DNA-content in endometrial carcinoma of tamoxifen-treated breast cancer patients

DNA measurements and histopathologic evaluation were performed in 17 patients treated with adjuvant tamoxifen for early breast cancer and who developed endometrial carcinoma during or after the tamoxifen therapy. The tumors were exclusively characterized by euploid DNA content except for two cases, one mixed mesodermal sarcoma, a highly malignant and rare tumor, and one adenocarcinoma. Although the use of adjuvant tamoxifen therapy most likely enhances the risk of developing endometrial carcinoma, the beneficial effects of adjuvant breast cancer treatment is of well-known clinical importance. The hazards of giving long-term tamoxifen seem to be low since the endometrial tumors were associated with low-grade malignancy and euploid DNA pattern.     

Uterine sarcomas in breast cancer patients treated with tamoxifen

Tamoxifen (TMX) has been related with the development of uterine sarcomas. Since the first reported case in 1988, 65 TMX-related cases have been referred to. Here we present three new cases of uterine sarcomas in patients with breast cancer treated with TMX and we comment on the outcome of the cases described in the literature. In the past 25 years, 60 uterine sarcomas have been diagnosed and treated in Hospital Clínic. Three patients have previously received TMX 20 mg/day for 3, 5, and 7 years for breast cancer. Uterine sarcoma appeared 5, 5, and 7 years, respectively, after the start of TMX treatment, and all of them had stage I (FIGO) disease. Two patients had a carcinosarcoma and one patient had an adenosarcoma. After treatment, the disease progressed in two patients and the third patient is alive having a follow-up of 42 months. The low incidence of uterine sarcomas makes it difficult to establish a relationship with TMX. Nevertheless, looking at the literature data, 20 mg/day of TMX over 1 year could be enough to develop uterine sarcoma; the sarcoma appears mainly during the first 8 years and seem to behave more aggressively. Although only 65 cases have been reported in the past 14 years, a strict follow-up is necessary in patients with breast cancer receiving TMX therapy.     

Pathologic stage III endometrial cancer treated with adjuvant radiation therapy

Gerszten K, Faul C, Huang Q. Pathologic stage III endometrial cancer treated with adjuvant radiation therapy. Int J Gynecol Cancer 1999; 9: 243–246.
This study was undertaken to evaluate the outcome of pathologic stage III endometrial carcinoma treated with adjuvant radiation therapy (RT). A retrospective review was performed on 32 patients receiving adjuvant RT following abdominal hysterectomy for stage III endometrial carcinoma (19 IIIA, 2 IIIB, 11 IIIC) between 1980 and 1996. Papillary-serous and clear cell adenocarcinomas were excluded. Pathologic nodal sampling was performed on 25 patients (78%). All patients received postoperative external beam RT to the pelvis and 25 of 32 received an additional brachytherapy boost to the vaginal apex. Three patients with involved para-aortic nodes received extended field RT. Mean follow up was 70 mos. Twenty-four patients remain disease-free at mean follow-up of 68 mos. Distant recurrence (DR) occurred in 7 patients at mean of 38 mo. Two local failures were associated with DR. Six patients died of disease after recurrence despite salvage systemic therapy. One patient developed isolated local failure (vaginal apex) and remains disease-free 37 mo after surgical/chemotherapeutic salvage. 5 of 8 (45%) stage IIIC patients developed recurrence vs. only 2 of 19 (10%) stage IIIA cases. 2 of 3 patients treated with extended field RT for positive para-aortic nodal disease remain disease-free at 128 and 56 mo. Long-term survival can be achieved in stage III endometrial carcinoma. Few patients with either adnexal metastases or positive cytology alone develop recurrence. However, patients with stage IIIC disease fare poorly with local therapy alone .     

Adenosarcoma of the uterus following tamoxifen treatment for breast cancer

Mourits MJE, Hollema H, Willemse PHB, De Vries EGE, Aalders JG, Van der Zee AGJ. Adenosarcoma of the uterus following tamoxifen treatment for breast cancer. Int J Gynecol Cancer 1998; 8 : 168–171.
A 71-year-old patient developed an uterine adenosarcoma two months after two years of tamoxifen adjuvant treatment for early breast cancer. After curettage for postmenopausal bleeding, the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Histologic examination revealed an adenosarcoma of the uterus without myometrial invasion or lymphatic spread. After four years of follow-up, there was no evidence of recurrent disease. The possible association between tamoxifen treatment and uterine sarcoma is discussed.     

Two-year follow-up of patients with endometrial carcinoma after preoperative fluid hysteroscopy

Gücer F, Tamussino K, Reich O, Moser F, Arikan G, Winter R. Two-year follow-up of patients with endometrial carcinoma after pre-operative fluid hysteroscopy. Int J Gynecol Cancer 1998; 8 :476–480.
The aim of the present study was to analyze whether pretherapeutic hysteroscopy increases the recurrence rate in patients with endometrial cancer confined to the uterus. Between January 1993 and December 1995 a total of 33 patients with endometrial carcinoma underwent surgical staging following diagnostic fluid hysteroscopy and curettage at our department. Twenty-seven patients who had disease confined to the uterus without involvement of the uterine serosa formed the study group. Fifty-five patients with endometrial carcinoma confined to the uterus who had undergone surgery after diagnostic curettage without hysteroscopy during the same period were identified as controls. The median follow-up in the hysteroscopy group and the controls was 29 months (range 26–46) and 30 months (range 10–48), respectively. In the hysteroscopy group, no patient died of disease but one patient (3.7%) developed a local recurrence 37 months after primary treatment. In the control group, one patient (1.8%) had a local and para-aortic recurrence 20 months after primary treatment. Preceding diagnostic fluid hysteroscopy does not seem to increase the risk of early recurrence in patients with endometrial carcinoma histologically confined to the uterus.     

乳腺癌患者服用三苯氧胺后子宫内膜病变150例临床病理分析

目的分析乳腺癌患者服用三苯氧胺(tamoxifen,TAM)后子宫内膜的病理变化,以期制定随访中的相应对策。方法对北京大学第一医院1993年1月至2008年8月乳腺癌患者术后服用三苯氧胺期间或停药后,因妇科问题而住院诊治者150例进行回顾性分析。结果绝经前53例,绝经后97例。与使用三苯氧胺有关的子宫内膜病理结果为:内膜息肉、内膜单纯性增生、内膜非典型增生和内膜癌的例数在绝经前组合计为10例(10/53,18.9%),在绝经后组中49例(49/97,50.5%)。子宫内膜非典型增生和子宫内膜癌均发生在绝经后组。乳腺癌患者服用三苯氧胺后,发生子宫内膜息肉等病理表现与患者是否绝经、是否有阴道出血这两个因素呈正相关,而与三苯氧胺服用时间、剂量及乳腺癌患病年限无明显相关性。结论应重视并加强对绝经后乳腺癌患者服用三苯氧胺期间和之后的随访工作,对绝经后服用三苯氧胺的患者,建议用药前进行妇科评估,包括B超了解子宫内膜厚度,并加强用药期间的随访工作。     

Angiogenesis in endometrial carcinoma

Increasing microvessel density correlates with adverse prognosis in many tumors. The aim of this study was to quantify angiogenesis in a range of endometrial carcinomas, by measuring microvessel density in the stroma, and to explore any relationship with known prognostic features. Sections from 60 hysterectomy specimens were stained with Factor VIII related antigen, and the microvessel count per mm² of stroma was determined for each case. Carcinomas arising in an atrophic or inactive endometrium had a significantly higher stromal vascular density than those arising in a hyperplastic or proliferative endometrium. There was no significant association between stromal vascular density, and age, histologic grade, tumor type, presence of lymphovascular space permeation, or depth of myometrial invasion. We conclude that higher stromal vascularity is a feature of the more aggressive subtype of endometrial carcinomas arising in an atrophic endometrium but does not correlate with any other prognostic features.     

Failure of megestrol acetate to reverse tamoxifen induced endometrial neoplasia: two case reports

Abstract. Rose PG, Brandewie EV, Abdul-Karim FW. Failure of megestrol acetate to reverse tamoxifen induced endometrial neoplasia: two case reports.
Tamoxifen's agonist effect on the endometrium has been associated with an increased incidence of endometrial carcinoma. It has been suggested that this agonist effect may be averted by the concomitant use of a progestational agent. We report two patients with breast cancer receiving tamoxifen who developed endometrial carcinoma and atypical endometrial hyperplasia, respectively. In one patient, this occurred despite the use of concomitant megestrol acetate. In the other patient, tamoxifen-associated endometrial hyperplasia persisted and progressed despite cessation of tamoxifen and initiation of megestrol acetate therapy. These cases may have implications for strategies to avert tamoxifen induced endometrial neoplasia.     

子宫内膜癌1299例临床病理分析

目的分析子宫内膜癌临床病理特点及变化趋势,探讨子宫内膜癌诊治中的相关问题。方法回顾性分析1989年1月至2007年6月经四川大学华西第二医院手术治疗的1299例子宫内膜癌患者的临床病理资料,并分3时段进行对比分析(第1时段:1989-1995年,290例;第2时段:1996-2003年,499例;第3时段:2004-2007年6月,510例)。结果(1)我院3时段年均收治手术治疗子宫内膜癌患者分别为41、62、146例,呈逐年显著上升趋势。(2)3时段<45岁患者所占比例分别为5.5%、14.4%及18.6%,呈上升趋势(P<0.05)。(3)特殊病理类型(非子宫内膜样腺癌)所占比例第3时段上升至13.5%,高于第1时段的0.3%和第2时段的7.6%(P<0.05)。(4)每个时段内临床分期误差率以Ⅱ期为最高,3时段分别为80.5%、67.5%及77.8%。结论(1)子宫内膜癌发病逐年增多,且发病年龄有年轻化趋势。(2)特殊病理类型子宫内膜癌所占比例显著增加。(3)子宫内膜癌临床Ⅱ期分期误差率仍较高。     

子宫内膜癌保留生育功能的治疗

对于年轻未生育子宫内膜癌患者的治疗目前存在较多争议。文章结合临床实践体会和文献报道,重点就其适应证选择、治疗前评估、治疗方案、疗效评价、病情监测、治疗后的生育问题、完成生育后的处理等做一阐述。     

Expression of the epidermal growth factor system in endometrial cancer after adjuvant tamoxifen treatment for breast cancer

The aim of our study was to describe the expression of cerbB-1, cerbB-2, cerbB-3 and cerbB-4 in endometrial cancer tissue and its correlation with clinicopathologic features and prognosis of endometrial cancer patients diagnosed during or after tamoxifen treatment for breast cancer. Thirteen tamoxifen-related endometrial cancers were identified from the archives of the Department of Obstetrics and Gynecology of the University of Patras, Medical School. Tissue specimens from endometrial lesions were immunostained for cerbB-1, cerbB-2, cerbB-3 and cerbB-4. For cerbB-1, five cases were positive and eight were negative. For cerbB-2, ten cases were positive and three were negative. For cerbB-3, nine cases were positive and four were negative. For cerbB-4, eight cases were positive and five were negative. However, a limitation of our study is that the number of cases was small, and further investigations are necessary to allow a more focused evaluation of cerbB-1, cerbB-2, cerbB-3 and cerbB-4 status, as a prognostic factor for endometrial cancer after tamoxifen treatment.     

Omentectomy, peritoneal biopsy and appendectomy in patients with clinical stage I endometrial carcinoma

Abstract. Saygili U, Kavaz S, Altunyurt S, Uslu T, Koyuncuoglu M, Erten O. Omentectomy, peritoneal biopsy, and appendectomy in patients with clinical stage I endometrial carcinoma.
The aim of this study was to evaluate whether omentectomy, appendectomy, and peritoneal biopsy should be a routine part of staging surgery in endometrial carcinoma. Data of 97 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, and histology were investigated. The chi-square (χ²) test was used for statistical analysis.
Of 97 patients, six (6%) had omental metastases, which was microscopic in four. There was a statistically significant relationship between omental metastasis and tumor grade ( P < 0.01). Deep myometrial invasion was significantly more common in patients with omental metastases. Tumor was found in one of 55 appendectomy specimens (2%). Omentectomy may be included in surgical staging in patients with deeply invasive or grade 3 endometrial cancer because of the possibility of omental metastasis in spite of what appears to be stage I disease in laparotomy. In other cases, omentectomy and appendectomy and biopsies from peritoneal sites should be performed in the presence of grossly suspicious disease.     

Long-term transvaginal ultrasonographic endometrial follow-up in postmenopausal breast cancer patients with tamoxifen treatment.

OBJECTIVE: The aim of this study was to evaluate changes in transvaginal ultrasonographic endometrial thickness with increased duration of tamoxifen treatment in postmenopausal breast cancer patients. MATERIAL AND METHODS: In this prospective study we evaluated the changes (mean +/- SD) of endometrial thickness measured by transvaginal ultrasonography in 181 postmenopausal breast cancer patients, according to the duration of tamoxifen treatment. According to our protocol, the ultrasonographic evaluations were performed every 6 months for the first 2 years of the follow-up and every 12 months thereafter. Two such subsequent ultrasonographic evaluations were performed in 181 patients following 35.1 +/- 41.7 months of tamoxifen treatment, three studies in 127 patients following 44.7 +/- 47.98 months of treatment, four studies in 75 following 54.2 +/- 61.7 months of treatment, five studies in 51 patients following 65.3 +/- 74.4 months of treatment, and six studies in 27 patients following 79.5 +/- 98.8 months of treatment. RESULTS: The measured endometrial thickness detected varied from 8.84 +/- 4.66 to 10.61 +/- 12.35 mm. There were no significant changes in mean +/- SD of endometrial thickness following various durations of tamoxifen treatment. CONCLUSIONS: Extension of duration of tamoxifen treatment in postmenopausal breast cancer patients up to 79.48 +/- 98.79 consecutive months does not cause a significant increase in transvaginal ultrasonographic endometrial thickness.     

子宫内膜癌保留生育功能的治疗

未生育的年轻子宫内膜癌患者常常寻找保留生育功能的治疗方法。本文的主要目的是复习有关子宫内膜癌患者保留生育功能治疗的相关文献,探讨适合进行保留生育功能治疗的患者特征、治疗前的评估、治疗方案、疗效以及妊娠率。     

First reported case of endometrial carcinoma in association with HIV infection

Gard GB, McNally OM, Mulvany NJ, Bernshaw DML, Narayan K, Torresi J, Stewart JM, Quinn MA. First reported case of endometrial carcinoma in association with HIV infection. Int J Gynecol Cancer 1999; 9: 259–263.
Endometrial adenocarcinoma is the most common gynecologic cancer in developed countries, although it has never before been documented in a female infected with human immunodeficiency virus (HIV). By contrast, cervical carcinoma is well described in association with HIV infection and in 1993 was added to the AIDS case definition. We present the unique case of a 38-year-old HIV-infected female with endometrial carcinoma, who became rapidly disseminated following her initial surgery. Although HIV is unlikely to have an etiologic role in endometrial carcinoma, it is conceivable that immunosuppression contributed to an accelerated course of her malignancy.     

子宫内膜样腺癌术后辅助放化疗的临床观察

目的评价有高危因素的子宫内膜样腺癌术后辅助放化疗的价值。方法选择宫颈侵犯、G3级、深肌层浸润、淋巴脉管侵犯、腹水细胞学阳性等高危因素的子宫内膜样腺癌268例,140例接受术后放疗,128例接受术后放化疗,比较两组的5年生存率。结果术后辅助放疗和术后辅助放化疗的5年生存率分别为92．14％和92．19％,两者比较,差异无统计学意义（P〉0．05）。而两组的毒性反应比较,术后辅助放化疗组的毒性反应明显增加（P〈0．05）。结论术后辅助盆腔放疗加化疗不能提高具有高危因素的子宫内膜样腺癌的5年生存率,且毒性反应明显增加。     

Intraoperative frozen section examination of myometrial invasion depth in patients with endometrial carcinoma

The objective of this study was to evaluate the accuracy of frozen sections (FS) as a method for estimation of the depth of myometrial invasion in patients with stage I endometrial carcinoma. During a 3-year period (1989–1992), 46 consecutive patients with FIGO stage I endometrial carcinoma were included in this study. The depth of myometrial invasion was estimated by FS examination performed during surgery. The final histologic findings of the surgical specimen were compared to the FS evaluation. The results of this study demonstrate that deep or superficial myometrial invasions were correctly diagnosed by FS in 42 out of 46 cases (91.3%). Three cases (6.6%) with deep myometrial invasion were falsely diagnosed as superficially invasive. One case with superficial invasion (2.1%) was falsely diagnosed as deeply invasive. In conclusion, intraoperative FS examination of depth of myometrial invasion by endometrial carcinoma is a simple and accurate method, providing a good correlation with the final histologic report of the surgical specimen.