Computed tomography in evaluation of extrapelvic lymphadenopathy in carcinoma of the cervix

The diagnostic value of computed tomography for detecting metastatic tumor in common iliac and/or paraaortic lymph nodes among 44 patients with cervical carcinoma was analyzed. Pathologic confirmation of nodal status was obtained in 33 patients with primary disease and 11 patients with recurrent disease, either by staging laparotomy (82%) or fine needle aspiration (18%). Nodal metastases were detected in 12 patients. Fine needle aspiration of nodes 1.5 cm or greater in size detected 67% of metastatic nodes. The sensitivity of computed tomography for detection of metastatic nodes was 75%, specificity 91%, negative predictive value 91%, and positive predictive value 75%. There appears to be a role for computed tomography and fine needle aspiration of enlarged nodes in patients with advanced or recurrent cervical carcinoma.     

Computed tomography in the evaluation of clinical stage IB carcinoma of the cervix

A retrospective analysis of 47 cases of clinical stage IB cervical carcinoma radiologically staged with computed tomography (CT) was undertaken. There were no cases where CT provided information which altered staging. In 5 cases, CT suggested extension of disease beyond the cervix which was not confirmed surgically or with other staging procedures. In 3 cases, one or more normal-sized obturator or internal iliac nodes with metastatic disease were discovered at surgery, but the high common iliac and periaortic nodes were disease free. We conclude that routine use of CT in patients with clinical stage IB cervical carcinoma is not warranted unless the patient's body habitus precludes accurate physical examination.     

Computed tomography findings of primary serous papillary carcinoma of the peritoneum in women

With the aim to describe preoperative computed tomography (CT) findings, the clinical, histopathological, and CT findings of the 12 consecutive patients with a confirmed diagnosis of primary peritoneal serous papillary carcinoma (PPSPC) were retrospectively evaluated. Of the 12 patients with a mean age of 57.5 +/- 10.3 years, ten (83.3%) were postmenopausal. Serum Ca-125 levels were elevated in all patients. Ten (83.3%) had Stage III and two (16.7%) patients had Stage IV disease and none of the excised ovaries had deep parenchymal involvement. The most common CT findings were the omental (n = 11), mesenterial (n = 11) and parietal peritoneal involvements (n = 10), and variable amount of ascites (n = 10). Pelvic peritoneal involvement in four (33.3%) patients was so extensive that it resembled a mass in the Douglas pouch. Thickening of the wall of gastrointestinal viscera (n = 9), lymphadenopathy (n = 5) and pleural effusion (n = 5) were the other CT findings and calcification was seen in only three (25.0%) patients. Although, none of them was characteristic, CT features of diffuse peritoneal, omental and mesenterial involvement especially in middle-aged or elderly postmenopausal women with normal-size ovaries in the absence of an identifiable primary site in conjunction with elevated level of serum CA-125 should suggest the possibility of PPSPC.     

Use of angio computed tomography to evaluate extent of endometrial carcinoma

Patients with endometrial carcinoma underwent angio computed tomography (CT) prior to surgery to evaluate the extent of the carcinoma. The subjects of the study were 87 patients operated on at the Cancer Institute Hospital during the period 1983 to 1986. After preoperative bilateral internal iliac angiography, angio CT was performed using the already inserted catheters. Although the intact uterine wall was enhanced by the angio CT, the cancerous lesion was not, which permitted easy recognition of the cancerous lesion as a low-density area. To evaluate the degree of myometrial invasion, the minimal thickness of intact uterine wall was measured in the CT image, and was compared later with findings from the operative materials. The comparison showed that for all the patients, the minimal thickness of the intact uterine wall as shown in the CT image was comparable to the actual minimal thickness of the operative materials. Because depth of myometrial invasion is known as an important prognostic factor, measurement of the minimal thickness of the intact uterine wall as shown in the CT image is useful as an objective prognostic factor. Angio CT facilitates recognition of myometrial invasion preoperatively.     

Computed tomography: does it really improve the treatment of cervical carcinoma?

OBJECTIVE: The purpose of this study was to determine if computed tomography in cervical cancer staging resulted in treatment modifications leading to improved survival. STUDY DESIGN: Medical records of 246 consecutive women treated over a 3-year period for primary cervical cancer were reviewed. Frequency of recurrence was the outcome measure of interest and subjected to chi 2 analysis. RESULTS: Only eight patients had improved survival from treatment modifications based on computed tomography findings. Eight patients underwent additional surgical procedures because of computed tomography findings that proved to be erroneous. CONCLUSIONS: Considering the high cost and limited benefit, computed tomography for cervical cancer staging is not recommended.     

Computed tomography in obstetrics and gynecology.

Computed tomography (CT) has become essential in the diagnostic evaluation of the female pelvic. CT allows accurate delineation of neoplastic and inflammatory processes and provides an effective means of guiding percutaneous needle biopsy of masses and aspiration/drainage of fluid collections. In the pregnant woman, pelvimetry and excretory urography can be performed using the CT scout view with a radiation dose significantly lower than with conventional x-ray techniques. This paper covers the clinically relevant technical considerations involved in performing CT on women and follows with an overview of normal female pelvic anatomy and frequently encountered pathologic conditions.     

Computed tomography of the brain in eclampsia

Computed tomography (CT) of the brain was performed on 44 women with eclampsia, 31 during pregnancy and 13 postpartum. All CT scans were done within 24 hours of eclampsia, including 12 within 1 hour of the convulsions and eight before the repetition of additional seizures, 2 minutes to 14 hours later. Control scans were performed on 15 hypertensive pregnant patients and on ten normotensive pregnant women after fetal death or just after delivery. Among the women with eclampsia, 26 CT scans were considered normal with no evidence of cerebral edema, three displayed signs of cerebral hemorrhage or thrombosis, six showed areas of focalized hypodensity located in the cortical lobes and the subcortical white matter, and nine were classified as cerebral atrophy with enlarged cerebral ventricles. We conclude that radiologic evidence of diffuse brain edema is probably not a common feature in eclampsia.     

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.     

Incidence of endometrial carcinoma in patients with endometrial hyperplasia

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.     

Pipelle endometrial sampling in patients with known endometrial carcinoma

The purpose of this prospective clinical trial was to determine the reliability of the Pipelle endometrial biopsy instrument in recovering adequate tissue for confirmation of the diagnosis of endometrial cancer in patients with known endometrial carcinoma, and to compare endometrial histology of the sampling specimen with that of the subsequent hysterectomy specimen. Forty patients were enrolled in this study. All biopsies were performed in the office without anesthesia. The patients had a median age of 62 years (range 40-83). Discomfort was reported by the patient as mild, moderate, or severe; only two patients (5.0%) reported severe pain. There were no complications experienced with endometrial sampling. Thirty-nine of 40 specimens (97.5%) confirmed endometrial carcinoma; therefore, this study yielded a 97.5% sensitivity for the Pipelle endometrial sampling device. Comparing Pipelle and hysterectomy histology for individual patients, the histologic grade was the same in 29 (74.4%), while the Pipelle demonstrated a more advanced degree of differentiation in five (12.8%) and a lesser degree in five (12.8%). There was no residual tumor identified in one hysterectomy specimen (2.5%). Among the 12 patients who had a D&C for diagnostic purposes before referral, the Pipelle biopsy correlated with the D&C histology in ten of 12 (83.3%) and revealed a more advanced grade of tumor in one (8.3%) and a more differentiated grade in one (8.3%). In one patient, the D&C histology was adenocarcinoma grade 1, with the Pipelle demonstrating atypical hyperplasia and the hysterectomy specimen interpreted as endometrial adenocarcinoma in situ. This study demonstrates the Pipelle to be an accurate device for endometrial sampling in patients with endometrial carcinoma.     

子宫内膜不典型增生患者的内膜癌漏诊因素分析

目的:探讨子宫内膜不典型增生患者子宫内膜癌漏诊的因素及合理治疗方案。方法:回顾分析132例子宫内膜不典型增生子宫切除前后的临床病理资料。根据术前内膜取样方式分为宫腔镜组与诊刮组,比较两种方式的诊断符合率。比较术前病理与术中冰冻病理、术后常规病理,分析其主要临床病理资料。结果:132子宫内膜不典型增生患者中,术后证实为子宫内膜癌者42例(31.82%)。诊刮组的内膜癌漏诊率为32.99%(32/97),高于宫腔镜组28.75%(10/35),但无统计学差异(P0.05)。42例内膜癌患者中,95.24%(40/42)为子宫内膜样腺癌,ⅠA期38例(90.48%),高分化癌34例(80.95%)。术中行冰冻病理检查者115例,其中11例子宫内膜癌漏诊。长期月经紊乱、未生育患者子宫内膜癌漏诊的风险增高。结论:子宫内膜病理诊断为不典型增生的患者有子宫内膜癌漏诊的风险,尤其是长期月经紊乱、未生育的女性。子宫内膜不典型增生的治疗应采取个体化治疗方案。     

Growth patterns in endometrial carcinoma

One hundred patients with endometrial carcinoma underwent primary hysterectomy. Classification of the endometrial tumor growth patterns allowed identification of patients at high risk for myometrial penetration with a high degree of accuracy. Tumors with a diffuse origin within the endometrial cavity, and those with a polypoid or shaggy appearance, were at risk for deep myometrial penetration. When both patterns were present, 86.5% of the patients had penetration to a depth of greater than 10% of the myometrial width, and 61.1% had greater than 30% penetration. When only one of these characteristics was present, an intermediate degree of deep penetration was found. When neither diffuse origin nor bulky growth were present, the risk of penetration of greater than 10% was 4.8% and no patient had greater than 30% penetration. All recurrences were found in patients with bulky and diffuse disease. Low-pressure hysterography in the nonirradiated uterus successfully predicted these patterns of tumor growth. Hysterographic information concerning tumor growth patterns can be combined with knowledge of tumor grade to identify patients at high risk for deep myometrial penetration preoperatively.     

Prognostic factors in endometrial carcinoma

Endometrial carcinoma is the most common malignancy of the female genital tract in industrialized countries, and occurs predominantly after the menopause. Although most endometrial carcinomas are detected at low stage, there is still a significant mortality from the disease. In postmenopausal women, prolonged life expectancy, changes in reproductive behavior and prevalence of overweight and obesity, as well as hormone replacement therapy use, may partially account for the observed increases of incidence rates in some countries. In order to improve treatment and follow-up of endometrial carcinoma patients, the importance of various prognostic factors has been extensively studied. The identification of high-risk groups would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis. Over the past few decades, several studies have demonstrated the prognostic importance of different parameters including lymph node status, histological type of carcinoma (serous carcinoma and clear cell carcinomas are poor prognostic types), histological grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement. Other factors currently being investigated are estrogen and progesterone receptor status, p53 status, flow cytometric analysis for ploidy and S-phase fraction, and oncogenes such as HER-2/neu (c-erbB-2).     

Prognostic factors in endometrial carcinoma

In our study we tried to give more light and information about the most frequent prognostic factors in endometrial cancer. The evaluation of 500 patients and all possible prognostic factors gave us the opportunity to treat better and to choose better therapy for our patients. The results were similar like other western clinics. The clinical and therapeutical administration of the classic and histological factors, as well as the biological markers was not in such wide study cleared up. That is why we did this research in order to, satisfy these scientific needs. The results did not differ from other western clinics working in this field.