Brain metastasis in papillary serous adenocarcinoma of the endometrium / Metástase cerebral do adenocarcinoma seroso-papilífero do endométrio

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.

Expression and prognostic significance of SP1, KLF4 and p21 in ovarian serous carcinoma / 临床与实验病理学杂志

Purpose To explore the difference of expression and prognostic significance of SP1,KLF4 and p21 in low grade ovarian serous carcinoma (LGSC) and high grade ovarian serous carcinoma (HGSC).Methods The expression of SP1,KLF4 and p21 protein was examined with immunohistochemistry EliVision method in cases with LGSC and HGSC.Kaplan-Meier analysis and Cox multivariate survival analysis were used to assess the impact of SP1,KLF4 and p21 expression on prognosis of LGSC and HGSC.Results SP1,KLF4 and p21 expression were detected respectively in 74.5％,17.0％ and 11.7％ HG-SC cases,and in 65.2％,34.8％ and 26.1％ LGSC cases.Compared to control group,the expression level of SP1 was significantly higher (P ＜ 0.05),but the expression level of KLF4 and p21 were significantly lower (P ＜0.05).There was no significant difference of SP1,KLF4 and p21 expression between HGSC and LGSC (P ＞ 0.05).The expression of SP1,KLF4 and p21 were associated with FIGO stage,meanwhile SP1 associated with residual tumor size in HGSC (P ＜ 0.05).There was a significant negative correlation between SP1 and KLF4,p21 proteins in HGSC (P ＜ 0.05).Kaplan-Meier analysis revealed that there were significantly poor overall survival (OS) of 5 years for patients with HGSC displaying high expression of SP1,or low expression of KLF4 and p21 (P ＜0.05),but no significantly improved OS for patients with LGSC (P ＞ 0.05).Cox analysis showed that SP1 overexpression is an independent prognosis factor for HGSC.Conclusion Overexpression of SP1 and low expresion of KLF4 and p21 contribute to carcinogenesis of HGSC and LGSC.They are associated with a poor prognosis of HGSC,but not LGSC,meanwhile SP1 is an independant prognosis factor for HGSC.

Clinicopathological Characteristics of Tumor Infiltrating Lymphocytes in Ovarian Serous Adenocarcinoma / 实用妇产科杂志

Objective:To investigate the clinicopathological characteristics and immunohistochemical features of tumor-infiltrating lymphocyte(TIL) in ovarian serous adenocarcinoma,and their clinical value.Methods:The immunohistochemistry was used to observe 68 ovarian serous adenocarcinomacases'immunohistochemical features,and their correlations with clinicopathological characteristics were analyzed.Results:There were 43 cases with a large amount of TIL infiltrating in the 68 cases of serous adenocarcinoma,account for 63.24％.There were significant differences on the with or without a large amount of TIL infiltrating among the different tumor grade,different clinical stage,and different CA125 level (P ＜ 0.05).The numbers of CD3 +,CD4 + and CD8 + TIL in the cancer nest were significantly less than those in the stroma,with significantly statistical difference (P ＜ 0.05),Meanwhile the ratio of CD4 +/CD8 + in the cancer nest was significantly less than that in the stroma(P＜0.05).The ratio of CD4 +/CD8 + in the cancer nest and stroma at stage Ⅲ and with poor differentiation was significantly lower than in those at stage Ⅰ-Ⅱ and with good differentiation(P＜0.05).Meanwhile the ratio of CD8 +/FoxP3 + Treg in the cancer nest was less than that in the stroma(P＜0.05).The ratio of CD8 +/FoxP3 + Treg in the cancer nest at stage Ⅲ and with poor differentiation tumor was significantly lower than in those at stage Ⅰ-Ⅱ and with good differentiation(P＜0.05).The expression of GzmB in the cancer nest at stage Ⅲ and with poor differentiation tumor was significantly lower than that in the cancer nest at stage Ⅰ-Ⅱ and with good differentiation tumor(P＜0.05).Conclusions:With or without a large amount of TIL is related to tumor grade,clinical stage,and CA125 level inovarian serous adenocarcinoma.The numbers of TIL in ovarian serous adenocarcinoma increase considerably,but mainly in the stroma,and which may be related to several factors such as tumor cell differentiation and clinical stage.

A study on inorganic elements in psammomas from ovarian & thyroid cancer.

Background & objectives: Concentric lamellar calcifications known as psammoma bodies (PB) are found in benign and malignant tumours. Whether or not the inorganic element concentrations in psammomas are similar to serous adenocarcinoma of the ovary and thyroid papillary cancer tissues has not yet been ascertained. We undertook this retrospective study to establish if there is any difference in the concentrations of inorganic ions found in psammomas in serous adenocarcinoma of the ovary, and those found in thyroid papillary cancer tissue. Methods: PB samples from patients with adenocarcinoma of the ovary (n = 10) and with thyroid papillary cancer (n = 10) were analyzed through inductively-coupled plasma spectroscopy (ICP). Results: There were no significant differences in the concentrations of inorganic elements in PB from thyroid papillary cancer than in those PB from ovarian cancer. Interpretation & conclusions: Differences in the concentrations of inorganic elements may be due to the variation in environmental pollution. Our study had limitation of small sample size. Our results suggest that some inorganic elements can participate in the origin of psammoma bodies.

A Case of Colonic Metastasis from Borderline Ovarian Cancer

This report describes the case of a patient who had previously undergone surgery for resection of bilateral ovarian tumors and after 5 years presented with colonic metastasis. A 70-year-old woman visited the hospital for a clinical survey due to severe anemia. In 2007, the patient was diagnosed with cancer (papillary serous adenocarcinoma) in both ovaries. The patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by postoperative adjuvant chemotherapy. After treatment, the patient was stable during follow-up. After 5 years, she underwent incidental colonoscopic examination because of severe anemia. The colonoscopic findings revealed an elevated irregular lesion in the descending colon. Colonic metastasis from the papillary serous adenocarcinoma of the ovary was confirmed by immunohistochemical staining during the pathological diagnosis.

Serous adenocarcinoma arising from ovarian endometriosis after menopause / 대한산부인과학회지

Endometriosis is estrogen dependent disease in reproductive age. Endometriosis is a chronic inflammatory gynecologic disease. Problems associated with endometriosis include dysmenorrhea, dyspareunia, and infertility. Postmenopausal endometriosis is rare. Also, malignant transformation in endometriosis is rare. There is no report in Korea about serous adenocarcinoma arising from endometriosis after menopause. The authors present a case of serous adenocarcinoma arising from endometriosis after menopause with brief review of the literature.

Expression of TLR-4 in epithelial serous ovarian cancer / 부인종양

OBJECTIVE: This study was to determine the expression of Toll-like receptor 4 (TLR-4) in ovarian serous adenocarcinoma tissues. METHODS: TLR-4 expression was evaluated at the RNA level by real-time quantitative RT-PCR, in 24 fresh frozen ovarian serous adenocarcinoma tissues and 9 normal ovarian tissues. TLR-4 expression was also evaluated by immunohistochemistry (IHC) in each three ovarian carcinoma tissues and normal ovarian tissues. RESULTS: Positive immunoreactivity for TLR-4 was observed in the normal ovarian tissues but not in the ovarian carcinoma tissues. The staining was localized in the cytoplasm as well as on the cell surface. Real-time quantitative RT-PCR revealed that TLR-4 expression was significantly lower in tumors than in normal ovarian tissues (p=0.0003). There were no significant correlations between clinical parameters and the expression level of TLR-4 mRNA in ovarian serous adenocarcinomas. However, tumors without LN metastasis (p=0.068) and lower grade (p=0.075) showed trends of higher TLR-4 mRNA expression. CONCLUSION: TLR-4 expression was significantly lower in ovarian serous adenocarcinoma tissues than in normal ovarian tissues, and further studies on TLR-4 signaling pathway in ovarian carcinoma are needed.