Metastasis Of Endometrial Carcinoma Research Articles

First Case of Isolated Cystic Brain Metastasis from Endometrial Adenocarcinoma Treated by Surgery

Introduction: Lung cancer, breast cancer, renal cell cancer, gastrointestinal carcinoma, and melanoma are common sources of cerebral metastasis. Brain metastasis from malignant gynecological tumors are considered rare. According to the literature, fewer than 3% of all brain metastases originate from gynecological lesions. The primary mechanism of metastatic spread from genital tract cancers to the brain is through the hematogenous rout. The endometrial carcinoma metastasis to the brain is a very rare event. The objective of this study is to describe this rare event and conduct a brief review of the literature. Case description: We report on a unique case of a cystic endometrial adenocarcinoma metastasis treated by neurosurgical procedure. The patient underwent “en bloc” tumor resection guided by neuronavigation and there were no complications during surgery. After discharge, she underwent whole brain radiation therapy, currently makes quarterly outpatient follow-up and showed no signals of tumor recurrence. Conclusion: In this article we present a case of cystic brain metastasis from an endometrial adenocarcinoma that was successfully treated by neurosurgery tumoral resection. To our knowledge, this condition has not been reported previously in the literature.

Preoperative Prediction of Lymph Nodal Metastases in Endometrial Carcinoma: Is it Possible?: A Literature Review.

Lymph node status is one of the most important prognostic factors in endometrial cancer and crucial for deciding adjuvant therapy. The aim of the study was to assess the different models used to predict lymphatic nodal disease. A literature search was conducted to detect the relevant studies. Relevant papers comparing the preoperative modality with the final histopathological results including randomized clinical trials, case-control studies, and any publications with a minimum of 50 patients in the report. Molecular-based predictors are still far from a practical application. Preoperative radiological scans (positron emission tomography, computed tomography, magnetic resonance imaging, and ultrasound) have shown the best predictor of lymphatic dissemination. However, there is currently no ideal model available, which can be used within standard clinical care. Surgical staging still remains the criterion standard in the determination of lymph node status in endometrial cancer.

Analysis of Risk Factors for Lymphatic Metastasis in Endometrial Carcinoma and Utility of Three-Dimensional Magnetic Resonance Imaging in Gynecology.

BackgroundThe aim of our study was to evaluate the utility of three-dimensional magnetic resonance imaging (3D-MRI) in gynecologic fields. We examined the relation between tumor volume measured with 3D-MRI and lymph node metastasis in patients with endometrial carcinoma.MethodsA retrospective analysis of 84 patients with endometrial carcinoma who underwent hysterectomy, bilateral salpingo-oophorectomy with pelvic/para-aortic lymphadenectomy at our institute was performed. Of these, the tumor volume of 59 patients could be calculated using 3D-MRI. Age, serum CA125 level, histologic type and grade, volume of tumors were examined in relation to pelvic/para-aortic lymph node metastasis as preoperative risk factors. Tumor volume measurements were calculated using 3D-MRI with AqariusNET Server 4G software. Univariate and multivariate associations between the preoperative risk factors and pelvic/para-aortic lymph node metastasis were analyzed. Receiver operating characteristic (ROC) curves were used to determine the best cut-off points for CA125 levels and tumor volume to predict lymph metastasis.ResultsThe mean age, CA125 value and tumor volume were 61.6 years, 51.6 (IU/L) and 11.6 (cm3), respectively. Lymphatic metastasis occurred in 16.0% (10 of 59) patients. Univariate analysis indicated that a high CA125 level and a tumor volume were risk factors (P = 0.0111, 0.0123 respectively). Multivariate analysis revealed that tumor volume was an independent risk factor for lymphatic metastasis (hazard ratio (HR) 12.7, 95% CI 1.06 - 154). The potential cut-off values of CA-125 level and tumor volume were 29 IU/L (sensitivity: 0.744; specificity: 0.821) and 12.79 cm3 (sensitivity: 0.821; specificity: 0.744), respectively.ConclusionsOur results suggest that tumor volume calculated with 3D-MRI correlates with lymph node metastasis in endometrial carcinoma.

MicroRNA-381 inhibits cell proliferation and invasion in endometrial carcinoma by targeting the IGF-1R.

Endometrial carcinoma (EC) is the sixth most common type of malignant tumor occurring in females. MicroRNAs (miRNAs) serve as oncogenes or tumor suppressors in human cancer and play important roles in tumorigenesis, and tumor development by regulating various processes. Thus, further investigation into miRNAs involved in EC formation and progression may aid in developing effective therapeutic strategies for patients with this disease. miRNA‑381 (miR‑381) is aberrantly expressed in multiple types of human cancer. However, the expression pattern, biological roles and underlying mechanisms of miR‑381 in EC are poorly understood. In the present study, the results showed that miR‑381 was downregulated in EC tissues and cell lines. Decreased miR‑381 expression correlated with the International Federation of Gynecology and Obstetrics stage, lymph nodes metastasis and myometrial invasion of EC. The ectopic expression of miR‑381 significantly inhibited the proliferation and invasion of EC cells. Through a series of experiments, the insulin‑like growth factor receptor 1 (IGF‑1R) was identified as a novel direct target of miR‑381 in EC. Furthermore, IGF‑1R was highly expressed in EC tissues and inversely correlated with miR‑381 levels. IGF‑1R overexpression partially abrogated the tumor‑suppressive effects of miR‑381 on the proliferation and invasion of EC cells. miR‑381 targeted IGF‑1R to inactivate the protein kinase B (AKT) and extracellular signal‑regulated kinase (ERK) signaling pathways in EC. These results suggest that miR‑381 acts as a tumor suppressor in EC by directly targeting IGF‑1R, and indirectly regulating the AKT and ERK signaling pathways. Thus, miR‑381 should be investigated as a prognostic biomarker and novel therapeutic target for the treatment of patients with EC.

MIIP remodels Rac1-mediated cytoskeleton structure in suppression of endometrial cancer metastasis.

BackgroundEndometrial carcinoma (EC) is one of the most common malignancies of the female reproductive system. Migration and invasion inhibitory protein (MIIP) gene was recently discovered candidate tumor suppress gene which located at chromosome 1p36.22. 1p36 deletion was found in many types of tumor including EC. In the present study, we will determine the role and mechanism of MIIP in EC metastasis.MethodsImmunohistochemistry was used to measure MIIP expression in normal and EC tissue. Both gain-of-function (infection) and loss-of-function (siRNA) assays were used to alter MIIP expression levels. The effect of MIIP on cell migration and invasion was measured by transwell assay. F-actin immunofluorescence staining was used to observe the cell morphology. The activation of GTP-loaded Rac1 was evaluated by Rac activity assay kit. Immunoprecipitation/WB was used to measure the interaction between MIIP and PAK1.ResultsWe demonstrate that MIIP expression was significantly decreased in EC patients comparing to the normal ones, and decreased MIIP expression in EC tissues is associated with deep myometrial invasion, advanced stage, and the presence of lymph node metastasis. Using both gain-of-function (infection) and loss-of-function (siRNA) assays, we show that MIIP markedly blocked EC cell migration, whereas loss of MIIP led to increase in EC cell migration. We demonstrate that elevated expression of MIIP resulted in cytoskeleton reorganization with decreased formation of lamellipodia. We also provide evidence that MIIP is a key molecule in directing Rac1 signaling cascades in EC. Ectopically expressed MIIP consistently competed with Rac1-GTP for binding with the PAK1 p21-binding domain. Our data show that MIIP and PAK1 bind each other and that a C-terminal polyproline domain of MIIP is required for PAK1 binding. Deletion of the PAK1-binding domain of MIIP reduced cell migration-inhibiting activity.ConclusionsMIIP may function as a tumor suppressor gene for endometrial carcinoma. MIIP attenuates Rac1 signaling through a protein interaction network, and loss of this regulator may contribute to EC metastasis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13045-016-0342-6) contains supplementary material, which is available to authorized users.

Vaginal implantation metastasis of endometrial carcinoma: A case report.

Endometrial cancer is the most common malignancy of the female reproductive system. The three common spread patterns of endometrial cancer are local invasion, lymphatic spread and hematogenous spread. Vaginal metastasis occurs by submucosal lymphatic or vascular metastases in ~10% of patients with clinical stage I disease. Vaginal implantation metastasis of endometrial cancer is extremely rare. Here we present a case of endometrial carcinoma (International Federation of Gynecology and Obstetrics stage IA) spread to the vagina by implantation metastasis as opposed to any of the methods mentioned above. This conclusion was confirmed mainly from pathological examination. This case highlights the occurrence of vaginal implantation metastasis of endometrial carcinoma. Certain changes may be applied during surgery to prevent implantation metastasis in patients with endometrial cancer.

Research progress of matrix metalloproteinases in endometrial carcinoma metastasis

Tumor cell metastasis is a process of extracellular matrix hydrolyzed by protease, where tumor cells traverse the defect in the extracellular matrix into the lymphatic system and the capillaries to form new metastasis hematogenously. Matrix metalloproteinases (MMPs) are a kind of enzymes closely related to the metastasis. MMP, especially the relationship between MMP-9 and endometrial cancer metastasis in this paper will be summarized to get a better understanding about it. Key words: Endometrial cancer; Matrix metalloproteinases; Metastasis

Performance of 18F-FDG PET/CT in the diagnosis of recurrent and metastatic endometrial cancer

Objective To evaluate the clinical value of 18F-FDG PET/CT in the diagnosis of recurrent and metastatic endometrial cancer. Methods A total of 62 patients with endometrial cancer from October 2004 to February 2014 were retrospectively analyzed. The diagnostic efficiency of 18F-FDG PET/CT for the detection of recurrent and metastatic endometrial cancer was evaluated based on the results of pathological biopsy or clinical follow-up. Results There were 28 endometrial cancer cases with recurrence and metastasis, 9 cases with a second primary cancer and without recurrence and metastasis of endometrial carcinoma. PET/CT imaging had false positive findings in 3 cases, false negative findings in 2 cases. The overall sensitivity, specificity and accuracy of PET/CT for detection of recurrence and metastatic endometrial carcinoma were 93.3%(28/30), 90.6%(29/32), 91.9%(57/62), respectively. The sensitivity and specificity of PET/CT for the diagnosis of vaginal stump recurrence, lymph node metastasis and distant metastasis were 9/10 and 98.1%(51/52), 95.7%(22/23) and 92.3%(36/39), 15/18 and 95.5%(42/44), respectively. Conclusion 18F-FDG PET/CT is a useful diagnostic tool for the detection of recurrent and metastatic endometrial cancer and a second primary cancer. Key words: Endometrial neoplasms; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Effects of silencing MTA1 gene by RNA interference on invasion and metastasis of endometrial carcinoma.

The study aimed at the silence effect of MAT1 gene and proteins in Ishikawa cell of human endometrial carcinoma cell line through RNAi mediated by siRNA and also discussed the effect of MTA1 gene silence on the invasion and metastasis of endometrial carcinoma. According to the principle of designing siRNA sequence, siRNA aiming at MTA1 gene (MTA1-siRNA) and siRNA used for negative control (Control-siRNA) were designed and synthesized and Ishikawa cell was transfected by transfection reagents. RT-PCR method as well as western blot was used, respectively, to detect the MTA1 mRNA and protein expression of stably transfected cells. Transwell method and scarification experiment were adopted to detect the invasion and metastasis of Ishikawa cells. The expression results of MTA1 on the levels of mRNA and protein showed that the expression level in transfected MTA1-siRNA group was obviously lower than that in non-transfected group and transfected control-siRNA group (p <0.05), while there was no significant difference between non-transfected group and transfected control-siRNA group (p > 0.05). Effective interference on the expression of MTA1 gene remarkably lowered the invasion and metastasis of endometrial carcinoma Ishikawa cells. RNAi aiming at MTA1 can effectively inhibit the expression of MTA1 in endometrial carcinoma Ishikawa cells and the effective silence of MTA1 can weaken the invasion and metastasis of Ishikawa cells, which provides a new strategy for gene therapy of endometrial carcinoma and an experimental basis for inhibiting the invasion and metastasis of endometrial carcinoma.

The Bartholin Cyst that Wasn't: A Case Report of Metastatic Cancer

Bartholin gland cysts and abscesses are common disorders of the Bartholin glands, with carcinomas and benign tumors being rare [1]. Nevertheless, it may be suggested that patients over 40 years of age with a suspected Bartholin gland cyst or abscess should undergo both drainage and biopsy of the lesion in order to exclude potential carcinoma. While metastatic disease is common in primary cancers of the Bartholin gland secondary to its rich vascular and lymphatic network, we present a case report of a poorly differentiated endometrial carcinoma metastasis to the Bartholin gland that initially presented as a Bartholin gland abscess. This case also serves as a useful reminder that each presentation, no matter how seemingly common or innocuous, deserves critical inspection and must be managed in the context of the patient as a whole.

Mutant p53 induces EZH2 expression and promotes epithelial-mesenchymal transition by disrupting p68-Drosha complex assembly and attenuating miR-26a processing.

The tumor suppressor p53 and the transcriptional repressor Enhancer of Zeste Homolog 2 (EZH2) have both been implicated in the regulation of epithelial-mesenchymal transition (EMT) and tumor metastasis via their impacts on microRNA expression. Here, we report that mutant p53 (mutp53) promotes EMT in endometrial carcinoma (EC) by disrupting p68-Drosha complex assembly. Overexpression of mutp53 has the opposite effect of wild-type p53 (WTp53), repressing miR-26a expression by reducing pri-miR-26a-1 processing in p53-null EC cells. Re-expression of miR-26a in mutp53 EC cells decreases cell invasion and promotes mesenchymal-epithelial transition (MET). Rescuing miR-26a expression also inhibits EZH2, N-cadherin, Vimentin, and Snail expression and induces E-cadherin expression both in vitro and in vivo. Moreover, patients with higher serum miR-26a levels have a better survival rate. These results suggest that p53 gain-of-function mutations accelerate EC tumor progression and metastasis by interfering with Drosha and p68 binding and pri-miR-26a-1 processing, resulting in reduced miR-26a expression and EZH2 overexpression.

Accuracy of frozen section in management and prediction of lymph node metastasis in endometrial carcinoma

Abstract Objective This study aimed to investigate clinical factors affecting the concordance between frozen section (FS) and paraffin section (PS) findings in endometrial cancer, and evaluate the role of FS in predicting lymph node (LN) metastases. Methods Tumor grade and depth of myometrial invasion based on FS and PS findings were compared in 376 patients. Clinical factors affecting the accuracy of FS in predicting LN metastasis were evaluated. Overall survival was compared between patients who underwent lymphadenectomy and those who did not. Results Overall concordance of tumor grade was 78.6% (147/187). Later age at menopause ( p = 0.011) and a lower systolic/diastolic ratio of endometrial blood flow ( p = 0.015) were associated with high concordance between FS and PS for tumor grade. Overall concordance for the depth of myometrial invasion was 97.8% (178/182). There was greater concordance between FS and PS for myometrial invasion in patients with postmenopausal bleeding ( p = 0.018) and lower abdominal pain ( p = 0.013). G1 and G2 + no myometrial invasion predicted no metastasis; G1 + p = 0.086). Conclusion The accuracy of FS in determining tumor grade and myometrial invasion appears to be reliable. LN metastases cannot be predicted adequately by intraoperative FS. We recommend complete surgical staging for all patients with endometrial cancer.

Hsa-microRNA-181a is a regulator of a number of cancer genes and a biomarker for endometrial carcinoma in patients: a bioinformatic and clinical study and the therapeutic implication.

The aberrant expression of human microRNA-181a-1 (hsa-miR-181a) has been implicated in the pathogenesis of various cancers, serving as an oncogene or a tumor suppressor. However, the role of hsa-miR-181a in the pathogenesis of endometrial carcinoma (EC) and its clinical significance are unclear. This study aimed to search for the molecular targets of hsa-miR-181a using bioinformatic tools and then determine the expression levels of hsa-miR-181a in normal, hyperplasia, and EC samples from humans. To predict the targets of hsa-miR-181a, ten different algorithms were used, including miRanda-mirSVR, DIANA microT v5.0, miRDB, RNA22 v2, TargetMiner, TargetScan 6.2, PicTar, MicroCosm Targets v5, and miRWALK. Two algorithms, TarBase 6.0 and miRTarBase, were used to identify the validated targets of hsa-miR-181a-5p (a mature product of hsa-miR-181a), and the web-based Database for Annotation, Visualization and Integrated Discovery (DAVID) 6.7 was used to provide biological functional interpretation of the validated targets of hsa-miR-181a-5p. A total of 78 formalin-fixed, paraffin-embedded tissue specimens from 65 patients and 13 healthy subjects were collected and examined, including normal endometrium (n=13), endometrial hyperplasia (n=18), and EC (37 type I and 10 type II EC cases). Our bioinformatic studies have showed that hsa-miR-181a might regulate a large number of target genes that are important in the regulation of critical cell processes, such as cell fate, cell survival, metabolism, and cell death. To date, 313 targets of hsa-miR-181a have been validated, and 22 of these targets are cancer genes. The precision of predictions by all the algorithms for hsa-miR-181a-1’s targets was low. Many of these genes are involved in tumorigenesis of various cancers, including EC, based on the DAVID and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. In comparison with normal endometrial tissue, the expression level of hsa-miR-181a was significantly increased in type I and type II EC (P<0.05), and type II EC exhibited a significant higher expression level of hsa-miR-181a than that in type I EC (P<0.05). In addition, there was a significant increase in the expression level of hsa-miR-181a in type II EC compared with endometrial hyperplasia (P<0.05). Taken together, these results suggest that hsa-miR-181a may serve as an oncogene in endometrial tumorigenesis and that hsa-miR-181a might be used as a new biomarker in the prediction of prognosis of EC in clinical practice. More functional and mechanistic studies are needed to validate the role of hsa-miR-181a in the development, progression, and metastasis of EC.

Risk-stratification of endometrial carcinomas revisited: A combined preoperative and intraoperative scoring system for a reliable prediction of an advanced disease

ObjectiveThe aim of this study is to develop a risk-scoring system for predicting lymph node and distant metastasis in endometrial carcinoma. MethodsA total of 1166 patients, treated at a single institution between 1-2007 and 12-2013, were included in the study. The association of stage IIIC–IV disease with demographic factors (age, body mass index), biochemical factors (complete blood count, serum CA125), preoperative histology and tumor size was examined in unadjusted analyses. Logistic regression analysis was used for the identification of variables that independently predict an advanced disease. ResultsThrombocytosis, serum CA125>35U/mL, preoperative high-risk histology (nonendometrioid or grade 3 endometrioid carcinoma) and tumor size ≥3cm were independently associated with an advanced disease. These predictors were internally validated by a bootstrapping method with statistical significance. A risk-scoring system with an area under the receiver operating characteristic curve of 0.852 (95% confidence interval, 0.821–0.883) was developed. Total risk score points ranged from 0 to 8 for individual patients. With a cut-off of 1 point, stratifying 66.3% of patients to surgical staging, the model predicted stage IIIC–IV carcinomas with a sensitivity of 100%, specificity of 38.0%, positive predictive value of 17.1%, and negative predictive value of 100%. With the same cut-off, the corresponding values were 100%, 34.7%, 16.5% and 100% in predicting stage IIIC carcinomas in a subgroup that underwent lymphadenectomy and had a stage I–IIIC disease. ConclusionsThis risk-scoring system is highly sensitive in predicting an advanced stage endometrial carcinoma at a cut-off of risk score points that is associated with an acceptable lymphadenectomy rate.

Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: diagnostic value and error analysis in endometrial carcinoma.

To determine the ability of contrast-enhanced magnetic resonance imaging to predict myometrial invasion, cervical invasion, and pelvic lymph node metastasis in endometrial carcinoma and to analyze factors that lead to errors in this identification. A retrospective study. University general hospital. A total of 167 women diagnosed with endometrial carcinoma. All patients received a preoperative contrast-enhanced magnetic resonance imaging scan. Histopathological findings were used as the definitive diagnosis. The results were compared with histopathological findings, factors that make accurate assessment of myometrial invasion, cervical invasion, and pelvic lymph node metastasis difficult by contrast-enhanced magnetic resonance imaging were analyzed. The sensitivity, specificity, diagnostic accuracy, positive predictive values, and negative predictive values of contrast-enhanced magnetic resonance imaging were 90.9, 91.8, 91.6, 73.2 and 97.6%, respectively, for identifying deep myometrial invasion; 84.2, 96.0, 94.6, 72.7 and 97.9%, respectively, for identifying cervical invasion; and 45.0, 91.2, 85.6, 40.9 and 92.4%, respectively, for identifying pelvic lymph node metastasis. The main causes of error in contrast-enhanced magnetic resonance imaging were myomas, cornual lesions, deep myometrial invasion, large tumor size, non-endometrioid tumor type, and lower tumor grade. Contrast-enhanced magnetic resonance imaging has a high accuracy and a low tendency to produce false-negative predictive values. Gynecological oncologists should combine the imaging data and clinical information to make therapeutic decisions and avoid diagnostic errors.

Effects of forkhead box C2 on carcinogenesis and lymphatic metastasis in endometrial carcinoma.

We investigated the distribution of endometrial lymphatic vessels and expression of forkhead box C2 (FOXC2) in normal endometrium during menstrual cycle and in endometrial adenocarcinoma. Full-thickness uterine samples and endometrial adenocarcinoma samples were collected for immunohistochemical analysis using D2-40 and FOXC2 mouse monoclonal antibodies. The lymphatic vessel density (LVD) of the endometrium was significantly reduced compared with the myometrium during the cycle. Intra-tumoral LVD was significantly decreased in both stages of endometrioid adenocarcinoma compared with normal endometrium and myometrium. Intra-tumoral LVD significantly decreased from stage IA to stage IIIC. Peri-tumoral LVD for stage IA and stage IIIC tumors was significantly increased compared with normal endometrial LVD, but decreased compared with normal myometrial LVD. Stage IIIC showed increased peri-tumoral LVD when compared with stage IA. The positive rate of FOXC2 was 73.3% in proliferative endometrium and 80% in secretory endometrium. Secretory endometrium showed significantly increased FOXC2 expression compared with proliferative endometrium. Endometrioid adenocarcinoma showed significantly increased FOXC2 expression compared with normal endometrium, both in the epithelium and stroma. FOXC2 expression in the stroma significantly increased when pelvic and/or para-aotic lymph nodes were involved. FOXC2 was immunolocalized in low-risk endometrial carcinoma in endometrioid adenocarcinoma, but not in normal endometrium. Endometrial lymphatic vessels were located in normal endometrium and myometrium across the menstrual cycle and in intra-and peri-endometrioid adenocarcinoma, and increased in endometrial adenocarcinoma. Peri-tumoral lymphatics were associated with increased lymphatic metastasis. FOXC2 may be associated with the genesis of endometrial carcinoma and lymphangiogensis in endometrial adenocarcinoma in intra- and peri-tumoral lymphatics.

Diagnostic efficacy of diffusion-weighted MRI for pre-operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma.

To determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) for the pre-operative assessment of patients with endometrial carcinoma and to assess myometrial and cervical invasion as well as pelvic lymph node metastasis. Fifty-eight women who underwent surgery for histopathologically confirmed endometrial carcinoma were included in the current study. Prior to surgery, patients were evaluated using pelvic DW-MRI and gadolinium-enhanced T1-weighted imaging (Gd-T1WI). Gd-T1WI was evaluated together with T2-weighted images. DW-MR images were obtained in the axial plane using echo-planar spin-echo pulse sequences with different b factors. Endometrial carcinomas were observed as areas of increased intensity on DW-MRI images, and their intensity was compared with the surrounding hypo-intense myometrium. Pre-operative DW-MRI and Gd-T1WI results were compared with post-operative histopathological findings that served as reference standards. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and diagnostic accuracy of DW-MRI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 89%, 81%, 92% and 88%, respectively. The sensitivity, specificity and diagnostic accuracy rates were 82%, 91% and 89.6% for cervical invasion and 100%, 96% and 96.5% for pelvic lymph node metastasis, respectively. The sensitivity, specificity, PPV and NPV, and diagnostic accuracy of Gd-T1WI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 81.5%, 71%, 91% and 83%, respectively. The sensitivity, specificity and diagnostic accuracy were 73%, 89% and 86% for cervical invasion, respectively. These findings suggest that DW-MRI may be a good diagnostic tool with high sensitivity and specificity for assessing myometrial invasion and detecting tumour extension. We suggest that DW-MRI should be considered as a routine part of the pre-operative pelvic MRI in all patients with endometrial carcinoma.

The Accuracy of Integrated [(18)F] Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Detection of Pelvic and Para-aortic Nodal Metastasis in Patients with High Risk Endometrial Cancer.

Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography ([18F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [18F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [18F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [18F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [18F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [18F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [18F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [18F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.

Endoglin, VEGF, and its receptors in predicting metastases in endometrial carcinoma

Preoperative evaluation of the risk for metastases in endometrial carcinoma is challenging. The growth of new vessels, angiogenesis, is important for tumor growth and purported to be involved in the metastatic process. The aim of this study was to evaluate the significance of preoperative serum levels and immunohistochemical expression of angiogenic markers in predicting a metastasized disease. Preoperative sera from 98 consecutive women presenting with endometrial carcinoma were collected. Serum concentrations of VEGF, sFLT1, and CD105 were assessed by enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry was used to assess the expression of CD105, VEGF, FLT1, and KDR. The results were correlated to the presence of metastases, presence of deep (≥50%) myometrial invasion, and the histological grade of the tumor. Tumors with other than endometrioid histology were excluded. Of the 80 evaluable patients, 11 had a metastasized disease. The serum concentration of VEGF was higher in the group with metastases than in the group without metastases (median [range], 743 pg/mL [546-1,183 pg/mL] vs. 383 pg/mL [31-1,524 pg/mL], p < 0.001, respectively). In the multivariable analysis, the concentration of VEGF was the sole independent, albeit weak predictive factor for the presence of metastases (odds ratio, 1.004, 95% confidence interval, 1.002-1.007; p = 0.001). The immunohistochemical expression of the markers was not associated with any of the clinicopathological features of the tumors. The results of the present study suggest that preoperative serum VEGF concentration correlates with the presence of metastases in endometrioid endometrial carcinoma.

Oral malignant acanthosis nigricans associated with endometrial adenocarcinoma

We report a 59-year-old patient with malignant acanthosis nigricans associated with metastasis of endometrial carcinoma. The patient presented papillomatosis lesions that appeared to be benign on multiple skins of body folds, particularly on lips. The lesions in lips and axilla had histological characteristic appearances of acanthosis nigricans, while the masses in abdomen and pelvis were metastasis endometrial adenocarcinoma. The article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of doctors in screening for body internal tumors.