Diagnostic accuracy of diffusion weighted magnetic resonance imaging in the detection of myometrial invasion in endometrial carcinoma

Objective: To determine the diagnostic accuracy of Diffusion-Weighted Magnetic Resonance Imaging [DWMRI] in the detection of myometrial invasion in endometrial cancer taking histopathology as gold standard

Study Design: Cross-sectional validation study

Place and Duration of Study: Department of Radiology, The Aga Khan University Hospital, Karachi, from January to December 2012

Methodology: DWMRI [b-value = 50,400 and 800 s/mm[2]] was performed in 85 patients of biopsy-proven endometrial carcinoma before hysterectomy using body and spine coil at 1.5 Tesla. DWI was evaluated for presence of myometrial invasion by tumor with histopathology as gold standard. Sensitivity, specificity, the negative predictive value and positive predictive value and accuracy of DWI were assessed against the gold standard

Results: On DWI, superficial myometrial invasion was found in 42 patients and deep myometrial invasion in 43. On histopathology, superficial myometrial invasion was found in 53 patients and deep myometrial invasion in 32. Hence sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the assessment of myometrial invasion by endometrial tumor on DW images was 90%, 73%, 67%, 92% and 80%, respectively. Diagnostic accuracy of diffusion-weighted magnetic resonance imaging in detection of myometrial invasion in endometrial cancer was 80%

Conclusion: DWI is highly accurate in assessing myometrial invasion and can be used as an adjunct to routine MRI for pre-operative evaluation of myometrial invasion of endometrial cancer

Isolated tumor cells and micrometastases in regional lymph nodes in stage I to II endometrial cancer / 부인종양

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.

Transvaginal/transrectal ultrasound for assessing myometrial invasion in endometrial cancer: a comparison of six different approaches / 부인종양

OBJECTIVE: To compare the diagnostic performance of six different approaches for assessing myometrial infiltration using ultrasound in women with carcinoma of the corpus uteri. METHODS: Myometrial infiltration was assessed by two-dimensional (2D) transvaginal or transrectal ultrasound in 169 consecutive women with well (G1) or moderately (G2) differentiated endometrioid type endometrial carcinoma. In 74 of these women three-dimensional (3D) ultrasound was also performed. Six different techniques for myometrial infiltration assessment were evaluated. The impression of examiner and Karlsson's criteria were assessed prospectively. Endometrial thickness, tumor/uterine 3D volume ratio, tumor distance to myometrial serosa (TDS), and van Holsbeke's subjective model were assessed retrospectively. All subjects underwent surgical staging within 1 week after ultrasound evaluation. Definitive histopathological data regarding myometrial infiltration was used as gold standard. Sensitivity and specificity for all approaches were calculated and compared using McNemar test. RESULTS: The impression of examiner and subjective model performed similarly (sensitivity 79.5% and 80.5%, respectively; specificity 89.6% and 90.3%, respectively). Both methods had significantly better sensitivity than Karlsson's criteria (sensitivity 31.8%, p<0.05) and endometrial thickness (sensitivity 47.7%, p<0.05), and better specificity than tumor/uterine volume ratio (specificity 28.3%, p<0.05) and TDS (specificity 41.5%, p<0.05). CONCLUSION: Subjective impression seems to be the best approach for assessing myometrial infiltration in G1 or G2 endometrioid type endometrial cancer by transvaginal or transrectal ultrasound. The use of mathematical models and other objective 2D and 3D measurement techniques do not improve diagnostic performance.

morphological study of atypical uterine bleeding

To find out the Histopathological pattern of Endomyometrium in atypical uterine bleeding [AUB], also to study organic causes of AUB. A prospective, descriptive study. This study was conducted at the Departments of Pathology and Gynaecology and Obstetrics, Bolan Medical College Complex Hospital Quetta from January 2011 to January 2013. Specimens were received as endometrial curettage and hysterectomy specimens from patients hospitalized in the dept. of Gynaecology and Obstetrics of BMC Complex Hospital Quetta. This study included 300 women's presenting with AUB, irrespective of age and parity. A detailed clinical history followed by physical examination was also carried out in each patients to exclude systemic causes like psychological upsets and early pregnancy states and also exclude general physical abnormalities. After grossing and H and E staining all the sections were studied by group of pathologists. A Total 300 cases were studied, including 100 endometrial curetting's and 200 uteri in patients of atypical uterine bleeding at Bolan Medical Complex Hospital Quetta. The ages of these patients ranged from 20-69 years. Maximum numbers of cases were in age groups 40-49 years. Chronic endometritis [7 out of 100] 7% and the cystic hyperplasia [9 out of 100] 9% were the most important causes of atypical uterine bleeding in endometrial curetting's. No case of endometrial carcinoma was diagnosed in this series. The histological study of hysterectomy specimen revealed multiple leiomyoma's [135 out of 200] 67.5% and adenomyosis [38 out of 200] 19% as the commonest causes of atypical uterine bleeding. [2 out of 200] 1% case of leiomyosarcoma and [1 out of 200] 0.5% case of choriocarcinoma were diagnosed suggesting a lower frequency of uterine malignancy in our study. In conclusion leiomyoma's and adenomyosis are most important causes of AUB after 3[rd] decade of life. Fortunately the frequency of uterine malignancy [excluding cervix] including endometrial carcinoma is much low in our setup as compared to western studies

Leiomiomatosis intravenosa de localización cervicovaginal / Intravenous cervicovaginal Leiomyomatosis

La leiomiomatosis intravenosa (LIV) es una patología poco frecuente caracterizada por la presencia de músculo liso en las venas miometriales del cuerpo uterino. Se presenta un caso de LIV limitado a cuello uterino y manguito vaginal. Se realizó histerectomía total con diagnóstico prequirúrgico de miomatosis uterina y menometrorragia. El diagnóstico de LIV fue anatomopatológico mediante técnicas de inmunohistoquímica. Si bien el 70 por ciento de las pacientes con LIV pueden ser curadas con cirugía, en un 30 por ciento de los casos existe persistencia o recurrencia a distancia de la enfermedad. En nuestro caso los controles a treinta meses de la cirugía fueron negativos e incluyeron estudios cardiovasculares, pulmonares, hepáticos y cerebrales.

Intravenous leiomyomatosis (IVL) cervicovaginal is an uncommon pathology, characterized by the presence of sooth muscle in the myometrial veins of the uterine body. A case of IVL is reported, limited to the cervix uteri and the vaginal muff. A total hysterctomy was performed, with presurgical diagnosis of uterine myomatosis and menometrorrhagia. The diagnosis of IVL was performed by clinicopathological analysis and by immunohistochemistry techniques. Although the 70 percent of the patients with IVL can be cured by surgery, in a 30 percentof the cases, there exists persistence and recurrency at distancy from the disease. In our case, the controls after 30 months since surgery were negatives, and included cardiovascular, pulmonary, hepatic and cerebral studies.

Leiomiomatose atípica: relato de caso

Relata-se o caso de uma paciente de 36 anos, G1P1, com história de dois meses de dor abdominal tipo cólica, metrorragia, peso em membros inferiores e dificuldade para urinar que procurou o serviço de ginecologia do hospital do Campo Limpo. Feito diagnóstico de leiomioma uterino com nódulo de 181 cm3 om possível degeneração, através de ultra-sonografia transvaginal. Com o restante dos exames pré-operatórios normais, foi submetida a Histerectomia Total Abdominal sem complicações no intra e pós-operatório. O laudo anátomo patológico foi de leiomiomatose uterina atípica difusa, patologia que tem como características a presença de células com núcleo pleomórfico, grande, multilobulado ou com vários núcleos, além de cromatina grumosa, e possui comportamento biológico incerto. Em aproximadamente um ano de segmento a paciente não apresentou recidiva ou comprometimento de estruturas vizinhas. Entidade com poucos relatos nas literaturas médicas mundiais e várias controvérsias quanto ao diagnóstico histológico e padrão de malignização.

Leiomiomatose atípica: relato de caso / Atypical leiomyomatosis: case report

Relata-se o caso de uma paciente de 36 anos, G1P1, com história de dois meses de dor abdominal tipo cólica, metrorragia, peso em membros inferiores e dificuldade para urinar que procurou o serviço de ginecologia do hospital do Campo Limpo. Feito diagnóstico de leiomioma uterino com nódulo de 181 cm3 om possível degeneração, através de ultra-sonografia transvaginal. Com o restante dos exames pré-operatórios normais, foi submetida a Histerectomia Total Abdominal sem complicações no intra e pós-operatório. O laudo anátomo patológico foi de leiomiomatose uterina atípica difusa, patologia que tem como características a presença de células com núcleo pleomórfico, grande, multilobulado ou com vários núcleos, além de cromatina grumosa, e possui comportamento biológico incerto. Em aproximadamente um ano de segmento a paciente não apresentou recidiva ou comprometimento de estruturas vizinhas. Entidade com poucos relatos nas literaturas médicas mundiais e várias controvérsias quanto ao diagnóstico histológico e padrão de malignização.

Endometrial adenocarcinoma in young Thai women.

OBJECTIVE: To evaluate the clinicopathological characteristics and survival analysis in endometrial adenocarcinoma women younger than the age of 40 years compare to older women. METHODS: Medical records of 423 endometrial adenocarcinoma patients who received primary surgical treatment at King Chulalongkorn Memorial Hospital during 1996-2005 were reviewed. The patients were divided into two groups; 40 years of age or younger (group A, 42 patients) and older than 40 years (group B, 381 patients). RESULTS: Up to 10% (42/423) of endometrial adenocarcinoma patients were younger than the age of 40 years. The higher incidence of nulliparous and obesity (BMI > 30 kg/m2) was significantly demonstrated in group A (81%/34.1% and 52.4%/25.2%, respectively). However, obesity was an only independent factor in multivariate analysis. No significant difference in surgical stage distribution and the other pathologic characteristics was demonstrated between both groups. However, poor histologic grade (grade 3) and deep myometrial invasion (myometrial invasion more than 50%) tended to be found more frequent in the patients older than the age of 40 years, although there was no statistical significance (16% versus 4.7% and 31% versus 14.3%, respectively). Moreover, synchronous ovarian cancer seemed to be higher in young patients (7.1% and 2.9%, p > .05). Median time to follow was 63 months (range 0-145 months). Five years disease free survival and 5 years overall survival were 87.3% and 92.4% in group A versus 83.8% and 88.0% in group B without statistical significance between both groups. CONCLUSIONS: Obesity was the only independent factor associated with endometrial adenocarcinoma in young patients. Distribution of the surgical stage and the other pathologic characteristics were similar between both groups without survival benefit in young patients.

CD10 in diffuse uterine leiomyomatosis: a case report along with a few comments on histogenesis.

Diffuse uterine leiomyomatosis (DUL) is a rare entity with an unknown etiopathogenesis. A 24 years old female presented with abdominal discomfort and menorrhagia. Clinical and ultrasonographic examination revealed an enlarged uterus. The hysterectomy specimen showed a symmetrically enlarged uterus with a bosselated external surface. The cut surface showed multiple nodules of varying sizes diffusely involving the myometrium. Microscopically, the nodules were leiomyomas of varying degrees of cellularity. Some of the leiomyomas showed an increased vascularity either in the form of congeries of blood vessels with a lobular arrangement or occasionally as foci of 2-3 vessels. The vessels were surrounded by whorls of spindle cells. On immunohistochemistry the leiomyomas expressed vimentin, smooth muscle actin (SMA), desmin and CD10: the cells whorling around the blood vessels expressed vimentin, SMA and focally desmin and were negative for CD10 and HMB-45. The aim of this paper is to document that CD10 is expressed in diffuse uterine leiomyomatosis and discuss the histogenesis of DUL.

Forensic pathological significance of immunohistochemical study with CX43 in rats on early myocardial ischaemia / 法医学杂志

OBJECTIVE@#To explore one of evidence for pathologic diagnosis of early myocardial ischaemia.@*METHODS@#Rats were ligated of the left coronary artery according to a previously documented technique, and heart tissue was sampled at different ischaemia time. The expression of CX43 in myocardial cell was detected by Immunohistochemistry.@*RESULTS@#It is showed that the distribution and amount of CX43 positive staining in each group of the myocardial ischaemia was different from that of the control group.@*CONCLUSION@#The changes of CX43 detected by Immunohistochemical methods may be helpful for the diagnosis of early myocardial ischaemia, but further pathologic investigation and research is necessary.

Accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To evaluate the accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma in comparison with standard paraffin section. METHOD: A total of 111 patients with endometrial carcinoma diagnosed from fractional curettage underwent pre-operative transvaginal ultrasonography to assess myometrial invasion. Operation for surgical staging was subsequently performed and the hysterectomy specimen was evaluated for depth of myometrial invasion by standard paraffin section blinded from transvaginal ultrasound results. Final histopathologic diagnosis and depth of myometrial invasion were obtained from standard paraffin section. Ultrasonographic assessment was compared with the histopathological results. RESULTS: In evaluation of myometrial invasion, transvaginal ultrasound yielded the sensitivity of 69.4 per cent, specificity of 70.6 per cent, positive predictive value of 53.2 per cent, negative predictive value of 82.8 per cent, and accuracy of 70.3 per cent. The accuracy, sensitivity, specificity, negative predictive value, false positive and negative rates were comparable between grade 3 and grade 1 and 2 tumors. However, the positive predictive value was significantly higher among grade 3 than grade 1 and 2 tumors. The Kappa coefficients were 0.57 and 0.22 for grade 3 and grade 1 and 2 tumors respectively. CONCLUSION: Transvaginal ultrasound for assessment of depth of myometrial invasion in endometrial carcinoma provided acceptable accuracy compared with standard paraffin section. This technique might be of value for the decision making in the intra-operative management of endometrial carcinoma.

Unexpected pathology at vaginal hysterectomy for genital prolapse

Uterovaginal prolapse was a common disabling condition in multiparous women of advancing age in post-menopausal women. Among the various types of prolapse, second degree of uterovaginal prolapse was the most common finding and these all had normal coloured healthy looking cervix having normal cervical cytology and endometrial biopsy. Every vaginal hysterectomy specimen was subjected to detailed histopathological examination and out of all hysterectomy specimens; occult squamous carcinoma of cervix was detected in spite of normal previous cytology showing the false negativity of these screening tests. So it is necessary that every vaginal hysterectomy specimen, even if it grossly looks to be normal, should be subjected for detailed histopathological examination, so that the lady who was operated can have better follow up after recognition of unexpected finding

Ovarian strumal carcinoid--report of a case that matastasized.

Ovarian teratomas are known for their ability to form a wide variety of tissues. One unusual example of this potential is the strumal carcinoid in which the thyroid tissue is found in intimate association with carcinoid tumor. Although considered as a malignant transformation of struma ovarii, it is almost always benign. We report a rare case of strumal carcionid in a 44 year old lady who had metastasis in the contralateral ovary, myometrium and lungs.

Alteraçäo do eco da linha média da cavidade uterina: um sinal ecográfico para diagnóstico diferencial entre lesöes do endométrio e do miométrio submucoso / Alteration in the middle echo of the uterine cavity: an echographic signal in the differential diagnosis of endometrial versus myometrial submucous lesions

O presente trabalho originou-se de uma observação ainda não descrita da alteração do eco da linha média da cavidade uterina através da USTV; o método proposto mostrou-se de grande valor no diagnóstico diferencial entre as lesões do endométrio e do miométrio submucoso

Experimental toxoplasmosis in Balb/c mice: prevention of vertical disease transmission by treatment and reproductive failure in chronic infection

In a study of congenital transmission during acute infection of Toxoplasma gondii, 23 pregnant Balb/c mice were inoculated orally with two cysts each of the P strain. Eight mice were inoculated 6-11 days after becoming pregnant (Group 1). Eight mice inoculated on the 10th-15th day of pregnancy (Group 2) were treated with 100 mg/kg/day of minocycline 48 h after inoculation. Seven mice inoculated on the 10th-15th day of pregnancy were not treated and served as a control (Group 3). Congenital transmission was evaluated through direct examination of the brains of the pups or by bioassay and serologic tests. Congenital transmission was observed in 20 (60.6 per cent) of the 33 pups of Group 1, in one (3.6 per cent) of the 28 pups of Group 2, and in 13 (54.2 per cent) of the 24 pups of Group 3. Forty-nine Balb/c mice were examined in the study of congenital transmission of T. gondii during chronic infection. The females showed reproductive problems during this phase of infection. It was observed accentuated hypertrophy of the endometrium and myometrium. Only two of the females gave birth. Our results demonstrate that Balb/c mice with acute toxoplasmosis can be used as a model for studies of congenital T. gondii infection. Our observations indicate the potential of this model for testing new chemotherapeutic agents against congenital toxoplasmosis.

Embarazo cornual: diagnóstico precoz y tratamiento / Cornual pregnancy: early diagnosis and treatment

Se presenta un caso clínico de embarazo cornual diagnosticado y tratado precozmente, se discute su cuadro clínico y tratamiento

Avaliaçäo intra-operatória do estádio do carcinoma do endométrio / Intraoperative evaluation of endometrial carcinoma staging

A nova classificaçäo por estádios apra o câncer do corpo uterino adotado pela Federaçäo Internacional de Ginecologia e Obstetrícia (FIGO), em 1988, é baseada no exame anatomopatológico intra-operatório da peça de histerectomia, näo irradiada. Objetivo. Através do estudo intra-operatório com a biópsia de congelaçäo, reconhecer os fatores de risco para metástases ganglionares intra-abdominais e selecionar as pacientes que realmente devem ser submetidas à linfadenectomia da ilíaca comum e periaórtica. Métodos. Säo considerados fatores de maior risco para metástase: neoplasias pouco diferenciadas (grau histológico 3), invasäo miometrial profunda (mais da metade do miométrio), tipos histológicos especiais mais agressivos e extensäo da neoplasia ao colo uterino. O exame intra-operatório dura cerca de 30 minutos, quando o útero é aberto lateralmente e säo feitos vários cortes transversais completos para selecionar as áreas suspeitas de maior invasäo miometrial e cervical. Posteriormente, säo comparados os dados do exame de congelaçäo com as lâminas permanentes, em cortes de parafina. REsultados. A comparaçäo dos dados preliminares intra-operatórios com os preparados permanentes revelou alta taxa de concordância, ao redor de 90 por cento, para as diferentes variáveis estudadas. Conclusäo. O procedimento proposto pela FIGO para a nova classificaçäo de estádios do câncer do corpo uterino está sendo avaliado. A alta taxa de concordância encontrada fala a favor da confiabilidade do exame intra-operatório e da sua execuçäo. Tratamento radioterápico complementar é indicado conforme o estádio da doença. Como é um procedimento recente, somente mediante avaliaçäo uniforme dos estádios e protocolos de tratamento poderemos melhor avaliar estas modificaçöes

Peritumorous lymph-vascular invasion, grade of histologic differentiation, and myometrial infiltration as prognostic factors of endometrial carcinoma

The authors evaluated 50 patients with endometrial carcinoma studying the prognostic parameters: histologic grade, myometrial invasion and lymph-vascular space invasion. The patients were divided into two groups: A - a good prognosis group (33 cases) - with no recurrence and/or metastasis occuring for five years; and B - a bad prognosis group (17 cases) - with recurrence and/or metastasis or death within five years. We concluded that lymph-vascular space invasion was more frequent in group B, and was a reliable parameter for vad prognosis. The lymph-vascular space invasion was always accompained by myometrial invasion and patients whose myometrium had not been involved did not have lymph-vascular space invasion. In both groups, in well-differentiated tumors, there was no lymph-vascular space involvement. The well-differentiated tumors were statistically more frequent in the good prognosis group. Myometrial invasion was not statistically significant as a prognostic parameter