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Obesity is a well-known high-risk factor for many kinds of neoplasms. Adipokines secreted by adipose tissue play an important role in the process of obesity promoting tumorigenesis and development, and different adipokines play a role in promoting or suppressing cancer via different signaling pathways. Currently, lifestyle modification to control weight and targeted therapy of adipokines and their receptors are major research directions of cancer treatment, but most of the studies are still in the stage of basic and pre-clinical research. Therefore, the molecular mechanisms of adipokines in promoting or suppressing cancer should be further explored, and the dual inhibitors as well as combined therapy are the key research strategies for adipokines in cancer treatment in the future.
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IL-22 is a member of IL-10 cytokine family. In recent years, increasing evidence has shown that IL-22 is closely related to the immunity in female reproductive tract, and its role in disease development is two-sided. It can not only maintain the balance of microbiota, enhance the resistance to pathogens and reduce the tissue damage caused by infection, but also promote the development and progression of malignant diseases via various signaling pathways. More studies on the biological characteristics and functions of IL-22 are needed for clarifying the pathogenic mechanism and providing new insight into the diagnosis and treatment of female reproductive tract diseases.
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Ovarian Leydig cell tumor(LCT), also known as ovarian testicular stromal cell tumor, is a rare sex cord stromal tumor, accounting for about 0.1% of all ovarian tumors. LCT is often accompanied by clinical manifestations of elevated androgen, and the imaging manifestations sometimes lack specificity. The diagnosis requires histopathological examination. Surgery is the primary treatment method, and postoperative prognosis is generally favorable. This paper retrospectively analyzes the diagnosis and treatment of a patient with LCT in our hospital combining relevant literature, explore the clinical characteristics, diagnosis, and treatment progress of LCT, aiming to improve disease management.
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The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.
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The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.
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Objective@#To investigatethe clinicopathological features of stratified mucin-producing intraepithelial lesion (SMILE) and invasive stratified mucin-producing carcinoma (ISMC) of the cervix with review of the literature.@*Methods@#Sixteen patients with SMILE/ISMC components of the cervix were collected from files in the Department of Pathology at Xijing Hospital from January 2007 to March 2019. Clinicopathological data included age at diagnosis, clinical presentation, histological type, depth of invasion measurement, the status of lymphovascular space invasion (LVSI) and lymph node metastasis, FIGO staging and follow-up. Histochemistry AB and PAS-D staining and immunostaining for cytokeratin (CK) 7, p16, p63, p40, PAX8, MUC6, p53 were performed simultaneously. In addition, twelve cases with invasive endocervical adenocarcinoma were evaluated using three-tiered pattern-based system (also called Pattern Classification).@*Results@#The average age at diagnosis for patients was 49.7 years (range, 33 to 65 years), and vaginal bleeding occurred in the majority of cases (13/16). The characteristic morphology of SMILE and ISMC was present as non-invasive and invasive stratified epithelium that the full-thickness cells contained different amount of cytoplasmic mucin, respectively. Five cases of SMILE coexisted with adenocarcinoma in situ (1 case), high-grade squamous intraepithelial lesion (1 case), and invasive adenocarcinoma (3 cases). Thirteen cases with ISMC components included pure ISMC (3 cases), mixed with usual-type endocervical adenocarcinoma (8 cases) or squamous cell carcinoma (2 cases). All pure ISMC had lymph vascular space invasion and depth of invasion exceeded 10 mm. All eleven cases of invasive adenocarcinoma with ISMC components belonged to Pattern C tumors, which typically showed diffusely destructive stromal invasion, solid or poorly differentiated components. The results of histochemical staining confirmed that SMILE/ISMC cells were rich in acidic and neutral mucin. The immunohistochemical staining for CK7 and p16 was diffusely strong positive in SMILE (4/4) and ISMC (8/8) components. The positive expressions of p63 and p40 was located in peripheral cells of stratified epithelial nests or merely in a few cells of SMILE (1/3) and ISMC (2/8) components. In ISMC tissues, there were partial expression of MUC6 (5/7), focal expression of PAX8 (2/8), and wild-type expression pattern (4/10) or completely negative expression (6/10) of p53 protein. All thirteen patients with follow-up data were alive (mean 50.5 months, range 4 to 140).@*Conclusions@#As new tumor entities, SMILE is a rare and unique endocervical intraepithelial lesion, while ISMC belongs to an invasive leison. Given that the tumors with ISMC components may have aggressive behavior, it is important for clinicians and pathologists to fully understand the clinicopathological features of SMILE and ISMC.
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Objective@#To investigate the expressions of migration and invasion inhibitory protein (MIIP) and p21-activated kinase 1 (PAK1) in endometrial carcinoma (EC) and their correlation with clinicopathological features.@*Methods@#The protein levels of MIIP and PAK1 in 135 paraffin-embedded EC tissues, 55 atypical hyperplasia of endometrium (AHE) and 88 normal endometrium (NE) tissues were quantified by immunohistochemistry, the clincial significance and the relationship of these two proteins were also analyzed.@*Results@#The positive rates of MIIP expression in NE, AHE and EC tissues were 52.3%(46/88), 41.8% (23/55) and 34.8% (47/135), respectively. The expression of MIIP in EC was significantly lower than that of MIIP in NE (P<0.05). The positive rates of PAK1 expression in NE, AHE and EC tissues were 45.5% (40/88), 50.9% (28/55) and 62.2% (84/135), respectively. The expression of PAK1 in EC tissues was significantly higher than that of PAK1 in NE tissues (P<0.05). The expression of MIIP in EC tissues was significantly associated with myometrial invasion, International Federation of Gynaecology and Obstetrics (FIGO) stage and lymph node metastasis (P<0.05). The expression of PAK1 in EC tissues was significantly related with differentiation, myometrial invasion, FIGO stage and lymph node metastasis (P<0.05). The expressions of MIIP and PAK1 in EC tissues were marginally related with the overall survival of patients (P=0.092, P=0.052). The expression of MIIP in EC was negatively correlated with PAK1 (r=-0.329, P<0.001).@*Conclusions@#The down-regulation of MIIP and up-regualtion of PAK1 paticipate in the initiation and development of EC, which are correlated with the poor prognosis of EC. The protein expression of MIIP is inversely related with PAK1 in EC.
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Visfatin is a cytokine secreted by visceral adipose tissue, which plays an important role in obesity, diabetes, insulin resistance, atherosclerosis and polycystic ovarian syndrome. Additionally, visfatin is also involved in the metabolic syndrome-associated malignancies such as breast, colon, gastric and endometrial cancers. Visfatin inhibitor might be a potential antitumor therapeutic strategy for inhibiting the growth of many cancers.
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Objective@#To investigate the morphologic, immunohistochemical, genetic, clinical features and prognosis of Ewing-like BCOR-CCNB3 gene fusion undifferentiated sarcoma (BCOR-CCNB3 fusion sarcoma).@*Method@#Seventeen Ewing-like sarcoma cases were screened for CCNB3 expression and BCOR-CCNB3 fusion transcripts by immunohistochemistry and RT-PCR among 260 cases of Ewing-like sarcomas collected during Jan, 2006 to Dec, 2015. Three cases of BCOR-CCNB3 fusion sarcoma were found among 17 atypical Ewing sarcomas, and follow-up were conducted.@*Results@#The harboring of BCOR-CCNB3 fusion transcript was confirmed by RT-PCR and directly sequencing results. The three patients aged between 8 and 11 years old. Two of them were male and the other one was female. One patient achieved a complete response after chemotherapy, the other two died without chemotherapy after surgical excision in 12 months. Tumor cells in all 3 cases showed diffuse nuclear CCNB3, TLE1 and cyclin D1 positivity, while CCNB3 (0/12), TLE1 (1/12) and cyclin D1 (4/12) positivity was infrequent in the 12 cases of classical Ewing′s sarcoma. The oval or plump spindle tumor cells with fine chromatin arranged in solid pattern, the nucleoli was inconspicuous. The delicate capillary networks were obvious in the tumor.@*Conclusion@#With a detailed description of the histological spectrum, immunohistochemical features and clinical characteristic of BCOR-CCNB3 sarcoma, justify distinction from Ewing sarcoma could be possible.
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Objective@#To investigate the clinicopathologic features and grading of adenoid cystic carcinoma (ACC) of the breast.@*Methods@#Sixteen cases of ACC of the breast were analyzed and graded according to the previous report. Immunohistochemical (IHC) staining was used to detect the immunophenotype, Ki-67 proliferative index and expression of EZH2, and the association with tumor grade and outcome was analyzed.@*Results@#Of the 16 cases, 11 were grade Ⅰ, with the epithelial and myoepithelial cells being arranged into tubular and cribriform structure with no solid component; three were grade Ⅱ, which were composed of mixed tubular, cribriform and solid component (<30%); and two were grade Ⅲ, which showed mainly solid component (>90%) and the tumor cells showed basaloid features with scanty cytoplasm and hyperchromatic nuclei, and mitotic count was>5/10 HPF. Immunophenotypically, the epithelial cells expressed CK7, CK8/18 and CD117; the myoepithelial cells expressed p63 and CK5/6; while the basaloid cells were positive for CK5/6 and CD117.Tubular and cibriform ACC showed low Ki-67 and EZH2 expression, while the two cases of solid variant with basaloid features showed high level of Ki-67 and EZH2 expression. Follow-up data were available in 13 cases with a median follow-up period of 42 months. Lung metastasis occurred after 12 months in one grade Ⅱ case and the patient died of disease after 34 months. Vertebral metastasis occurred after 12 months in one grade Ⅲ case and axillary lymph node metastasis occurred in another grade Ⅲ case. All other patients were free of disease at the end of the follow-up periods.@*Conclusions@#ACC shows morphologic spectrum varying from low to high grade, the latter can may give rise to local and distant metastasis. ACC should not be regarded simply as low malignant potential, and should be graded for optimal treatment.
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To analyze and summarize the clinicopathological features of renal inflammatory lesions which were easily misdiagnosed as renal tumors.Methods The cases from March 2006 to August 2015 in the Department of Pathology at Xijing Hospital were analyzed,retrospectively.Due to the diagnosis made by clinicians that these were renal (including renal pelvic) tumors,all cases had undergone radical nephrectomy or tumor enucleation.Among them,several inflammatory lesions were confirmed,and were combined with the patients' clinicopathological data and literature review to investigate the diagnosis and differential diagnosis.Results Of the 1 195 cases,only 6 cases (less than 1％) were renal inflammatory lesions,named as xanthogranulomatous pyelonephritis (2 cases),renal malakoplakia (1 case),renal tuberculosis (1 case),IgG4-related tubulointerstitial nephritis (1 case),and renal Wegener's granulomatosis (1 case).These diseases occurred in two males and four females (aged 14 to 55 years).All patients underwent radical nephrectomy due to the detected unilateral solitary renal mass in the imaging examination.Conclusion Renal inflammatory lesions are very rare,which show masses that are easily misdiagnosed as neoplastic lesions.Some of them have similar histological features.As the differences of treatment,a sufficient understanding of the clinicopathological features of these diseases is important to make a correct diagnosis.
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Objective:To explore the expression of N-cadherin and its correlations with the clinicopathological features of human ovarian carcinoma.Methods:The expression of N-cadherin in 281 cases of ovarian carcinoma tissues were determined by immunohistochemical method.The correlations of N-cadherin expression with the clinicopathological features of human ovarian carcinoma were analyzed.Results:There was higher expression of N-cadherin in the metastatic lesions than its paired primary lesions (P =0.018).The expression level of N-cadherin in ovarian carcinoma was correlated with the FIGO stage (P =0.034),histological type (P ＜0.001) and tumor grade (P =0.004).Conclusions:High expression of N-cadherin might positively correlate with the invasion and migration ability of ovarian carcinoma cells,which was more common in the the advanced (FIGO Ⅱ-Ⅳ) ovarian carcinoma,high-grade serous carcinoma,and high grade ovarian carcinoma.N-cadherin might be useful in estimating the biological behavior of human ovarian carcinoma.
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Purpose To explore the expression and significance of histone methyltransferase EZH2,clinicopathological features in primary testicular diffuse large B-cell lymphoma (DLBCL).Methods Immunohistochemical of Ventana Ultra View two-step staining was used to detect expression of EZH2 in 17 cases of primary testicular DLBCL.The relationship between EZH2 expression and its clinicopathological features were analyzed.Sanger squencing was used to detect EZH2 Y641 mutation in these cases.Results Morphologically,the tumor cells resembled centroblasts in 11 cases,immunoblasts in 3 cases,and anaplastic variants in 3 cases.Immunophenotypically,14 cases were non-germinal centre B cell like (non-GCB) type and 3 cases were germinal centre B cell like (GCB) subtype.EZH2 overexpressed in all 17 cases.EZH2 overexpressed in nearly tumor celts with uniformly strong intensity in 15 cases,and more than 70％ tumor cells with moderate to strong intensity in 2 cases.The follow-up information was obtained in 9 patients,with a median survival time of 35 months.No association was found between the level of EZH2 expression and outcome of patients.No mutation of EZH2 Y641 was detected.Conclusion Primary testicular DLBCL is a rare aggressive B cell lymphoma with distinctive clinicopathological features.Detection of EZH2 expected to assist in the diagnosis and treatment of tumor.
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Objective To investigate the predictive value of preoperative serum human epididymis protein 4 (HE4) and CA125 in patients with high risk of stage Ⅰ endometrial cancer (EC)and to identify the optimal cutoff values. Methods Clinical and pathological data of 231 patients with stage Ⅰ EC were included in this study. Patients were divided into high risk group (n=96) and low risk group (n=135). The preoperative serum levels of HE4 and CA125 were measured, and their correlations with clinical pathological features were analyzed. The ROC curves were generated to determine optimal cutoff values of HE4 and CA125 levels with the maximum Youden index for prediction of high risk EC. Results There were significant differences in serum levels of HE4 and CA125 between patients with different depths of myometrial invasion, with or without vascular invasion, with or without lower uterine segment involvement, with different diameters of tumor and different risk classifications of stage ⅠEC (P<0.05). There were significant differences in serum levels of HE4 between patients with different menopausal status, hypertension, pathological types, histological grading and the involvement of cervical endometrial glands (P<0.05). The preoperative serum levels of HE4 and CA125 were positive correlated (r=0.262, P<0.05). The AUC value of HE4 for diagnosing stageⅠEC was 0.794(95%CI:0.734-0.854),the cutoff value was 74 pmol/L, the sensitivity was 75.0%, specificity was 83.0%, positive predictive value was 75.8%, negative predictive value was 82.4% and the accuracy rate was 79.7%. The AUC value of CA125 for diagnosing stage Ⅰ EC was 0.696 (95%CI: 0.624-0.767), the cutoff value was 17 kU/L, the sensitivity was 56.3%, specificity was 85.9%, positive predictive value was 74.0%, negative predictive value was 73.4%and the accuracy rate was 73.6%, respectively. The AUC value of combination of both markers was 0.847 (95%CI: 0.796-0.899), the corresponding values were 95.8%, 77.0%, 74.8%, 96.3%and 84.8%, respectively. Conclusion The best cutoff values of HE4 and CA125 are 74 pmol/L and 17 kU/L for detecting high risk stageⅠEC. The combined detection is better than that of the single detection in sensitivity, negative predictive value and accuracy rate.
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Objective To investigate the correlations of apparent diffusion coefficient (ADC) with fibrosis and fibroblast activation protein (FAP) score in pancreatic cancer .Methods Eighteen patients with pathologically confirmed pancreatic cancer were per‐formed conventional MR imaging ,DWI examinations .ADCs were measured with region of interest method on a “Single slice” .The wax blocks of 18 patients with pancreatic cancer were received Masson staining and FAP immunohistochemical staining .The correla‐tions of ADC with levels of fibrosis and FAP scores of pancreatic cancer were assessed by Pearson correlation analysis .Results The mild negative correlation between ADC value of cancerous foci and fibrosis was not significant (r= -0 .459 ,P=0 .056) .Significant negative correlation was found between ADC values of moderate and high differentiation cancerous foci and fibrosis (r= -0 .564 ,P=0 .044) .Significant negative correlation was found between ADC value and FAP score (r= -0 .497 , P=0 .036) .Conclusion The negative correlations are found between ADC and fibrosis ,FAP score of pancreatic cancer .DWI will be helpful to infer the pathologi‐cal characteristics .
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Objective To determine the clinical features and the factors affecting the recurrence of ovarian borderline epithelial tumors. Methods A retrospective data of 112 cases with ovarian borderline epithelial tumors admitted in General Hospital of Tianjin Medical University from 2000 to 2015 were analyzed. Results The average age was (50.59±16.90) years in 112 patients with FIGO stageⅠof 102 (91.07%) patients, stageⅡof 4 (3.57%) and stageⅢof 6 (5.36%). The serum tumor marker (CA125) was examined in 102 patients, and 27 cases with the elevated indicator (26.47%). Surgical treatment was performed in 112 patients. Younger patients were more likely to choose conservative surgery. Ninety-seven patients were followed up, and 5 of them relapsed. Non fertility preserving surgery was performed in patients with recurrence. The recurrence rates of patients with different clinical pathological factors were compared. The recurrence rate was higher in patients with micro infiltration than that of patients without micro infiltration [37.50%(3/8) vs. 2.25%(2/89), P=0.004]. And the recurrence rate was higher in patients with microemulsion type borderline serous tumor than that of patients with non-papillary tumors [40.00%(2/5)vs. 0(0/41),P=0.019]. Seven patients underwent conservative surgery had normal spontaneous pregnancy. Conclusion The fertility-sparing surgery can be used as the treatment procedures for young patients, which is safe and effective. It is necessary to be on alert of recurrence for the cases with micropapillary pattern, and microinvasive tumor.
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<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunophenotype and differential diagnosis of extraskeletal myxoid chondrosarcoma (EMC).</p><p><b>METHODS</b>The clinicopathologic features of 5 cases of EMC (during the period from 2008 to 2013) were retrospectively analyzed. Immunohistochemical study (EnVision method) was carried out using the archival material. The literature was reviewed.</p><p><b>RESULTS</b>There were altogether 3 female patients and 2 male patients. Their age ranged from 38 to 63 years (average = 51 years). The patients primarily presented with a tender soft tissue mass. All the tumors studied were solitary and the duration of disease onset varied from 3 months to 1 year. The sites of involvement included toe (number = 2), intracranial (number = 1), thigh (number = 1) and shoulder (number = 1). Gross examination showed white nodular masses with a gelatinous cut surface. The average tumor size measured 5.2 cm in greatest dimension. Histologically, a multinodular architecture with fibrous or loose fibrovascular septa separating lobules of tumor cells was identified. The lobules contained abundant myxoid stroma, with peripheral accentuation of tumor cellularity. Two cases were diagnosed as cellular variant of EMC, with invasive growth pattern and hemorrhage. The tumor cells in cellular EMC were arranged in solid nodules, with rare myxoid matrix in between. The nuclei were relatively uniform, round to oval and contained prominent nucleoli. The mitotic figure ranged from 5 to 10 per 10 high-power fields. Immunohistochemical study showed that all of the 5 cases were positive for vimentin, mitochondria and CD56. Two cases expressed synaptophysin and NSE. Focal positivity for these neuroendocrine markers was detected in the other 2 cases. Chromogranin and S-100 protein expression was demonstrated in 2 cases. The staining for epithelial membrane antigen was positive in case 2 and negative in the other 4 cases. CD117 showed diffuse positivity in case 1, the other 4 cases were not expressed.</p><p><b>CONCLUSIONS</b>EMC is a rare soft tissue sarcoma characterized by distinctive histopathologic features and often shows neuroendocrine differentiation. Although EMC is a slow-growing tumor, it carries a high local recurrence rate and even metastases, warranting long-term follow up.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , CD56 Antigen , Metabolism , Chondrosarcoma , Metabolism , Pathology , General Surgery , Chordoma , Metabolism , Pathology , Chromogranins , Metabolism , Diagnosis, Differential , Neoplasms, Connective and Soft Tissue , Metabolism , Pathology , General Surgery , Phosphopyruvate Hydratase , Metabolism , Retrospective Studies , Rhabdomyosarcoma , Metabolism , Pathology , S100 Proteins , Metabolism , Shoulder , Synaptophysin , Metabolism , Thigh , Toes , Vimentin , MetabolismABSTRACT
Objective To explore the influence of lack of parental accompaniment, physical abuse and neglect in childhood on the psychological distress of college entrant students. Methods In a comprehensive university in Sichuan Province, 8367 freshmen were surveyed using the 6-item Kessler psychological distress (K6) scale and a questionnaire for lack of parental accompany, physical abuse and neglect in childhood. The students were divided into rural group and urban group for data analysis. Results The months of lack of maternal and/or paternal accompaniment were more in rural group than that in urban group (P<0.05). In rural group, female (standardizedβ’=0.139, P<0.001), neglect (standardizedβ’=0.237, P<0.001) and physical abuse (standardized β’=0.076, P<0.001) were associated with K6 scale. In urban group, female (standardizedβ’=0.091, P<0.001), lack of paternal accompaniment (standardizedβ’=0.050, P<0.001), ne? glect (standardized β’=0.169, P<0.001) and physical abuse (standardized β’=0.095, P<0.001) related with K6 scale. Conclusions Neglect and physical abuse are independent risk factors to freshmen both from rural and urban areas. Lack of paternal accompaniment in childhood is a risk factor only in urban freshmen. Further research should select more rep?resentative samples and also include more factors which may interact with the loss of parental accompaniment such as pa?rental divorce and conditions regarding so calledleft-behindchildren in rural area.
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Objective To explore the clinicalpathological characteristics of Lynch syndrome associated ovarian cancer.Methods Totally 260 cases ovarian cancer patients were admitted to Tianjin Medical University General Hospital during Jan.2004 and Jan.2011,among which 10 patients( LS group) belonged to Lynch syndrome associated ovarian cancer according to Amsterdam Ⅱ criteria.One hundred ovarian cancer patients without any family cancer history were enrolled randomizely as control group (sporadic group).Results Lynch syndrome associated ovarian cancer accounted for 3.8％ ( 10/260),the incidence rate of ovarian cancer for female family members of Lynch syndrome was 8.7％ ( 10/115 ).Mean age at time of diagnosis in LS group was (46 ±7) years,significantly earlier than that in sporadic group [ (56 ±11 ) years,P ＜ 0.05 ].There was no statistical difference between two groups in histological type or International Federation of Gynecology and Obstetrics ( FIGO ) stage ( P ＞ 0.05 ).Most of the tissue differentiation in LS group were well or moderate differentiated,there was statistical difference between the two groups(9/10 vs.55％,P ＜0.05).The 3-year and 5-year survival rate in LS group were 87.5％ and 52.5％respectively,compared with 55.4％and 22.7％ in sporadic group(all P＜0.05).Conclusion Compared with sporadic ovarian cancer,Lynch syndrome associated ovarian cancer is more likely present as the clinicalpathological characteristics of early age of onset,serous adenocarcinoma,lower grade and better prognosis.
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Obesity,hypertension,and diabetes mellitus are main risk factors of endometrial cancer.The basis of metabolic syndrome is insulin resistance and hyperinsulinemia. Insulin resistance may contribute to an increased risk for endometrial cancer according to worldwide researches.