Endometrial Carcinoma In Women Research Articles

Cost effectiveness of pembrolizumab plus lenvatinib compared with chemotherapy for treating previously treated advanced endometrial cancer in Sweden

Objective Pembrolizumab plus lenvatinib was recently approved for the treatment of advanced or recurrent endometrial carcinoma in women with disease progression on or following prior treatment with a platinum‑containing therapy in any setting, and who are not candidates for curative surgery or radiation (KEYNOTE-775/Study-309; NCT03517449). The objective was to assess the cost effectiveness of pembrolizumab plus lenvatinib compared with chemotherapy from a Swedish healthcare perspective. Materials and methods A lifetime partitioned-survival model with three health states (progression free, progressed disease, death) was constructed. Chemotherapy was represented by paclitaxel or doxorubicin. Overall survival, progression-free survival, time on treatment, and utility data were obtained from KEYNOTE-775 (database lock: March 1, 2022). Costs (in 2020 Swedish Krona [SEK]) included drug acquisition and administration, health state, end of life, adverse event management, subsequent treatment, and societal (scenario analysis). Outcomes were calculated as quality-adjusted life-years (QALY) and life-years. Model results were presented as incremental cost-effectiveness ratios for all-comers, patients with proficient mismatch repair tumors, and deficient mismatch repair tumors. Deterministic and probabilistic sensitivity analyses were conducted. Results Pembrolizumab plus lenvatinib is a cost-effective treatment when compared with chemotherapy, with estimated deterministic and probabilistic incremental cost-effectiveness ratios of SEK 795,712 and 819,757 per QALY gained. Pembrolizumab plus lenvatinib was associated with a large incremental QALY and life-year gain per person versus chemotherapy over the model time horizon (1.49 and 1.76). Limitations Time-to-event data were incomplete and semiparametric and parametric curves were utilized for lifetime extrapolation. Willingness-to-pay thresholds, costs, and utility weights vary by country, which would vary the treatment’s cost effectiveness in different countries. Conclusions This partitioned survival analysis suggests that pembrolizumab plus lenvatinib is cost effective compared with chemotherapy in Sweden for women with advanced or recurrent endometrial carcinoma following previous systemic therapy. Results were robust to mismatch repair status and to changes in parameters/assumptions.

Incidence and outcomes of incidental endometrial carcinoma in women undergoing hysterectomy for pelvic organ prolapse (2147)

Incidence and outcomes of incidental endometrial carcinoma in women undergoing hysterectomy for pelvic organ prolapse (2147)

318 The role of 2D ultrasound, 3D ultrasound and 3D doppler in the diagnosis of endometrial cancer in women with uterine bleeding

Introduction and aims of the study: This systematic review aims to assess the diagnostic accuracy of three modalities in the prediction of endometrial carcinoma in women with post-menopausal or other abnormal uterine bleeding, as well as the accuracy of different diagnostic parameters, such as endometrial thickness, volume and vascular indices. Methods: Articles relevant to our research question were sought in the Web of Science, Scopus, MEDLINE/PubMed and Wiley Online Library databases, using a systematic approach in the search end evaluation for inclusion, as described in the PRISMA 2020 guidelines.

HISTOPOTHOLOGICAL STUDY OF ENDOMETRIALCARCINOMA IN WOMEN WITH POSTMENOPAUSAL BLEEDING

Postmenopausal bleeding represents one of the most common reasons for referral to gynecological services, largely due to suspicion of an underlying endometrial malignancy. The objective of this study is to find the prevalence of endometrial carcinoma in women with post-menopausal bleeding and to study the histopathology of endometrial carcinoma. Materials And Methods:A three and half years retrospective (May 2010 to Oct 2013) and one and half year prospective study (Nov 2013 to April 2015) of all D&C and hysterectomy specimens of patients presenting with postmenopausal bleeding were undertaken in the department of Pathology, KIMS Hubballi. Results:In our study out of 122 cases of postmenopausal bleeding there were 22 cases of endometrial carcinoma. In 22 cases 21 were endometrial adenocarcinoma 1 case was carcinosarcoma. Majority were in 56 to 65 years. There were various histopathological patterns showing endometriatype, endometroid type with papillary differentiation, squamousdifferentiation, mucinous differentiation and 1 case showingcarcinosarcoma. Majority ,18 cases (85.7%) were in Grade I, 2 cases (9.5%) were in Grade II and 1 case was in Grade III. Out of 22 cases 15 cases were hysterectomy specimen,7 cases were curettage samples. In 15 cases ,2 cases were confined to uterus (Stage IA),9 cases (60.6%) were stage IB,1 cases were stage IC.There was 1 case in in stage IIA with involvement of endocervicalmucosa, there were 2 cases in stage III with each showing involvement of bilateral ovaries(Stage IIIA) and bilateral pelvic lymph nodes (Stage IIIC).In our study there were 1cases of carcinosarcoma in stage IB in the age group 55 years. Hence postmenopausal bleeding is a dreaded and alarming symptoms and requires complete evaluation in order to ensure the absence of malignancy and to identify and treat high risk patients.

Diagnostic accuracy of uterine artery and spiral artery Doppler for evaluation of endometrial pathology in postmenopausal bleeding

IntroductionTraditional diagnostic workup for Endometrial carcinoma in women with post-menopausal bleeding (PMB) involves endometrial biopsy. Addition of colour and power Doppler ultrasound to transvaginal ultrasonography (TVS) might help in differentiating subset of women who are at high risk of carcinoma. The aim of this study was to determine the diagnostic value of Pulsatility Index (PI) and Resistance Index (RI) of uterine and spiral artery in PMB and to determine the diagnostic value of power Doppler flow mapping in them. Material and methodsA prospective study was done amongst 50 women with PMB. All women were subjected to TVS including uterine artery and spiral artery Doppler velocimetry, power Doppler flow mapping of spiral artery, hysteroscopy and endometrial biopsy. ResultsUterine artery PI and RI values were overlapping between benign and malignant endometrial pathologies. Whereas spiral artery PI ≤ 0.33 and RI ≤ 0.5 helps in differentiating malignant frombenign pathology. Power Doppler multiple vessel pattern is also found to have a better diagnostic ability in picking endometrial cancer. ConclusionAddition of spiral artery velocimetry and power Doppler flow mapping to those with thickened endometrium, aids in differentiating endometrial malignancy from benign pathology. This might be helpful in counselling the women for endometrial biopsy, as histopathological analysis is the gold standard diagnostic modality.

Risk Factors for Endometrial Carcinoma in Women with Postmenopausal Bleeding.

Most patients with postmenopausal bleeding do not have endometrial cancer. The primary objective was to evaluate risk factors for endometrial cancer among postmenopausal women with bleeding. This was a retrospective cross-sectional study. Women with postmenopausal bleeding presenting to a gynecology clinic were included in the study. Data on potential risk factors for endometrial cancer or atypical hyperplasia were collected. Univariate and multivariate analyses were performed to assess the risk factors. Among 212 women studied, 24 (11.3%) women had endometrial cancer. There were 38 (17.9%) with cervical cancer and 3 (1.4%) with ovarian cancer. Women 55 or older had an odds ratio of 7.5 (95% CI 2.2 to 26.2) as compared to women below 55years (p value = 0.002). Women with 2 or more episodes of postmenopausal bleeding had an odds ratio of 4.9 (95% CI 1.1 to 23.0) and those who had either diabetes or hypertension had an odds ratio of 3.1 (95% CI 1.3 to 7.4) of endometrial cancer as compared to those who did not. A third of patients with postmenopausal bleeding had a gynecological cancer. Age, frequency of bleeding, diabetes and hypertension, and increased endometrial thickness were independent risk factors for endometrial cancer.

Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Objective: The objectives of the study were to identify the common causes of post menopausal bleeding, benign and malignant causes of post menopausal bleeding and also the identification of risk factors for endometrial carcinoma in women with postmenopausal bleeding. Study Design: Cross sectional survey. Setting: Fauji Foundation Hospital Rawalpindi. Period: August 2018 to January 2019. Material & Methods: A total of 224 women with post menopausal bleeding were included in this study. Data was collected through the self structured questionnaire in which we have included patient’s demographics, risk factors of Post menopausal bleeding and risk factors of endometrial carcinoma. Histopathological investigations of endometrial sampling were done for identification of benign and malignant causes of post menopausal bleeding. Results: Mean age of the women was 59.17 years and mean parity was found to be 2.24. Out of 224 patients 106(47.3%) women had their menopause in duration of 6 to 10 years while 75(33.9%) had menopause in time duration of first 5 years showing high frequency trend of post menopausal bleeding in first ten years duration after menopause. Out of 224 patients 30(13.4) were of normal weight, 94(42.0) were overweight while 100(44.6) were obese according to BMI criteria. Endometrial carcinoma was found in 40 women with post menopausal bleeding. Among them age at menarche was found to be 9 to 13 years in 27(67.5%) patients while more than 13 years in 13(32.5%) women. Age at menopause was found more than 55 years in 20(50%) patients while less than 55 years also in 20(50%) patients. Personal history of breast carcinoma was reported in 6(15%) similarly family history was also found in 6(15%) women. Family history of CA endometrium was observed in 3(7.5%). History of PCOs was also observed in 5(12.5) patients. Menstrual irreguraity in perimenopausal period was found in 18(45%) patients with endometrial CA. Nulliparity was reported in 21(52.5%) patients. 12(30%) were on estrogen use while 4(10%) were on Tamoxifen use. Conclusion: Diabetes Mellitus and Hypertension were observed as common risk factors for post menopausal bleeding. Endometrial Carcinoma, cervix carcinoma and Hyperplasia with atypia were common malignant causes while endometrial polyp and fibroid uterus were commonly found benign causes of post menopausal bleeding. Early menarche, menopausal duration of more than one year, obesity and diabetes mellitus were common risk factors for endometrial carcinoma.

Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women with Postmenopausal Bleeding

Background: Postmenopause is defined as the permanent cessation of menstruation for one year due to failure of the ovarian follicular activity. Objective: This work aimed to study the role of endometrial thickness measured by transvaginal sonography in the detection of endometrial carcinoma in women with postmenopausal bleeding. Patients and Methods: A cross-sectional study was conducted on 120 women with postmenopausal bleeding admitted to the Obstetrics & Gynecology Department at Zagazig University hospitals through the period from September 2018 to September 2019. All cases were subjected to full history, full clinical examination, transvaginal sonography, and diagnostic endometrial biopsy which was taken for histopathological examination. We exclude premenopausal women and postmenopausal patients in HRT. Results: This study showed TVS evaluation of ET of the studied cases ranged from 1 to 20 mm with a mean of 9.65 mm. Also, 48.3% of the cases had endometrial thickness more than 10 mm, 34.2% had less than 5 mm, and 17.5% had from 5 to 10mm.that 34.2% of the studied cases had atrophic endometritis, 26.7% had an endometrial polyp, 17.5% had simple hyperplasia, 7.5% had atypical hyperplasia and 14.2% had endometrial adenocarcinoma. Conclusions: Transvaginal sonography evaluation of endometrial thickness is not sensitive enough to detect cancer of the endometrium and therefore couldn't replace histological evaluation of the endometrial tissue in women with postmenopausal bleeding.

Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women with Postmenopausal Bleeding

Background: Postmenopause is defined as the permanent cessation of menstruation for one year due to failure of the ovarian follicular activity. Objective: This work aimed to study the role of endometrial thickness measured by transvaginal sonography in the detection of endometrial carcinoma in women with postmenopausal bleeding. Patients and Methods: A cross-sectional study was conducted on 120 women with postmenopausal bleeding admitted to the Obstetrics & Gynecology Department at Zagazig University hospitals through the period from September 2018 to September 2019. All cases were subjected to full history, full clinical examination, transvaginal sonography, and diagnostic endometrial biopsy which was taken for histopathological examination. We exclude premenopausal women and postmenopausal patients in HRT. Results: This study showed TVS evaluation of ET of the studied cases ranged from 1 to 20 mm with a mean of 9.65 mm. Also, 48.3% of the cases had endometrial thickness more than 10 mm, 34.2% had less than 5 mm, and 17.5% had from 5 to 10mm.that 34.2% of the studied cases had atrophic endometritis, 26.7% had an endometrial polyp, 17.5% had simple hyperplasia, 7.5% had atypical hyperplasia and 14.2% had endometrial adenocarcinoma. Conclusions: Transvaginal sonography evaluation of endometrial thickness is not sensitive enough to detect cancer of the endometrium and therefore couldn't replace histological evaluation of the endometrial tissue in women with postmenopausal bleeding.

English

BACKGROUND Concurrent carcinoma endometrium occurs in around 40 % of hysterectomy specimen done for premalignant endometrial intraepithelial neoplasia. We intend to study the prevalence of coexisting endometrial cancer in patients who were diagnosed with endometrial hyperplasia with atypia and had undergone hysterectomy. METHODS This cross-sectional study conducted at Government Medical College, Thrissur, included all women with a pre-operative diagnosis of endometrial hyperplasia with atypia (WHO) undergoing hysterectomy during the study period. RESULTS A total of 40 women were found to have atypical endometrial hyperplasia in the study period. The mean age of presentation was 51 ± 2. 7 yrs. and was more common in multiparous postmenopausal women. Postmenopausal bleeding was the most common presenting symptom and more than 50 % of women were overweight. The proportion of concurrent endometrial carcinoma in women with atypical endometrial hyperplasia was found to be 37. 5 %. 93 % of cases with concurrent endometrial carcinoma were of grade I endometrioid type. High risk features were defined as > 50 % myometrial invasion, seen in 47 % patients. Stage 2 endometrial carcinoma was seen in 27 % patients. 53 % patients had less than 50 % myometrial invasion. Stage 1a and 1b endometrial carcinoma was seen in 53 % and 20 % of patients respectively. CONCLUSIONS Large dicer of overlap exists between atypical endometrial hyperplasia (AEH) and early-stage endometrial carcinoma. Therefore, we should recognise the limitation of endometrial sampling in distinguishing between these two groups. KEYWORDS Atypical Endometrial Hyperplasia, Endometrial Carcinoma, Endometrial Sampling

Assessment of Endometrial Thickness by TVS for Detection of Endometrial Carcinoma in Women with Post-Menopausal Bleeding

Objective: The aim of this study is to evaluate the role of endometrial thickness for detection of endometrial carcinoma in women with post-menopausal bleeding by use of Transvaginal ultrasound. Method: In this systematic review database by Medline, PubMed, science direct and Obsgyne online library were queried for studies published between 2005 to 2020 by using specific MeSH terms. Abstract from original peer-reviewed prospective Cohort studies that shows endometrial thickness with postmenopausal bleeding by specific ultrasound findings were included in this study. Results: Clinical data were extracted from 14 studies in which approx. 2500 women included with post-menopausal bleeding and 215(8.6%) cases were diagnose with endometrial carcinoma that shows endometrial thickness greater than 10mm on Transvaginal ultrasound. The prevalence of endometrial cancer was high in patients who had endometrial thickness >9.5 mm. Women with PMB that diagnose with EC had ET was 10 to 16mm.Women with PMB less than 4mm ET not diagnosed with EC. Conclusion: In this reviewed study we concluded that women with PMB showing ET greater than 10mm on Transvaginal ultrasound diagnosed with Endometrial carcinoma. Keywords: Endometrial Thickness (ET), Endometrial carcinoma (EC), Post-menopausal bleeding (PMB), Transvaginal Ultrasound (TVS). DOI: 10.7176/JHMN/82-11 Publication date: November 30 th 2020

Development and Validation of a Serum Metabolomic Signature for Endometrial Cancer Screening in Postmenopausal Women

Endometrial carcinoma (EC) is the most commonly diagnosed gynecologic cancer. Its early detection is advisable because 20% of women have advanced disease at the time of diagnosis. To clinically validate a metabolomics-based classification algorithm as a screening test for EC. This diagnostic study enrolled 2 cohorts. A multicenter prospective cohort, with 50 cases (postmenopausal women with EC; International Federation of Gynecology and Obstetrics stage I-III and grade G1-G3) and 70 controls (no EC but matched on age, years from menopause, tobacco use, and comorbidities), was used to train multiple classification models. The accuracy of each trained model was then used as a statistical weight to produce an ensemble machine learning algorithm for testing, which was validated with a subsequent prospective cohort of 1430 postmenopausal women. The study was conducted at the San Giovanni di Dio e Ruggi d'Aragona University Hospital of Salerno (Italy) and Lega Italiana per la Lotta contro i Tumori clinic in Avellino (Italy). Data collection was conducted from January 2018 to February 2019, and analysis was conducted from January to March 2019. The presence or absence of EC based on evaluation of the blood metabolome. Metabolites were extracted from dried blood samples from all participants and analyzed by gas chromatography-mass spectrometry. A confusion matrix was used to summarize test results. Performance indices included sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy. Confirmation or exclusion of EC in women with a positive test result was by means of hysteroscopy. Participants with negative results were followed up 1 year after enrollment to investigate the appearance of EC signs. The study population consisted of 1550 postmenopausal women. The mean (SD) age was 68.2 (11.7) years for participants with no EC in the training cohort, 69.4 (13.8) years for women with EC in the training cohort, and 59.7 (7.7) years for women in the validation cohort. Application of the ensemble machine learning to the validation cohort resulted in 16 true-positives, 2 false-positives, and 0 false-negatives, and it correctly classified more than 99% of samples. Disease prevalence was 1.12% (16 of 1430). In this study, dried blood metabolomic profile was used to assess the presence or absence of EC in postmenopausal women not receiving hormonal therapy with greater than 99% accuracy.

The Value of Endometrial Volume as Estimated by Three-Dimensional Ultrasound for Detecting Endometrial Cancer in Postmenopausal Women: A Systematic Review and Meta-Analysis

Objective: To analyse the diagnostic performance of endometrial volume calculated by three-dimensional (3D) ultrasound for diagnosing endometrial carcinoma in women with postmenopausal bleeding. Methods: An extensive search of papers analysing the role of endometrial volume calculated by 3D ultrasound for diagnosing endometrial carcinoma in women with postmenopausal bleeding was performed in MEDLINE/PubMed and Web of Science from January 1996 to January 2020. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: The extended search identified 318 citations but after exclusions, eight articles wereincluded in the meta-analysis. The risk of bias for most studies was high for the four domains assessed in QUADAS-2. Overall, after excluding three studies that contributed significantly to heterogeneity, pooled estimated sensitivity and specificity for diagnosing endometrial cancer were 87% (95% confidence interval: 80–92%) and 60% (95% confidence interval: 51–68%), respectively. Heterogeneity was low or moderate. Conclusion: Endometrial volume as estimated by 3D ultrasound using virtual organ computer-aided analysis (VOCALTM) software has a moderate diagnostic performance for detecting endometrial malignancy in women with postmenopausal bleeding.

How accurately can you suspect endometrial carcinoma in PMB?

Endometlial carcmoma is the second commonest gynaecological carcinoma worldwide, which is more frequently present as postmenopausal bleeding in early stages. Evaluation of endometrial thickness by 2D and 3D transvaginal ultrasonography, saline infusion sonography, MRI, blind and hysteroscopic guided endometiial biopsy are the investigations available to evaluate postmenopausal bleeding. Many studies has been conducted to assess and compare the accuracy of each investigation and found to have differences in sensitivity, specificity and predictive values on diagnosing endometrial malignancies. Therefore, systematic analysis of symptoms, risk factors and supportive investigations will give a better prediction of endometrial carcinoma in women presenting with postmenopausal bleeding.

Can vaginal ultrasound replace diagnostic curettage in the detection of endometrial pathology in post-menopausal bleeding?

Background and objective: Post-menopausal bleeding due to endometrial abnormalities is a common diagnostic challenge facing the ultrasonogists and referring gynecologists. This study aimed to detect the validity of transvaginal ultrasound to detect endometrial pathologies and its sensitivity and specificity for determining endometrial carcinoma in women with postmenopausal bleeding. Methods: A diagnostic accuracy study of transvaginal ultrasound and diagnostic curettage was conducted for evaluation of endometrial pathology in the College of Medicine, Hawler Medical University from October2016to January 2018. The sample size included 55 women with post-menopausal vaginal bleeding. The ultrasound findings were compared with histopathological results of endometrial biopsy. Results: Out of 55 women, 49.09% had endometrial atrophy, 29.09% had endometrial hyperplasia, 16.36% had endometrial polyp, 3.64% had endometrial carcinoma, and 1.82% had hyperplasia with atypia according to histopathological findings. The sensitivity of ultrasound in detecting cancer was 66.7%, the specificity was 100%, the positive predictive value (PV) was 100%, and the negative predictive value was 98.1%. The total agreement rate was 98.2%. Conclusion: Transvaginal ultrasound is an excellent diagnostic tool to determine whether further investigation with histopathological examination of endometrial biopsy is necessary for postmenopausal vaginal bleeding.

EP15.14: Endometrial carcinomas in women with polycystic ovary syndrome: sonohysterographic findings

To describe the sonohysterographic features of endometrial carcinomas in women with polycystic ovary syndrome (PCOS) and to determine the diagnostic role of sonohysterography (SH) in the evaluation of these lesions. SH findings of 52 PCOS patients with histologically confirmed endometrial carcinomas were evaluated. The mean age was 33.5 years (range 22-45 years). Histology included endometrioid type in 51 cases and Grade 1 in 46 cases, and 46 patients was stage IA. 23 Patients had high dose progestin treatment and 29 patients undergo surgery. SH demonstrated the endometrial thickening in 39 cases, endometrial mass in 6 cases, and endometrial thickening with mass in 7 cases. The endometrial thickness ranged from 5.5 to 27 mm (mean 9.6 mm) and the mass size ranged from 2 to 4.3 cm. They appeared as a diffuse polypoid endometrial thickening and a sessile endometrial mass with an inhomogeneous hyperechogenicity, an irregular surface, and obliteration of endometrial cavity. The tumour involved only to the endometrium in 35 cases and there were superficial myometrial invasion in 15 cases, deep myometrial invasion in 2 cases, and cervical invasion in 4 cases. The SH features of endometrial carcinomas associated with PCOS included a diffuse polypoid endometrial thickening and a sessile endometrial mass with an inhomogeneous hyperechogenicity, an irregular surface, obliteration of the cavity, and absent myometrial invasion. SH may provide more diagnostic value in the evaluation of endometrial carcinomas in women with PCOS. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Risk of Serous Endometrial Carcinoma in Women With Pathogenic BRCA1/2 Variant After Risk-Reducing Salpingo-Oophorectomy.

It has recently been shown that the risk of a rare subtype of endometrial carcinoma (serous type) in women carrying a germline BRCA1/2 pathogenic variant is increased. We assessed the incidence of serous endometrial carcinoma in an independent prospective cohort study of 369 BRCA1/2 women (1779 woman-years of follow-up) who underwent risk-reducing salpingo-oophorectomy by laparoscopy. This occurrence in two BRCA1 carriers led us to estimate that BRCA1/2 carriers present a higher risk than the control population (standardized incidence ratio = 32.2, 95% confidence interval = 11.5 to 116.4, P < .001, two-sided chi-square test, 1 degree of freedom). In addition, in both tumors, the wild-type BRCA1 allele was lost, indicating the inactivation of the BRCA1 gene and arguing for a link with endometrial carcinogenesis. Prophylactic hysterectomy could be discussed with informed women through a shared decision-making process although the estimated 3% life-long risk is moderate. Additional studies are required to establish future prophylactic surgery guidelines.

Sonohysterographic Findings of Endometrial Carcinomas in Women with Polycystic Ovarian Disease

To describe the sonohysterographic features of endometrial carcinomas in women with polycystic ovarian disease (PCOD) and to determine the diagnostic role of sonohysterography (SH) in the evaluation of these lesions. SH findings of 48 PCOD patients with histologically confirmed endometrial carcinomas were evaluated. The mean age was 33.5 years (range 22-45 years). Histology included endometrioid type in 47 cases and Grade 1 in 43 cases, and 43 patients was stage IA. 20 Patients had high dose progestin treatment and 28 patients undergo surgery. SH demonstrated the endometrial thickening in 35 cases, endometrial mass in 6 cases, and endometrial thickening with mass in 7 cases. The endometrial thickness ranged from 5.5 to 27 mm (mean 9.6 mm) and the mass size ranged from 2 to 4.3 cm (mean 2.9 cm). They appeared as a diffuse polypoid thickening and a sessile mass with an inhomogeneous hyperechogenicity, an irregular surface, and obliteration of the cavity. The tumor involved only to the endometrium in 32 cases and there were superficial myometrial invasion in 14 cases, deep myometrial invasion in 2 cases, and cervical invasion in 3 cases. The SH features of endometrial carcinomas associated with PCOD included a diffuse polypoid endometrial thickening and a sessile endometrial mass with an inhomogeneous hyperechogenicity, an irregular surface, obliteration of the cavity, and absent myometrial invasion. SH may provide more diagnostic value in the evaluation of endometrial carcinomas in women with PCOD.

Expression of DNA mismatch repair protein in endometrial carcinomas and its correlation with clinicopathologic features

To study the expression of mismatch repair protein in a series of endometrial carcinomas and its correlation with clinicopathologic features. The clinical data of 150 consecutive cases of endometrial carcinoma were collected during the period from December, 2014 to August, 2015 in Fudan University Cancer Center. Morphologic features including tumor infiltrating lymphocytes (TIL), peritumoral lymphocytes and tumor heterogeneity were reviewed. Immunohistochemistry for expression of mismatch repair proteins was performed. The correlation with clinicopathologic features was analyzed. Loss of mismatch repair protein expression was observed in 43 cases (28.7%), including loss of MLH1/PMS2 in 27 cases (18%), loss of MSH2/MSH6 in 7 cases (4.7%), loss of MSH6 in 6 cases (4%) and loss of PMS2 in 3 cases (2%). There were 23.3% and 27.1% of mismatch repair protein-deficient endometrial carcinomas in women under and above 50 years of age, respectively, which was not statistically significant. Amongst the 12 cases with family history of tumors, 4 of the 6 mismatch repair protein-deficient cases were under 50 years of age, which was higher than that in the 6 cases with mismatch repair protein expression (P=0.014). The mismatch repair protein-deficient group showed significantly more prominent TIL and peritumoral lymphocytes than protein-expression group (P=0.033 and <0.001). Moreover, there were also significant differences in depth of myometrial invasion and occurrence of synchronous malignancy (2 cases of ovarian clear cell carcinoma and 1 case of colonic carcinoma) between the two groups (P=0.039 and 0.022). However, there were no significant differences in lymph node metastasis, tumor heterogeneity, lower uterine segment involvement and tumor stage between the two groups. Prominent TIL and peritumoral lymphocytes characteristically occur in mismatch repair protein-deficient endometrial carcinomas. Patient age does not significantly correlate with the loss of mismatch repair protein expression, but individuals under 50 years of age are more likely to have no expression if there is family history of tumors.

ENDOMETRIAL CARCINOMA

Background: Bleeding from the reproductive tract in women is a naturallyoccurring event, generally the result of menstruation and childbirth, and is not associated with ableeding disorder in most cases. Dysfunctional uterine bleeding is the most common reason forwomen to undergo an interventional gynecologic procedure. The major task of the clinician is toexclude endometrial carcinoma in women and to identify organic pathology in order to manageit effectively. Objective. To determine the incidence of endometrial carcinoma in women withabnormal uterine bleeding. Study Design: Cross sectional study. Setting. Department ofObstetrics and Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan. Duration of study: Sixmonths (16th February 2013 to 15th August 2013). Material and method: One hundred andsixteen women with complaint of abnormal uterine bleeding, meeting the inclusion criteria wereselected. All the patients were undergone endometrial sampling and assessment of endometrialthickness was done which was confirmed by endometrial biopsy to evaluate endometrialpathologies. The collected data was noted on pre-designed proforma. Results: The mean agewas 42.07 years. According to parity, 56 women (48.2%) have 1-4 parity, 48 women (41.4%)have 5-8 parity and 12 women (10.4%) have 9-14 parity. The mean duration of dysfunctionaluterine bleeding was 14.64±7.87 months. Six women (5.2%) have endometrial carcinoma while110 women (94.8%) have no endometrial carcinoma. Conclusion: This study thus proved thatin our setup the incidence of endometrial carcinoma is very high. So every patient with abnormaluterine bleeding should undergo endometrial biopsy to rule out endometrial carcinoma.