Tumors Of Endometrium Research Articles

Imaging in Endometrium Tumors

Imaging in Endometrium Tumors

#331 : Bilateral Endometriomas Masquerading Synchronous Endometrial and Ovarian Cancer (SEOC) in an Infertile Female

Background and Aims: Endometriomas are diagnosed in clinical practice by imaging (mostly ultrasound) in females presenting with infertility. CA-125 level is an adjuvant investigation which may be indicative of endometriosis. A few research questions that are yet to be answered. Is ultrasound a sufficient modality to diagnose endometrioma? Is there any cut off as far as the measurement of endometrioma is concerned to step up the imaging modality to MRI? Synchronous endometrial and ovarian cancer (SEOC) is a rare phenomenon with an incidence of 1.4 - 3.8%. Mostly in SEOC, the ovarian endometroid carcinoma arises in background of endometriosis with endometrial carcinoma of lower stage and grade in premenopausal age group. Method: A 32-year-old female with Severe Dysmenorrhea and Secondary infertility had clinical evidence of bilateral endometriomas of 4-5 cm on ultrasound. She underwent hysterolaparoscopy. On hysteroscopy, endometrium was polypoidal and vascular, looking suspicious for malignancy. Hence endometrial biopsy was taken. On laparoscopy, B/L ovaries were enlarged, multiloculated, solid-cystic with granular surface and adhered in POD, decision for staging laparotomy with frozen section was taken. Frozen section was suggestive of Borderline tumor. Eventually, fertility sparing surgical staging was done (BSO + infracolic omentectomy + peritoneal biopsies). Peritoneal cytology was negative for malignant cells. Results: Histopathological examination revealed Endometriod adenocarcinoma grade 1a/1a in both endometrial and ovarian components with no involvement of omentum and peritoneum. Immunohistochemistry demonstrated P53 to be moderately positive in endometrium and strongly positive in ovary, whereas ER, PR was positive in both tumors of endometrium and ovary and WT-1 negative in ovaries. Hence diagnosed as SEOC and not metastatic tumor. Mirena was inserted in follow up and repeat biopsy is awaited. Conclusion: Suspicion of ovarian endometroid carcinoma must born in mind in cases with large bilateral endometriomas with long-standing endometriosis.

Diagnostic approach to Perimenopausal bleeding by Pipelle or Dilatation and Curettage

Perimenopausal bleeding, is a very common problem, which is an alarming symptom for both; women and their doctors because of the rising fears of cellular changes or tumor of endometrium. In our study we tried to prove that collecting endometrial samples using the outpatient method of Pipelle is as effective as collecting the endometrial samples in the traditional method of Dilation and Curettage (DandC) in operation theatre which necessitates general anesthesia. Ninety four patients more than 40 years old were included in the study, all of them were complaining of abnormal uterine bleeding (pregnant ladies and ladies using hormonal contraception were excluded from the study) and endometrial samples were collected first in outpatient clinic using the Pipelle and labelled as A samples and secondly in the theatre under general anesthesia by dilatation and curettage and labelled as B samples, all samples were sent for histopathology without informing the pathologist about the method of sample collection and patients past medical history. Then, the reports of histopathological examination were compared between Pipelle and DandC samples (group A and group B). From the results we can conclude that samples of endometrium using Pipelle could replace the traditional method of DandC, with high specificity and sensitivity in detecting endometrial carcinoma and endometrial hyperplasia.

Optimal protocol for PTEN immunostaining; role of analytical and preanalytical variables in PTEN staining in normal and neoplastic endometrial, breast, and prostatic tissues

In some tumors, phosphatase and tensin homolog (PTEN) inactivation may have prognostic importance and predictive value for targeted therapies. Immunohistochemistry (IHC) may be an effective method to demonstrate PTEN loss. It was claimed that PTEN IHC showed poor reproducibility, lack of standardization, and variable effects of preanalytical factors. In this study, we developed an optimal protocol for PTEN IHC, with clone 6H2.1, by checking the relevance of analytical variables in normal tissue and tumors of endometrium, breast, and prostate. Pattern and intensity of cellular staining and background nonspecific staining were quantified and subjected to statistical analysis by linear mixed models. The proposed protocol showed a statistically best performance (P < .05) and included a high target retrieval solution, 1:100 primary antibody dilution (2.925 mg/L), FLEX diluent, and EnVisionFLEX+ detection method, with a sensitivity and specificity of 72.33% and 78.57%, respectively. Staining specificity was confirmed in cell lines and animal models. Endometrial carcinomas with PTEN genetic abnormalities showed statistically lower staining than tumors without alterations (mean histoscores, 34.66 and 119.28, respectively; P = .01). Controlled preanalytical factors (delayed fixation and overfixation) did not show any statistically significant effect on staining with optimal protocol (P > .001). However, there was a trend of significance for decreased staining and fixation under high temperature. Moreover, staining was better in endometrial aspirates than in matched hysterectomy specimens, subjected to less controlled preanalytical variables (mean histoscores, 80 and 40, respectively; P = .002). A scoring system combining intensity of staining and percentage of positive cells was statistically associated with PTEN alterations (P = .01).

A taxonomy of epithelial human cancer and their metastases

BackgroundMicroarray technology has allowed to molecularly characterize many different cancer sites. This technology has the potential to individualize therapy and to discover new drug targets. However, due to technological differences and issues in standardized sample collection no study has evaluated the molecular profile of epithelial human cancer in a large number of samples and tissues. Additionally, it has not yet been extensively investigated whether metastases resemble their tissue of origin or tissue of destination.MethodsWe studied the expression profiles of a series of 1566 primary and 178 metastases by unsupervised hierarchical clustering. The clustering profile was subsequently investigated and correlated with clinico-pathological data. Statistical enrichment of clinico-pathological annotations of groups of samples was investigated using Fisher exact test. Gene set enrichment analysis (GSEA) and DAVID functional enrichment analysis were used to investigate the molecular pathways. Kaplan-Meier survival analysis and log-rank tests were used to investigate prognostic significance of gene signatures.ResultsLarge clusters corresponding to breast, gastrointestinal, ovarian and kidney primary tissues emerged from the data. Chromophobe renal cell carcinoma clustered together with follicular differentiated thyroid carcinoma, which supports recent morphological descriptions of thyroid follicular carcinoma-like tumors in the kidney and suggests that they represent a subtype of chromophobe carcinoma. We also found an expression signature identifying primary tumors of squamous cell histology in multiple tissues. Next, a subset of ovarian tumors enriched with endometrioid histology clustered together with endometrium tumors, confirming that they share their etiopathogenesis, which strongly differs from serous ovarian tumors. In addition, the clustering of colon and breast tumors correlated with clinico-pathological characteristics. Moreover, a signature was developed based on our unsupervised clustering of breast tumors and this was predictive for disease-specific survival in three independent studies. Next, the metastases from ovarian, breast, lung and vulva cluster with their tissue of origin while metastases from colon showed a bimodal distribution. A significant part clusters with tissue of origin while the remaining tumors cluster with the tissue of destination.ConclusionOur molecular taxonomy of epithelial human cancer indicates surprising correlations over tissues. This may have a significant impact on the classification of many cancer sites and may guide pathologists, both in research and daily practice. Moreover, these results based on unsupervised analysis yielded a signature predictive of clinical outcome in breast cancer. Additionally, we hypothesize that metastases from gastrointestinal origin either remember their tissue of origin or adapt to the tissue of destination. More specifically, colon metastases in the liver show strong evidence for such a bimodal tissue specific profile.

Simultaneously detected primary malignant tumors of ovary and endometrium with unusual histology

A case of a mucinous adenocarcinoma of the ovary with a synchronous endometroid tumor of the endometrium with focal features of undifferentiated carcinoma and deep myometrial invasion is reported. A review of the literature revealed that our case is interesting in view of the fact that simultaneous presentation of primary ovarian and endometrial neoplasms is rare and usually related to low-stage ovarian lesions and well-differentiated and superficial endometrial carcinomas in contrast to our case with the focal features of undifferentiated carcinoma and the deep myometrial invasion. These double tumors usually present in premenopausal subfertile women with abnormal uterine bleeding. The prognosis in most of the cases is surprisingly good even after total abdominal hysterectomy and bilateral oophorectomy alone without adjuvant chemotherapy or irradiation.

Simultaneous carcinoma of the endometrium and ovary vs. endometrial carcinoma with ovarian metastases: A clinical and immunohistochemical determination

The aim of this study was to perform a clinical and immunohistochemical comparison between simultaneous independent tumors involving endometrium and ovary and metastatic endometrial tumors, and to try to find clinical and /or immunohistochemical parameters differentiating between these two entities. Sixteen cases of simultaneous independent primaries of endometrium and ovary, presenting the same histologic type, were compared with 12 cases of primary endometrial cancer, demonstrating ovarian metastases. The comparison related to patients' characteristics and immunohistochemical expression of estrogen and progesterone receptors (ER,PR), bcl-2, HER-2 /neu, p53, and cell proliferation marker Ki-67 in endometrial and ovarian tumors.The only clinical parameter differentiating significantly between the groups was the prevalence of familial cancer, being more frequent in the group of metastatic tumors (P = 0.03). Immunohistochemical analysis demonstrated the same immunostaining in endometrium and ovary for all immunohistochemical parameters in cases of metastatic endometrial cancer. Conversely, 62.5% of cases with simultaneous tumors of endometrium and ovary could be differentiated from metastatic tumors by distinct immunohistochemical expression of ER and PR in endometrial and ovarian tumors (P = 0.0006), and 31.3% of cases could be differentiated by distinct immunostaining for bcl-2 (P = 0.03). Immunohistochemical parameters HER–2 /neu, p53 and Ki-67 were not appropriate for the distinction between the two study groups. We conclude that the application of immunohistochemical analysis may play an important role in the differentiation between cases of simultaneous independent carcinomas of endometrium and ovary vs. cases of endometrial carcinoma with ovarian metastases.

Malignant endometrial pathology

This review discusses recent papers on endometrial carcinoma variants, immunohistochemical studies, and prognostic indicators. The aggressive nature of uterine papillary serous carcinoma is confirmed, even in the absence of myometrial or vascular invasion, with a comprehensive review of the histology, clinical presentation, and proposed treatment protocols. The possible etiologic role of radiation in the development of uterine papillary serous carcinoma is alluded to. The virulence of endometrial carcinomas with trophoblastic differentiation, endometrial carcinomas with a malignant giant cell component, and clear cell carcinomas of the endometrium is documented. A series of immunohistochemical studies is presented suggesting that uterine carcinosarcomas are metaplastic carcinomas derived from a common stem cell and that a shared histogenesis of endometrial stromal tumors and uterine mesoderm exists. Immunohistochemical techniques may clarify diagnostic problems of uterine tumors and their metastases and differentiate mucinous tumors of endometrium from endocervical origin. Staining of both carcinoembryonic antigen and ferritin in neoplastic endometria may be helpful in their differentiation from hyperplasias in curettage specimens. Significant prognosticators in endometrial carcinoma are depth of myometrial invasion and lymphovascular space involvement with greatest prognostic information provided by the depth of myometrial invasion above DNA index.

The Increasing Trend in Japan of Müllerian Mixed Tumor of Endometrium

An increasing trend in Japan of Müllerian mixed tumor (MMT) of the endometrium has been suspected from both the Annual Pathological Autopsy Records in Japan (APARJ) and an analysis of surgical cases from the National Cancer Center Hospital (NCCH). One hundred and four MMT cases were recorded in APARJ during the period, 1965-1984, which constituted 1.1% of all malignant uterine tumors. The number of MMT cases in the past 10 years (87 cases during the period, 1975-1984) increased more than fivefold over that of the previous 10 years (17 cases during the period, 1965-1974). The proportion among malignant uterine tumors also increased from 0.5 to 1.5%. Eighteen patients with MMT underwent surgery in the NCCH during the period, 1963-1986, which accounted for 4.3% of endometrial malignant tumor cases. Of these only one was resected during the 12-year period, 1963-1974, while there were 17 surgically resected cases during the 12 years from 1975 to 1986. These represented 0.8 and 5.7%, respectively of malignant tumors of the endometrium during the two periods. In five out of 18 cases, MMT occurred as a second primary malignancy, and in all cases the histology was one of mesodermal mixed tumor. It was suggested that its occurrence as a second primary malignancy would be contributing to the recent increase of MMT in Japan.