Profil épidémiologique et à l'imagerie par résonnance magnétique (IRM) des cancers de l'endomètre au Sénégal

Objectifs : Donner le profil épidémiologique et à l'imagerie par résonnance magnétique (IRM) des cancers de l'endomètre rencontrés dans notre exercice. Evaluer l'apport de cette technique dans le bilan d'extension locorégionale par la classification FIGO-IRM et dans la recherche de récidive post-opératoire.Méthode : Etude rétrospective incluant 35 patientes d'âge moyen 59,9 ans adressées pour bilan d'extension d'un cancer de l'endomètre chez 31 patientes et pour suivi post chirurgical chez 4. Elles ont toutes bénéficié d'une exploration pelvienne avant et après injection de Gadolinium avec des IRM haut champs (1.5T) de marque Phillips et Siemens.Résultats : Toutes les patientes adressées pour bilan d'extension présentaient une lésion en hyposignal T1. Un hypersignal intermédiaire en pondération T2 était observé dans 30 cas (96,7 %) avec restriction de la diffusion et prise de contraste après injection de gadolinium chez 28 patientes (90,3 %). Le stade I de FIGO était plus représentatif, retrouvé chez 16 patientes (51,6 %) suivi du stade III (25,8%). Aucune récidive n'était notée chez les quatre patientes adressées pour suivi post traitement chirurgical d'un cancer de l'endomètre.Conclusion : l'IRM malgré son accès limité dans notre pays est devenue quasi incontournable dans le bilan d'extension locorégionale des cancers de l'endomètre ainsi que dans leur suivi post-thérapeutique

Características clínico-epidemiológicas y manejo del cáncer endometrial (2010-2013) / Clinical-epidemiological characteristics and management of endometrial cancer (2010-2013)

Introducción: el cáncer de endometrio ha incrementado su incidencia y se asocia a factores de riesgo presentes en muchas mujeres en la perimenopausia. El síntoma más común es el sangramiento y la modalidad de tratamiento más empleada es la cirugía. Objetivo: caracterizar el cáncer endometrial en el Hospital América Arias desde enero de 2010 hasta junio de 2013. Métodos: se realizó un estudio descriptivo en el Hospital América Arias, desde 1ro de enero de 2010 hasta el 30 de junio de 2013. Se incluyó el total las pacientes con sangramiento uterino anormal en la etapa peri y posmenopáusico a partir de 40 años de edad. Las pacientes con diagnóstico histopatológico de cáncer endometrial constituyeron la muestra (n= 49). Resultados: la edad promedio de las pacientes fue de 60,8 ± 9,9 años. Presentaban sobrepeso 30,6 por ciento, y 44,9 por ciento eran obesas. El examen histopatológico posquirúrgico muestra que la lesión estuvo limitada al endometrio en 14,3 por ciento de las pacientes; pero hubo invasión de los dos tercios externos del miometrio en 61,2 por ciento de ellas. La extensión al cuello y a los anejos uterinos fue de 38,8 por ciento y 22,4 por ciento respectivamente. Conclusiones: existe una tendencia a la aparición del adenocarcinoma endometrial en edades cada vez más avanzadas. Se asocia a factores de riesgo como obesidad, infertilidad y el uso de terapia hormonal de remplazo. Además de la cirugía, algunas pacientes requirieron tratamiento oncológico específico(AU)

Introduction: The incidence of endometrial cancer has increased and it is associated with risk factors present in many perimenopausewomen. The most common symptom is bleeding and the most widely used treatment modality is surgery. Objective: Characterize endometrial cancer at America Arias Hospital from January 2010 to June 2013. Methods: A descriptive study was conductedat America Arias Hospital, from 1 January 2010 to 30 June 2013. The total included over 40 year patients with abnormal uterine bleeding in perimenopausal and postmenopausal. Patients with histopathologic diagnosis of endometrial cancer constituted the sample (n= 49). Results: The mean age of patients was 60.8 ± 9.9 years. 30.6 percent were overweight and 44.9 percent were obese. Postoperative histopathologic examination shows that the lesion was limited to the endometrium in 14.3 percent of patients, but there was invasion of the two outer thirds of the myometrium in 61.2 percent. The extension cervix and adnexa was 38.8 percent and 22.4 percent, respectively. Conclusions: There is a tendency to the appearance of endometrial adenocarcinoma at increasingly advanced ages. It is associated with risk factors such as obesity, infertility, and the use of hormone replacement therapy. In addition to surgery, some patients required specific cancer treatment(AU)

Adenocarcinoma de endométrio: epidemiologia, tratamento e sobrevida de pacientes atendidas no Hospital de Clínicas de Porto Alegre / Endometrial adenocarcinoma: epidemiology, treatment and survival of patients treated at Hospital de Clínicas de Porto Alegre

Neste estudo, descreve-se o perfil clínico das pacientes e as características histopatológicas dos carcinomas de endométrio tratados no setor de Oncologia Genital do Hospital de Clínicas de Porto Alegre (HCPA), assim como as formas de tratamento, fatores prognósticos e sobrevida. Métodos: Estudo de coorte histórica incluindo todas as pacientes submetidas a tratamento cirúrgico primário entre 1996 e 2012. Após revisão de prontuários médicos, foram analisadas as variáveis idade, status hormonal, tipo histológico e grau tumoral, invasão miometrial, estadiamento cirúrgico, cirurgia realizada, tratamento complementar e sobrevida. Resultados: Cento e sessenta e quatro pacientes foram incluídas no estudo, com idade média de 64,2 anos (31-95 anos), sendo quase 90% delas pós-menopáusicas. O tempo de seguimento variou de 4 dias a 14,6 anos. O tipo histológico endometrioide foi o mais encontrado (78% dos casos). A histerectomia com salpingo-ooforectomia bilateral com linfadenectomia pélvica foi a cirurgia mais realizada (77,5%). Tratamento complementar foi realizado em 57,9% das pacientes, sendo a radioterapia o tratamento de escolha em 87,4% deles. Ocorreram 36 óbitos (22%) durante o seguimento, com uma sobrevida média global de 125 meses. Em análise bivariada, idade ≥ 65 anos, tipo histológico não endometrioide, tumores pouco diferenciados (G3), invasão miometrial ≥ 50% e metástase linfonodal relacionaram-se significativamente a um menor tempo de sobrevida. Em análise multivariada, a histologia não endometrioide, estádio III, estádio IV e a presença de comprometimento linfonodal foram significativamente associados ao óbito. Conclusão: Os resultados encontrados são compatíveis com a literatura existente e vêm em acréscimo à escassa estatística nacional...

This study describes the clinical profile and the hystopathologic characteristics of endometrial carcinomas from patients treated at the Gynecologic Oncology department of Hospital de Clínicas de Porto Alegre (HCPA), as well as the forms of treatment, prognostic factors, and survival. Methods: Historic cohort study including all patients subjected to primary surgical treatment between 1996 and 2012. After review of the medical records, the variablesage, hormonal status, tumor histologic type and grade, myometrial invasion, surgical staging, performed surgery, complementary treatment, and survival were analyzed. Results: One hundred sixty four patients were included, with a mean age of 64.2 years (31-95 years), of which almost 90% were postmenopausal women. Follow-up time ranged from 4 days to 14.6 years. Endometrioid adenocarcinoma was the most frequently histological type (78% of cases). Hysterectomy with bilateral salpingooophorectomy plus pelvic linfadenectomy was the most frequently performed surgery (77.5%). Adjuvant treatment was held in 57.9% of the patients, with radiotherapy being the treatment of choice in 87.4%. Thirty-six deaths (22%) occurred during followup, with a mean overall survival of 125 months. In the bivariate analysis, age ≥ 65 years, non-endometrioid histology, poorly differentiated tumors (G3), myometrial invasion ≥ 50%, and lymph node metastasis were correlated to lower survival. In the multivariate analysis, non-endometrioid histology, stage III, stage IV and lymph node metastasis were significantly associated with death. Conclusion: The results found are compatible with the existing literature and contribute to the scarce existing national statistics...

Physical activity for an ethnically diverse sample of endometrial cancer survivors: a needs assessment and pilot intervention / 부인종양

OBJECTIVE: To determine the physical activity (PA) behavior, needs and preferences for underserved, ethnically diverse women with a history of endometrial cancer (EC). METHODS: Women with a history of EC (41 non-Hispanic black, 40 non-Hispanic white, and 18 Hispanic) completed a needs assessment during their regular follow-up appointments at Montefiore Medical Center in Bronx, NY, USA. An 8-week pilot PA intervention based on the results of the needs assessment was conducted with 5 EC survivors. RESULTS: Mean body mass index (BMI) among the 99 respondents was 34.1+/-7.6 kg/m2, and 66% did not exercise regularly. Self-described weight status was significantly lower than actual BMI category (p<0.001). Of the 86% who were interested in joining an exercise program, 95% were willing to attend at least once weekly. The primary motivations were improving health, losing weight, and feeling better physically. Despite the high interest in participation, volunteer rate was very low (8%). However, adherence to the 8-week pilot PA intervention was high (83%), and there were no adverse events. Body weight decreased in all pilot participants. CONCLUSION: These data show that ethnically diverse EC survivors have a great need for, and are highly interested in, PA interventions. However, greater care needs to be taken to assess and identify barriers to increase participation in such programs.

Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer / 부인종양

OBJECTIVE: Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS: This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS: Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1+/-117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION: Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.

Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy / Lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica / Lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica

Objective : To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods : The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results : Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion : Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer. .

Objetivo : Avaliar a incidência de lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica. Métodos : Análise dos resultados de 1.020 exames anatomopatológicos de pacientes submetidas, em hospital público, à polipectomia histeroscópica, e achados em suas histeroscopias diagnóstica e cirúrgica. Em termos de estado menstrual, 295 (28,9%) pacientes encontravam-se na menacme. Do total, 193 (65,4%) apresentavam sangramento uterino anormal e 102 (34,6%) eram assintomáticas, com alteração da medida do eco endometrial à ultrassonografia transvaginal. Das 725 (71,1%) pacientes na pós-menopausa, 171 (23,6%) eram sintomáticas (sangramento uterino anormal) e 554 (76,4%) assintomáticas, com eco endometrial >5,0mm. Resultados : Vinte e uma (2,0%) pacientes apresentaram lesões precursoras nos pólipos, 13 com hiperplasia glandular simples, das quais 5 sem atipias e 8 com atipias. Oito pólipos apresentavam área focal de hiperplasia complexa, quatro com atipias e quatro sem lesões. Câncer foi diagnosticado em cinco (0,5%) pólipos. Dos 21 pólipos que abrigavam lesões precursoras, 12 foram interpretados como benignos nas histeroscopias diagnóstica e cirúrgica. Quatro dos pólipos com câncer também foram interpretados histeroscopicamente como normais. Conclusão : Os pólipos sintomáticos na menacme, bem como todos na pós-menopausa, devem ser ressecados para realização de exame anatomopatológico, por poderem apresentar aspecto benigno, mesmo quando abrigam áreas de atipia celular ou câncer. .

Cáncer de endometrio: experiencia de 10 años en el hospital San Juan de Dios / Endometrial cancer: 10 years experience in the San Juan de Dios hospital

Antecedentes: El cáncer de endometrio es uno de los cánceres ginecológicos más frecuentes. La incidencia de esta enfermedad pudiera ir en aumento dado los cambios epidemiológicos de la población femenina. Objetivo: Evaluar resultados clínicos y características de la población atendida por cáncer de endometrio. Método: Se analizaron las historia clínicas de 100 pacientes tratadas por cáncer de endometrio entre enero de 2000 y diciembre de 2009. En el análisis de los datos se consideró como base la etapificación FIGO 1988. Resultados: La edad promedio fue de 62 años, el 75 por ciento de las pacientes consultaron por hemorragia post menopáusica y en el 64 por ciento de las pacientes el diagnóstico se realizó por dilatación y curetaje. En el 60 por ciento se realizó etapificación completa. El 60 por ciento correspondió a etapa I y el 15 por ciento a etapa II. La sobrevida global en etapa I y II fue del 83 por ciento y 66 por ciento, respectivamente. Conclusión: El cáncer de endometrio se presenta preferentemente en pacientes post menopáusicas en etapas precoces. La mayoría accede a tratamiento quirúrgico con escasas complicaciones y alta sobrevida global.

Background: Endometrial cancer is one of the most frecuent gynecological cancer. The incidence of this disease could arise because of epidemiologycal changes in female population. Aims: To evaluate characteristics and clinical results of atended population with endometrial cancer. Method: Clinical histories of 100 patients treated for endometrial cancer between January 2000 to December 2009 were analized. In the data analysis, the FIGO 1988 staging was considered as base. Results: The age average was 62 years. The 75 percent of patients consulted for postmenopausal hemorrhage in the 64 percent of the patients the diagnosis was made by dilation and curettage. Full staging was made in the 60 percent. Stage I was 60 percent and 15 percent for stage II. Overall survival in stage I and II was 83 percent and 66 percent, respectively. Conclusion: Endometrial cancer presents preferably in early stages in postmenopausal patients. The mayority access to surgical treatment with few complications and a high survival rate.

Câncer de endométrio: mortalidade populacional e sobrevida de uma coorte Hospitalar no Rio de Janeiro, Brasil / Endometrial cancer: population mortality and survival of a cohort Hospital in Rio de Janeiro, Brazil

Os tumores do corpo do útero ocupam o sétimo lugar entre as neoplasias que acometem as mulheres e 60 por cento dos casos ocorrem nos países desenvolvidos. As taxas de mortalidade relacionadas a este tipo de câncer têm diminuído aproximadamente 60 por cento desde a década de 50 nos países desenvolvidos. A tendência temporal de mortalidade e os fatores associados à sobrevida do câncer de endométrio estão sendo estudados mundialmente, entretanto, pouco se conhece a respeito da temática no Brasil. Esta dissertação tem como objetivos analisar a mortalidade por câncer de endométrio entre mulheres residentes no estado do Rio de Janeiro e estimar a sobrevida dessas pacientes, atendidas no Hospital do Câncer-II do Instituto Nacional de Câncer. O desenvolvimentodeste trabalho deu origem a dois artigos que compõem a estrutura desta dissertação. O primeiro artigo aborda questões relacionadas à mortalidade e aponta para sua tendência estável após correção dos óbitos classificados como câncer de útero SOE. Já o segundoartigo, aponta os fatores associados à sobrevida e demonstra que estadiamentoavançado, baixo grau de diferenciação celular e histologia não endometrióide podem ser considerados marcadores independentes de pior prognóstico. Em resumo, os resultados observados no primeiro artigo apontam uma tendência constante da mortalidade por câncer de corpo do útero, resultado este diferente dos encontrados em alguns paísesdesenvolvidos, onde esta tendência se encontra decrescente. Os resultados do segundo artigo acompanham os resultados de estudos mundiais. O monitoramento das tendências assim como o conhecimento da sobrevida e fatores associados podem ser importantes indicadores das mudanças nos hábitos, exposições a fatores de risco ambientais, efetividade e acesso a serviços de saúde de determinada população.

Epidemiología del carcinoma de endometrio / Epidemiology of endometrial carcinoma

Conocer los factores de riesgo epidemiológico en pacientes atendidas por cáncer de endometrio y evaluar su incidencia. Estudio retrospectivo, descriptivo, epidemiológico de 44 pacientes con carcinoma endometrial atendidas entre 1999 y 2007. Servicios de Cirugía y Obstetricia del Hospital Central de Maracay. Las pacientes tenían edades entre 50-59 años en 31,8 por ciento. En índice de masa corporal el 24,9 por ciento tuvo obesidad. De las mujeres en posmenopausia 32,4 por ciento tenían edades entre 51 y 55 años. Paridad 36,4 por ciento tenía 5 gestas y más. La histogénesis resultó en 88,8 por ciento adenocarcinoma endometrioide. La estadiación clínico-patológica (FIGO 1988) reportó en 16 por ciento estadío 1b (G 1, 2, 3). Las mujeres con mayor riesgo para carcinoma endometrial tienen más de 50 años, son obesas, pos menopáusicas

To know risk factors related to the endometrial cancer and to evaluate the incidence. Analytical, epidemiological and retrospective study, of 44 cases of patients with endometrial cancer happened between 1999 and 2007. Hospital Central de Maracay. Patients were 31.8 percent between 50-59 years of age. Body mass index 24.9 percent was obese. Postmenopausal were 32.4 percent between 51-55 years of age. Parity between 5 or more: 36.4 percent. Histologic type 88.8 percent was adenocarcinoma. FIGO staging was 1b: 16 percent. Women with more risk for endometrial cancer are advanced age, obese, and postmenopausal

Necessity of Radical Hysterectomy for Endometrial Cancer Patients with Cervical Invasion

To determine whether radical hysterectomy is necessary in the treatment of endometrial cancer patients with cervical involvement, we reviewed the medical records of women who underwent primary surgical treatment for endometrial carcinoma and selected patients with pathologically proven cervical invasion. Among 133 patients, 62 patients underwent extrafascial hysterectomy (EH) and 71 radical or modified radical hysterectomy (RH). The decision regarding EH or RH was made at the discretion of the attending surgeon. The sensitivity of pre-operative magnetic resonance imaging for cervical invasion was 44.7% (38/85). In RH patients, 10/71 (14.1%) patients had frankly histologic parametrial involvement (PMI). All were stage III or over. Eight of 10 patients had pelvic/paraaortic node metastasis and two showed extrauterine spread. In 74 patients with stage II cancer, RH was performed in 41 and PMI was not seen. Sixty-six (89.2%) patients had adjuvant radiation therapy and there were 3 patients who had developed recurrent disease in the RH group and none in the EH group (Mean follow-up: 51 months). Although these findings cannot conclusively refute or support the necessity of radical hysterectomy in patients with cervical extension, it is noteworthy that the risk of PMI seems to be minimal in patients with a tumor confined to the uterus without evidence of extrauterine spread.

Assessment of gynecologic malignancies: A multi-center study in Tehran (1995-2005).

Objective: The observed differences in cancer incidence are mainly due to different individuals and social risk factors. This study aims to demonstrate the characteristics of female genital malignancies according to the pathological records in Tehran, Iran. Materials and Methods: In this cross-sectional study, all records of pathological specimens categorized as ovarian, uterine corpus or uterine cervix cancers from 1995 to 2005, in five teaching hospitals in Tehran, were studied. Age, marriage, parity, menopausal status, smoking, oral contraceptive usage, pathological staging, and histological grading were reviewed by a trained general practitioner. SPSS 14 was used for statistical analysis. Result: Mean age (SD) at the time of diagnosis was 50 (15). Fifty-nine percent of ovarian, 33.9 and 47.7% of uterine corpus and uterine cervix malignant patients were premenopausal. About 90% of all were nonsmokers and 82.7% were multiparae. Various types of gynecologic malignancies included ovarian (55.5%), uterine corpus (24.9%), and uterine cervical cancers (19.6%) were diagnosed. In tumors of the uterine corpus and uterus cervix, the most frequent stage of diagnosis was stage IIA. Conclusion: Ovarian cancer was the most frequently occurring gynecologic tumor. Although distribution of age in ovarian cancer was similar to that mentioned in the literature, occurrence of the cancer was more frequent in the premenopausal state.

Prognostic significance of ER, PR, Ki67, c-erbB-2, and p53 in endometrial carcinoma.

OBJECTIVE: To better discern the prognostic significance of estrogen-progesterone (ER-PR) receptor proliferative index, tumor suppressor gene, and over expression of oncogene c-erbB-2 in correlation with survival time and recurrence of tumor. MATERIAL AND METHOD: Paraffin blocks from 65 cases of endometrial carcinoma diagnosed and treatment at Rajavithi Hospital, Bangkok, Thailand with a follow-up time of at least 60 months were immunohistochemical studiedfor ER and PR status, tumor proliferative index (Ki-67), tumor suppressor gene (p53), and overexpression of oncogene c-erbB-2. Survival analysis was performed with the Cox proportional hazards. RESULTS: The mean age of the patients was 54.94 years with a range of 24 to 80 years. The mean follow-up time was 50.35 months. Nine patients (13.8%) had recurrent tumors, 5 years after treatment. Ten patients (15.4%) died of the primary disease during the follow-up period. ER was positive in 50 cases (76.9%) and negative in 15 cases (23.1%). PR was positive in 47 cases (72.3%) and negative in 18 cases (27.7%). Both ER and PR showed significant correlation (p<0.01). Ki-67 showed 27 cases (41.5%) having >35% positive nuclear staining and 38 cases (58.5%) had < or =35% positive nuclear staining. p53 was positive in 31 cases (47.7%) and negative in 34 cases (52.3%). c-erbB-2 was positive in one case (1.5%), equivocal in six cases (9.2%), and negative in 58 cases (89.3%). CONCLUSION: Survival analysis showed that cases with low-stage, low-grade, no recurrent tumor, ER and PR positive, and Ki-67 < or =35% had good survival compared to cases with high-stage, high-grade, presence of recurrent tumor, ER-PR-negative, and Ki-67 > 35% (p<0.05). Cox regression analysis showed ER-PR status and Ki-67 were significant independent prognostic indicators for survival time. Ki-67 expression was also a significant independent prognostic indicator for recurrent tumor p53 and c-erbB-2 displayed no statistical significance related to survival time.

Endometrial cancer in Thai women aged 45 years or younger.

The aim of this retrospective study was to clarify the clinopathologic profile of endometrial cancers in women aged 45 years or younger. All patients with histopathologically confirmed endometrial cancer treated at Songklanagarind Hospital from 1996-2005 were included. Of the 51 identified, 40 (78.4%) were in stage I, 7 (13.7%) in stage II, and 4 (7.8%) in stage III. The age range was 25-45 years (median 41) with a body mass index ranging from 17.6-44.2 (median 27.2). Eighty one percent reported abnormal vaginal bleeding, and twenty four percent polycystic ovaries. Prevalences of diabetes mellitus, hypertension and thyroid disease were 17.7%, 15.7%, and 3.9%, respectively. Seven cases (13.7%) had synchronous ovarian cancer with endometriod adenocarcinoma as the most common histopathological form. Forty patients had well differentiated, 8 moderately differentiated and 2 poorly differentiated tumors. The 5-year disease-free survival (and 95% CI) and 5-year overall survival rates were 88.0% (75.1-94.4%) and 87.5% (74.1-94.2%), respectively. Univariate analysis revealed that patients who had a history of hypertension or lymph node metastasis had a poor prognosis. We conclude that the majority of women aged 45 years or younger with endometrial cancer were obese and the tumors were most commonly in an early stage and were well differentiated.

Prevalência de lesões endometriais em mulheres obesas assintomáticas / Prevalence of endometrial injury in asymptomatic obese women

OBJETIVOS: A obesidade representa importante fator de risco para alterações endometriais. O presente estudo teve por objetivo avaliar a prevalência de lesões endometriais, como pólipos, hiperplasia e câncer de endométrio em mulheres obesas assintomáticas, assim como reconhecer os fatores de risco associados. MÉTODOS: Entre dezembro de 2004 e fevereiro de 2006, em estudo transversal foram avaliadas 94 mulheres obesas (índice de massa corpóreo >30Kg/m²), divididas em dois grupos com 47 participantes cada: em idade reprodutiva e após a menopausa. Foram analisados: história clínica, exame físico (antropométrico/ginecológico), determinações bioquímicas e avaliação do endométrio por ultra-sonografia endovaginal, biópsia e histeroscopia (para confirmar patologia endometrial). RESULTADOS: Nas mulheres em idade reprodutiva foram encontrados 12,8 por cento de casos de patologia endometrial, que se associaram significativamente com as elevações da idade, hipertensão arterial (HAS), colesterol e LDL-c. Após a menopausa, foram identificadas 40,4 por cento de lesões endometriais que se associaram significativamente com pressão arterial sistólica (PAS) > 140mmHg, elevação do LDL-c e da estrona. Dois casos de câncer de endométrio foram constatados, sendo um em cada grupo. CONCLUSÃO: O aumento de incidência da obesidade nos últimos anos tem elevado os fatores de risco para o câncer de endométrio. Na idade reprodutiva tivemos um pequeno tamanho amostral de alterações endometriais; com isso, poderíamos apenas sugerir, uma maior atenção àquelas com idade superior a 40 anos, que apresentem HAS e/ou elevação do LDL-c. O status menopausal eleva o risco de lesão endometrial; associado com elevações da PAS, LDL-c e/ou estrona, elas se tornarão candidatas à biópsia de endométrio, visando o diagnóstico precoce do câncer, decisivo para o prognóstico favorável da mulher.

OBJECTIVE: Obesity represents the most important risk factor for endometrial pathology. This study aimed to evaluate the prevalence of endometrial injuries, such as polyps, hyperplasia and endometrial cancer in asymptomatic obese women, as well as to recognize the associated risk factors . METHODS: A cross-sectional study was conducted between December 2004 and February 2006. Ninety-four obese (body mass index > 30 kg/m²) women were evaluated, divided in two groups of 47 participants each: pre-menopausal and postmenopausal women. Clinical characteristics, physical exams (anthropometric and gynecological), blood count and endometrial assessment by vaginal ultrasonography, biopsy, and hysteroscopy (only for confirmed endometrial pathology), were the variables appraised. RESULTS: In pre-menopausal women, 12.8 percent of cases had endometrial pathology statistically associated to age, hypertension, hypercholesterolemia and LDL-c increase. In the post-menopausal women, 40.4 percent of cases had a pathology identified as statistically associated with hypertension, LDL-c and estrone increase. Two cases of endometrial cancer were identified, one in each group. CONCLUSIONS: The increased incidence of obesity over recent years has increased risk factors of endometrial cancer. In pre-menopausal women only a small number of cases with endometrial alterations was observed. Therefore, it is suggested that greater attention be given to those over 40 years of age, associated with hypertension and/or higher LDL-c . The menopausal status increases risk of endometrial injury, and when associated with hypertension, LDL-c and/or estrone increase, women become candidates to biopsy aiming for an early diagnosis of cancer, a decisive factor for a favorable prognosis.

Análise da tendência temporal da mortalidade por câncer de útero no Estado de São Paulo: 1980 a 1998 / Analysis of the tendencies over time of mortality due to uterine cancer in the state of São Paulo: 1980 to 1988

Trata-se de um estudo descritivo de série temporal sobre mortalidade por câncer de útero em mulheres residentes no Estado de São Paulo, segundo faixa etária e distribuição no Município de São Paulo ou demais municípios, durante o período entre 1980 e 1998. A partir de dados populacionais obtidos da Fundação IBGE, e dados de óbitos por câncer de corpo de útero e de útero (SOE) obtidos do CDROM do Ministério da Saúde sobre Sistema de Informação sobre mortalidade, foram analisados 19 anos consecutivos, entre 1980 e 1998, levando-se em consideração as variáveis: local de residência (Município de São Paulo ou demais municípios), idade da mulher e ano do óbito. A análise da tendência dos coeficientes foi realizada calculando-se os coeficientes brutos e padronizados de mortalidade, anualmente. A análise temporal da mortalidade por câncer de útero no Estado de São Paulo, Município de São Paulo e demais municípios do Estado. O Estado de São Paulo e o Município apresentam perfis de países desenvolvidos, quanto às elevadas incidências de neoplasia uterina, entretanto, não se enquadram na mesma categoria quanto à consecução de medidas necessárias à prevenção, diagnóstico precoce e controle da doença, uma vez que as taxas de mortalidade também aumentam significativamente.

Achados histeroscópicos em mulheres na pós-menopausa com diagnóstico de espessamento endometrial por ultra-sonografia transvaginal / Hysteroscopic findings in postmenopausal women with endometrial thickening diagnosed by transvaginal ultrasound

OBJETIVO: correlacionar espessamento endometrial diagnosticado por ultra-sonografia com os achados histeroscópicos, em mulheres na pós-menopausa. MÉTODOS: foi realizado estudo transversal com avaliação histeroscópica em 121 mulheres na pós-menopausa, com diagnóstico de espessamento do endométrio por ultra-sonografia transvaginal. Das pacientes incluídas, 23 (19 por cento) recebiam diferentes esquemas de hormonioterapia e 98 não referiam uso de reposição hormnonal.; 55 pacientes queixavam-se de sangramento por via vaginal e as restantes apresentavam-se sem esta condição. Os exames endoscópicos foram realizados ambulatorialmente, utilizando-se histeroscópio rígido de 4 mm. Para a distensão da cavidade uterina empregou-se gás carbônico (CO2). Biópsia foi praticada em todas as pacientes, com auxílio de cureta tipo Novak, de 3 mm, e o material obtido submetido a estudo histopatológico. RESULTADOS: a espessura do endométrio variou entre 6 e 38 mm, com média de 10,7 ± 5,3 mm. Os achados histeroscópicos foram: lesão polipóide, em 51 pacientes (42,1 por cento); endométrio atrófico, em 15 (12,4 por cento); sinéquia senil, em 15 (12,4 por cento); espessamento focal, em 13 (10,7 por cento); lesão cerebróide, em 6 (5,0 por cento); endométrio proliferativo, em 5 (4,1 por cento); muco, em 5 (4,1 por cento); mioma, em 4 (3,3 por cento); endométrio secretor, em 3 (2,5 por cento); hiperplasia endometrial, em 3 (2,5 por cento) e atrofia cística, em 1 (0,8 por cento). Observou-se correlação entre os achados histeroscópicos e os resultados da histopatologia em 30 dos 51 casos de pólipo, em 12 dos 15 de endométrio atrófico e na totalidade dos casos sugestivos de hiperplasia endometrial e de adenocarcinoma. CONCLUSAO: na maioria das pacientes, o exame histeroscópico revelou que não se tratava de real espessamento endometrial, mas sim de outras variedades de lesão da cavidade uterina.

Carcinoma de endométrio: revisão da literatura e casuistica do serviço de ginecologia do Hospital Universitário Antonio Pedro da Universidade Federal Fluminense entre 1995 e 2002 / Endometrial carcinoma: case series and literature review of the service of gynecology at the University Hospital Antônio Pedro, Fluminense Federal University between 1995 and 2002

O Câncer do útero é a neoplasia mais comum do trato genital feminino. Geralmente é diagnosticado em estádios iniciais e localizado no fundo uterino com bom prognóstico quando correta e incipientemente diagnosticado e tratado. A fim de cotejar os dados do Serviço de Ginecologia do Hospital Universitário Antonio Pedro acerca de câncer endometrial, encorpa essa monografia um estudo retrospectivo de casos com a casuistica dos ultimos oito anos cujos resultados são apresentados com devida significância estatística...

Medical disorders associated with endometrial carcinoma.

From January, 1990 to December, 1995, 113 cases of endometrial carcinoma were registered. Of them, 24 patients (20%) had associated medical disorders. A total of 37 medical disorders were found in these 24 patients. The distribution was as follows: diabetes mellitus in 15 patients, hypertension in 13 patients, coronary artery disease in two, asthma in one, RBBB in one and hypothyroidism in five patients. Age of the patients ranged from 48-76 years (Median 62 years). Fifteen patients underwent surgery and rest nine were inoperable due to medical illnesses. Eleven patients received radiotherapy and four received chemotherapy. Of the two failures, one developed metastasis to lung and another to bone. No local recurrence was observed. Median survival was 20 months. Late radiation morbidity was noticed in four patients (36%), all of them were diabetic. CONCLUSION: Hypothyroidism which was unexpectedly found in five patients may also be a risk factor associated with endometrial carcinoma. This finding has never been reported in the literature and it needs to be curiously studied in future series. The risk of late radiation complications is higher in diabetic patients. Overall prognosis of endometrial carcinoma associated with medical illnesses is not very good.

Synchronous endometrioid carcinoma of the ovary and endometrium associated with ovulation induction

Over the last 2 decades great concern about the possible association between ovarian cancer and ovulation induction has been raised. Between the first reported case in 1982 and the end of year 2000, there have been 44 cases of ovarian carcinoma reported to occur in women previously treated with ovulation induction drugs. Most of these tumors were of the serous type with low malignant potential. In the present case, the patient had secondary anovulatory infertility and previous left cystoophorectomy for ovarian endometrioma. She was treated with human menopausal gonadotrophin alone or in combination with clomiphene citrate for 13 cycles prior to presentation. Screening ultrasound revealed multicystic right ovarian mass [15 x 9 x 6 cm]. Hysterectomy and right salpingo-oophorectomy were carried out. Intraoperative and histological examinations showed stage 1A endometrioid ovarian cancer and well-differentiated endometrial adenoacanthoma with minimal myometrial invasion. A brief but critical review of published literature regarding the association of ovulation induction and increased risk of ovarian cancer is presented