Presence Of Cervical Involvement Research Articles

Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Cervical spine involvement may lead to severe complications in rheumatoid arthritis (RA). In the era of modern therapies, atlantoaxial subluxation (AAS) may be rare; however, it may still be detected in asymptomatic patients. The onset of myelopathy can occur at any time. Altogether 49 female RA patients were included. Among them, 15 were methotrexate treated, biologic free, while 34 patients received biologics. The patients had no cervical pain or any neurological symptoms. We assessed the first (C1) and second (C2) cervical vertebrae by 3 T magnetic resonance imaging (MRI). In addition to AAS, we also determined odontoid erosion or periodontal soft tissue thickening. We associated our MRI findings with clinical, laboratory parameters, and hand radiography. We detected anterior AAS and soft tissue thickening in one-quarter, while odontoid erosions in eight (16%) of RA patients. There were no significant differences among the therapeutic subgroups. No posterior or vertical AAS was seen. Anterior AAS was associated with higher degree of inflammation, soft tissue thickening was seen at younger age, while odontoid erosions were associated with van der Heijde–Sharp scores of the hand. None of the patients had any lesions requiring surgery. The presence of cervical involvement in RA patients with 10–11 years of disease duration is still an important and frequent phenomenon. Higher disease activity and erosive disease are associated with atlantoaxial involvement. 3 T MRI is a sensitive method to assess AAS, as well as soft tissue lesions and odontoid erosions.

The Value of Papanicolaou Tests in the Diagnosis of Endometrial Carcinoma: A Large Study Cohort From an Academic Medical Center.

To determine on a large scale whether routine cervical Papanicolaou (Pap) tests play a role in endometrial carcinoma diagnosis. A retrospective search of an academic women's hospital pathology archive for cases of surgically resected endometrial carcinoma with Pap smears within 36 months before the histologic diagnosis was performed. Demographic features, Pap test results, and tumor features were recorded. We identified 554 (30.5%) of 1,817 cases of endometrial carcinoma with documented Pap test results within 36 months before histologic diagnosis. Among these 554 patients, 405 (73.0%) had Pap test results within 5 months before histologic diagnosis. In total, 154 (38%) cases demonstrated abnormal glandular cells, and 25 (6.2%) had only benign endometrial cells in women 40 years or older. The presence of glandular abnormality on the Pap test is significantly correlated with tumor size, tumor type, depth of invasion, presence of cervical involvement, and presence of lymphovascular invasion (P < .05). The rate of detecting abnormal glandular cells was higher in cases with a high International Federation of Gynecology and Obstetrics (FIGO) stage than in cases with a low FIGO stage (47.5% vs 35.5%; P < .05). The Pap test may play a role in the detection of endometrial carcinoma, especially for those with cervical involvement, lymphovascular invasion, and/or advanced stage.

CA 125 normalization with chemotherapy is independently predictive of survival in advanced endometrial cancer

Objective Changes in CA 125 with chemotherapy predict outcome for epithelial ovarian cancer. There is no such data for advanced endometrial cancer. Method Retrospective review of all women receiving carboplatin and paclitaxel for advanced endometrial cancer at any of the institutions of the British Columbia Cancer Agency between September 1995 and September 2006. Results 185 newly diagnosed women were treated. Univariable analysis for progression-free survival identified as adverse predictors: grade 3, positive residual, age > 60, deep myometrial invasion, increasing stage/substage, papillary serous subtype, presence of cervical involvement, ECOG 1 or greater, CA 125 above 35 either preoperatively or at start of cycle 1 and CA 125 greater than 24 at the start of cycle 3. Upon multivariate analysis, CA 125 above 24 at cycle 3, grade 3 and positive residual remained as independent predictors. The single most important factor identified by decision tree analysis was CA 125 level at cycle 3. Conclusion As with epithelial ovarian cancer, changes in CA 125 are highly predictive of outcome for advanced, chemotherapy treated endometrial cancer.

Stage IA vs. IB endometrial stromal sarcoma: Does the new staging system predict survival?

Objective To determine the correlation of the new FIGO staging system with survival in stage I patients with low-grade and high-grade endometrial stromal sarcomas. Methods Data were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Kaplan–Meier log rank and Cox proportional hazards models were used for survival analysis and to identify possible predictors for survival. Results The identified cohort included 464 women, 310 (67%) low-grade endometrial stromal sarcoma, 96 (21%) high-grade endometrial stromal sarcoma, and 58 (12%) unclassified endometrial stromal sarcoma. Among low-grade and high-grade endometrial stromal sarcomas, there was no significant demographic or clinico-pathologic difference between stages IA and IB. The 5-year overall survival was worse in high-grade endometrial stromal sarcoma than low-grade endometrial stromal sarcoma (45.4% vs. 97.2%, p < 0.001). The difference in 5-year overall survival among women with low-grade endometrial stromal sarcoma between stages IA and IB was significant (100% vs. 93.5%, p = 0.003), but not among women with high-grade endometrial stromal sarcoma (51.4% vs. 43.5%, p = 0.27). Although age ( p = 0.001), race ( p = 0.005), and stage ( p = 0.004) were all significant prognostic factors in low-grade endometrial stromal sarcoma, only cervical involvement ( p = 0.02) was a significant predictor in high-grade endometrial stromal sarcoma. Conclusion The new staging system is appropriate for risk stratification in low-grade endometrial stromal sarcoma. The prognosis in high-grade endometrial stromal sarcoma seems to be most influenced by the presence of cervical involvement and not by tumor size as the staging criteria would suggest.

Abstract LB-71: Stage Ia vs. Ib endometrial stromal sarcoma: Does the new staging system predict survival

Abstract Background: In 2008, a new FIGO staging system was specifically designed and approved for endometrial stromal sarcoma. Our objective was to determine the impact of this new staging system on survival in patients with stage I endometrial stromal sarcoma (ESS). Methods: Data were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Kaplan-Meier log rank and Cox proportional hazards models were used for survival analysis and to identify possible predictors for survival. Results: The identified cohort included 464 women, with 310 (67%) low-grade endometrial stromal sarcoma (LGESS), 96 (21%) high-grade endometrial stromal sarcoma (HGESS), and 58 (12%) unclassified ESS. LGESS compared to HGESS differed significantly with regards to the patient age (48 vs. 60 years, p&amp;lt;0.001), tumor size (5.6 cm vs. 8.0 cm, p&amp;lt;0.001), cervical involvement (5.2% vs. 18.8%, p&amp;lt;0.001), myometrial invasion (62% vs. 66.6%, p=0.01), and stage IB disease (44% vs. 76%, p&amp;lt;0.001). Similarly, compared with LGESS, a greater percentage of HGESS patients underwent lymphadenectomy (29.0% vs. 60.4%; P &amp;lt;0.001), salpingo-oophorectomy (78.4% vs. 93.7%, p=0.001), and administration of radiotherapy (14.8% vs 50.0%; P&amp;lt;0.001). There was no significant difference between stages IA and IB with regards to the above-mentioned demographic and clinico-pathologic variables, in both LGESS and HGESS. The 5-year overall survival was worse in HGESS than LGESS (45.4% vs. 97.2%, p&amp;lt;0.001). The difference in 5-year overall survival between stages IA and IB was significant in LGESS (100% vs. 93.5%, p=0.003), but not in HGESS (51.4% vs. 43.5%, p=0.2). Although age (p=0.001), race (p= 0.005), stage (p=0.004) were all significant prognostic factors in LGESS, only cervical involvement (p=0.02) was a significant predictor in HGESS. Conclusion: The new staging system is appropriate for risk stratification in LGESS. The prognosis in HGESS seems to be most influenced by the presence of cervical involvement and not by tumor size as the staging criteria would suggest. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-71.

Preoperative hemoglobin and platelet count and poor prognostic factors in patients with endometrial carcinoma

The aim of this study was to evaluate the relationship between preoperative hemoglobin and platelet count and prognostic factors in patients with endometrial cancer. Sixty-one patients with endometrial carcinoma who underwent surgical treatment consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, pelvic and para-aortic lymph node dissection, and peritoneal cytology were retrospectively analyzed. Preoperative hemoglobin and platelet count, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, lymphovascular invasion (LVSI), adnexal involvement, positive peritoneal cytology, cervical stromal invasion, and tumor size were investigated. Kruskal-Wallis, Mann-Whitney U, Fishers Exact and Chi-square tests were used for univariate analyses. The multivariate analysis was performed with logistic regression analyses. Twenty-six (42.6%) patients had a pre-treatment hemoglobin value of < or =12 g/dL. These 26 patients had significantly higher rates of positive cytology (P = 0.008), advanced FIGO stage (P = 0.03), omental metastases (P = 0.01), cervical involvement (P = 0.02), and thrombocytosis (P = 0.02). The multivariate analysis revealed cervical involvement (P = 0.019, OR = 4.030, 95% CI = 1.255-12.947) and positive peritoneal cytology (P = 0.022, OR = 12.509, 95% CI = 1.43-109.36) to be significantly associated with low hemoglobin level. In the univariate analysis, the presence of cervical involvement and lymphatic metastasis were associated with significantly higher median preoperative platelet counts. Low pre-treatment hemoglobin level may reflect poor prognostic factors such as positive cytology and cervical involvement in patients with endometrial cancer that is associated with thrombocytosis.

Role of endocervical curettage (ECC) in the preoperative staging of endometrial carcinoma

article i nfo Article history: Received 2 September 2008 Available online 10 January 2009 Objective. The presence of cervical involvement is important to establish a rational treatment for endometrial cancer patients. We investigated the value of preoperative endocervical curettage (ECC) in predicting cervical involvement. Methods. Preoperative ECC of 290 patients with clinical stage I epithelial endometrial cancer was compared with histopathology of the uterus. Results. Amongst all ECCs, 245 (84.5%) were negative and 45 (15.5%) were positive for endometrial cancer. In the uterine specimen, cervical involvement was found in 20% (58/290). PPV and NPV of ECC were 86.7% and 92.2%. False negative and false positive ECC occurred in 6.6% and 2.1%. Of all patients with positive ECC, 46.7% had FIGO stage II disease and 46.7% had extra uterine tumor spread (FIGO III, IV). Conclusion. ECC is an acceptable diagnostic tool to predict the presence or absence of cervical involvement in early stage endometrial cancer patients.

Endometrial Endometrioid Adenocarcinoma

We reviewed 827 consecutive cases of pure endometrial endometrioid adenocarcinoma (EEA) treated by hysterectomy to update the distribution of pathologic features. Tumor grade (reported in a 2-tiered system), depth of myometrial invasion, presence of cervical involvement, lymphovascular invasion (LVI), and evidence of extrauterine disease were recorded.The median age at diagnosis was 62 years (range, 30-94 years). The tumor was high grade in 94 cases (11.4%), invaded into the outer half of the myometrium in 249 (30.1%), was positive for cervical involvement in 171 (20.7%), and was positive for LVI in 182 (22.0%). Lymph nodes (sampled in 85 cases) were positive in 13 (1.6%), and ovarian metastases were present in 15 cases (1.8%). High tumor grade was significantly associated with deep myometrial invasion (P > .0001), cervical involvement (P = .0065), and LVI (P > .0001).EEA manifests most commonly with low tumor grade and without deep myometrial invasion. High tumor grade is significantly associated with deep myometrial invasion, cervical involvement, and LVI.

An analysis of the impact of pathology review in gynecologic cancer

Purpose: To analyze the impact of pathology review in gynecologic malignancies. Methods and Materials: For all new gynecologic patients seen between December 2, 1993 and January 4, 1996, we conducted a retrospective chart review to determine if a pathology review by the institute’s consultant pathologist changed the diagnosis, and if so whether the change altered patient management. A total of 514 patients were seen, of whom 120 had cervical cancer, 226 had endometrial cancer, 122 had a primary ovarian or peritoneal malignancy, 9 had a vaginal malignancy, 28 had vulvar cancer, and 9 had a miscellaneous gynecologic malignancy. Results: On pathology review the diagnosis changed for 200 of 599 specimens (33%). This altered management for 63 of 514 patients (12%). For patients with cervical cancer, the grade of tumor was the main change in pathologic diagnosis, with occasional change in the presence of lymph vascular invasion. These did not translate into patient management alterations. Eight patients (1.5%) had management alterations. The changes in depth of invasion and vascular invasion altered management for 3 patients. Changes in pap smears resulted in two management alterations, and changes in histologic diagnoses altered management for 3 cases. For endometrial primaries the changes in pathologic diagnosis included grade, depth of invasion, and the presence of cervical involvement. This did alter management in 40 cases (8%). For the ovarian malignancies, the main changes were grade, extent of disease, or histologic classification, some of which (10 patients, 2%) resulted in altered management. One patient with a vaginal lesion had the diagnosis changed, which did alter management. Of the patients diagnosed with vulvar cancer, the pathologic diagnosis changed for 11 patients. This included changes in grade and depth of invasion. This altered management of 2 patients. The remaining miscellaneous gynecologic malignancies had only two diagnosis changes that altered management. Conclusions: Pathologic review of gynecologic malignancies is justified as it can alter patient management. In addition, the process facilitates cooperation of the multidisciplinary team and provides a valuable educational forum to enhance patient care.

Endometrial adenocarcinoma.

Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for some 36,000 cases of invasive cancer each year. Hyperplastic lesions of the endometrium follow a continuum, with the risk of progression to carcinoma being related to the severity of the disorder. Risk factors associated with the development of adenocarcinoma include hyperplasia, obesity, menstrual abnormalities, diabetes, hypertension, prior pelvic irradiation, sequential oral contraceptive use, diet, and exogenous estrogen use. There is also some evidence of genetic predisposition, and some data indicating the possibility of specific genetic abnormalities and activation of oncogenes as factors determining the etiology of the disease. At this time there is no accepted screening test for endometrial carcinoma, though the role of immunochemistry techniques for screening and follow-up has just begun to be realized. Dilatation and curettage along with hysteroscopy remain the major means of diagnosis. A variety of prognostic variables including tumor cell type, histologic grade, depth of myometrial invasion, status of peritoneal cytology, presence of disease in preformed vascular spaces, presence of adnexal metastases, and presence of cervical involvement have been defined. Although the treatment plan for each patient must be individualized, the mainstay of treatment remains total abdominal hysterectomy with bilateral salpingo-oophorectomy. Metastatic and recurrent disease is usually treated with hormonal therapy and systemic chemotherapy. Radiation therapy like surgery in recurrent disease is only applicable for the treatment of local recurrences.

Management of malignant, mixed mesodermal tumors of the uterus

Forty-two patients with malignant, mixed mesodermal tumors of the uterus were identified by retrospective chart review. Only 2 patients were premenopausal at the time of diagnosis. Six of the patients had previously received pelvic radiotherapy. Surgical/pathologic findings were inconsistent with clinical staging in 17 of the patients. Patients with stage I tumors were found to have extrauterine extension of tumor in 39% of the cases. Overall, 2- and 5-year actuarial survival rates were 40 and 18%, respectively. The surgical extent of disease was a major prognostic factor in patient survival (P = 0.006). Patients with tumors showing no invasion or invasion limited to the inner two-thirds of the myometrium also demonstrated a significant survival advantage as compared to those with deeper myometrial invasion (P = 0.02). However, no statistically significant relationship was demonstrated between survival and patient age, the nature of the sarcomatous element (homologous or heterologous), or the presence of cervical involvement. Patients with recurrent or persistent disease did poorly; only 4 patients have survived more than 1 year after documentation of recurrent disease. Two patients had prolonged disease stabilization with radiotherapy and cisplatin. Another patient with pulmonary metastases had a 6-month, complete response to cisplatin.

Nature of cervical involvement in endometrial carcinoma.

In patients with endometrial carcinoma the prognostic significance of clinical and histopathologic variants of cervical involvement is unknown. Fifty-eight patients with endometrial carcinoma and cervical involvement diagnosed by gross examination or endocervical curettage are reviewed. Three clinicopathologic groups were identified: gross cervical involvement (10 patients), occult stromal invasion (25), and no evidence of stromal invasion (23). There were no differences in clinical, pathologic, surgical, or therapeutic characteristics. There was no significant difference in actuarial 5-year survival rates between patients with gross cervical involvement (70%) and occult disease (65%). There was also no significant difference in survival rates among patients with occult cervical stromal invasion (67%). The presence of cervical involvement in endometrial carcinoma is an important prognostic factor. However, the extent of cervical involvement does not appear to be of significant prognostic value.