The association of polypoid growth pattern with lymphnode involvement in endometrioid type endometrial adenocarcinoma

Background: Tumor size is an independent predictor of lymph node metastasis and survival in the endometrioid type endometrial adenocarcinoma (EC). However, some of the ECs tend to grow towards the cavity in the polypoid pattern, which can reach very large sizes. In this study, we aimed to analyze the association of growing in the polypoid pattern of the tumor with the proportion of lymph node metastasis and extrauterine tumor spread. Methods: Four hundred seven patients were analyzed retrospectively. The effect of tumor size, tumor growing pattern, myometrial invasion, grade, and lymphovascular space invasion on the lymph node metastasis and extrauterine tumor spread were investigated. Statistical analysis consisted of unpaired t?tests for parametric data and Mann Whitney?U test for non?parametric data, whereas the Chi?square test for categorical variables. Logistic Regression, Cox Regression and multivariate analysis were used to estimate the risk predictors. Results: No association was found between the growing in polypoid pattern and lymph node metastasis (P > 0.05). In the analysis of endometrioid type EC patients who had myometrial invasion less than � as a subgroup, no association was found between the growing pattern and lymph node metastasis and extrauterine disease. Tumor size was found to be a statistically significant predictor of lymph node metastasis and extrauterine disease (P < 0.05). Conclusions: Lymphovascular space invasion, grade, and myometrial invasion are associated with a higher proportion of lymph node metastasis. The polypoid growth pattern of the tumor does not correlate with any histopathological parameters

A comparative study of subjective and objective techniques using two‑dimensional ultrasound in the preoperative assessment of cervical and myometrial invasion in patients with endometrial cancer / Philippine Journal of Obstetrics and Gynecology

Context@#Endometrial cancer is the third most common malignancy of the female genital tract in the Philippines, following cervical and ovarian cancer. Ultrasound as the first line in imaging has a major role in preoperative treatment and planning.@*Aims@#To compare the diagnostic accuracy of subjective versus objective ultrasound measurement techniques in detecting cervical stromal invasion (CSI) and deep myometrial invasion (MI).@*Materials and Methods@#Fifty‑seven patients were enrolled in this cross‑sectional study. Deep MI and CSI were evaluated both subjectively and objectively by measuring tumor‑free distance (TFD), distance from the outer cervical os to lowest edge of the tumor border (Dist‑OCO), and distance from the internal cervical os to caudal tumor border (Dist‑ICO). Histopathological result used as the gold standard.@*Results@#Subjective assessment for deep (MI) had 79.3% sensitivity, 82.1% specificity, 82.1% positive predictive value (PPV), 82.1% negative predictive value (NPV), and 80.7%. Subjective assessment for CSI had a sensitivity, specificity, PPV, NPV, and overall accuracy of 80%, 90.4%, 44.4%, 97.9%, and 89.5%. Objective measurement (TFD ≤0.8 cm) to detect deep MI had 86.2% sensitivity, 57.1% specificity, 67.4% PPV, 80% NPV, and 71.9% overall accuracy. Adjusting TFD cutoff to 0.65 increased to 71.4% specificity, making it comparable with subjective assessment. Dist‑OCO (≤2.1 cm) yielded 100% sensitivity, 86.3% specificity, 30% PPV, 100% NPV, and 87% overall accuracy. Dist‑ICO was first used in this study, hence no cutoff yet. By using receiver operating characteristics, cutoff was 0.45 cm, which yielded a 60% sensitivity and 92% specificity (area under the curve 0.731, P = 0.09).@*Conclusions@#Subjective assessment of CSI and deep MI performs better than objective measurement techniques. TFD and Dist‑OCO as the objective measurements showed clinically comparable accuracy to subjective assessment by an expert. Dist‑ICO needs to be validated to a larger population to determine its clinical value in predicting CSI.

Endometrial serous carcinoma: A retrospective review of histological features & their clinicopathological association with disease-free survival & overall survival

Background & objectives: Endometrial serous carcinoma (ESC) is a high-grade epithelial neoplasm with increased risk for metastasis and recurrence. This study was aimed to assess various histomorphological features of ESC and their clinicopathological association with disease-free survival (DFS) and overall survival (OS). Methods: A total of 205 slides (belonging to 120 patients) diagnosed as ESC from January 2009 to December 2015 were reviewed. Receiver operating characteristics (ROC) curves were established for the diagnostic performance of depth of invasion (DOI), tumour-free distance (TFD) to serosa and percentage myometrial invasion (MI%). OS and DFS were generated by Kaplan-Meier curves and prognostic significance by Cox regression analysis. Results: The mean age at diagnosis was 61.8 yr and the mean tumour size was 4.01 cm. Majority of the females were multiparous (84%; n=94) and postmenopausal (89.2%; n=107). On histopathology, <50 per cent of MI was identified in 37 of the 104 (35%), while 62/104 (59.61%) patients had ?50 per cent MI. Seven (6.7%) patients had full-thickness invasion with serosal involvement, while five (4.8%) patients had no microscopic MI (minimal uterine serous carcinoma). Information about MI was not available in 16 patients. TFD ?7.0 mm, DOI ?6.0 mm and MI% ?40 were significant variables in univariate analyses for OS; however, on multivariate analysis; none of these turned out to be an independent predictor in terms of OS. For DFS, DOI (?6.0 mm) and MI% (?40%) showed a significant association, in univariate as well as multivariate analysis; however, TFD (?7.0 mm) did not show any significant association with DFS. Follow up data were available in 111 of the 120 (92.5%) patients with a five-year OS and DFS of 22.2 and 17.2 per cent, respectively. Interpretation & conclusions: Conventionally calculated DOI (less than or more than half thickness) did not show significance in the present study. Thus, calculating the actual myometrial DOI, MI% and TFD to serosa have the potential for contributing meaningfully to prognostication of ESC

Partial hydatidiform mole evolving into metastatic trophoblastic tumor: case report

Partial hydatidiform mole can evolve into a metastatic trophoblastic tumor. A 36-year-old, multiparous woman, pregnant with a 22-week embryonic hydatidiform mole, having spontaneously expelled. Histopathological examination showed a non-invasive partial mole. During biological monitoring, a trophoblastic tumor was diagnosed with pulmonary metastasis on CT-scan and myometrial invasion by MRI. Authors opted for a monochemotherapy with a good evolution. The potential risk of malignant transformation of the partial hydatidiform mole requires an adequate therapeutic strategy with strict monitoring.

Overexpression of ezrin and galectin-3 as predictors of poor prognosis of cervical cancer

The aim of this study was to explore the correlation of ezrin and galectin-3 expressions with prognosis in cervical cancer. The immunohistochemical method was applied to detect ezrin and galectin-3 expressions in normal cervix tissues (n=30), cervicitis tissues (n=28), cervical intraepithelial neoplasia (CIN) tissues (classified as I-III, n=89), and cervical carcinoma tissues (n=84). Follow-up was conducted for 5 to 78 months to analyze the correlation of protein expressions with prognosis. Ezrin and galectin-3 expressions in cervical cancer were significantly higher than in normal cervix, cervicitis and CIN (all P<0.05), and expressions in CIN were significantly higher than in normal cervix and cervicitis (both P<0.05). The expressions of ezrin and galectin-3 were both related with histological grade, deep myometrial invasion and lymph node metastasis (all P<0.05). Spearman analysis showed that ezrin expression was positively correlated with galectin-3 expression in cervical cancer (r=0.355, P<0.05). The survival rate of patients with high expressions of ezrin and galectin-3 was significantly lower than those with low expressions of proteins (both P<0.05). The expressions of ezrin and galectin-3, histological grade, depth of stromal invasion, and lymph node metastasis are risk factors affecting the survival rate of patients with cervical cancer. The expressions of ezrin and galectin-3 were correlated with the development of cervical cancer, and overexpressions of those proteins were indicative of poor prognosis in patients with cervical cancer.

Surgical treatment of endometrial cancer in developing countries: reasons to consider systematic two-step surgical treatment

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. .

Successful delivery after conservative resectoscopic surgery in a patient with a uterine tumor resembling ovarian sex cord tumor with myometrial invasion

Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation. The clinical characteristics of a UTROSCT are not fully understood. Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility. We present a case of UTROSCT with myometrial invasion, which resulted in a successful delivery after the patient was treated by resectoscopic surgery and conservation of the uterus, and a brief review of the literature.

A retrospective clinicopathological study of 131 cases with endometrial cancers - Is it possible to define the role of retroperitoneal lymphadenectomy in low-resource settings.

AIM: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor grades, and their implications on lymph node metastasis. MATERIALS AND METHODS: We conducted a retrospective descriptive study of 131 cases of endometrial cancer examined and treated at a tertiary regional cancer institute between the years 2003 and 2009. We reviewed the oncology database as well as the clinical records and surgico‑pathological registry of all these patients. STATISTICAL METHODS USED: All the summary measure computation and Chi‑square test for comparing more than one proportion was done in spreadsheet (Excel). RESULTS: The multiparity association with endometrial cancer was commonly seen 113/131 (86.2%). Twelve (9.7%) patients preoperatively diagnosed as Grade 1 tumors upgraded to Grade 3 changes in postoperative specimens and six of these 12 patients (50%) had lymph node metastasis. A total of 14/131 (10.6%) cases had lymph nodes metastasis. CONCLUSIONS: There is a poor correlation between the preoperative and the postoperative tumor grades. Routine pelvic lymphadenectomy may be a valuable method in low‑risk cases and para‑aortic lymphadenectomy may be limited to high‑risk endometrial cancers.

Analysis of factors to affect on MR assessment of myometrial invasion and cervical involvement in endometrial cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to assess the depth of myometrial invasion and cervical involvement by endometrial cancer using magnetic resonance imaging (MRI). METHODS: Forty three patients with histological diagnosis of endometrial cancer were studied with the results of MRI at 1.5T and subsequently underwent staging operation. The MRI results were compared with pathologic results. Presence of large polypoid tumors, leiomyoma, adenomyosis, distension of uterine cavity by large tumor, atrophy of uteri, utetrine anomalies and tumor protruding into the cervical canal were analyzed. RESULTS: On review, the sensitivity for the detection of myometrial invasion was 93.5%, specificity 58.3%, positive predictive value (PPV) 85.3% and negative predictive value (NPV) 77.8%. For the detection of deep myometrial invasion, sensitivity was 87.5%, specificity 85.7%, PPV 58.3% and NPV 96.8%. For the detection of cervical involvement, sensitivity was 100%, specificity 92.9%, PPV 25%, NPV 100%. Distension of uterine cavity by large tumor (p=0.009) and adenomyosis (p=0.041) were associated with incorrect MRI assessment of myometrial invasion. For cervical involvement, tumor protruding into the cervical canal was associated but did not reach statistical significance (p=0.062). CONCLUSION: MRI scans as reported offered some clinical benefit in preoperative assessment of endometrial cancer, but for assessment of cervical involvement, showed low PPV. When present, distension of uterine cavity by large tumor and adenomyosis may make it difficult to assess myometrial invasion at MR imaging.

Malignant Mixed Mullerian Tumor of the Uterus: Retrospective Study of 26 cases / 대한산부인과학회지

OBJECTIVE: To review the clinicopathological characteristics and prognosis of patients with malignant mixed Mullerian tumor (MMMT) of the uterus. METHODS: Retrospective clinical study was done on 26 patients diagnosed with the MMMT of the uterus at our hospital from Janurary, 1994 to December, 2004. Demographic data, pathologic findings, stages, treatment, prognosis and survival time were reviewed. RESULTS: The median age of patients was 59 years. Most of the patients (76.9%) were in the postmenopausal state. The most common symptom was vaginal bleeding (65.4%). There were 17 patients (65.4%) with stage I, 3 patients (11.6%) with stage II, 4 patients (15.4%) with stage III, 2 patients (7.6%) with stage IV disease in this study. Of the hysterectomy specimens, 4 (15.4%) of them were heterologous tumors, 22 (84.6%) of them were homologous tumors. Overall 5 year survival rate of all stages was 60% and the patients with advanced stages (III, IV) showed poorer prognosis than the patients with early stages (I, II) (P=0.001). Myometrial invasion depth was also significant prognostic factor (P<0.001). CONCLUSION: The MMMT of the uterus is a highly malignant tumor and the significant prognostic factor is the FIGO stage and myometrial invasion depth.

A Case of Papillary Serous Carcinoma of Endometrium / 대한산부인과학회잡지

Uterine papillary serous carcinoma (UPSC) has been recognized as an aggresive tumor with early and deep myometrial invasion, frequent lympho-vascular space involvement, and a high relapse rate. It has also been shown that deep myometrial invasion cannot predict the risk of extrauterine disease. UPSC accounts for 2-10% of all endometrial cancer and generally occurs in postmenopausal women (mean age 66 years) who usually present with abnormal vaginal bleeding. Obesity, diabetes, hypertension, or a history of previous hormone replacement treatment, known as risk factors of endometrial cancer, are not usually seen in women with UPSC. In this paper, we present a case of uterine papillary serous carcinoma with obesity, hypertension, diabetes. The initial endometrial biopsy showed an endometrioid adenocarcinoma but the result of postoperative pathologic finding revealed UPSC with extension to less than half thickness of the muscle layer and involvement of pelvic lymph node.

Comparison of MRI's Prediction of Myometrial, Cervical Invasion and Surgical Staging in Endometrial Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was accuracy evaluation of MRI in prediction of myometrial, cervical invasion in endometrial carcinoma by comparing with histopathologic findings and to find causes of inaccurate MRI readings. METHOD: Fifty patients with endometrial carcinoma who were evaluated with MRI imaging prior to surgery were reviewed. And then, we compared MRI findings and histopathologic findings in view of myometrial, cervical invasion. RESULTS: Overall accuracy of MRI in prediction of myometrial invasion was 48%. Sensitivity/specificity/ PPV/NPV in prediction of no myometrial invasion were 100%/42.9%/42.9%/100% respectively, in prediction of superficial myometrial invasion were 20.0%/86.7%/50.0%/61.9% respectively, in prediction of deep myometrial invasion were 33.3%/94.3%/71.4%/76.7%, respectively. Accuracy in prediction of cervical invasion was 84% and sensitivity/specificity/PPV/NPV were 50.0%/88.6%/37.5%/92.9% respectively. Among the probable causes of inaccurate MRI readings, polypoid tumor occupies large portion. CONCLUSION: MRI has some value in pre-operative evaluation of patients with endometrial carcinoma. We should cautiously accept the MRI readings when tumor shows polypoid growth.

Evaluation of depth of myometrial invasion by gross visual estimation versus microscopic technique.

A diagnostic test evaluation was performed to compare the evaluation of depth of myometrial invasion by gross visual estimation versus microscopic examination in the uteri of 40 patients who had endometrial adenocarcinoma and underwent surgical treatment in Siriraj Hospital from November 1993 to March 1995. The accuracy of gross visual estimation was 85%, the sensitivity was 63.6% (95% CI=31.6-87.6), the specificity was 93.1% (95%CI=75.8-98.8), the positive predictive value was 77.8% (95% CI=40.2-96.1), the negative predictive value was 87.1% (95% CI=69.2-95.8), the false positive rate was 6.9% and the false negative rate was 36.4%. Although gross visual estimation showed good specificity, high false negative rate and should not be used in preference to microscopic examination.