Malignancy In Postmenopausal Women Research Articles

Asymptomatic Thickened Endometrium in Postmenopausal Women: Malignancy Risk

Study ObjectiveTo assess the diagnostic findings and determine the frequency of malignancy in postmenopausal women evaluated by office hysteroscopy for a thickened endometrium without bleeding. DesignRetrospective cohort (Canadian Task Force classification II-B). SettingAcademic medical center in the Midwestern United States. PatientsOver 3600 women underwent an office hysteroscopy between January 1, 2007, and October 20, 2011, for abnormal uterine bleeding or an abnormal ultrasound. Of these, 154 postmenopausal women had a thickened endometrium (>4 mm) and no bleeding. InterventionsFlexible office hysteroscopy using a 3.1-mm scope with saline as the distending media was performed for clinical reasons, and results were captured within a research database. Measurements and Main ResultsFor the 154 women, the range of endometrial measurements was 4.2 to 28 mm (mean = 10.0 mm). Hysteroscopy diagnoses included 93 patients with polyps, 19 with myomas or uterine synechiae, and 34 with benign-appearing endometrium. Nine hysteroscopies were inadequate because of poor visualization (n = 1), cervical stenosis (n = 6), or patient discomfort (n = 2). Endometrial biopsies (EMBs) were performed in 109 patients, and none were found to have cancer or an atypical endometrium. Six had simple hyperplasia without atypia, and their endometrial measurements were within the range of the patients in our study who had a benign endometrium (5–15 mm, mean = 10.3). Of the women with a polyp, 73 (78.4%) subsequently underwent polypectomy. On final pathology, 1 had cancer (endometrial measurement = 24 mm), and 1 had complex hyperplasia with atypia (endometrial measurement = 17 mm). EMBs performed in the office for these 2 patients showed an insufficient endometrium and inactive endometrium, respectively. ConclusionCancer and atypia can occur in asymptomatic women. Endometrial thickness was 17 mm or greater in 2 cases, and EMBs performed in the office were inconsistent with the final diagnosis. Hysteroscopy is important when ultrasound and EMB do not agree. Polypectomy may be indicated even in asymptomatic women, but further studies regarding an endometrial measurement threshold or polyp size are warranted.

Which Endometrial Pathologies Need Intraoperative Frozen Sections?

Endometrial cancers are the most common gynecologic cancers. Endometrial sampling is a preferred procedure for diagnosis of the endometrial pathology. It is performed routinely in many clinics prior to surgery in order to exclude an endometrial malignancy. We aimed to investigate the accuracy of endometrial sampling in the diagnosis of endometrial pathologies and which findings need intra-operative frozen sections. Three hundred nine women applying to a university hospital and undergoing endometrial sampling and hysterectomy between 2010 and 2012 were included to this retrospective study. Data were retrieved from patient files and pathology archives. There was 17 patients with malignancy but endometrial sampling could detect this in only 10 of them. The endometrial sampling sensitivity and specificity of detecting cancer were 58.8% and 100%, with negative and positive predictive values of 97.6%, and 100%, respectively. In 7 patients, the endometrial sampling failed to detect malignancy; 4 of these patients had a preoperative diagnosis of complex atypical endometrial hyperplasia and 2 patients had a post-menopausal endometrial polyps and 1 with simple endometrial hyperplasia. There is an increased risk of malignancy in post-menopausal women especially with endometrial polyps and complex atypia hyperplasia. Endometrial sampling is a good choice for the diagnosis of endometrial pathologies. However, the diagnosis should be confirmed by frozen section in patients with post-menopausal endometrial polyps and complex atypia hyperplasia.

Asymptomatic Thickened Endometrial Stripe in Postmenopausal Women: Malignancy Risk

To determine the frequency of malignancy in postmenopausal women evaluated by office hysteroscopy for asymptomatic thickened endometrial stripe (ES).

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.

Analysis of Genital Tract Malignancies in Postmenopausal Indian Women

ABSTRACT Introduction Genital malignancies in women varies widely from developed to developing countries. Postmenopausal women are at risk of developing various genital malignancies. Objectives (1) To determine frequency of genital tract malignancies in postmenopausal women, (2) to determine the type and stage of genital tract malignancies, (3) to create awareness of screening in women. Materials and methods This descriptive cross-sectional study was carried out over a period of 2 years from March 2010 to Feb. 2012. It included 200 postmenopausal women admitted with complaints like mass or fullness of abdomen, bleeding or discharge per vaginal and ulcer over vulva. They were evaluated clinically followed by relevant investigations. Malignancy was confirmed by histopathology report. Results Out of 200 postmenopausal women admitted during study period, malignancy was confirmed in 55 women (27.5%). The type of malignancy was cervical carcinoma (30, 54.54%), ovarian carcinoma (18, 32.72%), carcinoma endometrium (5, 9.09%), carcinoma vulva (1, 1.81%) and carcinoma vagina (1, 1.81%). Majority of carcinoma cervix and ovarian carcinoma were in advanced stage. Conclusion Carcinoma cervix was commonest genital malignancy found our study followed by carcinoma ovary. Importance of routine gynecological check-up in postmenopausal women was emphasised. How to cite this article Somalwar SA, Joshi S, Kawthalkar A, Bhalerao A, Jain S, Somalwar A. Analysis of Genital Tract Malignancies in Postmenopausal Indian Women. J South Asian Feder Menopause Soc 2013;1(2):66-69.

215 Endometrial polyps and risk factors for malignancy in postmenopausal women

215 Endometrial polyps and risk factors for malignancy in postmenopausal women

Interplay Between Insulin Resistance and Estrogen Deficiency as co- Activators in Carcinogenesis

Both insulin resistance and estrogen deficiency result in complex metabolic disorder based mainly on defective cellular glucose uptake and on an atherogenic serum lipid profile. These alterations may be regarded as high risks for several life-threatening human diseases, such as type-2 diabetes, cardiovascular lesions and malignancies. Insulin resistance and estrogen deficiency are concomitant disorders with mutual interrelationship. Insulin resistance and the compensatory hyperinsulinemia provoke increased androgen synthesis at the expense of decreased estrogen production. Similarly, a moderate or severe decrease in serum estrogen levels enhances the prevalence of insulin resistant states both in men and women. Healthy premenopausal women enjoy the defensive effect of estrogens against metabolic and hormonal disorders. However, even a slight decrease in their circulatory estrogen levels associated with insulin resistance may increase the risk for cancers, particularly in the organs having high estrogen demand (breast, endometrium and ovary). On the other hand, postmenopausal state with profound estrogen deficiency confers high risk for cancers in different organs with either high or moderate estrogen demand. After menopause, hormone replacement therapy improves insulin sensitivity and decreases the enhanced inclination to malignancies in postmenopausal women. Recognition of the thorough interplay between insulin resistance and estrogen deficiency may illuminate many apparently controversial experimental and clinical findings concerning cancer development and therapeutic possibilities. Moreover, their interactions in the initiation and progression of human malignancies may supply new strategies in primary cancer prevention and cancer cure.

Obesity and breast cancer: status of leptin and adiponectin in pathological processes

It is well recognized that obesity increases the risk of various cancers, including breast malignancies in postmenopausal women. Furthermore, obesity may adversely affect tumor progression, metastasis, and overall prognosis in both pre- and postmenopausal women with breast cancer. However, the precise mechanism(s) through which obesity acts is/are still elusive and this relationship has been the subject of much investigation and speculation. Recently, adipose tissue and its associated cytokine-like proteins, adipokines, particularly leptin and adiponectin, have been investigated as mediators for the association of obesity with breast cancer. Higher circulating levels of leptin found in obese subjects could be a growth-enhancing factor as supported by in vitro and preclinical studies, whereas low adiponectin levels in obese women may be permissive for leptin's growth-promoting effects. These speculations are supported by in vitro studies which indicate that leptin promotes human breast cancer cell proliferation while adiponectin exhibits anti-proliferative actions. Further, estrogen and its receptors have a definite impact on the response of human breast cancer cell lines to leptin and adiponectin. More in-depth studies are needed to provide additional and precise links between the in vivo development of breast cancer and the balance of adiponectin and leptin.

The risk of malignancy in post-menopausal women presenting with adnexal torsion

Objectives. Adnexal torsion is usually diagnosed in pre-menopausal women and is less common in post-menopausal patients. The risk of malignancy in cases of torsion in menopausal patients is not known. We set out to describe our experience with adnexal torsion in post-menopausal women and to discuss issues related to management in this situation. Methods. A retrospective chart review was conducted of all post-menopausal patients diagnosed with torsion of the adnexa from January 1990 through December 2005. Patient charts were reviewed for information regarding pre-operative signs and symptoms, pathology, demographics, surgical findings, procedure and outcome. As a control group, we chose a consecutive cohort of 29 pre-menopausal patients diagnosed with adnexal torsion during 2002. Results. Twenty-seven patients were found to be menopausal at the time of diagnosis of adnexal torsion. Median age at presentation was 63 years (range 43–93). A median delay of 40 h was found between the time of hospital admittance to surgery for post-menopausal patients in comparison to the pre-menopausal ones. The cause of torsion was benign in pre-menopausal patients whereas 22% of post-menopausal patients were diagnosed with malignant disease. More adnexas were found to be necrotic in menopausal patients and this resulted in under-diagnosis of malignancy on frozen section analysis. Conclusion. The diagnosis of adnexal torsion is less evident in post-menopausal patients leading to delayed treatment. The high risk of malignancy is of major importance and should be taken into account when counseling patients and when using frozen section during surgery.

Ovarian Thecoma with Meigs Syndrome Mimicking Malignancy in Postmenopausal Women

To report a case of ovarian benign ovarian tumor with massive ascites, hydrothorax and elevation of tumor marker, mimicking an ovarian malignancy. A 52-year-old, para 3, female visited our obstetrics and gynecology clinic due to progressive abdominal fullness of 3 weeks' duration. A huge pelvic tumor with massive ascites and hydrothorax was found by a series of imaging studies, including ultrasonography and computed tomography. In addition, serum CA125 was elevated (1,678 U/mL). An exploratory laparotomy was performed under the suspicion of an ovarian malignancy. A huge right ovarian tumor without adhesive bands or a defined metastatic lesion was noted. The gross picture of the yellowish tumor showed a homogeneous solid component with hemorrhage. A right salpingo-oophorectomy was performed. Frozen section showed uniform and cytologically bland-looking spindle cells arranged in fascicles. The final histopathologic findings showed it to be a benign ovarian thecoma. Meigs syndrome is not uncommon in gynecology. The clinical signs and symptoms, and imaging and laboratory findings may not sufficiently differentiate Meigs syndrome from malignancy. An exploratory laparotomy is essential for the final diagnosis of this syndrome.