Hysterectomy Specimens Research Articles

Excellent concordance of the molecular classification between preoperative biopsy and final hysterectomy in endometrial carcinoma

ObjectiveThe 2023 International Federation of Gynecology and Obstetrics classification with molecular classification shows superior discriminatory ability compared to staging systems lacking molecular data. However, the accuracy of endometrial biopsy data in molecular classification remains uncertain. This study aimed to assess the concordance of molecular classifications between preoperative biopsy and hysterectomy to predict prognosis before surgical staging. MethodsEndometrial biopsies and corresponding hysterectomy specimens were collected at the National Cancer Center Hospital between 2012 and 2023. Immunohistochemistry for p53 and mismatch repair (MMR) proteins and next-generation sequencing of all exons of polymerase epsilon (POLE) were performed. Given the limited number of POLE mut cases in prior studies, we prepared a POLE mut-enriched cohort. Cohen's kappa estimates were used to determine concordance for molecular and clinicopathological subgroup assignments. ResultsAmong 70 patients classified into four molecular subtype groups, 33 exhibited POLE mutations, 15 showed loss of MMR protein expression, 13 had p53-abnormality, and 9 had no specific molecular profile. Concordance between biopsy and hysterectomy specimens was 100% (κ = 1.000). In contrast, histological types and grades between biopsy and surgical specimens showed moderate and substantial agreement (κ = 0.420 and κ = 0.780, respectively). ConclusionsMolecular subtypes were completely consistent with those derived from surgical specimens, demonstrating high concordance between preoperative and postoperative molecular classifications. This suggests that endometrial biopsies could reliably predict prognosis. Future studies should investigate how biopsy-based molecular profiling influences treatment planning and patient outcomes.

Characterization of E-Cadherin, SSEA-1, MSI-1, and SOX-2 Expression and Their Association with Pale Cells in Adenomyosis

Adenomyosis (AM) is a gynecological disease characterized by the invasion of endometrial glands and stroma within the myometrium. The etiology and pathogenesis of AM remain inadequately understood. Pale cells were identified as a novel cell type characterized by the absence of desmosomal contacts and light-colored cytoplasm. These cells were observed to migrate individually through ultra-micro ruptures in the basal membrane of the endometrial glands, translocating into the stroma and then further into the myometrium. Our study aimed to explore the possible stem cell properties of these pale cells. Forty hysterectomy specimens were analyzed using immunohistochemistry and immunofluorescence to assess negative E-cadherin expression and the positive expression of stem cell markers SSEA-1, MSI-1, and SOX-2. Immunohistochemical analysis revealed the presence of pale cells and occasionally rounded, enlarged E-cadherin-negative cells predominantly in the basal endometrial epithelium. The stem cell marker SSEA-1 was significantly elevated in the basalis epithelium, as well as in the ectopic epithelium. SSEA-1 positive cells were also identified in the stroma and myometrium. Sporadic colocalization of SSEA-1+/E-cadherin– cells was confirmed through immunofluorescence. The positive staining of pale cells for SSEA-1 and MSI-1 was also confirmed at the ultrastructural level by immunoelectron microscopy. These findings indicate that pale cells may possess stem cell characteristics, particularly a positive SSEA-1 profile, warranting further in vitro investigation into their role in the pathogenesis of adenomyosis.

Reduced cervical sampling of hysterectomy specimens with negative margins on conization: An opportunity to improve resource utilization.

The current recommendation for hysterectomy specimens performed for cervical cancer following conization is that the entire cervix be submitted for histologic examination. Given the high cost of medical procedures and concerns regarding difficulties with laboratory staffing, we sought to evaluate the potential for selective histologic examination in this setting. Post-conization hysterectomy cases were reviewed for the presence of residual disease in relation to the findings of the prior conization, with consideration of margin status. Residual disease was then assessed for clinical significance. The number of submitted blocks was recorded and the associated costs were estimated. Among 32 cases with invasive carcinoma, only cases with margins positive for invasive carcinoma on the conization specimen had residual invasion in the hysterectomy (n = 7), and there were no upgrades due to subtle microscopic disease; 1 case had a change in pathologic stage from pT1b1 to pT2b due to parametrial involvement in the setting of a grossly apparent lesion. Among 20 cases performed following a diagnosis of dysplasia, none were upgraded to invasive carcinoma. Based on protocol-based submission of the entire cervix, 16 blocks of cervix were submitted on average (range, 4-41). We estimate that representative sections from each cervical quadrant would save approximately 2 work hours for laboratory staff per case and up to 6 hours for larger cases, reducing costs for the laboratory accordingly. Selective cervical sampling in the setting of negative margins on conization provides an opportunity for improved resource utilization without compromising patient care; as this is a small study, confirmation of these findings in a larger number of cases may be warranted. Additional studies are necessary to determine what other contexts in surgical pathology could benefit from a similar reductive approach.

Cesarean Scar niche: Comparison of Transvaginal Ultrasound Findings and Uterine Tissue Samples after Hysterectomy

BackgroundThe cesarean scar (CS) niche, a consequence of incomplete wound healing, can lead to gynecological complications and affect future pregnancies. While internal niches have been well-studied, external and bidirectional niches are also important. ObjectivesWe aimed to conduct a comparative analysis of the prevalence and measurements of different types of niches. Study DesignThis cross-sectional study examined 200 patients with prior cesarean delivery (CD) undergoing hysterectomy due to abnormal uterine bleeding. It evaluated internal, external, and bidirectional niche prevalence, measurements (height, residual myometrial thickness, and adjacent myometrial thickness), and classification in hysterectomy specimens compared to pre-hysterectomy TVS reports. The secondary outcome was to determine niche presence in uterine tissue samples based on the number of previous CDs. ResultsThe mean age of the study participants was 48.19 years, with 30% having undergone only one CD. Notably, 83.5% had niches detected via sonography, while 91% had niches identified in uterine tissue samples post-hysterectomy (p-value =0.008). Internal niches were common, with significant associations between niche presence and the number of previous CDs. 23.3% of patients with one CD had internal niches. Additionally, external niches were detected in 4% of hysterectomy samples but not observed in ultrasound reports. Key parameters such as RMT and AMT differed notably between ultrasound and tissue samples, highlighting discrepancies in niche detection methods. RMT ranged from 2.8-24 mm (7.68 ± 3.09 mm) in ultrasound reports versus 0-25 mm (4.28 ± 2.71 mm) in tissue samples (p < 0.001). AMT ranged from 6-29 mm (17.08 ± 4.53 mm) in ultrasound reports versus 7.5-30 mm (16 ± 5.03 mm) in tissue samples (p < 0.001). This study underscores the importance of accurate niche assessment in patients with prior CD. ConclusionsWe performed a comparative analysis of niche prevalence and measurements in gross specimens and TVS reports. The results highlight the importance of considering external and bidirectional niches, in addition to internal niches. These niches can reduce residual myometrial thickness and increase future pregnancy complications. Furthermore, we demonstrated that niche formation can occur after a single CD.

Histopathological Spectrum of Hysterectomy Specimens: A Retrospective Analysis at a Tertiary Care Center

Histopathological Spectrum of Hysterectomy Specimens: A Retrospective Analysis at a Tertiary Care Center

Endometrial pattern in women with abnormal uterine bleeding attending a tertiary care centre of Kathmandu

Background: Abnormal uterine bleeding is one of the most common problems among pre and postmenopausal women. Abnormal uterine bleeding is diagnosed when there is a substantial change in frequency, duration, or amountof bleeding during or between periodsin the absence of any organic pathology. The study was perform to assess the endometrial causes of abnormal uterine bleeding and their incidence in different age groups. Materials and methods: It was a cross sectional and descriptive study carried out at a Manmohan medical College &amp; hospital, over a period of two year from 13th April, 2020 to 15th March, 2022. In the study all the endometrial tissue either obtained by endometrial curettage and biopsy or hysterectomy presenting with abnormal uterine bleeding for more than 3 months were included Results: A total of 88 cases were received during this period, out of which there were 78 endometrial tissue samples and 10 hysterectomy specimens. The patient’s age ranged from 20 years to 73years. The pattern of endometrial biopsy are Proliferative (37.5%) and secretory (20.45%) phase endometrium is the most common pattern seen, followed by disordered proliferative endometrium (13.63%), endometrial hyperplasia without atypia (9.09%), Change consistent with Exogenous Hormone (5.68%), Chronic Endometritis (5.68%), Endometrial Polyp(3.40%), Endometrial Hyperplasia with Atypia(2.27%) and Endometrial Carcinoma (2.27%). Conclusions: Patients with abnormal uterine bleeding show a varying spectrum of endometrial pattern. Cyclic endometrium is commonly seen in the reproductive age group whereas hyperplasia and carcinomas are seen in pre/postmenopausal age group. Endometrial biopsy with histopathological examination is a major diagnostic tool in the evaluation of abnormal uterine bleeding.

β‑catenin expression in endometrioid type endometrial cancer: Expression patterns and impact on disease outcomes.

Determination of nuclear and/or cytoplasmic expression of β-catenin by immunohistochemistry in patients with endometrial cancer (EC) may constitute a potential diagnostic method for identifying patients with a catenin β1 (CTNNB1) gene mutation and those at risk of disease recurrence. The present study aimed to investigate β-catenin expression patterns in hysterectomy specimens of patients with endometrioid type EC using immunohistochemistry, and to examine the prognostic impact of β-catenin. The study was a single-institutional, retrospective cohort trial enrolling consecutive patients with a postoperative histopathological diagnosis of endometrioid EC who underwent hysterectomy between January 2015 and December 2018. Histopathology slides from 75 patients were stained with a monoclonal antibody targeting the β-catenin protein. Any percentage of nuclear staining, whether focal or diffuse, was considered 'β-catenin nuclear-positive'. The cytoplasmic staining reaction of β-catenin was assessed based on the percentage of stained cells and staining intensity. Immune-reactivity score (IRS) values were determined by multiplying the scores for the percentage of staining and staining intensity. IRS values 0 to 2 were regarded as negative expression, 3 to 4 as low expression, 6 to 8 as moderate expression, and 9 to 12 as high expression. Recurrence-free survival (RFS) was used as the prognostic endpoint. Only 2 out of 75 tissue samples (2.7%) exhibited nuclear β-catenin expression, with a low staining percentage of 5%. By contrast, cytoplasmic staining was observed in all samples (100%). According to the IRS findings, 1.3% of the samples exhibited negative cytoplasmic expression, 42.7% low expression, 38.7% moderate expression and 17.3% high expression. Cox regression analysis revealed that staining with β-catenin, either nuclear or cytoplasmic, had no impact on RFS, and stage was the sole independent prognostic factor. In conclusion, based on these results, β-catenin expression in endometrioid EC was revealed to be mostly cytoplasmic, with only 2.7% of tissue samples exhibiting nuclear expression. Overall, β-catenin expression has no impact on RFS.

Evaluation of Leiomyoma: A Clinicopathological Study in a Tertiary Care Center in Kathmandu

Uterine leiomyoma is one of the common gynecological benign tumors. It is usually observed in female of reproductive age group and often presented with symptoms like abdominal pain, dysmenorrhea and fertility disorders. Hysterectomy and myomectomy are the procedure for management of uterine leiomyoma. The prime objective of our study was to evaluate the demographic distribution and clinicopathological changes in hysterectomy and myomectomy specimens with leiomyomas. A descriptive hospital based cross-sectional study was conducted in the Department of Pathology, Nepal Medical College Teaching Hospital (NMCTH), Nepal from May 2023 to October 2023. A total of 57 uterine leiomyoma samples received in the department of Pathology for histopathological examination were included in the study. Ethical approval for the study was obtained from Institutional Review Committee of NMCTH and informed consent was taken from each patient. The tissue biopsies were routinely processed and stained with Hematoxylin and Eosin (H and E). The observed findings were managed in MS Excel sheet and later analyzed using SPSS 17. The most common age group diagnosed with uterine leiomyoma was 41 to 50 years (64.9%). The leiomyomas were highly prevalent in women from Janajati community (47.4%). Pelvic pain, menorrhagia and bleeding disorders were the most frequent clinical manifestations. Intramural was the commonest site (77.2%) and the hyalinization was the most usual secondary changes (19.2%) found. The correlation between age distribution and site of leiomyoma, age distribution and secondary changes and site of leiomyoma and secondary changes were statistically not significant. However, detailed histopathological examination gives many information related to leiomyoma and it is necessary for the effective management.

Evaluation of Cold Conization Indications and Results

Objective: The aim of this study was to determine the efficiency and indications of cold knife conization in the treatment of high-grade cervical lesions. Materials and Methods: This study included patients with high-grade cervical lesions treated with cold knife conization (CKC) within 9 years. Histopathological correlation analyses were carried out among the smear, colposcopic biopsy (CBx), CKC results, and total hysterectomy specimens available. Results: One hundred thirty-one cold knife cone biopsy cases were analyzed for this study. The most common pathology was cervical intraepithelial neoplasia (CIN) II–III, with a frequency of 64 (48.9%). Other conization results in order of frequency were as follows: CIN I at a rate of 29 (22.1%), Carcinoma (Ca) at 19 (14.5%), cervicitis at 14 (10.7%), and negative results at 5 (3.8%). Conclusions: CKC remains an acceptable option in the treatment of CIN and microinvasive carcinoma of the cervix, and the excellent diagnostic and therapeutic efficacy of CKC is well-known and confirmed. When properly performed, the procedure has a low risk of complications and provides an accurate histological representation of the disease process. It is also curative in most cases. Of course, excellent clinical results still require careful, long-term, and attentive follow-up.

Abnormal uterine bleeding and hysterectomy: Insights from histopathological analysis of hysterectomy specimens from a tertiary care hospital

Abnormal uterine bleeding and hysterectomy: Insights from histopathological analysis of hysterectomy specimens from a tertiary care hospital

Histopathological spectrum of uterine lesions in hysterectomy specimens of patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is an overarching term that reflects any departure from normal menstruation or regular menstrual cycle patterns. Treatment depends upon the cause. Hysterectomy being a definite treatment for structural uterine pathology. Methods: This cross-sectional observational study was conducted in department of pathology, Netaji Subhash Chandra Bose medical college Jabalpur (M.P.). The study comprised of 140 hysterectomy specimens with or without salpingo-oophorectomy obtained from AUB patients and submitted for histopathological examination in our department during study period of 18 months. The relevant data of the patients was collected and analyzed as per designed proforma. Results: Out of 140 cases, majority of the patients were in 41-50 years age group 63 cases (45%), followed by 31-40 years age group 59 cases (42.14%). Most common clinical presentation was heavy menstrual bleeding in 83 cases (59.28%), followed by intermenstrual bleeding and pain in abdomen in 66 cases (47.14%) each. Commonest lesion found was leiomyoma, 83 cases (59.28%), second being dual pathology of adenomyosis with leiomyoma 23 cases (16.42%) followed by adenomyosis, 19 cases (13.57%). Four cases (2.85%) of benign endometrial polyp and endometrial carcinoma each and 1 case of adenomyoma, simple endometrial hyperplasia and endometrial stromal sarcoma, each, were reported. Conclusions: A wide spectrum of histopathological findings, ranging from normal cyclic endometrium to benign pathology and malignancy were seen. In some patients, dual pathologies, incidental findings and occult malignant lesions, which were missed clinically or radiologically, was diagnosed on histopathological examination, thus making it a gold standard for definite diagnosis.

Immunohistochemical expression of B-cell lymphoma 2 gene -Bcl-2 in endometrial carcinoma

Background and objectives: Apoptosis, a process of cell death, is inhibited by the B-cell lymphoma 2 protein, leading to the prolonged survival of cells. Participation of Bcl-2 in starting and advancement of endometrial carcinoma remains inconclusive, with varying results observed. The aims of this study were to assess the frequency of B-cell lymphoma 2 expression in endometrial carcinoma, and to investigate the connection between B-cell lymphoma 2 expression with some clinicopathological parameters. Methods: A retrospective study was carried out for seventy-eight formalin fixed paraffin embedded blocks of total abdominal hysterectomy specimens diagnosed as endometrial carcinoma, which were randomly obtained from a private laboratory and Rizgary teaching hospital laboratory in Erbil city during June 2021-June 2022. In this study, endometrial carcinoma cases were subjected to the utilization of B-cell lymphoma 2 gene, which is a Mouse monoclonal antibody, and its expression was evaluated. Results: The expression of Bcl-2 was observed in 61.5% of the studied cases. The majority (93.6%) of EC cases were of low grade, although Bcl-2 expression was observed at a greater frequency (64.4%) in low-grade endometrial carcinoma, but there was no significant association. Additionally, no statistically significant correlation was found between B-cell lymphoma 2 gene expression and other clinicopathological parameters like, age, myometrial invasion, lympho-vascular invasion, lymph node status and tumor stage. Conclusion: Bcl-2 was expressed in 61.5% of the studied cases with no significant association with any of the variables, additional research is necessary to assess the expression of B-cell lymphoma 2 gene in relation to endometrial carcinoma invasion and metastasis.

Epithelioid Trophoblastic Tumor—A Challenge to Manage due to Its Rare Existence: A Case Report with Review of Literature

AbstractEpithelioid trophoblastic tumor (ETT) is the rarest type of gestational trophoblastic neoplasia. It has variable presentations and is an aggressive tumor. Because of its rarity, it is difficult to establish an appropriate diagnosis, management, and follow-up. A woman of age 45 years postmenopausal status with an antecedent term pregnancy 13 years back was diagnosed to have ETT in the hysterectomy specimen. She had come with urinary retention as the tumor was infiltrating the bladder. Beta-human chorionic gonadotropin levels were normal. Immunohistochemistry confirmed the diagnosis. Though metastatic workup was normal, adjuvant multiagent chemotherapy was given as the bladder flap margin was not free of tumor cells and antecedent pregnancy was &gt; 4 years. Every new case of ETT needs to be reported to bring about more awareness of the unusual presentations, and it may help come to a consensus for appropriate management.

Exploring uterine involvement in hysterectomy samples following conization for adenocarcinoma in situ of the uterine cervix: Insights from a multicenter study by the FRANCOGYN group

BackgroundAdenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy is standard, conservative management may be considered for women desiring future pregnancies. This study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional therapy with clear margins for AIS. MethodsA retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative predictors of residual disease and comparing recurrence rates between patients with and without residual disease. ResultsOf 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group, 18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI (27.5 kg/m² vs. 23.6 kg/m², p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences were observed during follow-up. ConclusionDespite clear margins on the initial conization for AIS, 20% of patients had residual disease in their hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after completing childbearing, even if initial margins are clear.

Evaluation of the Vascular Endothelial Growth Factor and Smooth Muscle Actin Expression With Microvessel Density and Morphometric Analysis of Endometrial Vessels in Patients With Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) that occurs in a structurally normal uterus with regular menstrual cycles and without other identifiable etiology is often caused by a primary endometrial disorder (AUB-E). Altered vascular morphological changes and expression of markers of angiogenesis have been implicated as an underlying cause in these cases. The study was conducted to investigate the expression of vascular endothelial growth factor (VEGF) and smooth muscle actin-alpha (SMA-α), and to perform microvessel density (MVD), andmorphometric evaluation of endometrial vessels in patients with AUB-E. Endometrial biopsies and hysterectomy specimens of 40 patients clinically diagnosed with AUB-E were included in the study with 40 age-matched controls. Immunohistochemistry (IHC) with VEGFandSMA-αwas performed, and the expression and staining pattern was recorded as the number of positive vessels per 10 high power fields and intensity scores. Morphometric analysis was performed on CD34 stained sections using Leica Application Suite, version 4.4.0 software (Leica Microsystems, Wetzlar, Germany). MVDwas calculated by the vascular hotspot method. A statistically significant increase in VEGF vessel count (p-value<0.001) and a decline in SMA-α expression (p-value=0.23) was seen in cases as compared to the control group.There was a statistically significant increase in microvessel caliber (p-value=0.01) and MVD (p-value <0.001) in cases as compared to controls. These findings support aberrant vascular proliferation and impaired vessel maturation, contributing to the pathology of AUB-E. Alterations in angiogenesis in these patients reveal potential therapeutic targets for AUB.

Timeliness and Completeness of Endometrial Cancer Pathology Reports Before and After the FIGO 2023 Endometrial Cancer Staging Guidelines Update

Introduction: Uterine cancer is the most common gynecologic malignancy among women in the United States with an estimated 66,200 new cases and 13,030 deaths in 2023.1 These cancers are divided into endometrial adenocarcinomas (EAC) and uterine sarcomas. In 2013, the Cancer Genome Atlas (TCGA) proposed four new molecular classifications based on genome and exome sequencing of EACs including POLE-mutant, mismatch repair deficiency (MMRd), p53 abnormal, and no specific molecular profile (NSMP).4 In June of 2023, the International Federation of Gynecology and Obstetrics (FIGO) published an updated staging system for uterine cancer to incorporate these molecular indices along with the traditional anatomical distribution of disease and histology used in older FIGO staging guidelines.5 The primary objective of this project was to analyze the timeliness and completeness of pathology reports and IHC staining of patients who underwent hysterectomies for uterine cancer at Detroit Medical Center from October 2022 – December 2023. Methods: Patients were identified from the list of patients presented at the Karmanos Cancer Insitute’s (KCI) Gynecologic Oncology Tumor Board. Given the June publication timing of the FIGO 2023 staging guidelines, this served as the intervention for the study. The pre-intervention group consists of surgical cases from October 2022 through June 2023, and the post-intervention group consists of cases from July 2023-December 2023. Differences in time from surgery to pathology report, surgery to IHC result, pathology report to IHC result as well as completeness of IHC results were compared pre- and post-intervention. Because neither group was normally distributed, a MannWhitney-U test was used to calculate P-value. IHC result completeness pre- and post-intervention was calculated using a Fisher exact test. Results: A total of 106 cases were included, of which 67 were preintervention (63%) and 39 were postintervention. The median number of days from surgery to final pathology report was statistically significant (p=0.003) between the groups. The median number of days from pathology report to IHC result was not a statistically significant difference (p=0.19). The median number of days from surgery to completed IHC also not statistically significant. In terms of IHC staining, there was a statistically significant difference in the number of specimens pre- and post-intervention for p53 (p=0.004) and HER2 (p=0.04). There was no change in the MMR and MSI testing between the two groups. Conclusions: Following the implementation of the FIGO 2023 staging guidelines in June of 2023, there was a significant decrease in the time from surgery to finalized pathology report and a significant change in the completeness of staining for p53 and HER2 on hysterectomy specimens. By finalizing the results of both pathology and IHC for endometrial cancer specimens in a timelier manner, patients can be informed of their diagnosis sooner. Additionally, with a complete pathologic and molecular diagnosis, our gynecologic oncologists can also more efficiently and effectively communicate within a multidisciplinary team of providers including radiation oncology and genetic counseling colleagues to formulate a treatment plan.

Blood Vessel Invasion Is an Independent Prognostic Factor in Endometrial Endometrioid Carcinoma Compared to Lymph Vessel Invasion and Myometrial Invasion Pattern.

We studied 115 cases of EEC diagnosed on hysterectomy specimens. Double immunohistochemical staining (D2-40/CD31) was performed in all 115 cases to show LVI and BVI on the same slide. MELF pattern invasion was present in 24/115 (21%) cases. MELF-positive tumors had a higher frequency of LVI than MELF-negative tumors (58% and 23%, respectively); the frequency of BVI was twice as high in MELF-positive tumors in comparison to MELF-negative tumors (25% and 12%, respectively). These differences were significant (p ˂ 0.0001). All tumors with positive BVI also had a concomitant LVI. The presence of MELF invasion had no impact on overall survival, confirming previous studies. 5-year survival rates were almost equal in cases with negative LVSI and cases with positive isolated LVI (98% vs. 97%). However, in cases where BVI was also present, the 5-year survival rate was significantly lower, 63% (p ˂ 0.0001). Furthermore, BVI proved to be an independent prognostic factor for overall survival, disease-free survival, and recurrence in the multivariate analysis. In conclusion, MELF pattern invasion is a good predictor of lymphatic and blood vessel invasion but has no prognostic value. Our results suggest that BVI in EEC has greater clinical value than isolated LVI or myometrial invasion patterns, and the therapeutic approach should be guided by BVI presence. Therefore, we hope this study will promote the routine evaluation of BVI in the context of EEC diagnostic procedures.

Tumor Stiffness Measurement at Multifrequency MR Elastography to Predict Lymphovascular Space Invasion in Endometrial Cancer.

Background Pathologic lymphovascular space invasion (LVSI) is associated with poor outcome in endometrial cancer. Its relationship with tumor stiffness, which can be measured with use of MR elastography, has not been extensively explored. Purpose To assess whether MR elastography-based mechanical characteristics can aid in the noninvasive prediction of LVSI in patients with endometrial cancer. Materials and Methods This prospective study included consecutive adult patients with a suspected uterine tumor who underwent MRI and MR elastography between October 2022 and July 2023. A region of interest delineated on T2-weighted magnitude images was duplicated on MR elastography images and used to calculate c (stiffness in meters per second) and φ (viscosity in radians) values. Pathologic assessment of hysterectomy specimens for LVSI served as the reference standard. Data were compared between LVSI-positive and -negative groups with use of the Mann-Whitney U test. Multivariable logistic regression was used to determine variables associated with LVSI positivity and develop diagnostic models for predicting LVSI. Model performance was assessed with use of area under the receiver operating characteristic curve (AUC) and compared using the DeLong test. Results A total of 101 participants were included, 72 who were LVSI-negative (median age, 53 years [IQR, 48-62 years]) and 29 who were LVSI-positive (median age, 54 years [IQR, 49-60 years]). The tumor stiffness in the LVSI-positive group was higher than in the LVSI-negative group (median, 4.1 m/sec [IQR, 3.2-4.6 m/sec] vs 2.2 m/sec [IQR, 2.0-2.8 m/sec]; P < .001). Tumor volume, cancer antigen 125 level, and tumor stiffness were associated with LVSI positivity (adjusted odds ratio range, 1.01-9.06; P range, <.001-.04). The combined model (AUC, 0.93) showed better performance for predicting LVSI compared with clinical-radiologic model (AUC, 0.77; P = .003) and similar performance to the MR elastography-based model (AUC, 0.89; P = .06). Conclusion The addition of tumor stiffness as measured at MR elastography into a clinical-radiologic model improved prediction of LVSI in patients with endometrial cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Ehman in this issue.

A HISTOMORPHOLOGICAL STUDY OF FALLOPIAN TUBES IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Introduction: Fallopian tubes are complex structures 1. Fallopian tubes are part of female genital tract named after Italian physician Gabriele Fallopias in 16thcentury 2,16. Fallopian tube lesions are non-neoplastic and neoplastic. Non neoplastic lesions are the major cause of sterility13. Present study was under taken with objectives of study all histomorphological lesions of fallopian tubes in bilateral salphigoophorectomised patients. Material and methods: A total number of 249 specimens of hysterectomy with bilateral salpingectomy. Histosalphingooophorectomy cause were studied in the department of pathology SDM College of medical sciences and Hospital Dharwad over a period of 7 years form July 2012 to June 2019. The clinical data, gross and microscopic findings were studied. Incidence and prevalence were calculated. Results: In our study Hydrosalphinx (20.1%) is the commonest finding, Tubal atypia 14.9%, Tubal metaplasia 14%, acute salphingitis 9.2%, Metastatic lesions 6%, Hematosalphinx 6.8%, fallopian tube showing STIC lesions 3.6%, TuberculousSalphingitis 3.2% Conclusion: Fallopian tube lesions present with different pathological findings. Precursors of malignancy in fallopian tube has to be thoroughly examined.

Follow-up of women with cervical adenocarcinoma in situ treated by conization: A single centre clinical experience

ObjectiveHysterectomy has been the historical gold standard final step in the treatment algorithm of adenocarcinoma in situ (AIS) recommended by most North American colposcopy guidelines. AIS disproportionately affects young childbearing age women, therefore a fertility sparing treatment option is desirable. Our study examines the impact of conservative treatment of AIS with conization followed by serial surveillance. MethodsA retrospective chart review was completed of patients treated for AIS from 2006 to 2020. Charts were identified by pathologic diagnosis of AIS on cervical and uterine specimens. Charts were excluded if AIS was not treated with conization, if AIS was not confirmed on initial conization specimen, or if invasive disease was found at initial conization. Results121 patient charts were analyzed. Median age of patients at first conization and hysterectomy was 34.8 and 40.9, respectively. First conization was by Cold Knife Cone in 58% of patients, and by Loop Electrosurgical Excisional Procedure in 42% of patients. Median follow-up period in our study was 609 days. 5% of patients had recurrence, with only one patient who recurred as cancer. One case of recurrence had a positive initial conization margin. Median time to recurrence was 700 days. 47% of patients underwent eventual hysterectomy. Residual AIS was found in 23% of hysterectomy specimens. Adenocarcinoma was diagnosed on hysterectomy specimen in four patients. ConclusionOur study demonstrates the oncologic safety of treating AIS with conization and serial surveillance. Routine hysterectomy completed as a part of the AIS treatment algorithm, as in current clinical guidelines, is unnecessary.