Agreement of histopathological findings of preoperative uterine curettage and hysterectomy specimens: impact of time factor and hormonal therapy.

OBJECTIVES: To study the agreement of preoperative curettage and definitive histology after hysterectomy as well as the correlation of time factor and hormonal therapy to this agreement. METHODS: This retrospective study was done in the Departments of Obstetrics and Gynecology and Pathology, Faculty of Medicine, Mansoura University, Egypt. Pathology reports of patients exposed to dilatation and curettage followed by hysterectomy during the period from May, 2004 to April, 2011 were reviewed. RESULTS: We reviewed 83 cases who fulfilled the inclusion criteria. There were non-significant differences between findings of D&C and hysterectomy specimens (P = 0.42). The concordance rate between D&C and hysterectomy was 79.5%. One case of endometrial carcinoma (1.2%), one case of simple endometrial hyperplasia, one case of atrophic endometrium, and two cases of endometrial polyp were diagnosed only after hysterectomy (4.8%). Furthermore, histologic examination of hysterectomy specimens confirmed only 8 of 13 cases (61.5%) of endometrial hyperplasia with atypia. No significant correlation of time factor and hormonal therapy to the agreement between findings of D&C and hysterectomy specimens (P = 0.58 & 0.19 respectively). CONCLUSION: There was no significant difference between preoperative endometrial histology and hysterectomy specimens (P = 0.41).This agreement had not been significantly affected by time interval and hormonal therapy. Future researches with larger number of cases are needed to confirm or disagree with our findings.

The impact of uterine re-curettage, pre-evacuation and week-one level of hCG on the number of chemotherapy courses in treatment of post molar GTN.

BACKGROUND: Post molar GTN was reported to occur in 7.5-20% of patients following evacuation of complete hydatidiform moles and in 2.5-7.5% following evacuation of partial moles. The role of uterine re-curettage in post molar GTN is not clear. OBJECTIVES: Study of the correlation of pre-evacuation and week- one level of hCG, and uterine re-curettage to the number of chemotherapy courses in treatment of post molar GTN. PATIENTS AND METHODS: This retrospective study included 29 cases of post molar GTN through reviewing their medical records. RESULTS: There were 25 cases (86.21) of low risk, and 4 cases of high risk score (13.79%). The 3 year survival was 96.6%. There were non-significant correlation of age, parity, pre-evacuation level and hCG in week-1 to number of chemotherapy courses, while uterine re-curettage was significantly correlated to number of chemotherapy courses (p = 0.04). CONCLUSION: Uterine re-curettage was significantly correlated to less number of chemotherapy courses in patients with post molar GTN (p = 0.04). Pre-evacuation and week-1 hCG were not correlated to number of chemotherapy cycles. A large prospective randomized trial to clarify the beneficial effect of uterine re-curettage is recommended.

Pretreatment study of P53 overexpression for selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma: a randomized-controlled study.

PURPOSE: To study the value of pretreatment testing of P53 overexpression in selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma. PATIENTS AND METHODS: This prospective randomized clinical study included 38 patients with histologically confirmed endometrial carcinoma and staged clinically as stage I. Immunohistochemical staining of the tumor specimens obtained by dilatation and curettage with P53 monoclonal antibodies was done. The patients were randomized into two groups according to the planned surgical treatment: hysterectomy group and hysterectomy plus pelvic lymphadenectomy group. RESULTS: There was no significant difference in mean age, parity, medical status, surgical stage, histologic types, grade of differentiation, and myometrial invasion between the two groups. The survival rate in the hysterectomy group in our study was 82.4% and the recurrence rate was 17.6%, while in hysterectomy and lymphadenectomy group the survival rate was 81.0% and the recurrence rate was 19%. Adding pelvic lymphadenectomy was found to be associated with prolonged recurrence time in the P53-positive patients (24.07 vs. 17.8 months for group A). CONCLUSION: Pretreatment testing of P53 expression is recommended to help with other prognostic factors in the selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma.