Endometrial and endocervical curettage findings at the time of cervical conization

The medical records and histopathology of 250 patients who underwent cervical conization between January 1979 and December 1982 were reviewed. Two hundred thirty (92%) had endometrial curettage at the time of cervical conization. Abnormal findings were present in 7 (3%) of the 230 curettings. Limiting the performance of endometrial curettage at the time of conization to patients meeting specific criteria would have reduced the number of combined procedures by 75% without jeopardizing our ability to detect significant pathology. Endocervical curettage was performed on 221 (88%) of the 250 patients undergoing conization. The endocervical curettings were not a good predictor of the involvement of the cone margins with neoplasia. Only 7 (20%) of 35 patients with involved endocervical margins had a positive endocervical curettage. While the cone margins predicted residual carcinoma in the hysterectomy specimen with a sensitivity of 1.0, the sensitivity of the endocervical curettings for predicting residual carcinoma was 0.5. Although endocervical curettings can detect an invasive cancer not detected in the cone specimen, a negative endocervical curettage does not rule out invasive cancer above the excision line.     

Endometrial cancer: prognostic significance of risk classification based on pre-intraoperative findings

Purpose  

The aim of this study was to determine whether a pre-intraoperative prognostic classification of endometrial cancer (EC) patients may accurately predict prognosis.     

Endometrial findings in long-term treatment with synthetic sex steroids in Turner syndrome

In 9 patients with Turner's syndrome (karyotype 45/X0) aged from 23 to 50 years (average age 34 years) a curettage was performed. In these women there has been a treatment with mestranol 80 micrograms or ethinylestradiol 50 micrograms and chlormadinome acetate 2 mg as a sequential therapy in a cyclic manner for 5 to 22 years. Additionally in 3 patients a biopsy from the uterine cervix was performed because of abnormal colposcopic findings. Only in one patient an atrophic endometrium was found, whereas in the other patients the endometrium showed a weak proliferation or a slight secretion. Ectasia of the endometrial glands was observed in 4 patients. A hyperplastic endometrium wasn't found in any patient.     

Endometrial cancer: asymptomatic endometrial findings. Characteristics of postmenopausal endometrial cancer

Endometrial cancer affects patients at every age, however it occurs more frequently in menopause (> 50) and in postmenopause (> 70). The most frequent symptoms are bleeding and vaginal discharge. When hematometra or pyometra is present the patient may feel pain. In some cases endometrial adenocarcinoma is asymptomatic and the diagnosis is casually made during ultrasound examination or by histological examination of a uterus surgically removed for other indications. In these cases the most frequent findings are polyps and abnormally increased thickness of the endometrial mucosa. In postmenopause polyps and abnormal endometrial thickness are usually limited to a small area and surrounded by atrophic mucosa. Higher incidence rates of endometrial cancer were correlated with polyps and an increased number of serous type tumors were identified in the > 65-year age group. Endometrial carcinoma may be estrogen correlated or non-estrogen associated. Patients in postmenopause are often affected by non-estrogen correlated endometrial carcinoma. According to Kurman and other authors the first type of endometrial adenocarcinoma (estrogen correlated) is characterized by low-grade malignancy. On the contrary, non-estrogen correlated neoplasia is more aggressive. In our case series including 102 women aged > 70 years with endometrial carcinoma we found that survival was correlated with stage and grading - early stages were the most frequent and the grade increased with stage. In fact all the patients with relapses had grade 2 or 3 adenocarcinomas. Thirty-one patients > 70 years (30.69%) had a non-endometrioid type of cancer.     

Endometrial findings in asymptomatic postmenopausal women on exogenous estrogens—A preliminary report

Multiple retrospective studies have been done implicating estrogen replacement therapy as a factor in the increasing rise of endometrial cancer. This prospective study consisted of 94 asymptomatic postmenopausal females on exogenous estrogen. Duration of therapy ranged from 1 through 5 and greater than 5 years. All these patients were subjected to endometrial biopsies. We encountered a total of 71 negative biopsies (75.5%) and 23 positive biopsies (24.4%) ranging from cystic hyperplasia, through frank adenocarcinoma. All positive biopsies underwent formal diagnostic curettage. Histologic findings on the dilation and curettage specimens correlated with the original biopsy findings. All histologic slides were reviewed by an independent pathologist without knowledge of history or previous grading. Risk factors in the Positive biopsy group were present in only 17%. Therefore, it is not possible to predict the patient on estrogen who is at a higher risk for developing future hyperplasia, and in order to avoid missing early precursor lesions in endometrial carcinoma all patients must be biopsied. Significant cancer precursor lesions did not appear until after the patients had been on at least 3 years duration of unopposed estrogen replacement therapy. We conclude that postmenopausal patients on estrogen therapy at high risk can not be identified by risk factors alone, and as a minimum their endometrial status should be evaluated at least every 3 years.     

Endometrial stromal sarcoma mimicking submucosal myoma protruding to the vagina: MRI findings

A 46-year-old woman complained of persistent abnormal vaginal bleeding over ten days. Her intrauterine device had been removed two years before. Soon after, she suffered from menorrhagia and metrorrhagia. An incidental finding of severe anemia was also noted. In this admission, our initial T2-weighted magnetic resonance imaging (MRI) revealed a well-demarcated mass predominantly in the uterine cavity. The mass was depicted by an isointense signal relative to the myometrium on T1-weighted images, high signal intensity on T2-weighted images, and slightly heterogeneous enhancement on post-contrast images. The patient refused surgery. After two years, follow-up MRI showed a pedunculated mass protruding into the upper third of the vagina with a stalk connecting to the posterior wall of the uterine cavity, simulating submucosal myoma. Histological diagnosis was compatible with low-grade endometrial stromal sarcoma.     

Endometrial hyperplasia and carcinoma in endometrial polyps: clinicopathologic and follow-up findings.

The objectives of this study were: 1) to evaluate findings in follow-up hysterectomy specimens after a diagnosis of complex atypical hyperplasia or carcinoma in endometrial polyps (EMPs) for possible significance in management strategies; and 2)to identify features in these polyps, that are predictive of the presence of endometrial hyperplasia or carcinoma in subsequent hysterectomy. Records of all cases of EMPs with endometrial hyperplasia were retrieved from the files of New York University Medical Center from 1993 to 2005. Those cases with follow-up hysterectomy were selected for the study. Of the 29 patients with complex atypical hyperplasia within the polyp, 19 out of 29 (66%) patients had hyperplasia of the non-polyp endometrium, and adenocarcinoma was observed in 9 out of 29 (31%) patients on follow-up hysterectomy. The percentage of polyp area involved by the hyperplasia was predictive of finding endometrial disorder in subsequent hysterectomy (P = 0.005). Of the 8 patients with adenocarcinoma in situ (AIS) within the polyp 3 (38%) had myoinvasive adenocarcinoma. In contrast, in cases without AIS, 4 out of 21 (19%) had myoinvasive adenocarcinoma in follow-up hysterectomy. Eight of the nine cases with carcinoma in endometrial polyp had endometrial pathology on hysterectomy. Approximately two thirds of the patients with hyperplasia and 90% of patients with adenocarcinoma in endometrial polyps show endometrial pathology on subsequent hysterectomy. The above findings reinforce the need for hysterectomy especially in postmenopausal women with atypical complex hyperplasia or carcinoma in endometrial polyps even if these changes appear confined to the polyp in initial sampling.     

子宫内膜厚度与容受性的研究

目的:探讨血管内皮生长因子(VEGF)与子宫内膜厚度的关系,进一步指导体外授精/单精子卵细胞胞浆内注射-胚胎移植(IVF/ICSI-ET)的临床工作.方法:收集我中心不孕患者50例,预移植日B超检查测量子宫内膜厚度,根据内膜厚度分为≤8 mm组和>8 mm组,并取子宫内膜测量雌激素受体(ER)、孕激素受体(PR),免疫组化测定VEGF值,静脉血检测雌激素(E2),孕激素(P),并作比较.结果:两组E2和P值比较,差异均无统计学意义(P>0.05);两组ER、PR表达无论是在间质还是腺体比较,差异均无统计学意义(P>0.05);VEGF的表达,>8 mm组(1.31±0.50)高于≤8 mm组(1.05 4-0.30),两组比较差异有统计学意义(t=2.065,P=0.044).结论:子宫内膜厚度≤8mm者,VEGF表达低,容受性下降.     

Endometrial hyperplasia

Atypical and severe hyperplasia of the endometrium is often associated with a carcinoma and, on their own, present a malignant potential which requires a specific treatment, involving an extension of the indications for hysterectomy after the menopause.     

子宫内膜癌的病理分类

198 8年国际妇科病理协会 (ＩＳＧＰ) [1] 及 1994年ＰｏｕｌｓｅｎＨ .Ｅ .全新完善的分类 ,将子宫内膜癌分为①腺癌 ;②浆液性腺癌 ;③透明细胞腺癌 ;④粘液性腺癌 ;⑤鳞状细胞癌 ;⑥混合性癌 ;⑦未分化癌。其中 ,腺癌被称为“子宫内膜样”腺癌 ,而腺棘癌、腺鳞癌、分泌性癌、纤毛细胞癌被认为是普通腺癌的变异 ,另外 ,浆液性乳头状腺癌、透明细胞腺癌、粘液性腺癌 ,属于非子宫内膜样癌 ,但它们中的任意一种都可以与子宫膜样腺癌并存[2 ] 。现将其病理类型分述如下。1　巨检子宫内膜癌多见于子宫底部内膜 ,以子宫两角附近居多 ,依病变形态…     

Endometrial cancer

Endometrial carcinoma is the most common gynaecological malignancy in the Western world. The standard management of endometrial carcinoma is total hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and para-aortic lymph-node dissection. Increasingly, endometrial cancer is being diagnosed in younger women in whom preserving fertility may be an important consideration when deciding optimal management. Conservative management of endometrial carcinoma may be a therapeutic option in carefully selected women with well-differentiated endometrial cancer in the absence of any myometrial invasion or adnexal disease seen on imaging. The biggest concern with conservative management of endometrial carcinoma is disease progression while on treatment or after initial response to medical treatment. Women opting for conservative management should be aware that hormonal therapy is not the standard form of management. Potential adverse outcomes should be taken into consideration.     

Endometrial hyperplasia

Endometrial hyperplasia covers a group of abnormalities encompassing premalignant lesions of the endometrium. It is classified according to cellular and structural appearances, and is recognised as an oestrogen-dependant condition. Predisposing factors include therapies resulting in exogenous oestrogenic stimulation and conditions causing excessive oestrogen production.The risk of progression to cancer in untreated cases is uncertain as a result of a tendency by gynaecologists to intervene, but the classification identifies those types of hyperplasia that are more likely to develop into invasive malignancy.Many cases are asymptomatic and probably resolve spontaneously. Symptoms may include irregular premenopausal vaginal bleeding, as well as postmenopausal bleeding and discharge. Management of endometrial hyperplasia will be influenced by the type of abnormality along with the woman's age, symptoms and desire for future fertility. Therapeutic options include various hormonal treatments and surgical interventions of which hysterectomy is the most important in cases associated with cellular atypia.     

Endometrial cancer

The incidence of endometrial cancer in the UK has risen steeply since the 1990s. It is not one but several different diseases with different aetiologies, histological and molecular characteristics and prognosis. Survival has improved significantly over several decades but outcomes for 25% of women remain poor. Surgery is the main treatment. Radiotherapy and chemotherapy are used to reduce recurrence, and for upfront treatment in selected cases. Following years of debate about the role of lymphadenectomy, sentinel node surgery now offers accurate surgical staging without the morbidity of systematic lymphadenectomy. Advances in laboratory analysis of tumours are likely to improve care further. Molecular characterisation now offers better risk stratification and a tailored approach to the use of post-operative treatment. The introduction of widespread testing of tumours for genetic abnormalities, improves identification of at-risk families. The traditional model of hospital follow-up has also been replaced with a more patient-centred risk-stratified approach.