The diagnosis of endometrial cancer in women with asymptomatic endometrial polyp does not increase survival rates: an israel gynecologic oncology group study.

OBJECTIVE: To compare outcomes of symptomatic and asymptomatic women with endometrial cancer and a preoperative diagnosis of an endometrial polyp. DESIGN: An Israel Gynecologic Oncology Group multi-center retrospective cohort study. METHODS: Of 635 patients with endometrial cancer and a preoperative diagnosis of an endometrial polyp who underwent surgery between 2002 and 2014 in one of 11 centers in Israel were divided into two groups according to the presence of bleeding symptoms. Outcome measures included recurrence-free survival, disease-specific survival and overall survival. Survival data were plotted according to the method of Kaplan and Meier and compared using the log-rank test. RESULTS: There were 513 symptomatic and 122 asymptomatic women with endometrial cancer and a preoperative diagnosis of an endometrial polyp. The median follow-up was 52 months (range 12-120 months). There were no differences between patients who experienced bleeding and those who did not in 5-year recurrence-free survival (85.2 % vs. 85.7 %; p=0.83, respectively), disease-specific survival (88.2 % vs. 89.2 %; p=0.71, respectively), or overall survival (80.2% vs. 78.4 %; p=0.97, respectively). CONCLUSION: The diagnosis of endometrial cancer in patients with asymptomatic endometrial polyps is not associated with improved outcomes as compared with patients with bleeding. In the absence of factors indicating a high risk of endometrial cancer, clinical and sonographic follow-up is the advised management strategy for these patients.

Effect of tea saponin on ephyrae and polyps of the moon jellyfish Aurelia sp.1.

The moon jellyfish (Aurelia sp.1) is thought to be a nuisance for the sea cucumber aquaculture, which commonly occur in the sea cucumber (Apostichopus japonicus) culture ponds of the Yellow Sea, China. To develop an appropriate method to control Aurelia sp.1 blooms, the toxic effects of tea saponin on Aurelia sp.1 ephyrae and polyps were tested in laboratory experiments. Our results revealed that tea saponin caused significant morphological changes, behavioral abnormality and mortality in Aurelia sp.1 ephyrae and polyps in 24 h and 48 h exposure experiments. The 24 h and 48 h median lethal concentrations (LC50) values of tea saponin for Aurelia sp.1 ephyrae were 1.9 and 1.1 mg L-1 respectively, while the LC50 value for Aurelia sp.1 polyps was 0.4 mg L-1 after 24h and 48 h of exposure to tea saponin. Comparison with literature results of tea saponin on A. japonicus indicates that the resistance of A. japonicus to tea saponin is 12-18 times greater than that of Aurelia sp.1 ephyrae. Therefore, the appropriate tea saponin dosage for the control of Aurelia sp.1 should be paid enough attention in order to minimize possible damage for sea cucumber. We suggest that the recommended level of tea saponin to eradicate Aurelia sp.1 ephyrae and polyps in sea cucumber culture ponds be lower than 1.35 mg L-1.

Synchronous polyps predict metachronous colorectal lesions after curative resection of colorectal cancer.

BACKGROUND: The principal aim of endoscopic follow-up programs after curative resection of colorectal cancer (CRC) is to improve survival and identify local recurrence and metachronous CRC. The aim of our study was to identify the possible predictors of metachronous colorectal lesions. METHODS: The records of 348 consecutive patients with CRC and who completed at least 1 year of endoscopic follow-up after surgery were analyzed. In this group, 336 patients underwent surgery for primitive CRC and 12 for metachronous cancer. Patients' characteristics, operative details, and endoscopical follow-up findings were retrieved. Multivariate survival analyses were used to identify patient categories at risk of metachronous colonic lesions. RESULTS: 128 patients presented a metachronous lesion: 118 adenomas and 10 adenocarcinomas. At multivariate analysis, active smoke (HR = 1.84, p = 0.03), neoadjuvant therapy (HR = 0.24, p = 0.01), and presence of synchronous polyps (HR = 1.55, p = 0.04) resulted independent predictors of metachronous adenoma after CRC removal while neoadjuvant therapy (HR = 0.25, p = 0.02), active smoke (HR = 1.54, p = 0.04), and presence of synchronous polyps (HR = 1.86, p = 0.02) resulted independent predictors of metachronous lesions after CRC removal. CONCLUSIONS: This study demonstrated a high rate of metachronous lesions in the early follow-up after curative CRC resection. The negative effects of synchronous polyps should be carefully evaluated when planning patients' follow-up.

Long-term effects of levonorgestrel-releasing intrauterine system on tamoxifen-treated breast cancer patients: a meta-analysis.

OBJECTIVE: The aim of the study is to assess the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) on the tamoxifen-induced endometrial lesions in breast cancer patients. METHODS: PubMed and EMBASE databases were searched for eligible studies. Odds ratios were obtained to estimate the association between the LNG-IUS and tamoxifen-induced endometrial lesions. The fixed effects or random-effects model was used to combine data depending on heterogeneity. RESULTS: With three eligible randomized clinical trials involving 359 patients, this analysis demonstrated tamoxifen-treated breast cancer patients using the LNG-IUS derived benefit from de novo polyps prevention (P < 0.0001, OR 0.18, 95% CI: 0.08-0.42). However, the LNG-IUS only showed a trend of maintaining endometrial proliferation or secretory status (P = 0.05, OR 0.36, 95% CI 0.13-1.02) and no statistical difference in atrophic or inactive changes (P = 0.13, OR 0.24, 95% CI 0.04-1.53) or endometrial hyperplasia without atypia (P = 0.08, OR 0.20, 95% CI 0.04-1.18). The LNG-IUS didn't have an increased incidence in breast cancer recurrence (P = 0.28, OR 1.75, 95% CI: 0.64-4.80) and cancer-induced death (P = 0.71, OR 1.22, 95% CI: 0.42-3.52). Bleeding in the treatment group was statistically more frequent than that in the control group (OR 6.20, 95% CI: 2.99-12.85, P < 0.00001). CONCLUSIONS: This analysis verifies the efficacy of the LNG-IUS in preventing tamoxifen-induced polyps. The LNG-IUS didn't have an increased incidence in breast cancer recurrence and cancer-induced death. Long-term, large randomized studies of the LNG-IUS will be necessary to determine the benefit and risk in tamoxifen-treated breast cancer patients.

Asfixia por un pólipo fibrovascular gigante de la hipofaringe / Asphyxiation due to a giant fibrovascular polyp of the hypopharynx

La asfixia mecánica debida a factores intrínsecos tales como los tumores de la hipofaringe es poco frecuente. Presentamos un caso de muerte súbita en un varón de mediana edad que se atragantó mientras comía. La autopsia médico-legal reveló la presencia de un pólipo fibrovascular gigante (PFV) en la glotis que no estaba diagnosticado. El tallo del tumor se originaba a partir de la mucosa hipofaringea. La muerte fue considerada natural. El PFV es una masa tumoral muy rara que puede alcanzar un gran tamaño, y potencialmente bloquear la entrada laríngea. Hasta donde llega nuestro conocimiento, solo han sido publicados 13 casos de asfixia debida a aspiración de un PFV (AU)

Mechanical asphyxia due to intrinsic factors such as tumors of the hypopharynx is an uncommon situation. Here, we report a case of sudden death in a middle-aged man who began to choke while eating. The medico-legal autopsy revealed an undiagnosed giant pedunculated fibrovascular polyp (FVP) impacted in the glottis. The stalk of the tumor originated from hypopharynx mucosa. The cause of death was ruled natural. FVP is a very rare benign tumor-like condition that can reach a large size and potentially block the laryngeal inlet. To our knowledge, only 13 cases of asphyxia due to aspiration of a FVP have been reported (AU)

NF-κB and COX-2 expression in nonmalignant endometrial lesions and cancer.

OBJECTIVES: To examine the immunohistochemical expression of cyclooxygenase-2 (COX-2) and nuclear factor-κB (NF-κB) in benign endometrial polyps (EPs), endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN), and endometrioid endometrial cancer (EC). METHODS: The immunohistochemical expression of COX-2 and NF-κB was performed using an Aperio Scanscope XT automated system in 218 patients with endometrioid EC and 107 patients with nonmalignant endometrial lesions: 53 with benign EPs, 37 with EH, and 17 with EIN. RESULTS: COX-2 and NF-κB p50 expression were significantly lower in EC compared with nonmalignant lesions. We observed significant decreased NF-κB p65 expression in EC vs EPs (P < .001) and EH (P = .014) as well as in EIN vs. EPs (P = .01). For patients with EC, COX-2 correlated positively with NF-κB p65 and NF-κB p50 (P < .001). Grade 3 tumors had a higher mean expression of NF-κB p65 (P = .03). NF-κB p50, NF-κB p65, and COX-2 expression had no impact on survival. CONCLUSIONS: We conclude that COX-2 and NF-κB expression are lower in EC compared with nonmalignant endometrial lesions. COX-2 and NF-κB expression have no prognostic value in EC.

Geminin, Ki67, and minichromosome maintenance 2 in gastric hyperplastic polyps, adenomas, and intestinal-type carcinomas: pathobiological significance.

BACKGROUND: Geminin negatively regulates Cdt1 and induces the formation of prereplicative complexes by loading mini-chromosome maintenance proteins (Mcm) onto chromatin and limiting DNA replication to once per cell cycle. Recent studies have suggested that geminin expression is a marker of the S/G2/M phase of the cell cycle and is associated with a poor prognosis in various human malignancies. This study aimed to clarify the pathobiological role of geminin in intestinal-type gastric carcinoma, and its relationships with minichromosome maintenance 2 (Mcm2) and Ki67 expression. METHODS: We performed western blot analysis of seven human gastric cancer cell lines, and immunohistochemical analysis of 72 gastric mucosal lesions and 128 surgically removed advanced intestinal-type gastric carcinomas. Double-labeling immuno-fluorescence was performed to identify the coexpression of geminin and Ki67. RESULTS: Geminin was detected in all cell lines. Geminin labeling indices (LIs) in hyperplastic polyps, low-grade adenomas, high-grade adenomas, and intestinal-type adenocarcinomas were 3.9%, 10.5%, 18.6%, and 27.2%, respectively. The equivalent LIs for Ki67 and Mcm2 were 17.7%, 42.2%, 52.6%, and 59.7%; and 26.7%, 70.0%, 67.8%, and 77.8%, respectively. Double-labeling immunofluorescence revealed coexpression of geminin and Ki67 in both normal and tumor cells. The LI for geminin was significantly correlated with N stage, International Union Against Cancer (UICC) stage, Mcm2 LI, and Ki67 LI. Patients in stages I-IV and stage III with higher LIs for geminin (>25%) had significantly worse prognoses (P < 0.05 and P < 0.04, respectively). Univariate Cox regression analysis indicated that the overall survival of stage I-IV tumors was significantly correlated with high geminin LIs (relative risk [RR] = 1.94; P = 0.04). CONCLUSIONS: Geminin expression might reflect the biological nature of gastric intramucosal neoplasms and could be a possible prognostic marker in advanced intestinal-type gastric carcinomas.

[Superficial stomach cancers: surgical experience and study of prognostic factors in 102 patients]. / Les cancers superficiels de l'estomac: expérience chirurgicale et étude des facteurs de pronostic chez 102 patients.

STUDY AIM: The aim of this retrospective study was to analyze the characteristics, treatment and prognosis of early gastric carcinoma in a series of 102 patients. METHODS: Between 1973 and 1994, 102 patients (68 males, 34 females) with a mean age of 65 years, were operated on for an early gastric carcinoma. Mean follow-up was 7 years. Survival was calculated using the Kaplan-Meier method. Prognosis was determined with univariate and multivariate analysis according to Cox model. RESULTS: The carcinoma was limited to the mucosa in 57 patients (56%) and extended to the submucosa in 45 (44%). There was a lymph node invasion in 17 patients (16.5%). The postoperative mortality rate was 5.8% (n = 6). Secondary deaths occurred in relation with the gastric cancer in 10.4% (n = 10). The 5- and 10-year actuarial crude survival rates were 84% and 68.6%, respectively. Univariate analysis of prognosis factors showed a significant survival difference according to the age (P = 0.001), submucosal extension (P = 0.03), lymph node invasion (P = 0.0005) and type of gastric resection performed (P = 0.03). With multivariate analysis of prognostic factors, advanced patient age and lymph node metastases were the only statistically significant independent prognostic factors, advanced patient age and lymph node metastases were the only statistically significant independent prognostic factors (P = 0.0002 and P = 0.002, respectively). CONCLUSIONS: Prognosis of early gastric cancer is usually excellent. Patients with high risk of recurrence may be identified in relation with prognostic factors and mainly with lymph node invasion.

nm23-H1 protein immunoreactivity in laryngeal carcinoma.

BACKGROUND: The nm23-H1 gene encodes a 17-kilodalton cytoplasmic and nuclear protein that has recently been shown to be reduced in a number of human carcinomas including breast, colorectal, lung, gallbladder, and biliary tract carcinomas. This study examines the immunohistochemical staining characteristics of the nm23-H1 protein in human laryngeal carcinomas and nonneoplastic laryngeal polyps, and attempts to determine if there is any relationship between reduction of nm23-H1 protein immunoreactivity and prognosis of patients with laryngeal carcinoma. METHODS: Routine streptavidin-biotin immunohistochemistry with a polyclonal antibody was employed to study the expression of the nm23-H1 protein in laryngeal squamous cell carcinoma (SCC) (N = 22) and nonneoplastic polyps (N = 8). The carcinomas were classified as well differentiated (N = 2), moderately differentiated (N =15), and poorly differentiated (N = 5). Tissues from metastatic tumor deposits in lymph nodes (N = 5) were also studied. A semiquantitative immunostaining index was derived from the intensity and extent of staining of the cells. RESULTS: All laryngeal polyps showed intense immunostaining for the nm23-H1 gene product in the squamous epithelium. However, reduced immunoreactivity was found in nearly half of the SCC cases (N = 10; 46%), with the least staining intensity found in tumor metastases in lymph nodes (N = 4; 80%), and were associated with a shorter median survival of 14.3 months. In contrast, tumors that demonstrated moderate to strong nm23-H1 protein immunostaining were associated with a longer median survival period of 20.4 months. CONCLUSIONS: There is reduced expression of the nm23-H1 gene in human laryngeal SCC compared with nonneoplastic laryngeal polyps. Reduction in the intensity and extent of nm23-H1 protein immunostaining appears to correspond to reduced duration of patients survival.

Evaluating constraints that allow survival-adjusted incidence analyses in single-sacrifice studies.

Ideally, analyses of tumor incidence data from long-term animal experiments should allow the incidence rates to vary with age, without restricting tumor lethality, without requiring data on cause of death, and without assuming independence of competing risks. This article focuses on nonparametric methods that not only satisfy these conditions, but also accommodate studies having just one sacrifice time, by constraining the effects of age on one of the three functions used to characterize the likelihood. Several constrained analyses were evaluated using data on over 18,000 mice from the ED01 study. Of the five constraints considered, only the assumption of constant differences between the death rates for animals with and without the tumor of interest produced reasonable results across a wide range of tumor lethalities.

Gastroduodenal polyps in familial adenomatous polyposis.

A retrospective review of the medical records of 30 patients with familial adenomatous polyposis who underwent oesophagogastroduodenoscopy was performed to evaluate the spectrum of gastroduodenal polyps. Twenty-five patients (83%) had gastroduodenal polyps. Eighteen patients (60%) had gastric polyps and 21 patients (70%) had duodenal polyps. Five patients (17%) had gastric and 20 patients (67%) had duodenal adenomatous polyps. Three patients (10%) died from an upper gastrointestinal tract adenocarcinoma. Three of nine patients with periampullary adenomas had a normal-appearing papilla of Vater. Since gastroduodenal polyps are common in familial adenomatous polyposis, oesophagogastroduodenoscopy should be performed at the time of diagnosis. Biopsy of polyps as well as biopsy of a normal-appearing papilla of Vater should be performed. Due to their malignant potential, if identified, gastroduodenal adenomatous polyps should be destroyed.

[Digestive lymphomatous polyposis]. / Polypose lymphomateuse digestive.

We report 7 prospectively followed cases of lymphomatous polyposis of the gastrointestinal tract. They were characterized by multiple polypoid lesions affecting several segments of the gastrointestinal tract always involving the colon and the rectum. An ileocecal mass was present in 4 cases. Regional lymph node involvement was constant. Peripheral lymphadenopathy was frequent (5 cases out of 7), as was other extra-digestive extension to the bone marrow (4 cases out of 7) and cavum (3 cases out of 7). The histopathological aspect was that of a small cleaved cells (working formulation) or centrocytic (Kiel classification) non-Hodgkin's lymphoma. The peculiar morphology and phenotype of the tumoral B-lymphocytes suggest their possible follicle marginal zone origin. Lymphomatous polyposis bore a rapidly fatal prognosis in every case (mean survival 20 months). This study of seven patients together with the 20 well-documented cases of the literature confirms the existence of lymphomatous polyposis as a distinctive clinicopathological entity among gastrointestinal non-Hodgkin's lymphoma.

The difference in malignancy between pedunculated and sessile polypoid lesions of the gallbladder.

Surgically resected polypoid lesions of the gallbladder from 97 patients were evaluated to determine both the shape (pedunculated or sessile) and diameter of the polypoid lesions, in association with malignancy. At the time of analysis, the largest polypoid lesion examined was when two or more lesions were detected in one patient because they were histologically the same. Carcinoma was noted in 9 (13%) of the 67 pedunculated lesions and in 10 (33%) of the 30 sessile lesions. The sessile carcinoma was 14 +/- 4 mm (8-20 mm) in maximum diameter, which was not significantly larger than the 8 +/- 4 mm of the benign polyps, but significantly smaller than the 22 +/- 8 mm (14-35 mm) of pedunculated carcinomas (p less than 0.05). Cancer invasion extended beyond the muscular layer in eight cases (80%) of sessile carcinoma, and two of them were 10 mm or less in diameter. On the other hand, cancer invasion was beyond the muscular layer in two cases (22%) of pedunculated carcinoma (p less than 0.05), and these two were 30 mm or more in diameter. Likewise, sessile carcinoma was characterized by both a higher incidence of nodal involvement and poorer prognosis, compared with pedunculated carcinoma. These findings indicate that surgery should be undertaken when sessile polyps are detected by ultrasonography, even though the polyp may be less than 10 mm in diameter. On the other hand, with regard to the pedunculated type, malignancy should be suspected when the polyp is more than 10 mm in diameter.

[Optimization of the treatment of patients with malignant polyps of the cervix uteri]. / Optimizatsiia lecheniia bol'nykh s malignizirovannymi polipami sheiki matki.

The study was concerned with an analysis of 5-year results of treatment of Ca in situ (II) and invasive cancer (53 patients) arising in cervical polyps. Recurrences were observed in 15.1% of cases undergoing sparing procedures. Conization assures an optimal removal of tissue for Ca in situ. Reproductive patients with invasive carcinoma should also undergo conization. Extirpation of the uterus with appendages should be carried out in menopausal patients and cases of concomitant uterine pathology.

Prognosis for polypoidal melanoma is determined by primary tumor thickness.

Survival of 23 patients with polypoidal malignant melanomas was compared with an identical number of patients with nonpolypoidal melanomas of similar thickness, stage, and location. Five-year survivals for the two groups were not significantly different. The dominant prognostic factor leading to the adverse prognosis associated with polypoidal melanomas was the primary tumor thickness (all greater than 1.70 mm) and not the polypoidal morphologic configuration per se.

[Factors affecting patient survival in cervical cancer]. / Faktory, vliiaiushchie na vyzhivaemost' bol'nykh rakom sheiki matki.

The study is concerned with an evaluation of 636 case histories of cervical carcinoma. Combined treatment was given in 596 cases; treatment was confined to surgery in 40 cases. The study included an assessment of the end results with respect to stage, age of patient, histological pattern and type of growth of tumor and stage at which radiation therapy was given. Prognosis for cervical carcinoma appeared to depend on the stage of tumor process, age and type of growth, while no correlation was observed between histological pattern and survival, except for microcarcinoma and malignant polyp. Better results were obtained, when preoperative radiation course was given to patients with cervical carcinoma stage II (parametrial variant). The end results were worse in cases of regional metastases.