Complex Endometrial Hyperplasia Research Articles

Аналіз клініко-епідеміологічних аспектів гіперпластичних процесів ендометрію жінок із застосуванням багато параметричної нейромережевої кластеризації

<p>Резюме . З метою підвищення ефективності діагностики гіперпластичних процесів ендометрія у жінок<br />перименопаузального віку було проведено ретроспективний аналіз 52 карт стаціонарного хворого жінок, які<br />перебували на лікуванні в гінекологічних відділеннях Тернополя і області. У відповідності з патогістологічним<br />висновком 1 групу склали 28 жінок з простою гіперплазією ендометрія, 2 групу – 24 жінки з комплексною гіперплазією<br />ендометрія. В групу порівняння увійшли 12 соматично здорових жінок. Середній вік хворих 1 групи – (47,0±1,0)<br />років, 2 групи – (56,0±1,5) років. З метою поглибленого аналізу показників застосовано багатопараметричну<br />нейромережеву кластеризацію. Встановлено, що до факторів ризику розвитку гіперпластичних процесів<br />ендометрія у жінок перименопаузального періоду належать неблагополучні соціально-економічні фактори:<br />проживання в сільській місцевості, тяжкі умови праці, шкідливі звички та обтяжений акушерсько-гінекологічний<br />анамнез, 3 і більше вагітностей, велика кількість (4 і більше) акушерсько-гінекологічних втручань, використання<br />внутрішньоматкової контрацепції. У жінок з різними видами гіперплазії ендометрія клімактеричний синдром<br />перебігав середньотяжко чи тяжко з нейровегатативними, ендокринно-обмінними та психоемоційними проявами.<br />Серед коморбідних станів найчастіше спостерігали дисгормональну патологію молочних залоз та порушення<br />гепатобіліарного тракту.<br />Ключові слова : гіперпластичні процеси ендометрія, клімактеричний синдром, перименопаузальний вік,<br />дисфункційні маткові кровотечі, коморбідні стани, нейромережева кластеризація.</p>

Hyperplastic processes of endometrium: what's new?

According to the extended today WHO classification (1994) there are simple and complex endometrial hyperplasia non-atypical; simple and complex atypical endometrial hyperplasia; adenocarcinoma. In numerous studies of the last decades it has been proven that the simple and complex non-atypical endometrial hyperplasia are the result of absolute or relative hyperestrogenism, and atypical endometrial hyperplasia is a progressive monoclonal mutational damage with the independent hormonal effects of local growth. With this in mind, it has been proposed the term “endometrial intraepithelial neoplasia” (EIN), which should be viewed as precancer. Based on this approach, EIN-classification also provides a simple and complex non-atypical endometrial hyperplasia interpreted as endometrial hyperplasia (endometrial hyperplasia), which is the result of estrogenic stimulation and, therefore, lends itself well to hormone therapy. In terms of diagnosis and treatment of endometrial hyperplastic processes the most appropriate are recommendations of the American College of Obstetrics and Gynecology (ACOG) and the Society of Gynecologic Oncology (SGO) at 2015: • preferred fencing material at hysteroscopy, separate diagnostic curettage (suspicious areas and all endometrium must be histological exanimated); • there are insufficient data on the efficacy of progestin therapy and monitoring the endometrial intraepithelial neoplasia; • in the progestin treatment it is need histological control every 3–6 months, 7–10 days after withdrawal bleeding; • supravaginal hysterectomy, morcellation, endometrial ablation are unacceptable in the case of endometrial intraepithelial neoplasia. In Ukraine, the treatment of endometrial hyperplasia regulated by the order of the Ministry of Health of Ukraine of 31.12.2004 № 676, which includes I stage – the removal of endometrial changes, followed by a morphological study. According to the recommendations of ACOG and SGO, the II stage of treatment of endometrial hyperplasia without atypia includes conservative therapy with progestins also permissible resectoscope endometrial ablation. Stage III involves the normalization of estrogen/progesterone ratio. The main method of treatment of endometrial hyperplasia with atypia, according to the ACOG and SGO recommendations, is total hysterectomy with/without adnexal.

The importance of age and menopausal status in endometrial complex hyperplasia with atypia

The effects of menopausal status and age on the intra-operative and post-operative pathology results of patients operated on with a pre-operative diagnosis of complex hyperplasia with atypia (CHA) were assessed. A hundred and eleven patients diagnosed in our centre between January 1993 and March 2013 were included. Cancer was detected in the paraffin blocks (PBs) of 52 (46.8%) patients. Among these, 50 patients had stage-IA disease. In 31.1% of the pre-menopausal patients and 66% of the post-menopausal patients, PB revealed cancer (p < 0.0001). The results of frozen section (FS) and PB were concordant in 51% and 70% in the pre-menopausal and post-menopausal patients, respectively (p = 0.041). In the patients operated on with a pre-operative diagnosis of CHA, the probability of detecting cancer in PB increases with increasing age and menopause. The reliability of FS is limited in younger and pre-menopausal patients.

Triage of Atypical Glandular Cell by SOX1 and POU4F3 Methylation: A Taiwanese Gynecologic Oncology Group (TGOG) Study.

IntroductionInvasive procedures including loop electrosurgical excision, cervical conization, and endometrial sampling are often recommended when atypical glandular cells (AGC) are detected on Pap smear with unsatisfactory colposcopy. These invasive procedures may result in patient anxiety, increased medical expense, and increasing the risk of preterm delivery in subsequent pregnancies. This study was performed to assess methylation biomarkers in the triage of AGC on Pap smear for invasive procedures.MethodsWe conducted a multicenter study in 13 medical centers in Taiwan from May 2012 to May 2014. A total of 55 samples diagnosed “AGC not otherwise specified” (AGC-NOS) were included. All patients with AGC underwent colposcopy, cervical biopsy, endometrial sampling, and conization if indicated. Multiplex quantitative methylation-specific polymerase chain reaction (QMSPCR) was performed. Sensitivity, specificity, and accuracy were calculated for detecting CIN3+ and endometrial complex hyperplasia.ResultsIn 55 patients with AGC, the sensitivity for methylated (m) SOX1m, PAX1 m, ZNF582m,PTPRRm, AJAP1m, HS3ST2m, and POU4F3m for detecting CIN3+ and endometrial complex hyperplasia lesions was 100, 86, 71, 86, 86, 57, and 100%; specificity was 67, 79, 85, 50, 52, 96, and 52%, respectively. Testing for high risk-HPV had a sensitivity of 57% and specificity of 75% for CIN3+ and endometrial complex hyperplasia lesions.ConclusionMethylated (m) SOX1m and POU4F3m could be new methylation biomarkers for detection of CIN3+ and endometrial complex hyperplasia in AGC. Women with AGC and positive SOX1m / POU4F3m, colposcopy, cervical conization or endometrial sampling should be considered.

Beyond fertility: The safety of ovarian preservation in women with complex endometrial hyperplasia with atypia

Objectives: To evaluate the safety of ovarian preservation in women undergoing surgical management of complex endometrial hyperplasia with atypia (CAH) and endometrial intraepithelial neoplasms (EIN).

OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ

Introduction : Characterized by tendency for delayed recurrences and good prognosis mostly, granulosa cell tumors represent the most common sex-cord stromal tumors of the ovary and form 2-3% of all ovarian cancers. Clinically, they are well-known for their potent estrogenic capacity and postmenopausal bleeding constitutes its most common clinical sign, which usually ensues following the prolonged exposure of the endometrium to estrogen released from the tumor. Therefore, estrogen-related endometrial anomalies are frequently encountered in patients with granulosa cell tumors. In this study we aimed to present the patients with granulosa cell tumors operated in our institution and to evaluate their endometrial findings in the light of a literature review. Material and methods: Endometrial findings of the patients who had been operated in the Obstetrics and Gynecology Department of Zeynep Kamil Training and Research Hospital were retrospectively analyzed. The pathological specimens belonging to the individual cases were re-evaluated and changes in the endometrium were noted. Endometrial findings were classified as endometrial cancer, endometrial hyperplasia (complex with/without atypia, simple with/without atypia), endometrial polyp, irregular proliferative endometrial layer and non-significant findings. Results: The analysis of 29 endometrial specimens has revealed endometrial polyp in 8 cases, irregular proliferative endometrium in 3 patients, endometrial hyperplasia in 7 cases and endometrioid adenocarcinoma in one patient. Among the patients diagnosed with endometrial hyperplasia 2 patients had complex endometrial hyperplasia with atypia, one had complex endometrial hyperplasia without atypia and 4 patients had simple endometrial hyperplasia without atypia. Neither the tumor differentiation grades nor the tumor diameters have demonstrated a correlation with the endometrial findings. Conclusion: Granulosa cell tumors are hormonally active, therefore they can give rise to endometrial pathologies leading to secondary symptoms and findings. Therefore when an adnexial mass is detected and a granulosa cell tumor is suspected, the evaluation of the patient should be extended for all endometrial pathologies

P4.08 - Expression of Epidermal Growth Factor Receptor in Human Endometrial Hyperplasia and Carcinoma

ABSTRACT According to researches, there are many discordant data about the prognostic significance of epidermal growth factor receptor in endometrium. The intensity of Epidermal Growth Factor Receptor (EGFR) expression in human endometrial hyperplasia and carcinoma was the focus of our study. 45 patients have been investigated clinically and morphologically. Of them, 27 patients of reproductive age, 8 patients of gestational age and 10 patients of postmenopausal period. Clinical examination revealed endometrial hyperplasia manifested by metrorrhagia in 35 (27 + 8) patients. For morphological study the material was collected by endometrial scrap. Histological and immunohistochemical studies were performed as well. The numeric data obtained were processed statistically using the SPSS-12 program. Based on the results, expression of epidermal growth factor receptor was diagnosed in 100% of the patients. Of them, mild EGFR expression was documented in 42.2% (p 0.1). In complex endometrial hyperplasia with atypia (only one case of atypical hyperplasia), EGFR was revealed with high intensity. The results of the study suggest that in complex hyperplasia mild EGFR expression predominates, while sharp EGFR expression is mostly typical of complex hyperplasia. At the same time, EGFR staining intensity increases with the severity of hyperplasia. With endometrial carcinoma (endometrioid carcinoma, adenocarcinoma), a drastic intensity of EGFR expression is observed.

Thermosensitive progesterone hydrogel: a safe and effective new formulation for vaginal application.

PurposeThe safe and functional delivery of progesterone through the vaginal route remains an unmet clinical need. The purpose of this work is to prepare a new progesterone (P4) gel for vaginal application using a thermosensitive mucoadhesive polymer, glycol chitin (GC).MethodThermogelling, mucoadhesive, mechanical, and viscoelastic properties of GC and the new formulation were evaluated using rheometry. In vitro release profile and the bioactivity of P4 were determined using vaginal fluid simulant (VFS) pH 4.2, and PR-reporter gene assay, respectively. In vitro safety of the formulations was tested using (VK2/E6E7) vaginal epithelial cell line and Lactobacillus Crispatus. Finally, in vivo safety and the efficacy of this formulation were evaluated using an endometrial hypoplasia mouse model.ResultsResults shows the aqueous solution of 5%; (w/v) GC loaded with 0.1%; (w/v) P4 prepared in pH 4.2, (GC-P4), forms a thermosensitive mucoadhesive hydrogel and can maintain stable physical properties at 37°C. GC-P4 gel release 50% of P4 in 4 h after exposure to VFS, and no significant decrease in % viability of VK2/E6E7 or Lactobacillus was found after exposure to 5% GC or GC-P4. GC-P4 does not exhibit obvious toxicities to vaginal tissue in vivo even after repeated application. Efficacy studies indicated that GC-P4 was capable of preventing the progression of simple endometrial hyperplasia (SEH) to complex atypical endometrial hyperplasia (CAEH) in vivo.ConclusionsResults indicates that GC-P4 retains many characteristics for an effective vaginal delivery system for P4. Therefore we believe that GC-P4 formulation is a promising alternative to current vaginal P4 formulation.Electronic supplementary materialThe online version of this article (doi:10.1007/s11095-014-1616-8) contains supplementary material, which is available to authorized users.

Concurrent endometrial carcinoma in hysterectomy specimens in patients with histopathological diagnosis of endometrial hyperplasia in curettage specimens.

The purpose of this study was to appraise the presence of Endometrial Carcinoma (EC) sequence in patients undergoing hysterectomy for Endometrial Hyperplasia (EH). Eighty-two patients undergoing hysterectomy with the indication of EH based on endometrial curettage between January 2009 and December 2013 were analyzed respectively All patients with a diagnosis of EH were investigated for age, parity history of diabetes mellitus and hypertension. The histopathology of the hysterectomy specimens were compared with their curettage specimens. A total number of 82 women; 48 (58.5%) postmenopausal and 34 (41.5%) premenopausal were determined to have EH on histopathological evaluation of endometrial tissues obtained by endometrial curettage performed for evaluation of various bleeding abnormalities. Mean-age of patients was 54.6?8.7. Among 82 patients found to have EH on curettage specimens 39 had EC on hysterectomy specimens (39/82. 47.5%). Consequently we determined well differentiated endometrial adenocarcinoma in 66% (35/53) of the patients with hyperplasia with atypia (17/35. 48.5% Grade 1 and 18/35.51.4% Grade 2) and 13.7% (4/29) hyperplasia without atypia (4/4.100% Grade 1). Postoperative diagnosis of endometrial pathology might be different from that of preoperative especially in cases with complex EH with atypia. Our study indicated that most of women diagnosed preoperatively with Atypical endometrial hyperplasia (AEH) may have a cancer at final examination of hysterectomy specimens. It may be useful to operate patients with AEH in specific centers because of invasive endometrial cancer risk in final histopathological evaluation.

Clinical significance of mismatch repair genes immunohistochemical expression of complex endometrial hyperplasia.

ObjectiveWomen with Lynch syndrome have an increased risk of developing colorectal and gynecologic malignancies such as endometrial cancer. Complex hyperplasia has about a 30% risk of developing into endometrial cancer. The aim of this study was to determine the genetic risk for developing endometrial cancer by immunohistochemical staining of premalignant lesions for mutL homolog 1, mutS homolog 2, mutS homolog 6, and postmeiotic segregation increased 2.MethodsTwenty cases (n=20) were selected from among patients with available sample blocks for analysis. Clinical information was obtained from medical chart review. Immunohistochemical staining was performed for all of the tumor blocks. Staining was scored based on the intensity (intensity score 0-3) .ResultsAmong the 20 cases of complex endometrial hyperplasia, 11 (55%) patients showed loss of expression of at least one of the following proteins: mutL homolog 1, mutS homolog 2, mutS homolog 6, or postmeiotic segregation increased 2. Seven (35%) patients were negative for the expression of two or more proteins, and one patient (5%) was negative for the expression of all four proteins.ConclusionMore than half of the patients showed loss of expression of at least one mismatch repair protein in our study population. Genetic risk counseling and further tests are recommended for these patients.

The investigation of complex endometrial hyperplasia prevalence by diagnostic curettage and some of riskfactors affiliated to it in ahvaz-razi hospital

The endometrial hyperplasia indicates the wide spectrum of limit variation of endometrial hyperplasia which has changed from intensification of physiological status to carcinoma. The endometrial hyperplasia is the introduction of the endometrial cancer, which is the most common female genital tract malignancy. Studies suggest that abnormal uterine bleeding is the most common indication of the endometrial hyperplasia that is performed for diagnosis of diagnostic curettage. With regard to the mentioned issue of this study, in order to identify factors associated with endometrial hyperplasia have been performed. This cross-sectional study has been performed on one thousand diagnostic curettage specimen’s from 1390 to 1393 (During the last three years) in RaziAhvaz hospital. The specimens based on the presence or absence of endometrial hyperplasia were divided into two groups. Then factors such as age, menstrual pattern, diabetes, hypertension, history of infertility, age over 45years, obesity, use of oral contraceptives were studied and compared. In this study of a thousand cases of diagnostic curettage, because of abnormal uterine bleeding in 160 patients(16%) complex hyperplasia, with factors such as oligomenorrhea38% vs.8/5 % (P 30 46% versus 18% (P<0/001), nulliparity 9% versus 1% (P<0/001) had significant relationship with endometrial hyperplasia. But there was no significant relationship with use of oral contraceptive. According to this study, women who were obese and have history of hypertension, diabetes, infertility, menstrual disorders as oligomenorrhea are at high risk for developing endometrial hyperplasia which at last leads to endometrial cancer.

O3-1-4 - Concentration of Blood Serum Melatonin in Patients with Simple and Complex Endometrial Hyperplasia

Background: The pineal hormone melatonin is involved in the circadian regulation and facilitation of sleep, the inhibition of cancer development and growth, and the enhancement of immune function. Additionally, these individuals are not only immune suppressed, but they are also at an increased risk of developing a number of different types of cancerThe goal of the present work was to study the levels of blood serum melatonin in patients with simple and complex endometrial hyperplasia.Methods: A total of 24 patients (aged from 38 to 55 years) with Complex Endometrial Hyperplasia were studied. Control group was represented by 19 patients (aged from 37 to 62 years) with the with Simple Endometrial Hyperplasia. Plasma levels of melatonin were estimated by liquid chromatography.Results: The results showed that mean levels of melatonin were observed to be by 29,33% (p< 0,01) higher in patients with simple endometrial hyperplasia (without atypia) as compared to those with complex endometrial hyperplasia (without atypia). The study demonstrated that with complex hyperplasia (without atypia) mean levels of serum melatonin were moderately reduced in contrast to simple hyperplasia (without atypia), which confirms anti-proliferative and anti-cancer action of melatonin, since complex endometrial hyperplasia (without atypia) represents a pre-stage to atypical hyperplasia while the latter is a pre-cancer condition.Conclusions: The results suggest that in clinical practice, with simple and complex endometrial hyperplasia (without atypia) administration of melatonin as anti-proliferative and pro-apoptotic drug considerably hinders further progression of disease and, to a certain extent, has a preventive effect against the development of uterus body cancer.

Treatment of simple and complex endometrial non-atypical hyperplasia with natural progesterone: response rate to different doses

The aim of this study is to evaluate the response rate to natural progesterone in non-atypical endometrial hyperplasia and to identify the lowest effective dose. A total of 197 patients of childbearing age with simple or complex hyperplasia were retrospectively identified. The women were treated with a cyclic administration of progesterone at different dosages (100 versus 200 versus 300 mg daily). Endometrial biopsies were performed at 6, 12, 18 months. In comparing progesterone to a regimen of no therapy, a significantly higher remission rate was observed in the progesterone group than in the latter (95 versus 75%, p = 0.05 for simple hyperplasia; 89 versus 35%, p < 0.001 for complex hyperplasia). Out of 60 women with simple hyperplasia, remission was observed in 9/11 (81.8%), 40/41 (97.5%) and 8/8 (100%) patients treated, respectively, with progesterone 100, 200 and 300 mg daily. Out of 72 women with complex hyperplasia, remission was observed in 3/5 (60%), 49/53 (92.4%) and 12/14 (85.7%) patients treated with progesterone 100, 200 and 300 mg daily, respectively. There was no statistically significant difference in the response rate in the two groups, neither with simple nor with complex hyperplasia. In conclusion, progesterone increased the regression rate of both simple and complex hyperplasia.

The outcome of infertility treatment in patients undergoing assisted reproductive technology after conservative therapy for endometrial cancer.

To elucidate the problems in infertility treatment for women after conservative therapy for endometrial cancer (EC) or atypical complex endometrial hyperplasia (ACEH). The clinical outcomes of 21 patients who underwent assisted reproductive technology after conservative therapy (group A) and 42 control women (group B) were retrospectively analyzed. There was no significant difference in the number of retrieved oocytes, fertilization rate or the number of transferred embryos between the two groups. Women in group A had a significantly thinner endometrium and a reduced implantation rate compared to those for women in group B. There was no significant difference in the cumulative clinical pregnancy and delivery rates between group A and B. The patients in group A required significantly more embryos for achieving a live-birth. Our results indicate that a thin endometrium after repeated curettage may have a negative effect on endometrial receptivity of patients after conservative treatment for EC/ACEH. Clinicians should reconsider their present protocols and make efforts to minimize the damage to normal endometrium.

Long-Term Clinical Outcomes Following Resectoscopic Endometrial Ablation of Non-Atypical Endometrial Hyperplasia in Women With Abnormal Uterine Bleeding

Study ObjectiveTo determine the feasibility, efficacy, and long-term clinical outcomes of resectoscopic endometrial ablation as primary treatment of simple endometrial hyperplasia (SH) and complex endometrial hyperplasia (CH) without atypia in women with abnormal uterine bleeding (AUB). DesignProspective follow-up study (Canadian Task Force classification II-2). SettingTeaching hospital. PatientsOne hundred sixty-one women with hyperplasia, either SH (n = 107) or CH (n = 54). InterventionsFrom January 1990 through December 2012, one of us performed 4729 primary resectoscopic endometrial ablation procedures in women with AUB. This group included 161 women with endometrial hyperplasia, identified either at office biopsy (n = 62) or incidentally during routine hysteroscopic endometrial ablation (n = 99). Endometrial tissue obtained at dilation and curettage and/or resected during resectoscopic surgery enabled identification of atypical hyperplasia in 6 patients (4 CH, 2 SH) and 1 patient with adenosarcoma. One patient with atypical CH and the patient with adenosarcoma underwent hysterectomy. The remaining 159 women, including 5 with atypical hyperplasia (3 CH, 2 SH), underwent resectoscopic endometrial ablation (102 SH, 52 CH) as primary treatment. Patient median age was 50 years (range, 30–87 years), and body mass index was 32 (range, 17–59). Comorbidities included hypertension in 25 patients, diabetes in 14, cerebrovascular disease in 3, cardiovascular disease in 7, and hypothyroidism in 8. Office biopsy demonstrated proliferative endometrium in 68 patients, SH in 43, CH in 19, and inadequate findings in 13. In 18 women, we were unable to perform biopsy because of cervical stenosis, morbid obesity, or patient intolerance. Endometrium was resected in 120 patients, electrocoagulated in 34, and a combination of procedures in 5, using a 9-mm (26F) resectoscope, 1.5% glycine, and 120W power. Patients were followed up annually. Three patients were lost to follow-up, and 1 died of an unrelated cause 5 years after surgery. Measurements and Main ResultsOne uterine perforation occurred, which required no additional treatment. After endometrial ablation, SH was identified in 70 patients, and CH in 35 patients. At a median follow-up of 7 years (range, 1.5–18), 12 patients underwent hysterectomy to treat persistent bleeding (n = 6), benign ovarian cyst (n = 2), pelvic organ prolapse (n = 1), chronic pelvic pain (n = 2), or myomas (n = 1). Uterine histopathology in 11 patients demonstrated no residual endometrial hyperplasia. We were unable to obtain a pathology report for 1 patient. The remaining 138 women were satisfied with the treatment, with no further bleeding or pain in 132 (95.7%). Six patients (4.3%) had monthly spotting. ConclusionWhen performed by surgeons experienced in hysteroscopy, resectoscopic endometrial ablation is feasible, safe, and effective for treatment of SH and CH without atypia in women with AUB.

Who should treat complex atypical endometrial hyperplasia?

Who should treat complex atypical endometrial hyperplasia?

Evaluation of a Levonorgestrel-Releasing Intrauterine System for Treating Endometrial Hyperplasia in Patients with Polycystic Ovary Syndrome

Objective: To evaluate the use of a levonorgestrel-releasing intrauterine system (LNG-IUS) for treating endometrial hyperplasia in patients with polycystic ovary syndrome (PCOS). Methods: LNG-IUSs were inserted in 60 PCOS patients with simple (40 cases), irregular (12 cases), or complex (8 cases) endometrial hyperplasia. Follow-ups were performed at 3, 6, 12, and 24 months after insertion. At each time point, changes in menstruation, hemoglobin level, and endometrial thickness and pathology were recorded. Menstrual changes were assessed with the Pictorial Blood Assessment Chart. Hemoglobin levels were measured by the Blood Routine Test. Endometrial thickness was determined by transvaginal ultrasound. Endometrial pathology was defined as simple, irregular, or complex endometrial hyperplasia by a pathologist after curettage. Outcomes at each time point were compared to baseline (pre-insertion) measurements by Student's t test or ANOVA (for multiple comparisons) with the post hoc Dunnett's test. Differences with a p < 0.05 were considered statistically significant. Results: At all time points after LNG-IUS insertion and in all patients, menstrual blood loss was decreased and hemoglobin level was increased significantly compared to pre-insertion levels. The endometrial thickness was significantly reduced in all groups after 12 months. Most patients showed transformation of the endometrial pathology, with complete disappearance of simple and irregular cases of endometrial hyperplasia and a decreased number of complex endometrial hyperplasia cases. Conclusions: LNG-IUS is an effective, safe, nonsurgical, and atraumatic approach with few side effects for the treatment of endometrial hyperplasia in patients with PCOS.

ATL

AT-rich interactive domain 1A (ARID1A) is a tumor suppressor gene that encodes the BAF250a protein. Recent studies have shown the loss of ARID1A expression in several types of tumors. We aimed to investigate the clinical and pathologic role of BAF250a in endometrial carcinoma. We examined the expression of BAF250a and its correlation with the expression of p53, estrogen receptor, progesterone receptor, glucocorticoid receptor, hypoxiainduciblefactor-1α, and vascular endothelial growth factor in normal and various malignant endometrial tissues. The expression of BAF250 was significantly down-regulated in endometrial carcinoma when compared with normal endometrial tissues. The loss of BAF250a expression was found in 25% of endometrial carcinoma samples but not in normal endometrial tissues, complex endometrial hyperplasia, and atypical endometrial hyperplasia samples. Subtypes of endometrial carcinoma, especially uterine endometrioid carcinoma and uterine clear cell carcinoma, had higher frequency of loss of BAF250a expression. In addition, the expression of BAF250a was positively correlated with estrogen receptor and negatively correlated with p53 in poorly differentiated endometrial adenocarcinoma. Moreover, the expression of BAF250a was significantly associated with the differentiation status of endometrial carcinoma but not associated with clinical stage, the depth of myometrial invasion, lymph node metastasis, and overall survival of patients with endometrial carcinoma. Our data showed that loss of BAF250a is frequently found in high-grade endometrioid and clear cell carcinomas but not in other types of endometrial carcinoma. The loss of BAF250a expression does not have prognostic value for endometrial carcinoma.

Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma

Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma

35. Clear cell carcinoma arising within an endometrioma

There is an increasing awareness that malignant transformation of endometriosis is an uncommon but distinct entity. We review one such case of a clear cell carcinoma arising within an endometrioma of a rectus sheath scar. These malignancies have a favourable prognosis, with extra-gonadal disease commonly associated with unopposed estrogen replacement therapy. Presentation A 56-year-old female presented to TQEH for management of post menopausal bleeding. She proceeded to undergo a hysterectomy and bilateral salpingo-oopgerectomy. She underwent a simultaneous excision of an endometrioma arising in a rectus sheath scar in the setting of previous endometritis. Her previous medical history is otherwise unremarkable with no other recorded malignancies or family history of endometrial adenocarcinoma. Findings 5-10% of the endometrium showed complex endometrial hyperplasia with secretory change. There was also a background of early mid-secretory change with corpus luteum formation in the right ovary. There were five intramural and subserosal leiomyomas (5-80mm in diameter) with no evidence of ovarian endometriosis. A single focus of cervical endometriosis was identified. Sectioning through the endometrioma from the rectus sheath showed a clear cell carcinoma arising in the setting of endometriosis. The tumour was ER negative, CK 7 positive, CK 20 negative and CDX2 negative. It measured 12 mm maximally with the closest soft tissue margin 3-4 mm. No origin from the ovaries or endometrium was identified. Conclusion Carcinoma arising in extra-ovarian foci of endometriosis is a rare but recognised phenomenon. Most of these tumours are either endometrioid or clear cell, as in this case. Radiation and/or chemotherapy is offered with favourable prognosis.