Myometrial invasion as a prognostic factor in endometrial adenocarcinoma

Myometrial invasion is one of the most important prognostic factors in endometrial cancer. MATERIAL AND METHOD: We have studied a cohort of 62 patients with endometrial cancer who underwent surgery in 4-th Gynecology Clinic of "Cuza Vod?" Hospital, Ia?i between 1997-2008. Myometrial invasion was determined intraoperatory by gross visual inspection and frozen section exam and by histopathological exam after surgery. RESULTS: We have investigated the relationship between myometrial invasion and other prognostic factors: histological type, grading and lymph node metastasis. In 36 cases the invasion was absent or minimal, and only in a cases the myometrum was completely invaded.     

Recurrence patterns and complications in endometrial adenocarcinoma with cervical involvement

Background: Cervical involvement in endometrial carcinoma is a diverse entity, and the optimal management of these patients is not well understood. Methods: Recurrence patterns and complications in 202 patients with histologically confirmed endometrial carcinoma with cervical involvement were retrospectively studied. Results: The 5-year actuarial survival rate for all patients was 65%. Recurrences were documented in 80 (40%) of the patients, and the overall long-term survival rate in this group was 4%. Patients treated with radical hysterectomy (n=33) had a 6% isolated pelvic recurrence rate and the lowest serious complication rate among the five treatment groups despite having the highest frequency of risk factors for recurrence among any of the groups studied. Patients treated with extrafascial hysterectomy alone (n=37) had a 14% pelvic recurrence rate and very few complications. When radiotherapy preceded extrafascial hysterectomy (n=37), the frequency of pelvic recurrences was 30%, and 19% experienced serious gastrointestinal or genitourinary tract complications. When radiotherapy followed extrafascial hysterectomy (n=68), the pelvic recurrence rate was 24%, and 13% experienced serious complications. Overall, 24% of patients (49 of 202) had isolated pelvic recurrences, whereas 10% (21 of 202) had isolated distant recurrences and 5% (10 of 202) were simulataneously diagnosed with both pelvic and distant recurrences. Conclusions: This large data base suggests that older conventional forms of therapy, particularly those using preoperative radiotherapy, subject the patient to significant morbidity over a 5- to 10-year period and, in terms of local control, are not necessarily superior to therapeutic modalities using primary surgical evaluation, such as radical hysterectomy. Consideration of primary surgery should be given in the appropriate situation, and radical hysterectomy should be considered when gross cervical involvement is encountered and intraoperative exploration does not show obvious extrauterine disease. Presented at the 47th Annual Cancer Symposium of The Society of Surgical Oncology, Houston, Texas, March 17–20, 1994.     

Bcl-X expression in normal endometrium, endometrial hyperplasia and adenocarcinoma

IntroductionThat apoptosis occurred in normal endometrium, endometrial hyperplasia and adenocarcinoma has been demonstrated by severalstudiesll 4]. The susceptibility of an individualcell to apoptosis is determined by the balanceof numerous intracellular proapoptotic and antiapoptotic gene expression. Recently, itwas shown that apoptosis in human endometrium was related to the expression ofBcl--2 and Ba-c[5'6]. Bcl--X, one of the membersof the Bcl--2 family, through alternate splicing, produ…     

Recurrent bladder adenocarcinoma in an ileal conduit stoma: A case report

BACKGROUND: The first case of a patient with recurrent adenocarcinoma in an ileal conduit stoma 7 months after radical cystectomy is reported. RESULTS/DISCUSSION: The most likely explanation of this case is hematogenous metastasis based on the clinical diagnosis and the pathological immunostaining examination of cytokeratin.     

Microsatellite instability in endometrioid type endometrial adenocarcinoma is associated with poor prognostic indicators

Microsatellite instability (MSI) has been reported in 25% to 45% of sporadic endometrial carcinoma. The clinicopathologic and molecular characteristics of MSI-high phenotype in colorectal and gastric carcinomas have been widely investigated; however, the clinicopathologic impact of MSI on endometrial carcinomas remained unclear. This study was performed to determine the clinicopathologic and molecular significance of MSI in endometrial carcinomas. We analyzed the MSI status using National Cancer Institute-recommended 5 microsatellite markers, and the immunohistochemical profiles of various regulatory proteins of cell cycle and apoptosis using tissue microarray in 100 endometrial carcinomas. The results were compared between MSI-high and MSI(-) groups as for the traditional clinicopathologic prognostic parameters and the immunoreactivities of various regulatory proteins. We especially focused on the endometrioid type adenocarcinoma to exclude the bias from nonendometrioid type adenocarcinomas with more aggressiveness and a close association with MSI(-) phenotype. The incidence of MSI-high phenotype was significantly higher in endometrioid type than in nonendometrioid serous type (20% vs. 0%, P<0.001). It showed orderly increase in the frequencies of MSI-high phenotype in higher histologic grade (13% vs. 21% vs. 50% in histologic grade I, II, and III, P=0.039). The MSI-high phenotype was related with the presence of lymphovascular invasion (P=0.008), deep myometrial invasion (P=0.040), and the higher clinical stages (P=0.018) independent of tumor grade. We also found a correlation between MSI-high phenotype and higher cyclin A and skp2 immunoreactivity (P=0.03 and 0.05, respectively), known to be the poor prognostic molecular indicators. According to these results, the MSI may represent the poor prognostic impact on the endometrioid type endometrial adenocarcinoma.     

子宫内膜癌术后激素替代治疗对肿瘤预后的影响——一项小样本的配对研究

目的探讨子宫内膜癌术后激素替代治疗（HRT）对肿瘤预后的影响。方法收集1983年1月至2005年12月期间,北京协和医院收治的年龄小于50岁、手术绝经的子宫内膜癌患者76例,按照患者的年龄段、接受治疗年限,以1：2匹配研究组和对照组。共收集到术后行HRT的患者17例,设为研究组。匹配未接受HRT的患者34例,设为对照组。对上述51例患者的临床资料进行回顾性分析和统计学检验。结果研究组1例复发（5．9％）,对照组4例复发（11．8％）,两组间差异无统计学意义（P=0．654）。病例组无瘤缓解期（64．00±33．20）月,对照组（49．38±36．97）月,两组间差异无统计学意义（P=0．346）。多因素Cox回归模型分析,HRT不是患者术后复发的独立危险因素（P=0．338）。结论对于Ⅰ期子宫内膜癌患者术后行HRT未增加肿瘤的复发率。     

Prediction of tumor grade and lymphovascular space invasion in endometrial adenocarcinoma with MR imaging-based radiomic analysis

PurposeTo evaluate the capabilities of two-dimensional magnetic resonance imaging (MRI)-based texture analysis features, tumor volume, tumor short axis and apparent diffusion coefficient (ADC) in predicting histopathological high-grade and lymphovascular space invasion (LVSI) in endometrial adenocarcinoma.Materials and methodsSeventy-three women (mean age: 66 ± 11.5 [SD] years; range: 45–88 years) with endometrial adenocarcinoma who underwent MRI of the pelvis at 1.5-T before hysterectomy were retrospectively included. Texture analysis was performed using TexRAD® software on T2-weighted images and ADC maps. Primary outcomes were high-grade and LVSI prediction using histopathological analysis as standard of reference. After data reduction using ascending hierarchical classification analysis, a predictive model was obtained by stepwise multivariate logistic regression and performances were assessed using cross-validated receiver operator curve (ROC).ResultsA total of 72 texture features per tumor were computed. Texture model yielded 52% sensitivity and 75% specificity for the diagnosis of high-grade tumor (areas under ROC curve [AUC] = 0.64) and 71% sensitivity and 59% specificity for the diagnosis of LVSI (AUC = 0.59). Volumes and tumor short axis were greater for high-grade tumors (P = 0.0002 and P = 0.004, respectively) and for patients with LVSI (P = 0.004 and P = 0.0279, respectively). No differences in ADC values were found between high-grade and low-grade tumors and for LVSI. A tumor short axis ≥ 20 mm yielded 95% sensitivity and 75% specificity for the diagnosis of high-grade tumor (AUC = 0.86).ConclusionMRI-based texture analysis is of limited value to predict high grade and LVSI of endometrial adenocarcinoma. A tumor short axis ≥ 20 mm is the best predictor of high grade and LVSI.     

孕激素对子宫内膜腺癌细胞RL95-2中骨桥蛋白表达的影响

目的探讨孕酮对人子宫内膜细胞RL95-2骨桥蛋白(OPN)表达的调节作用及其临床意义。方法利用免疫荧光方法观察OPN在RL95-2细胞的表达定位。将不同浓度的孕酮(1×10-9 mol/L、1×10-7 mol/L、1×10-5 mol/L)处理RL95-2细胞24h,采用逆转录聚合酶链反应(RT-PCR)技术和免疫印迹检测(Western blot)技术检测各组OPN mRNA和蛋白的表达水平,以不加孕酮的实验组为空白对照组。结果 OPN定位表达于RL95-2细胞膜表面;与对照组相比,高浓度孕酮(1×10-5 mol/L)组的OPN mRNA和蛋白的表达显著增加(P0.05),低浓度孕酮(1×10-9 mol/L)组则显著抑制OPN mRNA和蛋白的表达(P0.05)。结论在一定浓度范围内,孕酮可双向调节子宫内膜表面骨桥蛋白的表达。     

Low-grade mucinous adenocarcinoma of the uterine corpus: a rare and deceptively bland form of endometrial carcinoma

Uterine corpus mucinous epithelial proliferations present diagnostic challenges due to histologic similarities to cervical lesions. We present a rare but distinctive endocervical-like mucinous carcinoma of the uterine corpus resembling adenoma malignum of the cervix that can be mistaken for a benign endometrial process. The clinical-pathologic features of 16 endometrial carcinomas exhibiting a pure endocervical-like mucinous proliferation were evaluated. Hysterectomy and available prehysterectomy specimens were assessed for architectural complexity, nuclear pleomorphism, macronucleoli, nuclear pseudostratification, mitotic index, necrosis, prominent neutrophils, and voluminous extracellular mucin (mucin encompassing >50% of a ×40 field). Cases involving the cervix or lower uterine segment were confirmed as endometrial in origin based on immunohistochemical stains (estrogen receptor, progesterone receptor, p16, and vimentin). Patient age ranged from 45 to 70 years; 6 of 16 (38%) were premenopausal, 11 of 16 (69%) had abnormal bleeding, and 7 of 16 (44%) had a history of hormonal therapy. Prehysterectomy diagnoses were benign in 2 of 16 (13%) cases, borderline in 9 of 16 (56%) cases, and carcinoma in 5 of 16 (31%) cases, whereas 8 of 16 (50%) hysterectomy specimens showed myoinvasive adenocarcinoma. With the exception of 2 cases, architectural complexity was low-to-moderate and no specimens showed marked nuclear pleomorphism. Macronucleoli and abundant mitotic activity were absent. Nuclear pseudostratification was present in 7 of 16 (44%) cases, necrosis in 1 of 16 (6%) cases, prominent neutrophils in 7 of 16 (44%) cases, and voluminous extracellular mucin in 9 of 16 (56%) cases. Cytologically bland mucinous epithelial proliferations should be diagnosed with caution in endometrial samplings. The presence of an endocervical-like mucinous epithelial process in association with voluminous extracellular mucin should prompt consideration for a low-grade mucinous adenocarcinoma of the uterine corpus.     

Recurrent disease after microscopically radical (r0) resection of periampullary adenocarcinoma in patients without adjuvant therapy

The survival rate after microscopically radical resection of pancreatic duct adenocarcinoma is still poor. Patients with ampulla of Vater and distal common bile duct adenocarcinoma indicate a much more favorable prognosis. Controversy exists as to whether adjuvant therapy could improve the outcome in these patients after resection. The aim of the present study was to analyze the pattern of recurrence in patients with periampullary adenocarcinoma after pancreatoduodenectomy. Between January 1992 and December 2002, all patients with an R0 resection were identified and used for this analysis. A total of 190 patients underwent a microscopically radical resection and received no adjuvant therapy. Of those, 72 patients were diagnosed with pancreatic duct adenocarcinoma, 86 patients were diagnosed with ampulla of Vater adenocarcinoma, and 31 patients were diagnosed with distal common bile duct adenocarcinoma. Recurrent disease was indicated in 81% of the patients with pancreatic duct adenocarcinoma, 50% of the patients with ampulla of Vater adenocarcinoma, and in 74% of the patients with bile duct adenocarcinoma. Multivariate analysis revealed that lymph node metastases were prognostic for recurrent disease in patients with pancreatic duct adenocarcinoma (P = 0.038). The depth of invasion (T4, P < 0.032) and lymph node metastases (P < 0.001) were prognostic in patients with ampulla of Vater adenocarcinoma. Poor tumor differentiation (P < 0.001) was prognostic in patients with distal bile duct adenocarcinoma. Selected patients with periampullary malignancies exhibited a high recurrence rate and should be encouraged to enroll in clinical trials for adjuvant treatment including local therapy (radiotherapy) according to the identified prognostic factors. Presented at the Forty-Fifth Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation).     

对比弥散张量成像与弥散加权成像评估子宫内膜样腺癌病理分级的价值

目的对比弥散张量成像(DTI)与弥散加权成像(DWI)评估子宫内膜样腺癌病理分级的效能。方法回顾性分析41例经病理证实的子宫内膜样腺癌患者,其中高分化(G1级)15例、中分化(G2级)14例、低分化(G3级)12例,术前均接受常规MR平扫及DTI、DWI,比较各级子宫内膜样腺癌的表观弥散系数(ADC)、平均弥散系数(MD)及各向异性分数(FA)值,分析各参数对病理组织学分级的诊断效能。结果 G1、G2、G3级子宫内膜样腺癌之间ADC值及MD值差异均有统计学意义(P均0.001),FA值差异无统计学意义(P0.05)。子宫内膜样腺癌ADC值(r=-0.589,P0.001)、MD值(r=-0.724,P0.001)均与其组织学分级呈负相关。将G3级归为高危组、G1和G2级归为低危组,高危组ADC值、MD值均低于低危组(P均0.01)。受试者工作特征(ROC)曲线结果显示,ADC、MD值鉴别诊断高、低危子宫内膜样腺癌的曲线下面积(AUC)分别为0.792和0.868(P均0.01)。结论 DTI和DWI均可用于评估子宫内膜样腺癌病理分级,且MD值效能较ADC值更高。     

Recurrent clubfoot

About 25% of operated clubfeet will develop a recurrency or show a marked residual deformity. As main factor the failure of concentric reduction at the time of initial surgery has to be considered. Residual forefoot adduction and supination are the most common persistent deformities. Based on the experience with 94 recurrent/residual clubfeet (patients < 10 years) the surgical treatment at different age-groups is presented. As a general rule soft tissue release is applicable as a repeated procedure until the age of about eight to ten years. For revision in patients between two and eight years we recommend a closing wedge osteotomy of the cuboid and a tibialis transfer additional to repeated release-procedures. In patients older than eight to ten years mid-tarsal osteotomies, correction according to llizarov with the external fixator or triple arthrodesis are to be considered as single or combined procedures.