Endometrial Hyperplasia Group Research Articles

Clinical Correlations between Serological Markers and Endometrial Cancer.

Background: Endometrial cancer is associated with changes in blood cell counts and with high levels of inflammatory markers, thus reflecting the tumor's impact on various biological processes and suggesting their potential as biomarkers for endometrial cancer diagnosis, prognosis, and treatment response. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in peripheral blood sampled preoperatively from patients have been reported to be independently associated with the prognosis of different types of malignancies. Objectives: This study aimed to compare several blood markers-red blood cells, white blood cells, platelet parameters, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, C-reactive protein, and fibrinogen-in patients with benign or malignant endometrial tumors. Material and methods: Our retrospective study included 670 patients (192 diagnosed with endometrial cancer and 478 with endometrial hyperplasia), and we compared the serological parameters discussed above with those sampled the day before surgery. Results: Analysis of complete blood count indices revealed no significant differences in red blood cell or total white blood cell parameters between the endometrial cancer group and the endometrial hyperplasia group. However, a distinct pattern emerged in the white blood cell differential. The endometrial cancer group showed a statistically significant decrease in lymphocyte count compared with the endometrial hyperplasia group. In contrast, the endometrial cancer group showed significantly higher mean platelet counts and increased mean platelet volume compared with controls. Furthermore, the endometrial cancer group demonstrated a marked inflammatory response, as evidenced by significantly elevated levels of C-reactive protein, fibrinogen, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio compared with the endometrial hyperplasia group. Conclusions: The current research revealed statistically significant differences in multiple serological biomarkers between the two groups. These findings support the initial hypothesis regarding the potential utility of these biomarkers in endometrial cancer diagnosis, prognosis, and treatment response, highlighting the existence of biomarkers affordable for analysis under any health system, regardless of the country's level of development.

Investigation of Hyaluronan Synthase 2 and CD44 immune reactivity as a biomarker to predict Progesterone-Resistant Endometrial Hyperplasia without atypia: A retrospective case-control study.

In our study, the effect of hyaluronan synthase 2 (HAS2) and CD44 immunoreactivity as a predictive biomarker in the prediction of progesterone-resistant endometrial hyperplasia (EH) cases without atypia was investigated. In this retrospective study, HAS2 and CD44 immunoreactivity in the endometrial tissues of 60 patients diagnosed with EH and treated with progesterone and 20 patients diagnosed with proliferative endometrium (PE) were evaluated. Eighty patients were divided into four groups. Group 1 (G1) (n = 20) = PE group, G2 (n = 20) = EH group without atypia, G3 (n = 20) = group with continued EH with treatment, G4 (n = 20) = EH with treatment without atypia. Intergroup evaluation was done with One-way ANOVA and posthoc tukey test. P < 0.05 values were considered statistically significant. The HAS2 immunoreactivity score of G2 and G3 was higher than G1 and G4. On the other hand, there was no difference between G1 and G4. When G2 and G3 were compared, HAS2 immunoreactivity scores were significantly increased in G3. When CD44 immunoreactivity was compared with G1, a significant increase was detected in G2, G3, and G4. However, CD44 immunoreactivity scores were similar in G2, G3, and G4. HAS2 immunoreactivity may be an immunohistochemical biomarker in predicting EH cases without atypia resistant to progesterone therapy. Since CD44 immunoreactivity is increased in all EH groups without atypia, it is not effective in predicting treatment resistance.

Levonorgestrel-releasing intrauterine device to treat abnormal uterine bleeding; not one treatment option fits all.

Initially, medical treatment options are preferred in patients with abnormal uterine bleeding (AUB) who are hemodynamically stable. The aim of the present study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) in reducing bleeding symptoms in patients with AUB stratified by underlying pathology. In line with the polyp, adenomyosis, leiomyoma, malignancy (and hyperplasia), coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified classification system, patients who were administered LNG-IUD due to adenomyosis, endometrial hyperplasia, leiomyoma and AUB due to not otherwise classified causes were included in the study. A total of 172 otherwise patients with a mean age of 42.58±5.00 years were included. The distributions in the adenomyosis, endometrial hyperplasia, leiomyoma and otherwise unclassified groups were 30.8%, 12.8%, 26.2%, and 30.2%, respectively. Overall effectiveness of LNG-IUD in reducing menstrual bleeding was 82%. The proportion whose bleeding decreased was 95.50% in the endometrial hyperplasia group, 88.70% in the adenomyosis group, 55.60% in the leiomyoma group and 92.30% in the not otherwise classified group. The power of the current study was 99%. The efficacy of LNG-IUD was significantly less in the leiomyoma group (p<0.05) and thus this group were more likely to require surgical intervention. The overall incidence of spotting was 50%. Amenorrhea developed in 14% of patients. While LNG-IUD was more effective in reducing symptoms of AUB in patients with adenomyosis, endometrial hyperplasia and not otherwise classified causes, LNG-IUD was less effective in cases of leiomyoma.

Expression and clinical significance of HER2/neu, aromatase P450 and adhesion molecule CD24 in endometrial cancer.

This study aimed at exploring the expression and clinical significance of aromatase P450, adhesion molecule CD24 and HER2/neu in endometrial cancer. The expression of aromatase P450, adhesion molecule CD24 and HER2/neu was detected by immunohistochemistry in 15 cases of endometrial hyperplasia group, 50 cases of endometrial adenocarcinoma and 3 cases of uterine papillary adenocarcinoma, with 15 cases of normal endometrium as control group. We detected no expression of aromatase P450, adhesion molecule CD24 or HER2/neu in control group. Aromatase P450 positive expression rate was 66.7% in endometrial hyperplasia group and 70.3% in endometrial carcinoma group, without significant difference (p>0.05). There was no significant difference (p>0.05) in the positive expression rate of aromatase P450 between different myometrial invasion groups of endometrial adenocarcinomas. CD24 positive expression rate was 40.0% in endometrial hyperplasia group and 79.6% in endometrial carcinoma group, with significant difference (p<0.05). HER2/neu positive expression rate was 26.7% in the endometrial hyperplasia group and 57% in endometrial carcinoma group, with significant difference (p<0.05). In conclusion, aromatase P450 may be one factor associated with endometrial cancer cell proliferation, while CD24 and HER2/neu may be important factors associated with the invasion and metastasis of endometrial cancer.

Progestin plus metformin improves outcomes in patients with endometrial hyperplasia and early endometrial cancer more than progestin alone: a meta-analysis.

Progestin based therapy is the preferred option for fertility-sparing treatment of reproductive-age women with preserved fertility in endometrial hyperplasia (EH) or early endometrial cancer (EEC). Our objective was to investigate whether metformin could enhance the efficacy of progestin-based therapies by meta-analysis. We conducted a meta-analysis of randomized or non-randomized controlled trials by searching of PubMed, Embase, Web of science, and Cochrane database from inception to November 8, 2022. The results of enrolled studies were pooled using meta-analysis to estimate the effect of progestin plus metformin on remission, recurrence, pregnancy rate and live birth rate. In the analysis of progestin administered systemically or locally, complete response (CR) was significantly higher in progestin plus metformin versus progestin alone in the EH group (pooled OR 2.08, 95% CI 1.29 to 3.34, P=0.003), in the EEC group (pooled OR 1.86, 95% CI 1.13 to 3.05, P=0.01), but not in EEC and EH group (pooled OR 1.46, 95% CI 0.97 to 2.21, P=0.07). In the analysis of progestin administered systemically, complete response was improved in progestin plus metformin versus progestin alone, in the EH group (pooled OR 2.47, 95% CI 1.45 to 4.21, P=0.0009), in the EEC group (pooled OR 2.09, 95% CI 1.18 to 3.71, P=0.01), and in the EEC and EH group (pooled OR 2.03, 95% CI 1.16 to 3.54, P=0.01). The relapse rates of patients with EEC and EH were not different (pooled OR 0.54, 95% CI 0.24 to 1.20, P=0.13). For obstetric outcomes, the addition of metformin improved pregnancy rate (pooled OR 1.55, 95% CI 0.99 to 2.42, P=0.05), but not live birth rate (pooled OR 0.95, 95% CI 0.45 to 2.01, P=0.89). For fertility-sparing management, compared to progestin alone, the outcomes of patients with endometrial hyperplasia and early endometrial cancer were more improved with progestin plus metformin because progestin plus metformin increases the rate of remission and pregnancy.

Endometrial Hiperplazi ile Komplike Obez ve Premenopozal Hastalarda Vücut Yağ Dokusu Dağılımının Etkisi

Objective: There is a close association between obesity and menstrual irregularity. This study aims to investigate lipoid tissue accumulation between overweight or obese premenopausal patients with endometrial hyperplasia and with benign pathologic lesions via using the bioimpedance method.Materials and Methods: Obese or overweight volunteers with abnormal uterine bleeding were examined. Eighty-eight volunteers meet the inclusion criteria. We obtained fat mass, fat percentage and impedance of body parts by using Multi-Frequency Body Composition Analyzer. Blood lipid profile and ultrasonographic measurement of endometrial thickness were also performed. Results: 33 volunteers were in the hyperplasia group and 55 were in the control group. 28 of the 33 volunteers (84.8%) had at least one increased fatty acid. 41 of the 55 patients (74.5%) had at least one increased fatty acid in the control group. Total cholesterol levels are higher in the hyperplasia group than in the control group (p=0.006). There was no significant difference between the groups for bioimpedance analyses. Conclusion: Hyperlipidemia remains an important factor that contributes to endometrial pathologies. Serum cholesterols were significantly high in the endometrial hyperplasia group. Rather than lipoid tissue distribution, increased cholesterol may contribute to gynecologic pathology occurrence in obese individuals complicated with endometrial hyperplasia.

The relationship between oxidative stress markers and endometrial hyperplasia: A case-control study

Objective:Endometrial hyperplasia (EH) is considered an endometrial cancer precursor. This study aimed to determine the role of oxidative stress and thiol groups with antioxidant properties in EH pathogenesis.Materials and Methods:In our prospective case-control study, participants were washed with 5 mL of saline before the endometrial biopsy. Endometrial washing fluid was taken into microtubules, and thiol and disulfide levels were analyzed using the Ellman reagent.Results:A total of 108 patients were in the EH group and 84 patients in the control group. The total and native thiol levels were higher values in the control group (p<0.001, for both). Disulfide levels were higher in the EH group (p<0.001). Native/total thiol ratio and disulfide/total thiol ratio were higher in the EH group (p<0.001, for both). The analysis performed in the control group revealed a significant positive correlation between estradiol and disulfide levels (r=0.322, p=0.033). No significant correlation was found between estradiol and disulfide in the EH group.Conclusion:Oxidative stress level was higher in the washing fluids of patients with EH and this stress plays a role in the EH etiology.

Effect of Nonionizing Radiation on Progesterone Treatment in Endometrial Hyperplasia: An Experimental Rat Study

Objectives: The aim of the study was to evaluate the negative effect of nonionizing radiation on the treatment of endometrial hyperplasia (EH) with oral progesterone. Design: Forty oophorectomized Wistar Albino female rats were included in this experimental rat study. Materials and Methods: The 4 groups were planned as follows: Group A; sham group; Group B; group receiving oral estradiol hemihydrate 4 mg/kg/day; Group C; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day medroxy progesterone acetate (MPA) and Group D; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day MPA with exposure to nonionizing radiation at 1800 mHz/3 h/day. After the experimental model, uterine horns were sampled and the preparations were evaluated for pathological parameters (glandular density, epithelial cell length, and luminal epithelial cell length) via light microscopy. Nonionizing radiation was created by a signal generator and a compatible mobile phone. Results: Estrogen was found to increase all parameters related to EH (p < 0.05). Progesterone treatment was found to decrease parameters related to EH (Group B vs. C; luminal epithelial cell length, glandular density, and epithelial length; 11.2 vs. 13.2 μm p = 0.007; 32.5 vs. 35.5, p = 0.068; and 219.9 μm vs. 285 µm, p < 0.001, respectively). Final analyses revealed reduced effectiveness of progesterone treatment in the rats exposed to nonionizing radiation (Group C vs. D); luminal epithelial cell length, glandular density, and epithelial length (11.2 μm vs. 13.5 μm, p = 0.179; 32.5 vs. 52, p < 0.001; and 219.9 μm vs. 374.1 μm, p = 0.001, respectively). Limitations: The limitations of our study are that the results of animal experiments may not be appropriate for direct adaptation to humans and the relatively low number of rats included in the study. Conclusion: Nonionizing radiation reduces the effect of progesterone in patients receiving treatment for EH.

Metformin alleviates endometrial hyperplasia through the UCA1/miR‑144/TGF‑β1/AKT signaling pathway.

The objective of the present study was to investigate the molecular mechanism underlying the role of metformin (Met) in reducing the risk of endometrial hyperplasia (EH). Reverse transcription‑quantitative polymerase chain reaction, western blot and immunohistochemistry (IHC) assays were used to study the effects of Met and tamoxifen on the expression levels of urothelial cancer associated 1 (UCA1), microRNA‑144 (miR‑144) and other factors along the transforming growth factor‑β1 (TGF‑β1)/protein kinase B (AKT) signaling pathway. In addition, MTT and flow cytometry assays were performed to detect the effect of Met on cell proliferation and apoptosis. Tamoxifen treatment increased the weight of the uterus and the level of UCA1, while decreasing the expression of miR‑144. In addition, treatment with tamoxifen (2.0 and 3.5µg) upregulated the protein expression levels of TGF‑β and p‑AKT, while downregulating the protein expression of active Caspase‑3 in a dose‑dependent manner. By contrast, Met reduced cell viability, promoted cell apoptosis, and reduced the expression levels of UCA1, TGF‑β and p‑AKT, while upregulating the expression of miR‑144 and active Caspase‑3 in a dose‑dependent manner. Furthermore, Met also reduced the weight of uterus. However, tamoxifen and Met did not exert any effect on the protein levels of total AKT and total Caspase‑3. The levels of TGF‑β and p‑AKT proteins in the EH group were much higher when compared with those in the sham group, while Met treatment reduced these protein levels to a certain extent. In addition, the expression of active Caspase‑3 in the EH group was much lower than that in the sham group, while Met treatment increased its level to a certain extent. In conclusion, the current study suggested that Met reduces the risk of EH by reducing the expression levels of UCA1, TGF‑β and p‑AKT, while increasing the levels of miR‑144 and active Caspase‑3 in a dose‑dependent manner.

Evaluation of serum irisin levels in patients with endometrial hyperplasia: A controlled cross-sectional study

Aim: Irisin, which is proteolytically splited form of fibronectin type III domain containing 5 (FNDC5), is a protein with 112 amino acid. Irisin is an exercise-induced hormone excreted primarily by cardiac muscle and skeletal cells which can be described as an exercise hormone and a new potential target for the treatment of metabolic diseases and obesity. Our goal was to evaluate the serum irisin levels in patients with endometrial hyperplasia (EH). Methods: An observational study is planned. The study population consisted of two groups: 1) the EH group (study group), consisting of participants who had been histopathologically diagnosed with simple EH without atypia and 2) the control group, consisting of healthy participants admitted to the clinic for an annual examination without any complaints or symptoms. Primary outcome of the study was evaluation irisin status. Serum irisin levels were determined by an enzyme-linked immunosorbent assay (ELISA) method.Results: After sample size analysis, 52 participants enrolled into the study as study group (EH group) (n=26) and control group (n=26). The mean age was 39.5±3.8 years in the EH group and 40.7±2.4 years in the control group (p=0.258). Mean BMI was 28.8±2.1 kg/m2 in the EH group and 28.5±1.2 kg/m2 in the control group (p=0.666). Gravidity, parity, systolic blood pleasure, diastolic blood pleasure, fasting glucose levels, smoking status, alcohol use were similar for both groups (p=0.499, p=0.278, p=0.248, p=0.424, p=0.646, p=0.486 and p=0.153, respectively). In control group regular exercise rates was significantly higher than EH group (26.9%, 3.84%, respectively p&lt;0.001). The mean serum irisin level was 1.9±0.7 μg/ml in the EH group and 3.5±2.0 μg/ml in the control group. Serum irisin levels were found to be significantly lower in the EH group compared to the control group (p&lt;0.001). Conclusion: The data from the current study indicate that serum irisin levels were significantly decreased in patients with endometrial hyperplasia. Serum irisin levels may open up new horizons for therapeutic targets for the treatment of patients with EH.

The PTENP1 Pseudogene, Unlike the PTEN Gene, Is Methylated in Normal Endometrium, As Well As in Endometrial Hyperplasias and Carcinomas in Middle-Aged and Elderly Females

The tumor suppressor PTEN controls multiple cellular functions, including cell cycle, apoptosis, senescence, transcription, and mRNA translation of numerous genes. In tumor cells, PTEN is frequently inactivated by genetic mutations and epimutations. The aim of this study was to investigate the methylation patterns of the PTEN gene and its pseudogene PTENP1 as potential genetic markers of endometrial hyperplasia (EH) and endometrial carcinoma (EC). Methylation of the 5'-terminal regions of the PTEN and PTENP1 sequences was studied using methyl-sensitive PCR of genomic DNA isolated from 57 cancer, 43 endometrial hyperplasia, and normal tissue samples of 24 females aged 17-34 years and 19 females aged 45-65 years, as well as 20 peripheral venous blood samples of EC patients. None of the analyzed DNA samples carried a methylated PTEN gene. On the contrary, the PTENP1 pseudogene was methylated in all analyzed tissues, except for the peripheral blood. Comparison of PTENP1 methylation rates revealed no differences between the EC and EH groups (0.80 < p < 0.50). In all these groups, the methylation level was high (71-77% in patients vs. 58% in controls). Differences in PTENP1 methylation rates between normal endometrium in young (4%) and middle-aged and elderly (58%) females were significant (p < 0.001). These findings suggest that PTENP1 pseudogene methylation may reflect age-related changes in the body and is not directly related to the endometrium pathology under study. It is assumed that, depending on the influence of a methylated PTENP1 pseudogene on PTEN gene expression, the pseudogene methylation may protect against the development of EC and/or serve as a marker of a precancerous condition of endometrial cells.

Clinical characteristics of endometrium in elder women and the diagnostic value of hysteroscopy

Objective To evaluate the value of hysteroscopy in elder women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. Methods Fifty-three cases in the AUB group and seventy-eight cases in the endometrial hyperplasia group underwent hysteroscopy examination and hysteroscopy-guided biopsy, then the hysteroscopic and histopathological results were compared between the two groups. Results Of the 131 cases, the normal endometrium accounted for 29.8% (n=39), endometrial polyp for 49.6% (n=65), submucous myomas for 4.6% (n=6), hyperplasia endometrii for 6.1%(n=8) and endometrial carcinoma for 9.9% (n=13). Both the AUB group and the endometrial hyperplasia group had 8 cases of endometrial carcinoma (15.1%, 6.4%, respectively). For the diagnosis of normal endometrium with hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 88%, 97%, 94% and 95%, respectively, in the AUB group, versus 82%, 95%, 86% and 93%, respectively, in the endometrial hyperplasia group. For the endometrial polyps, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 100%, 79%, 74%, 100%, respectively, in the AUB group and 98%, 88%, 92%, 97%, respectively, in the endometrial hyperplasia group. For the endometrial cancer, hysteroscopy had a sensitivity, specificity, PPV and NPV of 75%, 100%, 100% and 96%, respectively, in the AUB group; while in the endometrial hyperplasia group, the sensitivity was 80%, the specificity and PPV were 100%, and the NPV was 99%. Conclusions In elder females, hysteroscopy allows for an accurate diagnosis in endometrial disease, and hysteroscopically directed sampling is mandatory, even if the uterine cavity appears normal at hysteroscopy, to rule out endometrial neoplasms. Key words: Hysteroscopy; Endometrial; Uterine hemorrhage

Expression of three proteins in endometrioid adenocarcinoma and their significance in clinical nursing, diagnosis and treatment.

This study aimed to investigate the role of NEDD9 (neural precursor cell expressed developmentally down-regulated 9), BCAR1/P130CAS (BCAR1/P130 Crk-associated substrate) and paxillin in predicting the prognosis of endometrioid adenocarcinoma (EA), so as to guild the nursing of EA. A total of 65 patients who visited Affiliated Hongqi Hospital of Mudanjiang Medical University between June 2015 and June 2017 were enrolled. They underwent gynecological surgery and had their EA confirmed by pathology, and they were assigned to the EA group. All EA tissues were sampled and archived in paraffin blocks. In addition, 40 specimens of atypical endometrial hyperplasia (EAH) (the EAH group) and 40 specimens of normal proliferative endometria with benign uterine fibroids (the EN group) were selected as controls. The protein levels of NEDD9, BCAR1/P130CAS, and paxillin in each group were then detected by immunohistochemical staining. The expression of the three proteins in the EA group and EAH group was significantly higher than that in the EN group, and their expression was significantly correlated with the clinical stage, histological grade and lymph node metastasis of EA. In addition, the expression of NEDD9, BCAR1/P130CAS, and paxillin in the EA group was positively correlated with each other. BCAR1/P130CAS and paxillin interact with NEDD9 to participate in the growth and migration of EA cells. Therefore, their proteins can be used as biomarkers for the diagnosis, treatment, and prognosis of EA.

Elastosonographic evaluation of patients with a sonographic finding of thickened endometrium

ObjectiveTo evaluate if elastosonography of the endometrium can differ between normal endometrial tissue and abnormal pathology. Study designOne hundred and six women with a sonographic finding of thickened endometrium were enrolled in this study. All patients underwent B-mode scanning and elastosonography, performed by the same operator who was blinded to the study design. After sonographic evaluation, all patients underwent endometrial tissue sampling via dilatation and curettage. Histopathological results indicated that 22 patients had endometrial hyperplasia, 20 patients had endometrial polyps, and 64 patients had normal pathology results, with or without abnormal uterine bleeding. Groups were formed according to histopathological results, and ultrasonographic findings (strain ratio, endometrial thickness) were compared. ResultsMedian age was 46 [interquartile range (IQR) 4] years, 37 (IQR 10) years and 36 (IQR 10) years for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively. Median age of the endometrial hyperplasia group was significantly higher compared with the endometrial polyps and normal pathology groups (p<0.001). Median parity was 3 (IQR 2), 2 (IQR 1) and 3 (IQR 1) for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively; differences between the groups were not significant (p=0.102). No differences were found between the groups in terms of endometrial thickness (p>0.05). When elastosonographic strain (B/A) ratios were compared between the groups, the endometrial hyperplasia and endometrial polyps groups had significantly lower B/A ratios (higher elasticity) than the normal pathology group (p<0.001). There was no significant difference in B/A ratios between the endometrial hyperplasia and endometrial polyps groups (p>0.05). ConclusionThe elasticity of endometrial tissue, measured non-invasively via elastosonography, was similar in women with endometrial polyps and endometrial hyperplasia, but differed significantly compared with women with normal pathology who had a sonographic finding of thickened endometrium and abnormal bleeding as the presenting complaint. According to these results, elastosonography cannot be used as a diagnostic tool to differentiate between endometrial hyperplasia and endometrial polyps. However, elastosonography can be used to differentiate between pathological endometrial changes and normal endometrium in patients presenting with a sonographic finding of thickened endometrium.

Differentiation between endometrial carcinoma and atypical endometrial hyperplasia with transvaginal sonographic elastography.

To assess the value of transvaginal sonographic elastography (TSE) in discriminating between endometrial hyperplasia and endometrial carcinoma. A total of 61 women with post-menopausal hemorrhage and/or normal TSE were included. There were 32 women (mean age: 53.1±14.1 years) with endometrial hyperplasia, 14women (mean age: 60.0±14.0 years) with endometrial carcinoma and 15women (mean age: 51.9±7.8 years) with no endometrial disease who served as a control group. The strain index (SI) values obtained during TSE in each group were compared using Mann-Whitney U test and Kruskal-Wallis analysis of variance test. The mean SI values were 0.80 (range: 0.30-1.30) in the endometrial hyperplasia group, 1.80 (range: 0.80-3.20) in the endometrial carcinoma group and 1.00 (range: 0.50-4.00) in the control group. No significant differences were found between endometrial hyperplasia group and control group, but significant differences were found between endometrial carcinoma and hyperplasia groups and between endometrial carcinoma and control groups (P<0.0001). TSE had a sensitivity of 81.3%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 70% in differentiating endometrial carcinoma from endometrial hyperplasia. The area under ROC curve (AUC) to distinguish between endometrial carcinoma and endometrial hyperplasia was 0.933 (95% CI, 0.853-1.000) using a threshold SI value of 1.05. The AUC to distinguish between endometrial carcinoma and control was 0.881 (95% CI, 0.735-1.000) using a threshold SI value of 1.15. Our results indicate that TSE can provide important information that help discriminate between endometrial carcinoma and endometrial hyperplasia.

Micronucleus testing as a cancer detector: endometrial hyperplasia to carcinoma

Endometrium carcinoma (EC) is the fourth common cancer among women worldwide and the incidence is increasing. It is important to define the EC earlier for survival of the patients. Women who had endometrial hyperplasia (EH) and EC in postmenopausal and premenopausal period were included to participate in this study. MN assay has been performed to participants for detection of the genetic damages and DNA instability. MN ratio was significantly higher in EC group compared to other two groups (EH and control groups) (p < 0.001). On the other hand, there was no significant difference among these groups with regard to number of gravidity and presence of a family history of cancer (p > 0.05). MN frequency and NDI were significantly correlated with the age in endometrial hyperplasia without atypia, endometrial cancer and control groups (r 0.546, p < 0.001; r 0.320, p 0.024; r 0.396, p 0.003, respectively). Similarly, MN frequency and NDI were significantly correlated with BMI in three groups (r 0.287, p 0.044; r 0.467, p 0.001; r 0.473, p 0.001, respectively). MN scoring in pre-neoplastic conditions of the endometrium can be used as adjunct in endometrium cancer screening. By using MN assay, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients. This is an easy, simple, reliable, reproducible objective test and can be used in routine patient examination.

P02.09: Study for the revised FIGO staging of the endometrial cancer and sonographic appearance

According to the revised FIGO staging for carcinoma of the endometrium in 2009, to investigate the staging and their correlation with sonographic apperrance. 208 cases (including 71 endometrial cancer patients and 137 patients with endometrial hyperplasia) who underwent both ultrasonography, pathological examine and staging were in this study. Preoperative sonography appearance was compared with the pathological findings. (1) The measurements of the uterine cavity thickness (mean 19.13 ± 10.18 mm) by ultrasound in endometrial cancer group were greater than those (mean 13.3 ± 5.8 mm) in endometrial hyperplasia group (P0.01). The measurements of the uterine cavity thickness were superposition, which > 15 mm and > 10 mm were respectively in 54.93% (39/71 cases), 87.32% (62/71 cases) with endometrial cancer and in 32.85% (45/137 cases), 65.69% (90/137 cases) with endometrial hyperplasia. (2) The pathological finding and staging: 63 cases were confirmed to have type1 endometrial cancer and 8 cases with type 2 endometrial cancer, among which there were in 1 stage 77.46% (55), in 2 stage 11 cases (15.71%), in 3 stage 3 cases (4.29%) and in 4 stage 2 cases (2.86%). 66 cases of 71 resected uterus cases showed myometrial invasion (92.95%), deep myometrial invasion in 13 cases (13/71, 18.0%). In 2 stage 11 cases, which showed superficial myometrial invasion in 8 cases and deep myometrial invasion in 3 cases. In 3 stage 3 cases which showed superficial myometrial invasion. In 4 stage 2 cases, the superficial and deep myometrial invasion were respectively 1 case. When the Tumor confined to the corpus uteri, there exists a certain correlation between degree of myometrial invasion and staging. Once the local and/or regional spread of the tumor, the degree of myometrial invasion was not important for staging.

Expression and Significance of p27 and MCM7 Proteins in Endometrioid Adenocarcinoma

Objective To study the expression of p27 and MCM7 protein in endometrioid carcinoma and its clinical significance.Methods The expression of p27 and MCM7 proteins were tested by SP immunohistochemistry from normal endometrium(30 cases),endometrial hyperplasia(30 cases),atypical hyperplasia(30 cases) and endometrioid carcinoma(50 cases).Results The positive expression of p27 decreased gradually in different groups:normal endometrium endometrial hyperplasia endometrial dysplasia endometrioid carcinoma.There was a significant difference amory these groups(P0.05).But the positive expression of MCM7 in four groups showed an increased gradually.The expression of MCM7 in endometrioid carcinoma and endometrial dysplasia groups were significently higher than those in normal endometrium and endometrial hyperplasia groups(P0.05).Negative correlation was found between the expression of p27 and MCM7(r=-0.3306,P0.02).In endometrioid carcinoma group,the lower expression of p27 protein was significantly associated with histological grading(P0.05)and pathologic stage(P0.05).The overexpression of MCM7 protein was significantly correlated with histological grading,myometrial invasion,lymph node metastasis and pathologic stage(P0.05),respectively.The lower expression of p27 and higher expression of MCM7 were related with recurrence in endometrioid carcinoma(P0.05).Conclusion The results suggest that the low expression of p27 and the overexpression of MCM7 protein may be involved in carcinogenesis and development of medometrioid carcinoma.Combined examining of p27 and MCM7 protein may be used as a biomarker in the early diagnosis and for the prognosis judgement of endometrioid carcinoma.

Serum and tissue angiogenin in patients with endometrial hyperplasia

Abstract Objective To evaluate angiogenin levels in both tissue and serum of patients with endometrial hyperplasia with and without atypia. Methods Sixty women were classified according to the histopathological findings of endometrium into three groups. The control group consisted of 20 women with normal non-hyper plastic endometrium. The second group included 20 women diagnosed as complex endometrial hyperplasia without atypia. The third group included 20 women diagnosed as complex endometrial hyperplasia with atypia. Serum and tissue angiogenin were measured by enzyme immunoassay (EIA) technique and confirmed in tissues with Western Blotting (WB) technique. Results There was a statistically significant increase in serum and tissue angiogenin levels of endometrial hyperplasia groups compared to those of control group ( P P Conclusion Elevated levels of serum angiogenin in endometrial hyperplasia could assist in determining which patients are at high risk for atypical change requiring aggressive treatment.

Clinical significance of the expression of serum level of CA125 and survivin protein in endometrial carcinoma

Objective To study clinical significance of the expression of serum level of CA125 and survivin protein in endometrial carcinoma. Methods The normal endometrium group(40 cases) ,atypical endometrial hyperplasia group (40 cases)and endometrial cancer group (40 cases). Compared the changes of serum level of CA125 and the expression of survivin protein between before and after surgery in each group and in different clinical and pathological stagings in the group of endometrial carcinoma. Results The serum level of CA125in endometrial cancer group before and after surgery are significantly higher than other two groups, the differences are statistically significant(P ＜ 0.05 ). Compare survivin positive expression rate and strong positive expression rate in atypical endometrial hyperplasia group and endometrial cancer group with the normal endometrium group, the differences are statistically significant( P ＜ 0.05 ). The rate of positive expression of serum level of CA125 in Ⅱ-Ⅳ period cases of endometrial carcinoma, higher pathological grade cases, deep myometrial invasion cases and recurrence cases is significantly higher. The strongly positive expression of survivin protein in Ⅱ-Ⅳ period cases, G3 cases, deep myometrial invasion cases and recurrent cases is significantly higher. Conclusion It is the significance of guidance for the serum level of CA125 to the surgical pathological staging of endometrial carcinoma. It is the certain reference value for survivin protein to the early diagnosis and clinical prognosis of endometrial carcinoma. Key words: CA125; Survivin protein; Endometrial cancer