Malignancy Of Genital Tract Research Articles

Magnetic resonance imaging in the diagnosis of serous adenocarcinoma of fallopian tubes - description of a clinical observation.

Serous adenocarcinoma of the fallopian tubes is an extremely rare and difficult to diagnose form of the female genital tract malignancies. This pathology is often asymptomatic or accompanied by a nonspecific clinical picture, including serosanguineous vaginal discharge, colicky pain in the lower abdomen and pelvis, and adnexal mass. These symptoms are known in the literature as the Lacko triad and are considered pathognomonic for fallopian tube cancer. However, all of these symptoms occur in less than 15% of patients. The low frequency of occurrence and the absence of pathognomonic clinical picture lead to a high number of diagnostic errors, or to the diagnosis of the disease already in a neglected stage, which significantly worsens the prognosis for the patient. The exact diagnosis at the preoperative stage is established in only 4% of cases. This clinical observation describes a case of serous adenocarcinoma of the fallopian tube with all manifestations of the Lacko triad and MR imaging, which allowed us to suspect the presence of serous adenocarcinoma in the patient at the preoperative stage.

Comparative Study between Acute Side Effects in Patients Treated with Brachytherapy versus External Beam Radiotherapy in Early Stage Endometrial Cancer

Abstract Background Adenocarcinoma of the endometrium is the most common malignancy of the female genital tract. The main line of treatment of early stage endometrial cancer is total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjuvant radiotherapy either external beam radiotherapy or vaginal brachytherapy. Aim of the Work To compare acute toxicities between patients who received adjuvant high-dose- rate (HDR) vaginal brachytherapy (VBT) and those who received external beam radiotherapy (EBRT) in early stage endometrial cancer. Patients and Methods This is a retrospective study was conducted on 62 patients with histologically proven endometrial carcinoma at the Clinical Oncology Department, Ain Shams University Hospitals, Cairo, Egypt for 6 months from January 2020 to December 2022. Results The results of this study showed that different side effects were less frequent in HDR VBT group than in EBRT group, the differences were statistically significant only in nausea, diarrhea, bleeding per rectum, dysuria, abdominal pain, bony aches and skin toxicity. Among cases with acute side effects, grades of side effects were lower in HDR VBT group than in EBRT group, but the differences were statistically non-significant. Conclusion HDR-VBT may be a less toxic option than EBRT for the adjuvant treatment of early stage endometrial cancer. However, more research is needed to confirm these findings and to better understand the long-term risks and benefits of each treatment option.

Cerebrospinal fluid cytology: A theragnostic and prognostic tool- Experience from a tertiary cancer care centre in central India

: CSF examination is the gold standard for diagnosing leptomeningeal metastases. Malignant cells may access the subarachnoid space by hematogenous dissemination, spreading directly from parenchymal brain lesions, or spreading along the spinal cord or cranial nerves. Cytological detection of malignant cells in CSF is still a crucial decision point for systemic and intrathecal chemotherapy, and it has prognostic significance even with improvements in biochemical analysis and CNS imaging. Over the course of two years, a total of 397 patients—regardless of gender and age—were investigated. There were sixty-four cases with involvement of the central nervous system documented, comprising 42 hematologic malignancies and 22 solid tumors. Cell centrifugation (Cytospin) method were used to prepare smears and cell blocks where prepared, as feasible and indicated. : A cytological analysis of the cerebrospinal fluid showed that metastatic tumors were much more prevalent than primary central nervous system tumours. Lung tumors were the most frequent primary site in our analysis, with breast, gastrointestinal, and female genital tract malignancies following closely behind. CNS involvement has been reported in patients with Lymphoma (DLBCL) and Leukemia (most commonly ALL, but also AML and JMML) among hematological malignancies. Two cases of Retinoblastoma and one each of Medulloblastoma and an Atypical teratoid/rhabdoid tumor were observed in the pediatric age group.: Cerebrospinal fluid cytology is a simple and useful method, used as a primary diagnostic method in the evaluation of leptomeningeal metastases. This helps in the early detection of secondary CNS lesions and allows for timely intervention, prognosis, and prediction of overall survival.

The Role of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding

Background: Endometrial cancer is currently the most common malignancy of the female genital tract. Most of the women with endometrial cancer initially present with postmenopausal bleeding (PMB) and may be assessed initially with either endometrial biopsy or transvaginal ultrasonography. Objective: The objective of this study was to evaluate transvaginal ultrasound (TVS) measurement of endometrial thickness (ET) in diagnosing endometrial cancer in women with postmenopausal bleeding. Materials and method: This was a prospective study. Transvaginal ultrasonography and Papanicolaou smear were performed in 291 women presenting with postmenopausal bleeding aged >50 years and were followed up for one year in BIRDEM General Hospital from September 2017 to August 2018. Results: One hundred and seventeen women had an endometrial thickness ≤4 mm and one endometrial cancer (0.85%) was diagnosed in this group. Endometrial biopsy was performed in women who had recurrent bleeding. But in women with an endometrial thickness of ≥5mm (174 out of 291 women), endometrial cancer was diagnosed in 9.77%, atypical hyperplasia in 5.17%, ovarian malignancy in 1.72% and total malignancy was 17.8%. Conclusion: Transvaginal ultrasonography using a ≤4 mm cut-off has high sensitivity for detecting endometrial cancer and can identify women with PMB who are highly unlikely to have endometrial cancer, thereby avoiding more invasive endometrial biopsy. Delta Med Col J. Jan 2021;9(2): 91-95

Clinicopathological Characteristics of Multiple Primary Malignancies Involving Female Genital Tract at a Tertiary Cancer Institute of Northeast India.

The term "Multiple Primary Malignant Neoplasms (MPMNs)" refers to two or more unrelated primary malignant neoplasms that originate from single or different organs and occur in one patient. MPMNs have been divided into synchronous and metachronous based on time duration after first malignancy. This was a hospital-based retrospective study conducted at a tertiary cancer institute in Northeast India. Clinicopathological factors of patients with multiple primary malignancies with at least one female genital tract malignancy attending the gynecological oncology outpatient department were observed. Those with ambiguous status of primary malignancy and incomplete treatment of first primary malignancy were excluded from the study. A total of 57 patients with MPMN, including one case of triple primary malignancy, were included in the study. 59.18% of cases had metachronous, and 40.81% had synchronous malignancies. The median time to the development of second primary malignancy was 60 months. Among the first diagnosed malignancies, cervix was the most common site (26.5%), followed by endometrium (20.4%) and ovary (14.28%), whereas ovarian malignancy was more commonly diagnosed second malignancy (38.77%), followed by endometrium (14.28%) and cervix (10.2%). In an analysis of synchronous malignancies, the most common genital tract involvement was seen with endometrium and ovary, with a predominance of low-grade endometrioid histology in 75% of cases. As the cancer survivor population continues to increase in future, these patients must be comprehensively evaluated on follow-up, and a cognizance of prior treatment taken should be kept. In addition, it is vital that the clinicians keep a lookout for high-risk population in which genetic testing may be beneficial.

Study of histopathological spectrum of ovarian tumors in a tertiary care hospital in India

Abstract Background: Ovarian tumors rank as the third leading cause of mortality among female genital tract malignancies. This study examined the histopathological spectrum of ovarian neoplasms based on our center’s 2020 World Health Organization (WHO) classification. Materials and Methods: This descriptive study was carried out over 5 years at our tertiary healthcare hospital, including 406 cases of ovarian neoplasms. After proper fixation and gross examination, sections were routinely processed and examined. The histopathological spectrum of ovarian neoplasms was analyzed according to the 2020 WHO classification. Results: Out of the 406 cases studied, 329 (81.03%) were benign, 65 (16.01%) were malignant, and 12 (2.95%) were borderline. The cases included 326 (80.29%) surface epithelial tumors, 58 (14.28%) germ cell tumors, 19 (4.68%) sex cord-stromal tumors, and 2 (0.49%) metastatic tumors. The majority of ovarian tumors (n = 340, 83.74%) occurred in the 20–60 years age group. Conclusion: The study reveals that benign tumors were more prevalent than malignant ones, with serous tumors being the most common among the benign cases. We observed a higher incidence of malignancy in women over the age of 40. Therefore, early and accurate histological diagnosis is crucial for initiating an appropriate management plan.

Pitfalls in Diagnosis of Endometrial Adenocarcinoma in Biopsy Specimens

Endometrial Adenocarcinoma is one of the common malignancies of the female genital tract. It is associated with specific risk factors, which can be acquired and genetic. There are various precursor lesions of this condition, which warrants detection by proper screening methods to aid in earlier diagnosis and thereby treat these conditions to prevent their progression to well established adenocarcinoma. There are Several Histo-pathological mimickers which simulate Adenocarcinoma, that need to be differentiated by proper clinicopathological evaluation, so the correct diagnosis is made, which helps in overall management of patient. This study is an attempt to describe various precursor lesions of Endometrial Adenocarcinoma and also the differentiation of Pathological conditions that are the look alike of Endometrial Adenocarcinoma. In addition various clinicopathological methods will be described which help to arrive at proper diagnosis. Risk categories for Endometrial carcinoma will be identified which helps in early diagnosis of Disease.

Prognostic significance of pyroptosis-associated molecules in endometrial cancer: a comprehensive immunohistochemical analysis.

Endometrial cancer, the most prevalent malignancy of the female genital tract, has a concerningly poor prognosis when diagnosed in advanced stages, with limited targeted therapy options available for advanced or recurrent cases. Pyroptosis, a type of nonapoptotic cell death mediated by caspase-1, has shown potential antitumor effects in various tumors. NLRP3, a cytosolic sensor, initiates the canonical pyroptotic pathway, leading to caspase-1 activation, subsequent gasdermin D cleavage, and plasma membrane pore formation. The ESCRT-III machinery, particularly CHMP4B, acts as a key inhibitor of pyroptosis by repairing gasdermin D-induced membrane damage. The current study aimed to evaluate the clinicopathologic relevance of key pyroptosis-associated molecules in endometrial cancer. Immunohistochemistry was used to assess the expression of four pyroptosis-associated molecules (NLRP3, cleaved caspase-1 p20, cleaved gasdermin D, and CHMP4B) in 351 patients with endometrial cancer, and their associations with clinical, pathological, and survival outcomes were analyzed. High NLRP3 expression was significantly associated with age ≤ 50 years and premenopause. Increased cleaved caspase-1 p20 expression was associated with nonendometrioid carcinoma, Federation of Gynaecology and Obstetrics (FIGO) grade 3, and the p53 mutant pattern and was independently associated with poor recurrence-free survival (RFS) and overall survival. Increased cleaved gasdermin D expression was associated with a body mass index of >25 kg/m², FIGO grades 1-2, early FIGO stage (I-II), and absence of lymph node metastasis. High CHMP4B expression was associated with nonendometrioid carcinoma and poor RFS. Cleaved gasdermin D-high/CHMP4B-low endometrial cancer was associated with endometrioid carcinoma, FIGO grades 1-2 and favorable RFS. Our study identified cleaved caspase-1 p20 as an independent predictor of adverse outcomes in endometrial cancer. CHMP4B, an inhibitor of pyroptosis, was associated with an unfavorable RFS, whereas high cleaved gasdermin D/low CHMP4B expression was associated with a favorable RFS. These findings underscore the prognostic significance of pyroptosis and the potential interaction between cleaved gasdermin D and CHMP4B in endometrial cancer.

Clinico-Morphological Features and Immunohistochemical Profile of a Rare Case of Three Synchronous Primary Malignancies in the Female Genital Tract

(1) Background: Synchronous tumors are defined as tumors that occur at the same time, appearing within 2 months, according to the Surveillance Epidemiology and End Results Program, with a frequency of tertiary tumors of 0.5%. The purpose of this presentation is to report a case of three synchronous tumors of the female genital tract, given the fact that it represents a challenge both therapeutically and in demonstrating that the malignant lesions are completely different from each other. (2) Methods: We report the case of a 45 year-old patient diagnosed with three synchronous tumors developed in the genital tract: clear-cell ovarian carcinoma, uterine endometrioid adenocarcinoma, and cervical adenosquamous carcinoma. (3) Results: Total hysterectomy with bilateral anexectomy was performed and accompanied by a biopsy of the greater omentum. The evolution of the patient was favorable during chemotherapy, but she died two weeks after the completion of this treatment, from a cause secondary to the adverse effects determined by it, namely, severe thrombopenia which caused a massive lower digestive hemorrhage. (4) Conclusions: This case demonstrates the maximum importance of the involvement of adjuvant diagnostic techniques, especially when it comes to a diagnostic challenge with direct implications in the subsequent therapy of the patient.

Frequency and pattern of female genital tract malignancies in patients presenting with gynecological problems

Introduction: Significant morbidity and mortality is caused by cancers in women all over the world. Cancers of the female reproductive organs are called genital tract cancers. They include cervical cancer, ovarian cancer, endometrial cancer, vaginal carcinoma, cancer of the fallopian tubes and gestational trophoblastic tumor. After breast carcinomas, they account for the second most common carcinomas in females. 
 Methodology: This cross-sectional study was conducted from 1 June 2018 to 31 May 2022. After taking written informed consent, 256 patients presenting to Gynae A Unit, Ayub Teaching Hospital, Abbottabad, were included in the study. Patients with a history of menstrual irregularities, vaginal bleeding, abdominopelvic pain or mass were included, while those presenting with other gynecological problems were excluded. The confirmed diagnosis was made based on histopathology reports by the consultant pathologist of the laboratory in the hospital after the patient's surgery.
 Results: Out of the 256 patients, 30 (11.71%) had female genital tract malignancies. The mean age was 48.79 years, and the standard deviation was 12.93 years. 17 patients (56.66%) had ovarian cancer, 5 (16.66%) had cervical cancer, 7 (23.33%) had endometrial cancer, and 1 (3.33%) had vaginal cancer. Ovarian cancer was the most common (56.66%), followed by endometrial cancer. Serous adenocarcinoma of the ovary was the most frequent type (26.66%). 
 Conclusion: The percentage of female genital tract malignancies in patients with gynecological problems is relatively high with serous adenocarcinoma of the ovary being the most common malignancy. Developing and implementing an effective policy regarding early cancer detection is necessary.

Immunohistochemical Expression Status of HER2/neu and E-cadherin in Prostate Adenocarcinoma: A Cross-sectional Study

Introduction: Prostate cancer is a common tumour, accounting for 92% of malignancies in the male genital tract. Due to the high recurrence rate, it is important to identify prognostic markers in prostate cancer. Human Epidermal Growth Factor Receptor 2 (HER2) and Epithelial cadherin (E-cadherin) are speculated to be associated with carcinogenesis, but the literature has provided controversial results. Aim: To investigate the expression of HER2/neu and E-cadherin in prostatic adenocarcinoma and its correlation with clinicopathological parameters. Materials and Methods: A retrospective cross-sectional study was conducted at the Department of Pathology, SDM University, Dharwad, Karnataka, India. The study duration was one year and five months, from October 2020 to March 2022. A total of 45 cases diagnosed as prostatic adenocarcinoma between October 2016 and September 2019 were included. Clinicopathological parameters such as age, Prostate- Specific Antigen (PSA) levels, metastasis, perineural invasion, Gleason score, Gleason grade, and two-year survival were retrieved from hospital records and through telephone interviews. Immunohistochemistry (IHC) staining for HER2 and E-cadherin was performed and assessed by pathologists. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 20.0, and the Chi-square test was applied. Results: The mean age of the study participants was 69.6 years, ranging from 52 to 95 years. The rates of HER2/neu overexpression/positivity and reduced E-cadherin expression were 25 (55.5%) and 14 (31.1%), respectively. No statistically significant associations were found between HER2 and E-cadherin expression and age, PSA levels, perineural invasion, Gleason score, Gleason grade, and two-year survival (p>0.05). However, a statistically significant association was observed between HER2 expression and distant metastasis (p-value=0.006), whereas no significant association was found with E-cadherin (p-value=0.81). Conclusion: The study demonstrated a significant association between HER2/neu overexpression and tumour metastasis, suggesting that HER2/neu could serve as a prognostic parameter to assist surgeons. In contrast, E-cadherin showed no association with clinicopathological parameters, raising questions about its involvement in the progression of prostatic adenocarcinoma.

Prognostic factors and survival of women with endometrial carcinoma attending a tertiary care center in South India

Background: Endometrial cancer is the most common malignancy of the female genital tract in developed countries and the 4th most common cancer in women after breast, lung, and colorectum. It has an estimated lifetime risk of 2.6% for women living in developed nations, and a median age at diagnosis of 61 years. The majority of women with endometrial carcinoma are diagnosed at an early stage and may be cured by surgery with or without radiotherapy. When detected early it has an average survival rate of 95%. There are various prognostic factors epidemiological, tumor characteristics, and the treatment undertaken that have a significant influence on the disease-free survival (DFS) and overall survival (OS) of the disease. Here an attempt was made to analyze the prognostic factors and to determine the DFS among women diagnosed to have endometrial cancer. Aims and Objectives: The aim of this study was to evaluate the factors determining the prognosis and survival of women with endometrial cancer. Materials and Methods: A retrospective review was conducted on 82 cases diagnosed as endometrial carcinoma registered in the Department of Obstetrics and gynecology department in a government hospital. They were subsequently followed up over a period of 42 months. Results: The recurrence-free survival rate was found to be 90.2%. The estimated mean survival time using the inverse Kaplan–Meir method was 37.5 months (95% CI 34.6–41.34) for recurrence-free survival and 38.24 months (95% CI 34.77–41.72) for OS. Endometroid adenocarcinoma was the most common histological variant (79.3%). Diagnosis at an early stage (FIGO Stage 1 and 2) was more (74.3%) as compared to advanced stages. The calculated recurrence rate was 9.5% with a tumor-related mortality of 32.9%. The most common site of recurrence was the vault (62.5%). The statistically significant variables affecting the recurrence rates were the histological type of tumor and the grade. Prognostic variables with statistically significant influence on recurrence-free survival and OS were age, stage of the tumor, grade of the tumor, type of surgical procedure underwent by the patient, and the use of adjuvant therapy. Conclusion: The present study was able to demonstrate that endometrial adenocarcinoma diagnosed at an early stage has a very good prognosis and survival rates in Kerala. FIGO stage and grade of the tumor being the most important variables determining DFS and OS.

Exosome-transmitted miR-30a-5p enhances cell proliferation, migration, and invasion in ovarian cancer

BackgroundOvarian cancer (OC) causes the highest rates of mortality among women’s genital tract malignancies. Micro-ribonucleic acid (miRNA), the most abundant long noncoding RNAs transmitted by exosomes, has been revealed to be a potential marker for OC since 2008. In this study, we aimed to determine the possible roles of miRNAs derived from exosomes in the early diagnosis of OC through miRNA microarray, besides, exploring the underlying mechanisms of miRNAs in the OC progression.MethodsWe isolated exosomes from high invasive OC cell line HO8910PM and its parent cell line HO8910 using transmission electron microscopy and western blot, and performed miRNA microarray to identify the exosome-transmitted miRNA from the two cell lines, respectively. The expression profile was obtained by quantitative analysis, and then the differentially expressed individuals were screened. miRNA-30a-5p, a stable miRNA in both cells of our sequencing data was set for further study. MiR-30a-5p mimics, inhibitor and their corresponding negative controls were applied in OC cells. Then the cell proliferation, migration, and invasion of different groups were analyzed via cell counting-kit 8 (CCK8), wound healing, and Transwell analyses. Besides, ZBE2 and LDH2 expressions were detected by qRT-PCR.ResultsCombined with the data report of miRNA microarray technology, we set miR-30a-5p as our target miRNA to analyze its molecular function in regulating proliferation, migration, and invasion in OC cells. Our results showed that the miR-30a-5p overexpression could significantly enhance the capability of proliferation, migration, and invasion of HO8910 and HO8910PM cells, whereas the miR-30a-5p inhibition showed the opposite tendency (all P < 0.05). Besides, miR-30a-5p may be involved in these oncogenic processes through the upregulation of ZEB2 and LDH2.ConclusionOur results demonstrate that exosome-transmitted miRNA-30a-5p promotes the malignant behavior of OC cells, which may be served as a promising diagnostic and prognostic marker for patients with OC.

MiR-1299 is regulated by KCNQ1OT1 and inhibits cervical cancer progression.

Cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) is the most common malignancy of the female genital tract. MiR-1299 serves as a tumor suppressor, while KCNQ1OT1 acts as an oncogene in multiple malignancies. This research was designed to investigate the impacts of miR-1299 and KCNQ1OT1 on CESC progression. The downstream target of miR-1299 and the underlying regulatory mechanism of KCNQ1OT1 action on miR-1299 were explored. RT-qPCR was applied for RNA expression detection in CESC tissues and cells. RNA immunoprecipitation, RNA pulldown and luciferase reporter assays were applied to evaluate the binding between molecules in CESC cells. Cell Counting Kit-8 and colony formation assays were used for the measurement of CESC cell viability and proliferation. Western blotting was utilized to measure levels of apoptosis-related in CESC cells. MiR-1299 was downregulated in CESC tissues and presented a negative correlation with KCNQ1OT1 expression. KCNQ1OT1 was directly bound to miR-1299 to negatively modulate miR-1299 expression in CESC cells. The proliferative ability of CESC cells was suppressed by miR-1299 overexpression and was facilitated by KCNQ1OT1 overexpression. CESC cells apoptosis was promoted by miR-1299 mimics and inhibited by KCNQ1OT1 overexpression. In addition, in in vivo studies, miR-1299 overexpression rescued the effects of KCNQ1OT1 overexpression on CESC xenograft tumor growth. Finally, KCNQ1OT1 was bound to miR-1299 to upregulate PDPK1 expression in CESC cells. Collectively, miR-1299 was regulated by KCNQ1OT1 and inhibited CESC progression in vivo and in vitro, suggesting the tumor-suppressor role of miR-1299 for CESC.

Identification of predictive biomarkers for endometrial cancer diagnosis and treatment response monitoring using plasma metabolome profiling

BackgroundEndometrial cancer (EMC) is the most common female genital tract malignancy with an increasing prevalence in many countries including Japan, a fact that renders early detection and treatment necessary to protect health and fertility. Although early detection and treatment are necessary to further improve the prognosis of women with endometrial cancer, biomarkers that accurately reflect the pathophysiology of EMC patients are still unclear. Therefore, it is clinically critical to identify biomarkers to assess diagnosis and treatment efficacy to facilitate appropriate treatment and development of new therapies for EMC.MethodsIn this study, wide-targeted plasma metabolome analysis was performed to identify biomarkers for EMC diagnosis and the prediction of treatment responses. The absolute quantification of 628 metabolites in plasma samples from 142 patients with EMC was performed using ultra-high-performance liquid chromatography with tandem mass spectrometry.ResultsThe concentrations of 111 metabolites increased significantly, while the concentrations of 148 metabolites decreased significantly in patients with EMC compared to healthy controls. Specifically, LysoPC and TGs, including unsaturated fatty acids, were reduced in patients with stage IA EMC compared to healthy controls, indicating that these metabolic profiles could be used as early diagnostic markers of EMC. In contrast, blood levels of amino acids such as histidine and tryptophan decreased as the risk of recurrence increased and the stages of EMC advanced. Furthermore, a marked increase in total TG and a decrease in specific TGs and free fatty acids including polyunsaturated fatty acids levels were observed in patients with EMC. These results suggest that the polyunsaturated fatty acids in patients with EMC are crucial for disease progression.ConclusionsOur data identified specific metabolite profiles that reflect the pathogenesis of EMC and showed that these metabolites correlate with the risk of recurrence and disease stage. Analysis of changes in plasma metabolite profiles could be applied for the early diagnosis and monitoring of the course of treatment of EMC patients.

An institutional study: Does Body Mass Index influence surgical approach, surgical morbidities, and outcomes in endometrial cancer patients?

Endometrial Cancer (EC), the most common genital tract malignancy in women, is recognised to be associated with a high Body Mass Index (BMI). The aim of the study was to evaluate the impact of obesity on intra and post-operative morbidity for patients treated for EC. This was a retrospective observational study including patients with EC that were surgically treated at Hospital de la Santa Creu i Sant Pau during nine consecutive years. The patients were divided in groups according to BMI: <30 Kg/m2, ≥30-<40 Kg/m2 and ≥40 Kg/m2. Demographic and pathological characteristics, surgical outcomes, perioperative complications and long-term outcomes were recorded. The study included 290 patients; 164 patients with BMI <30 Kg/m2(56.5%), 107 patients with ≥30-<40 Kg/m2 36.9%) and 19 patients with ≥40 Kg/m2(6.65%). Patients with BMI ≥40Kg/m2 were younger, presented a higher percentage of endometrioid histology (84.2%, p<0.01), well-differentiated tumours (73.7%, p<0.01) and were more frequently in the initial stages at diagnosis (94.7%) compared to the other groups. A significant percentage of the patients were operated on laparoscopically (88.7%, 88.8%, 94.7% respectively). No significant differences were found in the evaluation of the surgical outcomes. The results relative to complications showed an overall tendency toward increase in the ≥40 Kg/m2 BMI group but no statistical differences were identified among the groups in terms of complications or long-term outcomes. There was a rising trend towards increased complications with increasing BMI in the study population, however, this was found not to be statistically significant. Therefore, the optimisation of co-morbidities and the adaptation of surgical treatment is important for the management of obese patients with endometrial cancer. The study allows the comparison between groups with different BMI in patients with endometrial cancer. Different surgical outcomes, intra operative, early, and late complications are clearly identified, and survival outcomes are also investigated in our study.

Wnt/β-catenin Signaling in Endometrioid Endometrial Cancer and Precursor Lesions

Endometrioid endometrial carcinoma (EEC) is most common invasive malignancy of female genital tract. In spite of advances in diagnosis and treatment, incidence of EEC has been rising because of increasing aging population and prevalence of obesity. Therefore, there is need of research exploring the underlying molecular mechanism of EEC and its precursors. Wnt/ β-catenin signaling are involved in the progression and invasion of EEC. However, the potential role of Wnt/ β-catenin signaling and its effectors in endometrial cancer and precursor lesions remains to be investigated. In the present study a total of 95 samples of endometrial biopsies were assessed histopathologically along with β-catenin expression by immunohistochemistry and promoter methylation of adenomatous polyposis coli (APC) gene by bisulfite method. Women age ranged from 35 to 70 years whose endometrial biopsy and resected samples were obtained. Expression of β-catenin was observed in 28/39; 72% of EEC, 23/37; 62% of precancer cases and 4/19; 21% of normal proliferative endometrium. APC promoter was completely unmethylated in all controls (14/14) and precancer (10/10) groups, however, only one case (1/13, 8%) of cancer was methylated. The present study showed that expression of β-catenin was upregulated in EEC and precursor lesions suggesting involvement of Wnt/ β-catenin signaling from an early stage of development of cancer from precancer. The information might offer a potential therapeutic target for EEC and could also be used as a screening tool in endometrial hyperplasia (EH) cases for detecting potentially precancerous lesions.

Epidemiological-clinical characteristics of patients screened for cervical lesions in a low-resource setting in Kisangani. A cross-sectional study

Background. Cervical cancer is the most common malignancy of the female genital tract in developing countries and remains one of the leading causes of death due to cancer among women in Sub-Saharan Africa. This study aims to determine the epidemiological and clinical characteristics of patients screened for cervical lesions in a low-resource setting in Kisangani. Methods. A cross-sectional study conducted in the gynecology departments of the General Reference Hospital of Makiso-Kisangani and the Centre Médico-chirurgical Horizon during the period of one year including 209 participants whose age varied between 20 and 60 years and the VIA examination with household vinegar was made in all the participants. After encoding in the Excel file and grouped in the form of tables, the data was analyzed with percentage calculation. Results. The age interval of 40-49 years is 56 cases (26.7%) including 56.9% married living in Makiso commune. 44.4% are without complaints, came for screening, with 64.5% of multiparous; 47.8% declared a first sexual intercourse between 16-18 years old; 63 cases or 30.1% having known only one partner; 96.1% non-smokers with only 3.8% of smokers. 66% without notion of STI against 33.9% of STI. No physical signs (57.8%); VIA negative (89.9%); proven cancerous or invasive lesions (6.6%) and precancerous lesions (3.3%). Conclusion. Screening for cervical lesions poses a problem in Kisangani with a significant representation of invasive lesions. They show us that the use of VIA is the effective method in mass screening for low-resource settings.

ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of...

ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting.ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised. In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly.These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.