy or hysterectomy. PAX1 immunoreactivity was classified into low and high score groups based upon the extent and intensity of staining. There was intense intranuclear staining for PAX1 in premalignant endometrial lesions. A high PAX1 score was observed in a high percentage of samples of normal endometrium (93.3%), in endometrial hyperplasia without atypia (97.2%) and in endometrial atypical hyperplasia (87.5%), but this level was found in only one-third of the EC samples (30.1%). The PAX1 protein score was significantly higher in samples of premalignant endometrial lesions compared with those of EC (P < 0.001). Importantly, a higher PAX1 score in EC cases was correlated with good overall survival, with a hazard ratio of 0.22 for death (95% confidence interval, 0.05-0.96). PAX1 protein expression is a potential histopathology biomarker for the differential diagnosis of malignant and premalignant endometrial lesions. PAX1 is also a potential prognostic marker in cases of EC.