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Patrizi L, Ticconi C, Borelli B, Finocchiaro S, Chiaramonte C, Sesti F, Mauriello A, Exacoustos C, Casadei L. Clinical significance of endometrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery. BMC Womens Health 2022; 22:106. [PMID: 35392892 PMCID: PMC8991822 DOI: 10.1186/s12905-022-01682-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The overall clinical significance of the finding of endometrial abnormalities in predicting premalignant/malignant endometrial lesions is still incompletely determined. For this reason the management, surgical or expectant, of women in which an endometrial abnormality has been detected is debated. METHODS This retrospective study was carried out on 1020 consecutive women, 403 premenopausal and 617 postmenopausal, who underwent operative hysteroscopy in a University Hospital for suspected endometrial abnormalities, which were detected by transvaginal ultrasound (TVS) and/or office hysteroscopy. In these women, the clinical characteristics and findings at TVS and hysteroscopy were evaluated in relation to the presence/absence of premalignant/malignant endometrial lesions at pathology report. RESULTS The clinical characteristics considered were significantly different when the study women were compared according to their menopausal status. Premalignant/malignant lesions were found in 34/1020 (3.33%) women. Complex hyperplasia with atypia and endometrial cancer were detected in 22 (2.15%) and 12 (1.17%) cases, respectively. The postmenopausal women had a significantly higher risk of premalignant/malignant lesions than premenopausal women (O.R. = 5.098 [95% C.I.: 1.782-14.582], P < 0.005). This risk was even higher when abnormal uterine bleeding (AUB) was present (O.R. = 5.20 [95% C.I.: 2.38-11.35], P < 0.0001). The most significant associations with premalignant/malignant endometrial lesions were BMI, AUB in postmenopause, overall polyp size, atypical aspect of endometrial polyps at hysteroscopy, postmenopausal status, diabetes mellitus and patient age. CONCLUSIONS The results of the present study suggest that the proper, aggressive or expectant, management of endometrial abnormalities should take into account both ultrasonographic and hysteroscopic findings together with the specific clinical characteristics of the patients.
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Affiliation(s)
- Lodovico Patrizi
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy.
| | - Barbara Borelli
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Finocchiaro
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Chiaramonte
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Francesco Sesti
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Luisa Casadei
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
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Rodriguez AM, Polychronopoulou E, Hsu E, Shah R, Lamiman K, Kuo YF. Factors associated with endometrial cancer and hyperplasia among middle-aged and older Hispanics. Gynecol Oncol 2020; 160:16-23. [PMID: 33221024 DOI: 10.1016/j.ygyno.2020.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE While disparities in endometrial hyperplasia and endometrial cancer are well documented in Blacks and Whites, limited information exists for Hispanics. The objective is to describe the patient characteristics associated with endometrial hyperplasia symptoms, endometrial hyperplasia with atypia and endometrial cancer, and assess factors contributing to racial/ethnic differences in disease outcomes. METHODS This single-center, retrospective study included women aged ≥50 years with ≥ two encounters for endometrial hyperplasia symptoms, endometrial hyperplasia with atypia and endometrial cancer between 2012 and 2016. Multivariate logistic regression models evaluated the predictors of endometrial cancer and hyperplasia. RESULTS We included 19,865 women (4749 endometrial hyperplasia symptoms, 71 endometrial hyperplasias with atypia, 201 endometrial cancers) with mean age of 60.45 years (SD 9.94). The odds of endometrial hyperplasia symptoms were higher in non-Hispanic Blacks (Odds Ratio [OR] 1.56, 95% Confidence Interval [CI] 1.20-1.72), Hispanics (OR 1.35, 95% CI 1.22-1.49), family history of female cancer (OR 1.25, 95% CI 1.12-1.39), hypertension (OR 1.24, 95% CI 1.14-1.35), and birth control use (OR 1.29, 95% CI 1.15-1.43). Odds of endometrial cancer and atypical hyperplasia increased for ages 60-64 (OR 7.95, 95% CI 3.26-19.37; OR 3.66, 95% 1.01-13.22) and being obese (OR 1.61, 95% CI 1.08-2.41; OR: 6.60, 95% CI 2.32-18.83). Odds of endometrial cancer increased with diabetes (OR 1.68, 95% CI 1.22-2.32). CONCLUSION(S) Patients with obesity and diabetes had increased odds of endometrial cancer and hyperplasia with atypia. Further study is needed to understand the exogenous estrogen effect contributing to the increased incidence among Hispanics.
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Affiliation(s)
- Ana M Rodriguez
- Department of Obstetrics & Gynecology, USA; Sealy Institute for Vaccine Sciences, USA.
| | | | - Enshuo Hsu
- Department of Preventive Medicine and Population Health, USA
| | - Rahul Shah
- School of Medicine, The University of Texas Medical Branch at Galveston, TX, USA
| | | | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, USA
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Tian Y, Liu Y, Wang G, Lv Y, Zhang J, Bai X, Zhang H, Song X. Endometrial hyperplasia in infertile women undergoing IVF/ICSI: A retrospective cross-sectional study. J Gynecol Obstet Hum Reprod 2020; 49:101780. [PMID: 32360632 DOI: 10.1016/j.jogoh.2020.101780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the frequency and risk factors of endometrial hyperplasia (EH) in infertile women undergoing their first IVF/ICSI treatment. METHODS A total of 3198 infertile women undergoing their first IVF/ICSI cycle were recruited retrospectively from a fertility treatment center. Endometrial scratching and biopsy were conducted before IVF/ICSI treatment. The relationship between EH and clinical characteristics were analyzed. RESULTS EH without atypia, atypical hyperplasia, and endometrial cancer (EC) were diagnosed in 94 (2.94%), three (0.093%), and two (0.063%) women, respectively. The frequencies of EH were higher in patients with abnormal uterine bleeding (i.e. menstrual cycle irregularity in terms of frequency, volume, or length; 6.8% vs. 1.6%, P < 0.001, OR = 4.42), obesity (4.1% vs. 2.7%, P = 0.044, OR = 1.55), and elevated fasting glucose (4.6% vs. 2.5%, P = 0.017, OR = 1.85). In the multivariate analyses, all the three factors (abnormal uterine bleeding, obesity, elevated fasting glucose) were independently associated with risk of EH. In the subgroup analysis, among women with abnormal uterine bleeding, the frequency of EH in the elevated fasting glucose group was 10.7%, which was higher than that of the normal fasting glucose group (5.6%), even after adjustment for BMI (P = 0.014, OR = 1.53). CONCLUSION The frequency of EH in infertile women undergoing their first IVF/ICSI treatment was approximately 3%. Elevated fasting glucose was an independent risk factor for EH in infertile women undergoing IVF/ICSI.
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Chang FW, Hsu RJ, Liu SH. Characteristics of patients with endometrial hyperplasia under different air quality index conditions. Taiwan J Obstet Gynecol 2019; 58:282-287. [PMID: 30910154 DOI: 10.1016/j.tjog.2019.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Air pollution has been widely recognized to pose a threat to health. Urban outdoor air pollution was listed as the 14th biggest risk factor for global deaths in 2004 in the Global Health Risks report published by the World Health Organization in 2009. Many past studies have indicated that exposure to environmental contaminants promotes changes in the internal mechanisms of diseases, including the infection of various systems in the body, hormonal changes, and vascular proliferation. These changes may be related to the severity of endometrial hyperplasia. Therefore, this study used the air quality monitoring data of the Environmental Protection Administration (EPA) to examine the effects of air pollutant concentration on patients with endometrial hyperplasia. MATERIALS AND METHODS This population-based nationwide study used data for 2002-2013 from the National Health Insurance Research Database of Taiwan. Patients who developed endometrial hyperplasia before 2002 were excluded. In total, 14,883 patients with endometrial hyperplasia were tracked. The exposure levels and air quality index (AQI) values in this study were based on the taiwan air quality monitoring network data collected by the EPA from 2000 to 2013. The data were further divided into the good air quality group (AQI ≤ 50) and poor air quality group (AQI > 50). The study used linear regression model to estimate the correlation linking air pollutant concentration with endometrial hyperplasia. RESULTS The results indicated that, in comparison to endometrial hyperplasia patients who were exposed to air with good quality, those exposed to air with poor quality had a higher average age (p < 0.001) and higher proportion of living in southern Taiwan (p < 0.001), as well as higher rates of diabetes (p < 0.001), hyperlipidemia (p < 0.001), hypertension, cerebrovascular diseases (p = 0.024), cerebral vascular accidents (p = 0.024), and chronic kidney disease (p < 0.001). CONCLUSION The patients with endometrial hyperplasia in poor AQI area had severe comorbidity. Thus, attention must be paid to the improvement of air quality and the implementation of preventive measures against contaminants.
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Affiliation(s)
- Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Superintendent, Tri-Service General Hospital Penghu Branch, National, Defense Medical Center, Penghu Branch, Taiwan; Defence Medical Center, Penghu Branch, Taiwan
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Cancer Medicine Center of Buddhist Hualien Tzu Chi Hospital, Tzu Chi University, Hualien, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, The Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Hui Liu
- Department of Health Care and Social Work, Yu Da University of Science and Technology, Miaoli, Taiwan; Department of Leisure Management, Yu Da University of Science and Technology, Miaoli, Taiwan.
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Heng S, Evans J, Salamonsen LA, Jobling TW, Nie G. The significance of post-translational removal of α-DG-N in early stage endometrial cancer development. Oncotarget 2017; 8:81942-81952. [PMID: 29137235 PMCID: PMC5669861 DOI: 10.18632/oncotarget.17286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/11/2017] [Indexed: 01/11/2023] Open
Abstract
Endometrial cancer is one of the most common gynecological malignancies affecting post-menopausal women, yet the underlying mechanisms are not well understood. Dystroglycan (DG) is a large glycoprotein, consisting of α- and β-subunits that are non-covalently associated with each other. Modifications to α-DG have been linked to a variety of cancers, where the N-terminus of α-DG (α-DG-N) is post-translationally removed by a furin-like enzyme. However, the functional significance of α-DG-N removal is unknown. Our previous studies have established that the α-DG cleavage enzyme furin is significantly up-regulated in endometrial cancer. This study aimed to investigate the importance of α-DG-N removal in post-menopausal endometrial cancer. We demonstrated that α-DG-N removal predominantly occurred in early stage endometrial cancer tissues, and that the cleaved α-DG-N was significantly elevated in the uterine lavage of early grade endometrial cancer patients. Furthermore, α-DG-N removal significantly decreased the tight junction integrity and polarity of the endometrial epithelial cells, promoting the loss of polarity markers scribble and atypical protein kinase C (aPKC) and reducing the trans-epithelial electrical resistance. The removal of α-DG-N also sensitized the cells for estrogen-dependent proliferation. These results strongly suggest that α-DG-N removal plays an important role in early stage development of endometrial cancer, and that the elevated levels of α-DG-N in uterine fluid may provide a biomarker for early detection of endometrial cancer.
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Affiliation(s)
- Sophea Heng
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Jemma Evans
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Lois A Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Tom W Jobling
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,Epworth Research Institute, Epworth Health Care, Richmond, Victoria, Australia
| | - Guiying Nie
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Sciences, Monash University, Clayton, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
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Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endometrial hyperplasia. J Gynecol Oncol 2015; 27:e8. [PMID: 26463434 PMCID: PMC4695458 DOI: 10.3802/jgo.2016.27.e8] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 12/24/2022] Open
Abstract
Endometrial hyperplasia (EH) comprises a spectrum of changes in the endometrium ranging from a slightly disordered pattern that exaggerates the alterations seen in the late proliferative phase of the menstrual cycle to irregular, hyperchromatic lesions that are similar to endometrioid adenocarcinoma. Generally, EH is caused by continuous exposure of estrogen unopposed by progesterone, polycystic ovary syndrome, tamoxifen, or hormone replacement therapy. Since it can progress, or often occur coincidentally with endometrial carcinoma, EH is of clinical importance, and the reversion of hyperplasia to normal endometrium represents the key conservative treatment for prevention of the development of adenocarcinoma. Presently, cyclic progestin or hysterectomy constitutes the major treatment option for EH without or with atypia, respectively. However, clinical trials of hormonal therapies and definitive standard treatments remain to be established for the management of EH. Moreover, therapeutic options for EH patients who wish to preserve fertility are challenging and require nonsurgical management. Therefore, future studies should focus on evaluation of new treatment strategies and novel compounds that could simultaneously target pathways involved in the pathogenesis of estradiol-induced EH. Novel therapeutic agents precisely targeting the inhibition of estrogen receptor, growth factor receptors, and signal transduction pathways are likely to constitute an optimal approach for treatment of EH.
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Affiliation(s)
- Vishal Chandra
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
| | - Jong Joo Kim
- School of Biotechnology, Yeungnam University, Gyeongsan, Korea
| | - Doris Mangiaracina Benbrook
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anila Dwivedi
- Division of Endocrinology, CSIR-Central Drug Research Institute, Lucknow, India
| | - Rajani Rai
- School of Biotechnology, Yeungnam University, Gyeongsan, Korea.
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Vicennati V, Garelli S, Rinaldi E, Rosetti S, Zavatta G, Pagotto U, Pasquali R. Obesity-related proliferative diseases: the interaction between adipose tissue and estrogens in post-menopausal women. Horm Mol Biol Clin Investig 2015; 21:75-87. [PMID: 25781553 DOI: 10.1515/hmbci-2015-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/21/2015] [Indexed: 01/12/2023]
Abstract
Epidemiological studies have shown that overweight and cancer are closely related, even though obesity alone does not apparently heighten cancer risk by the same amount. Given the low overall risk of all cancers with obesity, it is unlikely that obesity alone causes cancer, but should instead be considered as a tumor promoter. There are three main hypotheses that could explain how obesity might contribute to cancer development and growth: the inflammatory cytokines from adipose tissue hypothesis, the insulin resistance and hyperinsulinemia hypothesis, and the unopposed estrogen cancer hypothesis. The link between obesity and cancer is that adipocytes constitute a major component of the tumor microenvironment for breast and abdominally metastasizing cancers, promoting tumor growth. This review will mainly focus attention on the relationship between adipose tissue, estrogens, and cancer risk.
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