ABSTRACT
BACKGROUND: According to the Histopathological Registry of Malignant Neoplasms in Mexico, endometrial cancer ranks third gynecological cancers after cervical cancer and ovarian cancer. In 2003 represented 2.16% of all female cancers and in 2007 was the cause of 2.8% of hospital discharges nationwide cancer. OBJECTIVE: To determine the possibility of coincidence of endometrial cancer in biopsy specimens of patients with endometrial hyperplasia. MATERIAL AND METHODS: We analyzed patients who underwent hysterectomy for hyperplasia preoperative biopsy between January 2007 and October 2008. RESULTS: We found 86 patients with biopsy specimens of hyperplasia who underwent hysterectomy, hyperplasia was confirmed in 70 (group A) and endometrioid endometrial cancer reported in 16 (group B). We found cancer in 2 of 61 patients with simple hyperplasia without atypia (3.2%), none of the 6 patients with atypical hyperplasia was found simple cAncer (0%) and 19 patients with complex hyperplasia with atypia was documented EC 14 (73.68%). Patients in group B are older vs 51.3 44.4 years, have a lower number of pregnancies 2.6 vs 3.1 and have a higher body mass index 34.71 vs 29.05 than group A. CONCLUSION: The percentage of agreement between complex endometrial hyperplasiaand endometrial cancer is the highest reported in the literature. Endometrial biopsy in our hospital has low sensitivity for predicting coexistence between complex endometrial hyperplasia and CE. Patients with endometrial biopsy complex endometrial hyperplasia associated with BMI greater than 30 and age over 50 years are at high risk for having coexistence with endometrial cancer. For the high frequency of coexistence with cancer, patients with preoperative biopsy complex endometrial hyperplasia should undergo hysterectomy with frozen section of the uterus to avoid reoperation in case of malignancy.
Subject(s)
Endometrial Hyperplasia/pathology , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/pathology , Adult , Aged , Biopsy , Endometrial Hyperplasia/complications , Endometrial Neoplasms/complications , Female , Humans , Incidence , Middle Aged , Retrospective Studies , Young AdultABSTRACT
INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.
Subject(s)
Ovarian Neoplasms , Aftercare , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Combined Modality Therapy , Drug Resistance, Neoplasm , Early Diagnosis , Female , Genes, Neoplasm , Humans , Laparoscopy , Lymph Node Excision , Neoadjuvant Therapy , Neoplasm Staging/standards , Neoplastic Syndromes, Hereditary/genetics , Omentum/surgery , Organoplatinum Compounds/administration & dosage , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Ovarian Neoplasms/genetics , Ovarian Neoplasms/pathology , Ovarian Neoplasms/therapy , Ovariectomy/methods , Palliative Care , Quality of Life , Radiotherapy, Adjuvant , Salvage Therapy , Taxoids/administration & dosageABSTRACT
Only 8 cases of spontaneous uterine rupture in untreated cervical cancer have been reported in the literature. We present the case of a 52-year-old female, who was admitted to the emergency room due to hypovolemic shock and signs of peritonitis. A 6x4x4 cm cervical tumor was detected at physical exam. At laparotomy 2000 mL of purulent material were found and a 1-cm perforation in the posterior portion of the uterine segment was identified. A subtotal hysterectomy was performed. The patient received antibiotic and support at Intensive Care Unit. Finally, the patient presented ascendant flaccid paralysis and died due to bronchoaspiration. Spontaneous pyometra rupture in untreated cervical cancer is a rare condition and must be considered in postmenopausal women with cervical tumors and peritonitis signs.
Subject(s)
Peritonitis/etiology , Uterine Cervical Neoplasms/complications , Uterine Diseases/complications , Fatal Outcome , Female , Humans , Middle Aged , Rupture, Spontaneous , SuppurationABSTRACT
El carcinoma de cervix con extensión al endometrio, y más aún al miometrio es muy raro. Actualmente solo existen 28 casos descritos en la literatura y 31 como primario de endometrio. El diagnóstico de esta condición requiere de criterios histológicos estrictos. El pronóstico de estas pacientes es malo. La cirugía continúa siendo la principal arma terapéutica; la radioterapia adyuvante no mejora la supervivencia y la experiencia con quimioterapia es limitada
