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1.
Rev. bras. ginecol. obstet ; 43(1): 35-40, Jan. 2021. tab
Article in English | LILACS | ID: biblio-1156073

ABSTRACT

Abstract Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. Results In78cases (75%), thepolyphad EC, and in 40(38.5%), itwas restricted tothe polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.


Resumo Objetivo Avaliar a presença de doença residual no exame anatomopatológico definitivo de pacientes com câncer de endométrio endometrioide após polipectomia ou biópsia de pólipo histeroscópica. Métodos Analisamos 104 pacientes (92 casos do Hospital AC Camargo e 12 casos do Hospital do Servidor Público Estadual de São Paulo) com pólipos diagnosticados durante histeroscopia e cuja biópsia histeroscópica ou exame patológico final do útero acusaram câncer de endométrio endometrioide. As pacientes foram submetidas a cirurgia para câncer de endométrio de janeiro de 2002 a janeiro de 2017. Os dados clínicos e anatomopatológicos de cada paciente foram retirados dos prontuários médicos Resultados Em 78 casos (75%), o pólipo continha a neoplasia, e em 40 (38.5%), ela estava restrita ao tecido do pólipo, sem envolvimento endometrial adjacente. O estadio final foi IA em 96 casos (92.3%) e em 90 (86.5%) tratava-se de grau 1 ou 2. Em 18 casos (17.3%), não havia doença residual no espécime uterino, mas emapenas 9 deles a histeroscopia sugeriu doença restrita ao pólipo. Em 5 casos (4.8%), não havia doença aparente extrapólipo na histeroscopia, mas havia invasão miometrial, sugerindo extravasamento do tumor pela base do pólipo. Conclusão Pacientes com câncer de endométrio associado a pólipos podem ter o tumor completamente removido durante a histeroscopia, mas, com as variáveis avaliadas, é difícil predizer com segurança qual paciente ficará sem tumor residual.


Subject(s)
Humans , Female , Polyps/surgery , Endometrial Neoplasms/surgery , Carcinoma, Endometrioid/surgery , Neoplasm, Residual/surgery , Neoplasm Recurrence, Local/surgery , Polyps/pathology , Hysteroscopy , Endometrial Neoplasms/pathology , Carcinoma, Endometrioid/pathology , Neoplasm, Residual/pathology , Middle Aged , Neoplasm Recurrence, Local/pathology
2.
Rev. bras. ginecol. obstet ; 43(1): 41-45, Jan. 2021. tab
Article in English | LILACS | ID: biblio-1156074

ABSTRACT

Abstract Objective The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. Methods Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. Results Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serummarker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. Conclusion Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.


Subject(s)
Humans , Female , Clinical Protocols/standards , Endometrial Neoplasms/mortality , Carcinoma, Endometrioid/mortality , Neoplasm Recurrence, Local/mortality , Spain , Women's Health Services , Tomography, X-Ray Computed , Retrospective Studies , Outcome Assessment, Health Care , Endometrial Neoplasms/surgery , Endometrial Neoplasms/pathology , Endometrial Neoplasms/diagnostic imaging , Carcinoma, Endometrioid/surgery , Carcinoma, Endometrioid/pathology , Carcinoma, Endometrioid/diagnostic imaging , Disease-Free Survival , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Staging
3.
Chinese Medical Journal ; (24): 2102-2109, 2021.
Article in English | WPRIM | ID: wpr-887662

ABSTRACT

BACKGROUND@#Endometrial cancer (EC) has been one of the most general cancers with respect to gynecological malignancies; however, there are debates on clinical strategies concerning treatments especially for patients with grade 3 (G3) endometroid endometrial cancer (EEC). Present study aimed to evaluate the lymphatic metastasis (LM) related factors and figure out the necessity of lymphadenectomy for G3 EEC patients.@*METHODS@#From January 2009 to April 2019, 3751 EC patients were admitted to Obstetrics and Gynecology Hospital of Fudan University. Clinical characteristics include age, grade, stage, and clinical pathological features. A total of 1235 EEC patients were involved in the multivariable analysis. Three hundred and eighty-one patients were involved in the survival analysis and the data attributed to sufficient follow-up information. Kaplan-Meier curve and log-rank test were utilized to analyze the survival rate.@*RESULTS@#Among the 1235 EEC patients, 181 (14.7%) were categorized as G3 and 1054 (85.3%) were grade 1 to grade 2 (G1-2). Multivariate analysis demonstrated that lymphovascular space invasion, adnexal involvement, and cervical stroma involvement were independent risk factors of LM in G3 cohort with odds ratio 3.4, 5.8, and 8.9; 95% confidence interval 1.1-10.6, 1.5-22.4, and 2.8-28.0, respectively. LM rates increased from 3.3% (3/92) to 75% (9/12) for G3 EEC cohort as related factor numbers increased from one to three. There were no differences between G3 and G1-2 EEC in overall survival and progression free survival. Additionally, no survival advantage was observed for G3 EEC patients at early stage with different plans of adjuvant treatment.@*CONCLUSIONS@#For G3 EEC patients without other pathological positive factor, the LM rate is lower than those with other pathological positive factor. Survival analysis showed no difference between G3 cohort and G1-2 cohort. Also, different adjuvant treatments had no impact on the overall survival for G3 EEC patients.


Subject(s)
Carcinoma, Endometrioid/pathology , Cross-Sectional Studies , Endometrial Neoplasms/pathology , Female , Humans , Lymphatic Metastasis , Neoplasm Staging , Prognosis , Retrospective Studies
4.
Rev. bras. ginecol. obstet ; 42(10): 642-648, Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144161

ABSTRACT

Abstract Objective To evaluate the agreement between the histopathological diagnoses of preoperative endometrial samples and surgical specimens and correlate the agreement between the diagnoses with the impact on surgical management and the survival of patients with endometrial adenocarcinomas. Methods Sixty-two patients treated for endometrial cancer at a university hospital from 2002 to 2011 were retrospectively evaluated. The histopathological findings of preoperative endometrial samples and of surgical specimens were analyzed. The patients were subjected to hysterectomy as well as adjuvant treatment, if necessary, and clinical follow-up, according to the institutional protocol. Lesions were classified as endometrioid tumor (type 1) grades 1, 2, or 3 or non-endometrioid carcinoma (type 2). Results The agreement between the histopathological diagnoses based on preoperative endometrial samples and surgical specimens was fair (Kappa: 0.40; p < 0.001). However, the agreement was very significant for tumor type and grade, in which a higher concordance occurred at a higher grade. The percentage of patients with lymph nodes affected was 19.2%;. Although most patients presenting with disease remission or cure were in the early stages (90.5%;), there were no significant differences between those patients who had a misdiagnosis (11/16; 68.8%;) and those who had a correct diagnosis (25/33; 75.8%;) based on preoperative endometrial sampling (p = 0.605). Conclusion Our findings corroborate the literature and confirm the under staging of preoperative endometrial samples based on histopathological assessment, especially for lower grade endometrial tumors. We suggest that the preoperative diagnosis should be complemented with other methods to better plan the surgical management strategy.


Resumo Objetivo Avaliar a concordância entre os diagnósticos histopatológicos de amostras endometriais pré-operatórias e cirúrgicas de pacientes com adenocarcinomas endometriais e avaliar o impacto da concordância entre os diagnósticos no planejamento cirúrgico e sobrevida das pacientes. Métodos Dados de 62 pacientes com câncer de endométrio operadas entre 2002 a 2011 em um hospital universitário foram avaliadas retrospectivamente. As pacientes foram submetidas à histerectomia e tratamento adjuvante, se necessário, e acompanhadas clinicamente de acordo com o protocolo institucional. Foram avaliados os resultados das análises histopatológicas das amostras endometriais pré-operatórias e cirúrgicas. As lesões foram classificadas como tumor endometrioide (tipo 1) graus 1, 2 ou 3 ou carcinoma não endometrioide (tipo 2). Resultados De modo geral, houve uma concordância baixa entre os diagnósticos histopatológicos das amostras endometriais pré-operatórias e cirúrgicas (Kappa: 0,40; p < 0,001). Entretanto, uma alta concordância entre os diagnósticos foi observada nos tumores de graus mais elevados. Comprometimento de linfonodos ocorreu em 19,2%; das pacientes e a maioria das que apresentaram remissão ou cura foram diagnosticadas nos estágios iniciais da doença (90,5%;). Não houve diferença significativa na taxa de remissão ou cura entre as pacientes que tiveram concordância (25/33; 75,8%;) ou divergência (11/16; 68,8%;) entre os resultados histopatológicos pré-operatórios e cirúrgicos (p = 0,605). Conclusão Nossos achados corroboram a literatura e confirmam o sub-estadiamento de amostras endometriais pré-operatórias com base na avaliação histopatológica, especialmente para tumores endometriais de baixo grau. Outros métodos complementares são necessários para um diagnóstico pré-operatório mais preciso a fim de melhorar o planejamento cirúrgico.


Subject(s)
Humans , Female , Adolescent , Adult , Adenocarcinoma/pathology , Endometrial Neoplasms/pathology , Pathology, Surgical , Brazil/epidemiology , Survival Analysis , Cross-Sectional Studies , Predictive Value of Tests , Retrospective Studies , Cohort Studies , Endometrial Neoplasms/mortality , Preoperative Period , Neoplasm Grading , Hysterectomy , Middle Aged , Neoplasm Staging
5.
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 263-269, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126161

ABSTRACT

ANTECEDENTES: existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully. OBJETIVO: presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo. CASO CLÍNICO: paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I. El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial. CONCLUSIÓN: el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.


BACKGROUND: there is a demonstrated association between endometriosis and some epithelial ovarian carcinoma histologies. On the other hand, it has been observed that up to 30% of ovarian neoplasms present concomitantly with endometrial neoplasms. To consider synchronicity between these neoplasms, they must meet strict pathological criteria such as those described by scully. OBJECTIVE: to introduce a case of an ovarian and endometrial synchronous endometrioid carcinoma implanted on endometriosis sites, as well as its diagnosis and management. CLINICAL CASE: a 27-year-old patient who consulted because of an intermenstrual spotting. The ultrasound image showed an endometrial polyp. Furthermore, a 42 mm left adnexal trilobal tumor with a 17×15mm solid pole was described. She underwent a hysteroscopic polypectomy and laparoscopic ovarian cystectomy. Likewise, resection of a suspicious implant in the posterior vaginal fornix was done. The pathological result of the surgical pieces was: endometrial polyp with complex hyperplasia with atypia and focal points of grade I endometrioid adenocarcinoma; the left ovarian cystectomy: endometriotic cyst with focal points of endometrioid adenocarcinoma. The peritoneal lesion corresponded to a grade I endometrioid adenocarcinoma implant. The study of the pathological characteristics and the presence of the peritoneal implant suggest the diagnosis of endometrioid ovarian carcinoma originated in a synchronous endometriotic lesion with endometrial endometrioid carcinoma. CONCLUSION: differential diagnosis between the synchronicity or spread of ovarian and endometrial endometrioid cell line carcinomas, is a great challenge and it is essential for the correct management of these neoplasms


Subject(s)
Humans , Female , Adult , Ovarian Neoplasms/diagnosis , Endometrial Neoplasms/diagnosis , Carcinoma, Endometrioid/diagnosis , Neoplasms, Multiple Primary/diagnosis , Ovarian Neoplasms/surgery , Ovarian Neoplasms/pathology , Endometrial Neoplasms/surgery , Endometrial Neoplasms/pathology , Carcinoma, Endometrioid/surgery , Carcinoma, Endometrioid/pathology , Diagnosis, Differential , Neoplasms, Multiple Primary/surgery , Neoplasms, Multiple Primary/pathology
6.
Rev. chil. obstet. ginecol. (En línea) ; 85(1): 53-59, feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1092775

ABSTRACT

INTRODUCCIÓN: el carcinoma endometrial es la sexta entidad maligna más común a nivel mundial. En la mayoría de casos se diagnóstica de forma temprana. Recurre principalmente a cúpula vaginal y a nivel linfático, sin embargo, se han descrito metástasis a vagina, peritoneo y pulmones, entre otros. PRESENTACIÓN DEL CASO: paciente femenina adulta mayor con antecedente de carcinoma endometrial hace 7 años, tratado quirúrgicamente con estudio histopatológico que evidenciaba un miometrio infiltrado en un 95% sin invasión a otros órganos y linfadenectomía libre de lesión (estadio FIGO IB), quien consulta por dolor abdominal localizado en mesogastrio y deposiciones melénicas, evidenciándose una lesión gástrica, con resultado de biopsia que reporta carcinoma pobremente diferenciado con positividad focal para vimentina compatible con metástasis gástrica secundaria a carcinoma endometrial. Se indica manejo sistémico con quimioterapia, se documenta respuesta total de la lesión. DISCUSIÓN: las lesiones tumorales a nivel de estómago son primarios en su gran mayoría, una metástasis a este nivel es inusual. En el momento del diagnóstico de una metástasis gástrica, la mitad de las pacientes presentan concomitante compromiso de otros órganos. El carcinoma endometrial no está descrito dentro de los primarios que generan este compromiso. CONCLUSIÓN: el caso expuesto es un reto clínico, que representa un vacío en la evidencia actual; se comparte la experiencia de un manejo exitoso. Son necesarios más estudios para evaluar el pronóstico, opciones de tratamiento y definir la pertinencia de métodos de tamización para la detección temprana de estos casos.


INTRODUCTION: the endometrial carcinoma is the sixth cancer worldwide. Usually it is diagnosed in early stages. The sites of recurrence includes vaginal cuff and lymph nodes, however some metastasis have been described to vagina, peritoneum and lungs, among others. CASE REPORT: Elder female with history of an endometrial carcinoma 7 years ago, surgically treated. With histopathology that reported myometrial infiltration in a 95% without invasion to other organs and lymphadenectomy free of neoplasm (FIGO IB), who consult at the emergency room due to abdominal pain and black stool, with further studies that make evident a gastric lesion with biopsy reported as a poorly differentiated carcinoma, vimentin positive, compatible with gastric metastasis secondary to an endometrial carcinoma. Chemoterapy was indicated, documenting total posterior response of the lesion. DISCUSSION: Secondary lessions in stomach are rare. If they are present at the moment of diagnosis half of the patients concomitantly have metastasis in other organs. The endometrial carcinoma hasn't been described as a common localization that result in this compromise. CONCLUSION: the case exposed is a clinical challenge, a therapeutic success is shared. Limited evidence is available. Further studies are necessary to evaluate the prognosis, therapeutic options and to define the relevance of screening tests for early detection.


Subject(s)
Humans , Female , Aged , Carcinoma/secondary , Endometrial Neoplasms/pathology , Gastrointestinal Neoplasms/secondary , Carcinoma/diagnostic imaging , Gastrointestinal Neoplasms/diagnostic imaging
7.
Rev. bras. ginecol. obstet ; 41(4): 264-267, Apr. 2019. graf
Article in English | LILACS | ID: biblio-1013603

ABSTRACT

Abstract Background Most endometrial cancers (75%) are diagnosed in early stages (stages I and II), in which abnormal uterine bleeding is the most frequent clinical sign.When the diagnosis is performed in stage IV, the most common sites of metastasis are the lungs, liver and bones. Central nervous system (CNS)metastasis is a rare condition. The aim of this study is to describe a case of uterine papillary serous adenocarcinoma of the endometrium that progressed to brain and bone metastases. Case Report We present the case of a 56-year-old woman with abnormal uterine bleeding and endometrial thickened echo (1.8 cm). A hysteroscopy with biopsy was performed, which identified poor differentiated serous adenocarcinoma of the endometrium. A total abdominal hysterectomy, with pelvic and para-aortic lymphadenectomy, was performed. Analysis of the surgical specimen revealed a grade III uterine papillary serous adenocarcinoma. Adjuvant radio/chemotherapy (carboplatin and paclitaxel-six cycles) was indicated. Sixteen months after the surgery, the patient began to complain of headaches. Brain magnetic resonance imaging demonstrated an expansile mass in the right parietal lobe, suggesting a secondary hematogenous implant subsequently confirmed by biopsy. She underwent surgery for treatment of brain metastasis, followed by radiotherapy. She died 12 months after the brain metastasis diagnosis due to disease progression. Conclusion Uterine papillary serous adenocarcinoma of the endometrium has a low propensity to metastasize to the brain. To the best of our knowledge, this is the fifth documented case of uterine papillary serous adenocarcinoma of the endometrium with metastasis to the CNS.


Resumo Fundamentos A maioria dos cânceres de endométrio (75%) é diagnosticada em estágios iniciais (estágios I e II), nos quais o sangramento uterino anormal é o sinalclínico mais frequente. Quando o diagnóstico é realizado no estágio IV, os locais mais comuns de metástase são os pulmões, o fígado e os ossos. A metástase para o sistema nervoso central (SNC) é uma condição rara. O objetivo deste estudo é descrever um caso de adenocarcinoma seroso-papilífero do endométrio que progrediu para metástases cerebral e óssea. Relato de Caso Apresentamos o caso de uma mulher de 56 anos com sangramento uterino anormal e eco endometrial espessado (1,8 cm). Foi realizada histeroscopia com biópsia que identificou adenocarcinoma seroso-papilífero pouco diferenciado do endométrio. Uma histerectomia abdominal total, com linfadenectomia pélvica e para-aórtica, foi realizada. A análise da peça cirúrgica revelou adenocarcinoma seroso-papilífero do endométrio grau III. Radioterapia adjuvante/quimioterapia (carboplatina e paclitaxel- seis ciclos) foi indicada.Dezesseismeses após a cirurgia, a paciente começou a se queixar de dores de cabeça. A ressonância magnética cerebral demonstrou uma massa expansiva no lobo parietal direito, sugerindo um implante hematogênico secundário posteriormente confirmado por biópsia. A paciente foi submetida a cirurgia para tratamento de metástase cerebral, seguida de radioterapia. A paciente morreu 12 meses após o diagnóstico de metástase cerebral devido à progressão da doença. Conclusão O adenocarcinoma seroso-papilífero do endométrio tem uma baixa propensão a metastizar para o cérebro. Até onde sabemos, este é o quinto caso documentado de adenocacinoma seroso-papilífero do endométrio com metástase para o SNC.


Subject(s)
Humans , Female , Brain Neoplasms/diagnosis , Endometrial Neoplasms/pathology , Cystadenocarcinoma, Serous/diagnosis , Uterine Hemorrhage/etiology , Brain Neoplasms/secondary , Brain Neoplasms/therapy , Endometrial Neoplasms/complications , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/therapy , Fatal Outcome , Cystadenocarcinoma, Serous/complications , Cystadenocarcinoma, Serous/secondary , Cystadenocarcinoma, Serous/therapy , Combined Modality Therapy , Diagnosis, Differential , Hysterectomy , Middle Aged
8.
Rev. chil. obstet. ginecol. (En línea) ; 83(4): 394-401, 2018. ilus
Article in Spanish | LILACS | ID: biblio-978111

ABSTRACT

RESUMEN El cáncer sincrónico endometrial y ovárico (SEOC) representa alrededor de un 5-10% de las neoplasias de endometrio y ovario. Cuando no existe extensión locorregional y presentan un patrón histológico de bajo grado, actúan como si fueran dos tumores primarios independientes, en lugar de comportarse como un cáncer en estadio avanzado. Los mecanismos para diferenciar si su origen es metastásico o por el contrario, son tumores primarios independientes conlleva una gran dificultad y ha generado una importante controversia dentro del estudio de este tipo de neoplasias. En este artículo, exponemos el caso clínico de una paciente de 46 años que presenta un tumor sincrónico de endometrio y ovario en estadio IA, desconocido hasta el estudio histológico de la pieza quirúrgica.


ABSTRACT Endometrial and ovarian synchronous cancer (SEOC) accounts for about 5-10% of endometrial and ovarian neoplasms. When there is no local extension and they present a low-grade histological pattern, they act as if they were two independent primary tumours, instead of behaving as an advanced stage cancer. Therefore, the differentiation of its origin (metastatic or independent primary tumours) is fraught with difficulty and has generated a significant controversy in the study of this type of neoplasms. In this article, we present the clinical case of a 46-year-old patient presenting a synchronous tumor of the endometrium and ovary in IA stage, unknown until the histological study of the surgical sample.


Subject(s)
Humans , Female , Middle Aged , Ovarian Neoplasms/diagnosis , Adenocarcinoma, Papillary/diagnosis , Endometrial Neoplasms/diagnosis , Carcinoma, Endometrioid/diagnostic imaging , Adenocarcinoma, Papillary/pathology , Endometrial Neoplasms/pathology , Cystadenocarcinoma, Serous/diagnosis , Adenocarcinoma, Clear Cell , Neoplasms, Multiple Primary
9.
Braz. j. med. biol. res ; 51(4): e6803, 2018. graf
Article in English | LILACS | ID: biblio-889059

ABSTRACT

Propofol is an intravenous sedative hypnotic agent of which the growth-inhibitory effect has been reported on various cancers. However, the roles of propofol in endometrial cancer (EC) remain unclear. This study aimed to explore the effects of propofol on EC in vitro and in vivo. Different concentrations of propofol were used to treat Ishikawa cells. Colony number, cell viability, cell cycle, apoptosis, migration, and invasion were analyzed by colony formation, MTT, flow cytometry, and Transwell assays. In addition, the pcDNA3.1-Sox4 and Sox4 siRNA plasmids were transfected into Ishikawa cells to explore the relationship between propofol and Sox4 in EC cell proliferation. Tumor weight in vivo was measured by xenograft tumor model assay. Protein levels of cell cycle-related factors, apoptosis-related factors, matrix metalloproteinases 9 (MMP9), matrix metalloproteinases 2 (MMP2) and Wnt/β-catenin pathway were examined by western blot. Results showed that propofol significantly decreased colony numbers, inhibited cell viability, migration, and invasion but promoted apoptosis in a dose-dependent manner in Ishikawa cells. Moreover, propofol reduced the expression of Sox4 in a dose-dependent manner. Additionally, propofol significantly suppressed the proportions of Ki67+ cells, but Sox4 overexpression reversed the results. Furthermore, in vivo assay results showed that propofol inhibited tumor growth; however, the inhibitory effect was abolished by Sox4 overexpression. Moreover, propofol inhibited Sox4 expression via inactivation of Wnt/β-catenin signal pathway. Our study demonstrated that propofol inhibited cell proliferation, migration, and invasion but promoted apoptosis by regulation of Sox4 in EC cells. These findings might indicate a novel treatment strategy for EC.


Subject(s)
Animals , Female , Apoptosis/drug effects , Endometrial Neoplasms/drug therapy , Hypnotics and Sedatives/pharmacology , Propofol/pharmacology , SOXC Transcription Factors/metabolism , beta Catenin/metabolism , Cell Line, Tumor , Cell Movement/drug effects , Cell Survival/drug effects , Endometrial Neoplasms/pathology , Mice, Inbred BALB C , Neoplasm Invasiveness , Propofol/administration & dosage , Tumor Stem Cell Assay , Wnt Proteins/metabolism , Xenograft Model Antitumor Assays
10.
Rev. chil. obstet. ginecol. (En línea) ; 82(2): 241-246, abr. 2017. ilus
Article in Spanish | LILACS | ID: biblio-899899

ABSTRACT

Los tumores sincrónicos del tracto genital femenino son un entidad infrecuente que plantea un reto en el diagnóstico diferencial con la enfermedad metastásica. La mayoría de ellos son cánceres de endometrio y ovario, siendo los tumores sincrónicos de endometrio (CE) y trompa (CT) una asociación excepcional. Presentamos el caso de una paciente de 54 años con un diagnóstico preoperatorio de CE en la en la pieza quirúrgica se desveló la existencia de un tumor sincrónico de trompa izquierda. A propósito de este caso se realiza una revisión del tema haciendo hincapié en cómo llegar a un correcto diagnóstico de los tumores independientes descartando la extensión tumoral y la enfermedad metastásica.


Synchronous primary cancers of gynecological tract are uncommon and a challenge in the differential diagnosis with metastatic disease. Most of them are endometrial and ovarian cancers. Synchronous primary endometrial (EC) and tube fallopian cancers (TC) are a very rare association. We report the case of a patient of 54 years with EC preoperative diagnosis with synchronous left TC postoperative diagnosis. We review the topic emphasizing how to reach a correct diagnosis of tumors independent refusing the tumor invasion and metastatic disease.


Subject(s)
Humans , Female , Middle Aged , Endometrial Neoplasms/pathology , Fallopian Tube Neoplasms/pathology , Neoplasms, Multiple Primary/surgery , Endometrial Neoplasms/surgery , Diagnosis, Differential , Fallopian Tube Neoplasms/surgery , Neoplasms, Multiple Primary/pathology
11.
Clinics ; 72(1): 30-35, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-840034

ABSTRACT

OBJECTIVES: To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy. METHODS: A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis. RESULTS: Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%. CONCLUSION: Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.


Subject(s)
Humans , Female , Adult , Aged , CA-125 Antigen/blood , Endometrial Neoplasms/pathology , Lymphatic Metastasis/diagnosis , Endometrial Neoplasms/surgery , Lymph Node Excision , Lymphatic Metastasis/prevention & control , Neoplasm Invasiveness , Predictive Value of Tests , Retrospective Studies , Risk Factors
12.
Rev. Assoc. Med. Bras. (1992) ; 62(2): 116-119, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-780967

ABSTRACT

Summary Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.


Resumo Os cânceres de endométrio e cervical são as neoplasias ginecológicas mais prevalentes. Enquanto o primeiro ocorre em mulheres mais velhas, o segundo é mais prevalente em mulheres jovens. A manifestação clínica mais comum nestas duas neoplasias ginecológicas é o sangramento vaginal. O diagnóstico do câncer de endométrio é feito a partir da avaliação histológica do endométrio e da avaliação por imagem, enquanto o câncer cervical é diagnosticado clinicamente, de acordo com a Federação Internacional de Ginecologia e Obstetrícia (FIGO). Apresentamos um caso de câncer ginecológico sincrônico de endométrio e cervical diagnosticado durante estadiamento por ressonância magnética e confirmado pela análise histológica da peça cirúrgica.


Subject(s)
Humans , Female , Aged, 80 and over , Carcinoma, Squamous Cell/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Uterine Cervical Neoplasms/diagnostic imaging , Endometrial Neoplasms/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Magnetic Resonance Imaging , Carcinoma, Squamous Cell/pathology , Adenocarcinoma/pathology , Uterine Cervical Neoplasms/pathology , Endometrial Neoplasms/pathology , Neoplasm Staging , Neoplasms, Multiple Primary/pathology
13.
Rev. chil. obstet. ginecol ; 81(2): 152-158, abr. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-780551

ABSTRACT

ANTECEDENTES: Los pólipos endometriales son protrusiones nodulares benignas de la superficie endometrial con características clínico-patológicas propias y de origen desconocido. Su prevalencia es alta, especialmente en pacientes con sangrado uterino anormal, se asocia a infertilidad y a cáncer de endometrio, lo que se traduce en que se trata de una patología muy importante en el quehacer ginecológico habitual. OBJETIVOS: Revisar la patogenia, actualizar y evaluar los métodos diagnósticos, y definir las mejores opciones terapéuticas de esta frecuente patología. MÉTODO: Revisión sistemática de la literatura publicada en el tema, mediante búsqueda en base de datos Pub Med. RESULTADOS: La patogenia es aun desconocida, es una patología muy heterogénea y no hay causa única, se han reportado varios hallazgos relacionados con alteraciones genéticas. La ultrasonografía de alta definición, la hidrosonografia y la histeroscopia son el estándar actual en el diagnóstico. Las opciones terapéuticas se extienden desde la observación y seguimiento con imágenes, hasta la histerectomía con biopsia contemporánea, siendo la histeroscopia quirúrgica el método más costo efectivo. CONCLUSIÓN: La patogenia de los pólipos endometriales se encuentra actualmente en revisión, no hay ninguna teoría que explique la génesis de todos los pólipos. La ultrasonografía con contraste y la histeroscopia constituyen el estándar en el diagnóstico. En el tratamiento, la indicación es la cirugía histeroscopica y en especial la resección electroquirúrgica, que permite una extracción completa del pólipo bajo visión directa, con enfoque diagnóstico y terapéutico, con riesgos bajos y recurrencia mínima.


BACKGROUND: Endometrial polyps are benign nodular protrusions of the endometrial surface with clinical and pathological features of unknown origin. Its prevalence is high, especially in patients with abnormal uterine bleeding, it is associated with infertility and endometrial cancer, what constitutes a common and important disease. AIMS: To review the pathogenesis, to update and evaluate diagnostic methods, and to define the best treatment options for this common condition. METHODS: A systematic review of the published literature on the subject by searching PubMed database. RESULTS: The pathogenesis is still unknown, it is a very heterogeneous disease and there is no single cause, there have been several findings related to genetic alterations. High definition ultrasonography, the hidrosonography and hysteroscopy are the current standard in diagnosis. Therapeutic options range from observation and follow up with images to the hysterectomy using contemporary biopsy, surgical hysteroscopy being the most cost effective method. CONCLUSION: The pathogenesis of endometrial polyps are currently under review, there is no theory to explain the genesis of all polyps. Contrast ultrasonography and hysteroscopy are standard in the diagnosis. In the treatment, the indication is histeroscopy surgery and especially electrosurgical resection, which allows complete removal of polyps, diagnostic and therapeutic approach, with low risk and low recurrence.


Subject(s)
Humans , Female , Polyps/diagnosis , Polyps/therapy , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/therapy , Polyps/pathology , Hysteroscopy , Endometrial Neoplasms/pathology , Hysterectomy
14.
Clinics ; 71(1): 10-16, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-771947

ABSTRACT

OBJECTIVE: The aim of this study was to determine the efficacy of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for the treatment of endometrial cancer. METHODS: Thirty-one patients with stage I-III endometrial cancer were recruited for this study. The stage I patients received only 252Californium neutron intracavitary brachytherapy with a two-channel applicator. The stage II and III patients received both 252Californium neutron intracavitary brachytherapy using a two-channel applicator and parallel-opposed whole pelvic radiotherapy. RESULTS: The five-year local control rate was 80.6% (25/31), the overall survival rate was 51.6% (16/31), and the disease-free survival rate was 54.8% (17/31). The incidence of serious late complications was 12.9% (4/31). CONCLUSIONS: 252Californium neutron intracavitary brachytherapy using a two-channel applicator combined with external beam radiotherapy was effective for treating endometrial cancer and the incidence of serious late complications related to this combination was within an acceptable range.


Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Adenocarcinoma/radiotherapy , Brachytherapy/methods , Californium/therapeutic use , Endometrial Neoplasms/radiotherapy , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brachytherapy/instrumentation , Combined Modality Therapy , Carmustine/therapeutic use , Cytarabine/therapeutic use , Endometrial Neoplasms/mortality , Endometrial Neoplasms/pathology , Follow-Up Studies , Melphalan/therapeutic use , Podophyllotoxin/therapeutic use , Survival Rate , Treatment Outcome
16.
Article in English | WPRIM | ID: wpr-21463

ABSTRACT

OBJECTIVE: The aim of this study was to clarify the clinical significance of isolated tumor cells (ITCs) or micrometastasis (MM) in regional lymph nodes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II endometrial cancer. METHODS: In this study, a series of 63 patients with FIGO stage I to II were included, who had at least one of the following risk factors for recurrence: G3 endometrioid/serous/clear cell adenocarcinomas, deep myometrial invasion, cervical involvement, lympho-vascular space invasion, and positive peritoneal cytology. These cases were classified as intermediate-risk endometrial cancer. Ultrastaging by multiple slicing, staining with hematoxylin and eosin and cytokeratin, and microscopic examination was performed on regional lymph nodes that had been diagnosed as negative for metastases. RESULTS: Among 61 patients in whom paraffin-embedded block was available, ITC/MM was identified in nine patients (14.8%). Deep myometrial invasion was significantly associated with ITC/MM (p=0.028). ITC/MM was an independent risk factor for extrapelvic recurrence (hazard ratio, 17.9; 95% confidence interval [CI], 1.4 to 232.2). The 8-year overall survival (OS) and recurrence-free survival (RFS) rates were more than 20% lower in the ITC/MM group than in the node-negative group (OS, 71.4% vs. 91.9%; RFS, 55.6% vs. 84.0%), which were statistically not significant (OS, p=0.074; RFS, p=0.066). Time to recurrence tended to be longer in the ITC/MM group than in the node-negative group (median, 49 months vs. 16.5 months; p=0.080). CONCLUSIONS: It remains unclear whether ITC/MM have an adverse influence on prognosis of intermediate-risk endometrial cancer. A multicenter cooperative study is needed to clarify the clinical significance of ITC/MM.


Subject(s)
Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Endometrial Neoplasms/pathology , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Myometrium/pathology , Neoplasm Invasiveness , Neoplasm Micrometastasis/pathology , Neoplasm Recurrence, Local , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Factors
18.
Article in English | WPRIM | ID: wpr-100614

ABSTRACT

OBJECTIVE: Uterine carcinosarcoma (UCS) shared the same staging system with endometrial carcinoma in the International Federation of Gynecology and Obstetrics 2009. The aim of the present study was to compare the clinicopathological and prognostic characteristics between UCS and grade 3 endometrioid endometrial carcinoma (G3EC). METHODS: A retrospective analysis of 60 UCS and 115 G3EC patients with initial treatment at the Department of Gynecology in the Fudan University Shanghai Cancer Center between February 2006 and August 2013. Chi-square analysis was used to compare differences between variables. Prognostic factors were determined using univariate/multivariate analysis, and the survival rates were assessed using the Kaplan-Meier method. The Cox regression model was used to assess the independent prognostic factor. RESULTS: UCS had significantly worse overall survival (OS) compared with G3EC. Carcinosarcoma subtype was an independent factor (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0 to 5.8; p=0.039), stratified based on stage. Compared with G3EC, UCS patients had a greater incidence of ascites fluid (55.0% vs. 15.7%, p<0.001) and adnexal involvement (20.0% vs. 8.7%, p=0.048) and larger median tumor volume (4.6 cm vs. 4.0 cm, p=0.046). Subgroup analysis of the prognostic factors revealed that UCS patients exhibited worse OS than G3EC patients in such specific subgroups as patients at younger ages, with postmenopausal status, without ascites fluid, with early stage diseases, without vagina invasion, without lymph node metastases and receiving adjuvant chemo/radiotherapy. Adjuvant radiotherapy with chemotherapy was predictive of better survival in UCS patients compared with chemotherapy or radiotherapy alone (5-year OS, 71.0% vs. 35.8%, p=0.028). Multivariate Cox regression revealed that tumor mesenchymal component (HR, 4.6; 95% CI, 1.4 to 15.8; p=0.014) was an independent prognostic factor for UCS, whereas advanced stages (HR, 5.9; 95% CI, 1.0 to 33.9; p=0.046) and ascites fluid (HR, 5.1; 95% CI, 1.1 to 22.7; p=0.032) were independently correlated with poor prognosis for G3EC patients. CONCLUSION: The distinctions in both clinicopathological and prognostic characteristics between UCS and G3EC suggest that this subtype should be treated separately from high-risk epithelial endometrial carcinoma.


Subject(s)
Adnexa Uteri/pathology , Adult , Age Factors , Aged , Aged, 80 and over , Aorta , Ascites/etiology , Carcinoma, Endometrioid/secondary , Carcinosarcoma/secondary , Chemotherapy, Adjuvant , Cytoreduction Surgical Procedures , Endometrial Neoplasms/pathology , Female , Humans , Hysterectomy , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm Staging , Pelvis , Postmenopause , Radiotherapy, Adjuvant , Retrospective Studies , Survival Rate , Tumor Burden , Vagina/pathology
19.
Rev. chil. obstet. ginecol ; 80(5): 367-372, ago. 2015. tab
Article in Spanish | LILACS | ID: lil-764066

ABSTRACT

OBJETIVO: Analizar la concordancia histológica pre y postoperatoria del cáncer de endometrio (CE) diagnosticado por cánula de biopsia tipo Cornier. MÉTODOS: Se incluyen 82 pacientes sometidas a biopsia ambulatoria a ciegas por aspirado con diagnóstico anatomo-patológico final de CE en la pieza de histerectomía. Se estudia la concordancia atendiendo al tipo y al grado histológico haciendo dos grupos para cada análisis: CE endometrioide/no endometrioide y Ce de bajo/alto grado. RESULTADOS: La sensibilidad de la biopsia para detectar malignidad fue del 100%. El grado de concordancia atendiendo al tipo histológico fue de 94% (96,7% para los tipo endometrioide y del 85% para los tipos no endometrioides). En cuanto al grado histológico la precisión en el diagnóstico fue del 90,2% (94,3% en los tumores de bajo grado y 82,7% en los de alto grado) con una tasa de subestimación del grado tumoral del 6%. CONCLUSIONES: La biopsia por aspiración con cánula tipo Cornier detecta adecuadamente el CE y la concordancia entre la biopsia preoperatoria y la pieza quirúrgica es alta, por lo que puede considerarse una técnica fiable en el diagnóstico del cáncer de endometrio y precisa en la valoración del grado y tipo histológicos. El grupo más discordante es el CE G3 de tipo endometrioide.


OBJECTIVE: Analyze pre and post operative histological concordance of endometrial cancer (EC) diagnosed by Cornier biopsy cannula. METHODS: 82 patients under going out patient biopsy aspirate blindly with EC in the hysterectomy specimen. We study the type and histological grade accuracy by two groups for each analysis: EC endometrioid/non-endometrioid and low/high grade. RESULTS: The sensitivity for detecting malignancy was 100%. The histological type agreement was 94% (96.7% for the endometrioid type and 85% for non-endometrioid type). The histological grade accuracy was 90.2% (94.3% in low-grade tumors and 82.7% in high grade) with a rate of under estimation of tumor grade of 6%. CONCLUSIONS: Cornier aspiration biopsy is safe in the diagnosis of EC. Grade and histological type accuracy between preoperative biopsy and surgical specimen is high. The most discordant is EC G3 endometrioid type.


Subject(s)
Humans , Female , Biopsy, Needle/statistics & numerical data , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/pathology , Carcinoma, Endometrioid/diagnosis , Carcinoma, Endometrioid/pathology , Biopsy, Needle/instrumentation , Predictive Value of Tests , Retrospective Studies , Longitudinal Studies , Sensitivity and Specificity , Cannula
20.
Clinics ; 70(7): 470-474, 2015. tab
Article in English | LILACS | ID: lil-752400

ABSTRACT

OBJECTIVE : The aim of this study was to determine the lymph node status in a large cohort of women with endometrial cancer from the public health system who were referred to an oncology reference center in Brazil to identify candidates for the omission of lymphadenectomy based on clinicopathological parameters. METHODS : We retrospectively analyzed a cohort of 310 women with endometrial cancer (255 endometrioid, 40 serous, and 15 clear cell tumors) treated between 2009 and 2014. We evaluated the histological type, grade (low vs. high), tumor size (cm), depth of myometrial invasion (≤50%, >50%) and lymphovascular space invasion to determine which factors were correlated with the presence of lymph node metastasis. RESULTS : The factors related to lymph node involvement were tumor size (p=0.03), myometrial invasion (p<0.01), tumor grade (p<0.01), and lymphovascular space invasion (p<0.01). The histological type was not associated with the nodal status (p=0.52). Only twelve of 176 patients (6.8%) had low-grade endometrioid carcinoma, tumor size ≤2 cm and <50% myometrial infiltration. CONCLUSIONS : The omission of lymphadenectomy based on the histological type, grade, tumor size and depth of myometrial invasion is not likely to have a large impact on the surgical treatment of endometrial cancer in our population because most patients present with large and advanced tumors. New strategies are proposed that prioritize hysterectomy performed in a general hospital as soon as possible after diagnosis, followed by an evaluation of the need for lymph node dissection at a reference center. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Endometrial Neoplasms/surgery , Lymph Node Excision/methods , Brazil , Endometrial Neoplasms/pathology , Hysterectomy , Lymph Nodes/pathology , Retrospective Studies
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