Uterine Spread Research Articles

Breast cancer metastasis to endometrium: Case report and up-date of literature

Introduction: Breast cancer is the leading neoplasia metastasizing to genital organs. Uterine metastases are seldom reported and those limited to endometrium account for 3.8% of patients with uterine spread. We reported on a woman with breast cancer metastasizing to endometrium and up-date of literature. Presentation of case: In July 2022, a 59 years-old woman with breast cancer was referred to Gynecological consultation due to Positron Emission Tomography showing an enhanced signal to the endometrium. Throughout the four previous years, she underwent bilateral surgery due to metachronous lobular cancers and adjuvant therapies consisting of Letrozole, Exemestane, chemotherapy, and Tamoxifen. In May 2022, bony metastases were found and she shifted to Abemaciclib/Fulvestrant therapy. No gynecological complaints were recorded, and physical examination was uneventful while Transvaginal Ultrasound demonstrated an enhanced endometrial thickness as a unique abnormality. Hysteroscopy showed mucosal thickenings attributed to Tamoxifen-related cysts formation. The biopsy pathology reported stromal infiltration of neoplastic cells staining for Cytokeratins and GATA-3. Negative staining was reported for PAX-8 and CD-10. On these findings, a breast cancer metastasis was established. Four months later the patients died from metastatic brain progression. Discussion: Endometrial metastasis from breast cancer is anecdotal. The case described supports that uterine spread is a late event, often concurrent with extragenital metastases and mostly associated with lobular histology. A hysteroscopic view can be misleading and a careful pathological study is needed for a differential diagnosis against endometrial primitiveness. Conclusion: Endometrial abnormalities in breast cancer patients might be caused by metastasis. The management of these patients is challenging and must be tailored to the clinical background.

Oncologic outcomes of patients with FIGO 2014 stage IB-IIA cervical adenocarcinoma who underwent radical surgery.

To identify prognostic factors of early-stage cervical adenocarcinoma in patients with FIGO IB-IIA, who were treated with radical surgery. Clinical data of 64 patients with stage IB-IIA cervical adenocarcinoma who underwent radical hysterectomy and lymphadenectomy with or without adjuvant therapy between 1993 and 2019 were retrospectively reviewed. The clinicopathologic factors that affect the oncological outcomes were evaluated. The Kaplan-Meier method was used for the assessment of survival outcomes. Survival curves were compared using the log-rank test. The 5-year recurrence-free survival and 5-year disease-specific survivals were 83% and 98%, respectively. Tumor size, stage of disease and uterine spread were significantly related prognostic factors for shorter recurrence-free survival. During the follow-up, nine (14.1%) patients recurred. Five of them were extrapelvic recurrence. No correlation was identified between histopathologic subtype and extrapelvic recurrence (p = 0.265). There was no difference between adjuvant only radiotherapy and concurrent chemoradiotherapy on recurrence-free survival in a univariate analysis adjusting for prognostic factors. It is important to determine the prognostic factors that predict disease outcome in surgically treated cervical adenocarcinoma for tailored adjuvant treatment. Tumor size, stage and uterine spread are determinant factors for recurrence. Risk stratifications, including uterine spread may especially be useful for patients with AC.

A population-based series of uterine carcinosarcomas with long-term follow-up

Background. Carcinosarcomas are a highly malignant type of endometrial carcinomas where extra uterine spread and recurrences are frequent. There is no consensus regarding the best treatment of this group of malignancies. Material and methods. In a complete geographic series of 322 cases of primary uterine carcinosarcomas prophylactic pelvic irradiation and/or chemotherapy was used as postoperative treatment in the majority of the cases. Vaginal brachytherapy was also added as a boost. The primary surgery was extended hysterectomy in 23 cases (10%), and simple hysterectomy in 220 cases (90%). In 46 cases (14%) no major surgery was possible. Results. In the complete series 123 recurrences (38%) were recorded. Locoregional recurrences (11%) and distant recurrences (28%) were most frequent. Type and extent of surgery was not associated with the risk of tumor recurrence. Extended surgery did not reduce the risk of local and regional recurrences. In the complete series, the five-year overall survival rate was 30% and the recurrence-free survival (RFS) rate was 27%. The five-year pelvic disease control was 82% in stage I, 68% in stage II, and 76% for more advanced stages. The five-year locoregional RFS rate was 63% for patients treated with surgery alone, 68% after addition of adjuvant chemotherapy, 86% after adjuvant radiotherapy, and 95% after combined chemotherapy and radiotherapy. Conclusion. Radiotherapy seems to be the most important constituent of the adjuvant therapy. Serious late tissue reactions, requiring surgery, from the bladder and intestine occurred in 2.5% of the irradiated cases. The death of three patients could be related to radiotherapy and of four patients due to the cytotoxic treatment. This population-based series may serve as a baseline for improvements by, e.g. standard care programs and referral to a few specialist centers for this rare and serious disease.