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Nam SH, Lee SW, Lee YJ, Kim YM. Safety and Tolerability of Weekly Genexol-PM, a Cremophor-Free Polymeric Micelle Formulation of Paclitaxel, with Carboplatin in Gynecologic Cancer: A Phase I Study. Cancer Res Treat 2023; 55:1346-1354. [PMID: 37189263 PMCID: PMC10582543 DOI: 10.4143/crt.2022.1436] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/12/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE This phase I study was conducted to determine the maximum tolerated dose and the recommended phase II dose of weekly administered Genexol-PM combined with carboplatin in patients with gynecologic cancer. MATERIALS AND METHODS This open-label, phase I, dose-escalation study of weekly Genexol-PM included 18 patients with gynecologic cancer, who were equally divided into three cohorts of dose levels. Cohort 1 received 100 mg/m2 Genexol-PM and 5 area under the curve (AUC) carboplatin, cohort 2 received 120 mg/m2 Genexol-PM and 5 AUC carboplatin, and cohort 3 received 120 mg/m2 Genexol-PM and 6 AUC carboplatin. The safety and efficacy of each dose were analyzed for each cohort. RESULTS Of the 18 patients, 11 patients were newly diagnosed and seven patients were recurrent cases. No dose-limiting toxicity was observed. The maximum tolerated dose was not defined, but a dose up to 120 mg/m2 of Genexol-PM in combination with AUC 5-6 of carboplatin could be recommended for a phase II study. In this intention-to-treat population, five patients dropped out of the study (carboplatin-related hypersensitivity, n=1; refusal of consent, n=4). Most patients (88.9%) with adverse events recovered without sequelae, and no treatment-related death occurred. The overall response rate of weekly Genexol-PM in combination with carboplatin was 72.2%. CONCLUSION Weekly administered Genexol-PM with carboplatin demonstrated an acceptable safety profile in gynecologic cancer pati-ents. The recommended phase II dose of weekly Genexol-PM is up to 120 mg/m2 when combined with carboplatin.
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Affiliation(s)
- So Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jae Lee
- Department of Obstetrics and Gynecology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Howroyd LR, Cornell I, Benson C, Napolitano A, Blackledge M, Sumhonmun T, Moskovic E, Kelly-Morland C, Adejolu M, Jones RL, Messiou C. Pseudoprogression in patients with uterine leiomyosarcoma treated with first-line single-agent doxorubicin. Eur J Cancer 2023; 192:113261. [PMID: 37604068 DOI: 10.1016/j.ejca.2023.113261] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
AIM To evaluate the incidence of pseudoprogression in patients with metastatic or inoperable uterine leiomyosarcoma (LMS) treated with first-line single-agent doxorubicin. METHODS The Royal Marsden NHS Foundation Trust Sarcoma Unit database was searched to identify all patients with metastatic or inoperable LMS treated with first-line doxorubicin from January 2006 to January 2022. Patients with available computed tomography scans performed at baseline and during doxorubicin therapy were included. Response evaluation criteria in solid tumours v1.1 and Choi criteria were applied. Any increase in the sum of the longest diameter that decreased on the subsequent scan was labelled as pseudoprogression. RESULTS The total number of patients evaluated was 52. In total, 19% (n = 10) of patients treated with doxorubicin showed pseudoprogression. However, pseudoprogression at the time of the second scan was not associated with time to doxorubicin failure. Choi criteria identified 30% (n = 3) of pseudoprogressors as responding. CONCLUSION Despite the use of doxorubicin as first-line therapy for soft-tissue sarcomas for over 40 years, pseudoprogression has not been described. This retrospective study shows that pseudoprogression occurs in 19% of patients with metastatic/inoperable uterine LMS treated with first-line doxorubicin. Choi criteria were not consistently able to differentiate pseudoprogression from true progression. It is imperative that oncologists and radiologists are aware of this as symptomatically stable/improving patients may benefit from continued treatment despite initial radiological growth in tumour size.
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Affiliation(s)
| | - Isabel Cornell
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
| | | | | | | | - Timothy Sumhonmun
- Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | | | | | | | - Robin L Jones
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Christina Messiou
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
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Ruiz-Echeverría FR, Beltrán-Salazar MI, Caicedo-Páez LM, Palencia-Palacios M, Salazar-Silva C, Viveros-Carreño D. Uterine collision tumor. Case report and review of the literature. Rev Colomb Obstet Ginecol 2023; 74:225-236. [PMID: 37937912 PMCID: PMC10652777 DOI: 10.18597/rcog.4011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/14/2023] [Indexed: 11/09/2023]
Abstract
Objectives To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a seroustype endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.
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Long L, Liu M, Deng X, Cao M, Zhang J, Lan X, Zhang J. 3D multifrequency magnetic resonance elastography in distinguishing endometrial and cervical adenocarcinoma. Magn Reson Imaging 2023; 102:62-68. [PMID: 37146780 DOI: 10.1016/j.mri.2023.05.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To prospectively evaluate the value of tomoelastography in determining the underlying origins of uterine adenocarcinoma. METHODS This prospective work was approved by our institutional review board, and all patients provided informed consent. 64 patients with histopathologically confirmed adenocarcinomas originated either from the cervix (CAC: cervical adenocarcinoma) or endometrium (EAC: endometrial adenocarcinoma) underwent MRI and tomoelastography examination on a 3.0 T MR scanner. To biomechanically characterize the adenocarcinoma, two MRE-derived parameters maps were provided in the tomoelastography, namely shear wave speed (c, m/s) and loss angle (φ, radian), which represented the stiffness and fluidity, respectively. The MRE-derived parameters were compared by using a two-tailed independent-sample t-test or Mann-Whitney U test. Five morphologic features were also analyzed by using the χ2 test. Logistic regression analysis was used to develop diagnosis models. Delong test was used to compare the receiver operating characteristic curves whith different diagnostic models and evaluate the diagnostic efficiency. RESULTS CAC were significantly stiffer and behaved more fluid like than EAC (c: 2.58 ± 0.62 m/s vs.2.17 ± 0.72 m/s, p = 0.029, φ, 0.97 ± 0.19 rad vs.0.73 ± 0.26 rad, p < 0.0001). The diagnostic performance for distinguishing CAC from EAC was similar for c (AUC = 0.71) and for φ (AUC = 0.75). For distinguishing CAC from EAC, the AUC of tumor location was the higher than c and φ (AUC = 0.80). A cmobined model consisting of tumor location, c, and φ achieved the best diagnostic performance, with an AUC of 0.88 (77.27% sensitivity and 85.71% specificity). CONCLUSIONS CAC and EAC displayed their unique biomechanical features. 3D multifrequency MRE provided added value to the conventional morphologic features in distinguishing the two types of diseases.
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Affiliation(s)
- Ling Long
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Meiling Liu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Xijia Deng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Meimei Cao
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China.
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Ota T, Tsuboyama T, Onishi H, Nakamoto A, Fukui H, Yano K, Honda T, Kiso K, Tatsumi M, Tomiyama N. Diagnostic accuracy of MRI for evaluating myometrial invasion in endometrial cancer: a comparison of MUSE-DWI, rFOV-DWI, and DCE-MRI. Radiol Med 2023:10.1007/s11547-023-01635-4. [PMID: 37120661 DOI: 10.1007/s11547-023-01635-4] [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] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES To compare the image quality of high-resolution diffusion-weighted imaging (DWI) using multiplexed sensitivity encoding (MUSE) versus reduced field-of-view (rFOV) techniques in endometrial cancer (EC) and to compare the diagnostic performance of these techniques with that of dynamic contrast-enhanced (DCE) MRI for assessing myometrial invasion of EC. METHODS MUSE-DWI and rFOV-DWI were obtained preoperatively in 58 women with EC. Three radiologists assessed the image quality of MUSE-DWI and rFOV-DWI. For 55 women who underwent DCE-MRI, the same radiologists assessed the superficial and deep myometrial invasion using MUSE-DWI, rFOV-DWI, and DCE-MRI. Qualitative scores were compared using the Wilcoxon signed-rank test. Receiver operating characteristic analysis was performed to compare the diagnostic performance. RESULTS Artifacts, sharpness, lesion conspicuity, and overall quality were significantly better with MUSE-DWI than with rFOV-DWI (p < 0.05). The area under the curve (AUC) of MUSE-DWI, rFOV-DWI, and DCE-MRI for the assessment of myometrial invasion were not significantly different except for significantly higher AUC of MUSE-DWI than that of DCE-MRI for superficial myometrial invasion (0.76 for MUSE-DWI and 0.64 for DCE-MRI, p = 0.049) and for deep myometrial invasion (0.92 for MUSE-DWI and 0.80 for DCE-MRI, p = 0.022) in one observer, and that of rFOV-DWI for deep myometrial invasion in another observer (0.96 for MUSE-DWI and 0.89 for rFOV-MRI, p = 0.048). CONCLUSION MUSE-DWI exhibits better image quality than rFOV-DWI. MUSE-DWI and rFOV-DWI shows almost equivalent diagnostic performance compared to DCE-MRI for assessing superficial and deep myometrial invasion in EC although MUSE-DWI may be helpful for some radiologists.
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Affiliation(s)
- Takashi Ota
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takahiro Tsuboyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Nakamoto
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideyuki Fukui
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keigo Yano
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Honda
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kengo Kiso
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mitsuaki Tatsumi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Nay P, Morice P, Blanc-Durand F. [Immunotherapy in oncogynaecology]. Bull Cancer 2023; 110:395-401. [PMID: 36759214 DOI: 10.1016/j.bulcan.2023.01.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Immune checkpoint inhibitors have deeply changed treatment paradigm of many tumor types, notably by providing long-term remissions, even in the metastatic setting. These immunotherapies aim to restore T-cells activity against tumour cells, in particular via the inhibition of PD1/PD-L1 interaction. As for lung or renal carcinomas, and melanomas, the management of endometrial and uterine cervical cancers has been disrupted by PD1/PD-L1 inhibitors efficacy. In locally advanced or metastatic cervical carcinomas, the combination of platinum-based chemotherapy with pembrolizumab demonstrated improved overall and progression-free survival in all subgroups of patients, and became the new standard of care. Regarding endometrial cancers, while single-agent immunotherapies have shown very limited activity in an unselected population, dostarlimab and pembrolizumab have been associated with remarkable antitumor activity in case of microsatellite instability (dMMR/MSI), detected in around 30% of patients. Finally, in endometrial cancer that has progressed after first-line chemotherapy, the association of pembrolizumab with an oral antiangiogenic kinase inhibitor (lenvatinib) has demonstrated its superiority over second-line chemotherapy regimens, regardless molecular subgroups, and has become the new standard of care in this indication.
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Affiliation(s)
- Paula Nay
- Institut Gustave Roussy, service d'oncologie-gynécologie, Villejuif, France; Sorbonne université, Paris, France
| | - Philippe Morice
- Institut Gustave Roussy, service d'oncologie-gynécologie, Villejuif, France
| | - Felix Blanc-Durand
- Institut Gustave Roussy, service d'oncologie-gynécologie, Villejuif, France.
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Lin YC, Lin Y, Huang YL, Ho CY, Chiang HJ, Lu HY, Wang CC, Wang JJ, Ng SH, Lai CH, Lin G. Generalizable transfer learning of automated tumor segmentation from cervical cancers toward a universal model for uterine malignancies in diffusion-weighted MRI. Insights Imaging 2023; 14:14. [PMID: 36690870 PMCID: PMC9871146 DOI: 10.1186/s13244-022-01356-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/04/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the generalizability of transfer learning (TL) of automated tumor segmentation from cervical cancers toward a universal model for cervical and uterine malignancies in diffusion-weighted magnetic resonance imaging (DWI). METHODS In this retrospective multicenter study, we analyzed pelvic DWI data from 169 and 320 patients with cervical and uterine malignancies and divided them into the training (144 and 256) and testing (25 and 64) datasets, respectively. A pretrained model was established using DeepLab V3 + from the cervical cancer dataset, followed by TL experiments adjusting the training data sizes and fine-tuning layers. The model performance was evaluated using the dice similarity coefficient (DSC). RESULTS In predicting tumor segmentation for all cervical and uterine malignancies, TL models improved the DSCs from the pretrained cervical model (DSC 0.43) when adding 5, 13, 26, and 51 uterine cases for training (DSC improved from 0.57, 0.62, 0.68, 0.70, p < 0.001). Following the crossover at adding 128 cases (DSC 0.71), the model trained by combining data from adding all the 256 patients exhibited the highest DSCs for the combined cervical and uterine datasets (DSC 0.81) and cervical only dataset (DSC 0.91). CONCLUSIONS TL may improve the generalizability of automated tumor segmentation of DWI from a specific cancer type toward multiple types of uterine malignancies especially in limited case numbers.
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Affiliation(s)
- Yu-Chun Lin
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 33302 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Yenpo Lin
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Yen-Ling Huang
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Chih-Yi Ho
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Hsin-Ju Chiang
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Hsin-Ying Lu
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Chun-Chieh Wang
- grid.145695.a0000 0004 1798 0922Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 33302 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Jiun-Jie Wang
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Shu-Hang Ng
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Chyong-Huey Lai
- grid.145695.a0000 0004 1798 0922Gynecologic Cancer Research Center, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Gigin Lin
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.145695.a0000 0004 1798 0922Gynecologic Cancer Research Center, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
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AziziKia H, Didar H, Teymourzadeh A, Nakhostin-Ansari A, Jafari Doudaran P, Ferasatifar B, Hoveidaei A, Roshandel G. Uterine and Cervical Cancer in Iran: An epidemiologic analysis of the Iranian National Population-Based Cancer Registry. Arch Iran Med 2023; 26:1-7. [PMID: 37543915 PMCID: PMC10685806 DOI: 10.34172/aim.2023.01] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/27/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Gynecologic cancers, including neoplasms of the cervix and uterine, are the fourth most common malignancies, causing 3.46% of deaths in women aged 15 to 59. OBJECTIVES We aimed to report the Iranian National Population-based Cancer Registry (INPCR) results for Cervical and Uterine cancers in 2017. METHODS The total population of Iran in 2017 was 80881792. INPCR collected data on cervical and uterine cancer incidence from 31 provinces of Iran. In this project, we retrospectively examined all the country's regions in terms of screening for the existence of these two cancers. The registry data bank in Iran was used. RESULTS Overall, 3481 new cervical and uterine cancer cases were registered in INPCR, including 842 cases of cervical cancer (with a crude rate of 1.04) and 2639 cases of uterine cancer (with a crude rate of 3.26). The average age-standardized incidence rate (ASR) was 0.99 for cervical cancer and 3.29 for uterine cancer. Out of 3481 new cervical and uterine cancer cases, 2887 were registered with pathological findings and 594 without pathological confirmation. In cervical cancers, the highest rate was related to squamous cell carcinoma, with 486 cases (57.72%). CONCLUSION Our results showed that Iran is a low-risk area for the incidence of cervical and uterine cancers. In this study, the highest rate of cervical cancer was related to squamous cell carcinoma, confirming previous reports. However, this rate was lower than previous studies and suggested an increase in other types of cervical cancer in Iran.
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Affiliation(s)
- Hani AziziKia
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hamidreza Didar
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azin Teymourzadeh
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bahareh Ferasatifar
- Department of Chemistry, Iran University of Science and Technology, Tehran, Iran
| | - Armin Hoveidaei
- BSc in Radiotherapy Technology, Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
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Bogani G, Palaia I, Perniola G, Fracassi A, Cuccu I, Golia D'Auge T, Casorelli A, Santangelo G, Fischetti M, Muzii L, Benedetti Panici P, Di Donato V. Assessing the role of low volume disease in endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2022; 274:68-72. [PMID: 35598492 DOI: 10.1016/j.ejogrb.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
The role of retroperitoneal staging in endometrial cancer is still unclear. Although the prognostic value of lymphadenectomy has been demonstrated no data support the therapeutic value of nodal dissection. Sentinel node mapping represents an evolution of lymphadenectomy. Sentinel node mapping allows a more accurate identification of low-volume diseases (i.e., micrometastasis and isolated tumor cells) that are not always detectable via conventional histopathological evaluation. Adjuvant therapy might play a role in patients with low-volume disease. However, the presence of isolated tumor cells alone seems to not impact outcomes of endometrioid endometrial cancer patients. Hence, the choice to deliver adjuvant therapies has to be tailored based on uterine factors only. The introduction of molecular and genomic profiling would be useful in selecting appropriate surgical and adjuvant treatments. The molecular-integrated risk profile should be integrated in clinical practice to overcome the need of retroperitoneal staging (in case of non-bulky nodes) in patients at low risk.
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Affiliation(s)
- Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy.
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Alice Fracassi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Ilaria Cuccu
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Tullio Golia D'Auge
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Assunta Casorelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
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10
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Lin Y, Wu RC, Huang YL, Chen K, Tseng SC, Wang CJ, Chao A, Lai CH, Lin G. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdom Radiol (NY) 2022; 47:2197-2208. [PMID: 35347386 DOI: 10.1007/s00261-022-03431-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/03/2023]
Abstract
Uterine leiomyoma, also known as uterine fibroid, is the most common gynecological tumor, affecting almost 80% of women at some point during their lives. In the same time, other fibroid-like tumors have similar clinical presentations and about 0.5% of resected tumors of which were presumed benign fibroids in the preoperative diagnosis revealed as malignant sarcomas in the final histopathological examination. Amid the emergence of nonsurgical or minimally invasive procedures for symptomatic benign uterine fibroids, such as uterine artery embolization, high-intensity-focused ultrasound, or laparoscopic myomectomy, the preoperative diagnosis of uterine tumors through imaging becomes all the more relevant. Preoperative tissue sampling is challenging because of the variable location of the myometrial mass; thus, the preoperative evaluation of size and location is increasingly performed through magnetic resonance imaging. Features in images might also be useful for examining the full spectrum of such growths, from benign fibroids to neoplasms of uncertain behavior and malignant sarcomas. Benign fibroids include usual-type leiomyomas, myomas with degeneration, and mitotically active leiomyomas. Neoplasms of uncertain behavior include smooth muscle tumors of uncertain malignant potential, leiomyomas with bizarre nuclei, and cellular leiomyomas. Malignant sarcomas comprise leiomyosarcomas, endometrial stromal sarcomas, adenosarcomas, and carcinosarcomas. The purpose of this article is to review the spectrum of MRI findings of uterine fibroid-like tumors, from benign variants, uncertain behavior to malignant sarcomas, and update the advanced imaging modalities, including diffusion-weighted imaging, positron emission tomography/computed tomography, combining texture analysis and radiomics, to tackle this important issue.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Shu-Chi Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chin-Jung Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Angel Chao
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
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11
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Pozzar RA, Hammer MJ, Paul SM, Cooper BA, Kober KM, Conley YP, Levine JD, Miaskowski C. Distinct sleep disturbance profiles among patients with gynecologic cancer receiving chemotherapy. Gynecol Oncol 2021; 163:419-426. [PMID: 34521555 DOI: 10.1016/j.ygyno.2021.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/04/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In a sample of patients with gynecologic cancer receiving chemotherapy, we sought to identify subgroups of patients with distinct sleep disturbance profiles and assess for differences in patient characteristics and the severity of co-occurring symptoms among these subgroups. METHODS Adults with gynecologic cancer (n = 232) completed questionnaires six times over two chemotherapy cycles. Sleep disturbance was assessed using the General Sleep Disturbance Scale (GSDS). Clinically meaningful sleep disturbance was defined as a GSDS total score of ≥43. Subgroups of patients with distinct sleep disturbance profiles were identified using latent profile analysis. Differences in patient characteristics and co-occurring symptoms were assessed using Chi-square, Kruskal Wallis, and one-way analysis of variance. RESULTS Four distinct sleep disturbance profiles were identified: Low (18.5%), Moderate (43.6%), High (29.3%), and Very High (8.6%). Compared to the Low class, patients in the other three classes had lower functional status scores and higher levels of depressive symptoms, trait anxiety, and morning and evening fatigue. Compared to the Low class, patients in the Very High class were younger, had a higher body mass index, and were more likely to report a diagnosis of depression or back pain. CONCLUSIONS Over 80% of the patients with gynecologic cancer reported sleep disturbance that persisted over two cycles of chemotherapy. Patients in the Very High class experienced problems with both sleep initiation and maintenance. Clinicians should routinely assess sleep disturbance alongside depression, anxiety, and fatigue. Interventions that target the underlying mechanisms of these co-occurring symptoms are warranted.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, United States of America
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, United States of America; School of Medicine, University of California, San Francisco, CA, United States of America.
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12
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Kyi C, Friedman CF, Mueller JJ, Benayed R, Ladanyi M, Arcila M, Yang SR, Hensley ML, Chiang S. Uterine mesenchymal tumors harboring ALK fusions and response to ALK-targeted therapy. Gynecol Oncol Rep 2021; 37:100852. [PMID: 34522753 PMCID: PMC8427213 DOI: 10.1016/j.gore.2021.100852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/21/2021] [Indexed: 12/21/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) of the uterus is a rare but aggressive malignancy that is often misdiagnosed. Approximately 50% of uterine IMTs (UMT) harbor rearrangements involving the ALK gene on chromosome 2p23 with subsequent overexpression of the ALK protein. Molecular characterization and wider availability of immunohistochemistry (IHC) and next generation sequencing (NGS) have improved clinical recognition and accurate diagnosis of UMT. The discovery of ALK fusions as a genomic driver led to the FDA approval of ALK inhibitors in ALK-altered lung cancers, but there are limited data to date on the spectrum of ALK fusions or patterns of response and resistance to ALK inhibitors in ALK-altered UMT. In this report we describe the genomic and histopathological characteristics and the response to ALK-targeted therapy in four patients with UMT. In all four patients, clinical activity of ALK inhibition was observed, with durable responses lasting 12 months or more. Moreover, three patients derived benefit from a second-generation ALK inhibitor after progression of disease or intolerance to the first-generation inhibitor crizotinib. Our report advocates for consideration of expanding the current National Comprehensive Cancer Network (NCCN) guidelines to include later-generation ALK inhibitors for the treatment of ALK-rearranged UMTs.
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Affiliation(s)
- Chrisann Kyi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York, NY, United States
| | - Claire F Friedman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York, NY, United States
| | - Jennifer J Mueller
- Weill Cornell Medical College, New York, NY, United States.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Maria Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Soo Ryum Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York, NY, United States
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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13
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Slaager C, Hofhuis W, Hoogduin K, Ewing-Graham P, van Beekhuizen H. Serous endometrial intraepithelial carcinoma (SEIC): Current clinical practice in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2021; 265:25-29. [PMID: 34416579 DOI: 10.1016/j.ejogrb.2021.08.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Serous endometrial intraepithelial carcinoma (SEIC) is a rare diagnosis, defined as an intraepithelial lesion with cells identical to serous type endometrial carcinoma. SEIC is considered to be potentially metastatic, however clear and robust data on prognosis are lacking, potentially leading to variability in clinical management. OBJECTIVE The aim is to establish the opinion of gynecologists on the optimal management of patients with SEIC. METHODS An online questionnaire with 15 multiple choice questions was sent to all gynecologists with expertise in gynecological oncology in 19 expert centers in The Netherlands. RESULTS A total of 24 gynecologists participated. The majority of respondents (n = 18/24, 75%) do not consult a guideline regarding the treatment of SEIC. In current practice, 14 of the 24 respondents perform surgical staging in women with SEIC (58.3%) while seven choose hysterectomy with bilateral salpingo-oophorectomy (29.2%), and three (12.5%) have no firm preference. Eleven of the 14 respondents who perform a surgical staging procedure believe that this is certainly the optimal treatment. The majority of respondents have no firm opinion on whether lymph node sampling or lymph node dissection is preferable during surgical staging (n = 15/23, 65.2%). Most respondents do not give adjuvant therapy (n = 15/24, 62.5%), 25.0% recommend brachytherapy (n = 6/24). Follow-up is for 5 years in almost all cases (n = 23/24). CONCLUSION There is no consensus on the optimal surgical treatment and the use of adjuvant therapy for patients with SEIC. Our research team is therefore conducting a nationwide cohort study in which treatment modality, morbidity and survival will be evaluated.
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Affiliation(s)
- Ciska Slaager
- Franciscus Gasthuis en Vlietland, Department of Obstetrics and Gynecology. Kleiweg 400, Rotterdam, The Netherlands.
| | - Ward Hofhuis
- Franciscus Gasthuis en Vlietland, Department of Obstetrics and Gynecology. Kleiweg 400, Rotterdam, The Netherlands.
| | | | - Patricia Ewing-Graham
- Erasmus Medical Center, Department of Pathology. Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Heleen van Beekhuizen
- Erasmus MC Cancer Institute, Department of Gynecological Oncology. Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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14
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Zhang Q, Ouyang H, Ye F, Song Y, Xie L, Zhao X, Yu X. Feasibility of intravoxel incoherent motion diffusion-weighted imaging in distinguishing adenocarcinoma originated from uterine corpus or cervix. Abdom Radiol (NY) 2021; 46:732-44. [PMID: 32671441 DOI: 10.1007/s00261-020-02586-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively assess the incremental value of intravoxel incoherent motion (IVIM) DWI in determining whether the adenocarcinoma originated from the uterine corpus or cervix. METHODS Eighty consecutive uterine adenocarcinomas from the cervix or endometrium confirmed by histopathology underwent IVIM DWI acquisition on a 3.0T MR scanner before treatment. Five morphologic features were analyzed using Fisher exact test; IVIM DWI-derived parameters, including apparent diffusion coefficient (ADC), true coefficient diffusivity (D), perfusion-related diffusivity (D*), and perfusion fraction (f) were compared using two-sample independent t-test or Mann-Whitney U test. Logistic regression analysis was used to develop different diagnosis model. The ROCs of these variables and diagnostic models were compared to evaluate the diagnostic efficiency. RESULTS Among single morphologic features, tumor location yielded the highest AUC of 0.891 in distinguishing endometrial adenocarcinoma (EAC) from cervical adenocarcinoma (CAC). Among single IVIM DWI-derived parameters, f values showed the best diagnostic performance (AUC: 0.837) at the optimal cut-off value of 0.261. Additionally, the combined diagnostic model, which consisted of tumor location, ADC and f showed the largest AUC of 0.967 with the highest sensitivity of 88.14%, highest specificity of 100.00%, and highest accuracy of 91.25%. CONCLUSION IVIM DWI-derived parameters add additional diagnostic value to conventional morphologic features. A combined diagnosis model is a promising imaging tool for predicting the origin of uterine adenocarcinoma, further contributing to therapeutic decision-making.
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15
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Bai P, Bu J, Li R, Sun P, Sun H, Sun JH. [Operative efficacy of 13 malignant uterine tumors after Cf-252 intracavitary irradiation]. Zhonghua Zhong Liu Za Zhi 2021; 42:882-884. [PMID: 33113632 DOI: 10.3760/cma.j.cn112152-20190903-00570] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the surgical therapeutic efficacy of uterine tumors patients underwent Cf-252 neutron intra-cavity and external radiotherapy, and evaluate the application value of Cf-252 neutron radiotherapy. Methods: Thirteen cases of uterine tumor with local suspicious lesions or poor prognostic factors after CF-252 neutron intracavity and external radiotherapy were treated with surgery. Among them, 12 cases underwent extrafascial hysterectomy, 1 case underwent extensive hysterectomy and lymphadenectomy. The postoperative pathology and follow-up results were used to evaluate the efficacy. Results: Nine cases showed severe response to radiotherapy in postoperative cervical pathological tissues without residual tumor, and survived for more than 3-14 years, the median survival time was 8 years. All of 4 cases with residual tumor died within 1 year. Delayed healing of vaginal wounds occurred in 3 of the 12 cases. Conclusions: Cf-252 is a good brachytherapy source. The cervical tissue shows severe response to radiotherapy and prolonged healing time of vaginal wound is observed in some cases after CF-252 radiotherapy. To those uterine tumor patients with local suspicious lesions or poor prognostic factors after CF-252 neutron intracavity and external radiotherapy, extrafascial hysterectomy is a safe and feasible treatment method.
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Affiliation(s)
- P Bai
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J Bu
- Department of Radiotherapy, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - R Li
- Department of Radiotherapy, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - P Sun
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - H Sun
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J H Sun
- Department of Gynecology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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16
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Cabrera S, Bebia V, Acosta U, Franco-Camps S, Mañalich L, García-Jiménez A, Gil-Moreno A. Survival outcomes and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma. Clin Transl Oncol 2020; 23:1210-1219. [PMID: 33210235 DOI: 10.1007/s12094-020-02512-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/07/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To review the diagnostic and therapeutic procedures of patients diagnosed with Endometrial Stromal Sarcoma (ESS) and Undifferentiated Uterine Sarcoma (USS) at our institution and investigate their clinical outcomes and factors affecting prognosis. METHODS We retrospectively collected demographic data, preoperative diagnostic methods and therapeutic management of patients treated for ESS and UUS between January 1995 and December 2019 at Vall d'Hebron Barcelona Hospital Campus, Spain. Overall survival and disease-free survival were calculated. Cox proportional-hazards regression models were calculated. RESULTS Sixty-three patients were included in the study, of which 51(81%) had a diagnosis of ESS and 12(19%) of UUS. Twenty patients (31.7%) were diagnosed after a previous non-oncologic surgery, and 12 of them (60%) suffered from tumor disruption. Cytoreductive procedures were needed in 29 patients (46%), and optimal cytoreduction was achieved in 80.9% of the patients. The median follow-up was 7.6 years (IQR = 0.99-14.31). Five-year overall survival was 57.6% (44.2-68.8) and was significantly better for low-grade ESS (LG-ESS) patients (p < 0.01). Five-year disease-free survival was 57.1% (42.8-69.1) and was also significantly higher in LG-ESS cohort (p = 0.03). After multivariate analysis histological type, age, FIGO stage, optimal surgery and mitotic index were found significantly correlated with survival. For high-grade EES (HG-ESS) and USS patients adjuvant radiotherapy also correlated with improved survival. CONCLUSION Overall survival and disease-free survival are significantly better in patients with LG-ESS cohort. HG-ESS and UUS show similar survival outcomes. Age, FIGO stage, optimal surgery and histological type were significantly correlated with survival in the global cohort, whilst adjuvant radiotherapy correlated with improved survival in HG-ESS and UUS patients.
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Affiliation(s)
- S Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - V Bebia
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - U Acosta
- Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - S Franco-Camps
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - L Mañalich
- Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A García-Jiménez
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A Gil-Moreno
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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17
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Abstract
Endometrial cancer (EC) in young women tends to be early-stage and low-grade; therefore, such cases have good prognoses. Fertility-sparing treatment with progestin is a potential alternative to definitive treatment (i.e., total hysterectomy, bilateral salpingo-oophorectomy, pelvic washing, and/or lymphadenectomy) for selected patients. However, no evidence-based consensus or guidelines yet exist, and this topic is subject to much debate. Generally, the ideal candidates for fertility-sparing treatment have been suggested to be young women with grade 1 endometrioid adenocarcinoma confined to the endometrium. Magnetic resonance imaging should be performed to rule out myometrial invasion and extrauterine disease before initiating fertility-sparing treatment. Although various fertility-sparing treatment methods exist, including the levonorgestrel-intrauterine system, metformin, gonadotropin-releasing hormone agonists, photodynamic therapy, and hysteroscopic resection, the most common method is high-dose oral progestin (medroxyprogesterone acetate at 500–600 mg daily or megestrol acetate at 160 mg daily). During treatment, re-evaluation of the endometrium with dilation and curettage at 3 months is recommended. Although no consensus exists regarding the ideal duration of maintenance treatment after achieving regression, it is reasonable to consider maintaining the progestin therapy until pregnancy with individualization. According to the literature, the ovarian stimulation drugs used for fertility treatments appear safe. Hysterectomy should be performed after childbearing, and hysterectomy without oophorectomy can also be considered for young women. The available evidence suggests that fertility-sparing treatment is effective and does not appear to worsen the prognosis. If an eligible patient strongly desires fertility despite the risk of recurrence, the clinician should consider fertility-sparing treatment with close follow-up.
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Affiliation(s)
- Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
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18
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Chan N, Vythianathan M. Uterine lipoma: A case report. Case Rep Womens Health 2020; 28:e00247. [PMID: 32874929 PMCID: PMC7451788 DOI: 10.1016/j.crwh.2020.e00247] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Uterine lipomas are a rare benign gynaecological tumour of uncertain histogenesis. Clinically, a uterine lipoma may be mistaken for leiomyoma or a malignant tumour. Radiological findings may be suggestive but can also often be inconclusive. However, it has a distinctive appearance on histopathological examination. We present a case of uterine lipoma in a 70-year-old woman, to increase awareness of this unusual entity. Uterine lipomas are a rare benign tumour of the uterus. Imaging, particularly MRI, may help in pre-operative diagnosis. Histopathological examination is recommended to confirm diagnosis.
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Affiliation(s)
- Noni Chan
- Department of Anatomical Pathology, NSW Health Pathology, Orange Base Hospital, Orange, NSW, Australia
| | - Mathumathi Vythianathan
- Department of Anatomical Pathology, NSW Health Pathology, Orange Base Hospital, Orange, NSW, Australia
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19
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Dursun P, Dervisoglu H, Daggez M, Turan T, Kiliç F, Tekin ÖM, Üreyen I, Toptaş T, Demirayak G, Önder AB, Çelik Ç, Bayramoğlu D, Guzel AB, Arioz DT, Bilir F, Ozdemir IA, Tasci T, Karalok A, Karateke A. Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study. Int J Gynaecol Obstet 2020; 151:33-38. [PMID: 32623717 PMCID: PMC9087698 DOI: 10.1002/ijgo.13296] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022]
Abstract
Objective To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID‐19) pandemic and the safety of surgical approach. Methods Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0. Results Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non‐emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID‐related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID‐19 on polymerase chain reaction testing. Conclusion Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID‐19 pandemic while adhering to the measures. Postponement or non‐surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID‐19 pandemic while adhering to measures. Only 1% of patients developed COVID‐19‐related symptoms during the postoperative follow‐up period. Gynecologic cancer surgery should continue during the COVID‐19 pandemic while adhering to measures. Only 1% of patients developed COVID‐19‐related symptoms during the postoperative follow‐up period.
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Affiliation(s)
| | - Haluk Dervisoglu
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Dr. Abdurrahman Yurtaslan Ankara Oncological Education and Research Hospital, Ankara, Turkey
| | - Mine Daggez
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Taner Turan
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Fatih Kiliç
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Özlem M Tekin
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Işin Üreyen
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Health Sciences Antalya Education and Research Hospital, Antalya, Turkey
| | - Tayfun Toptaş
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Health Sciences Antalya Education and Research Hospital, Antalya, Turkey
| | - Gökhan Demirayak
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Istanbul, Turkey
| | - Ayşe B Önder
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Istanbul, Turkey
| | - Çetin Çelik
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Denizhan Bayramoğlu
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Ahmet B Guzel
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dagistan T Arioz
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Afyonkarahisar Health Sciences University Medical School, Afyonkarahisar, Turkey
| | - Filiz Bilir
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Afyonkarahisar Health Sciences University Medical School, Afyonkarahisar, Turkey
| | - Isa A Ozdemir
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Medipol University, Istanbul, Turkey
| | - Tolga Tasci
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Bahçeşehir University Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Alper Karalok
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Liv Hospital Ulus, Istanbul, Turkey
| | - Ateş Karateke
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Medeniyet University, Istanbul, Turkey
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20
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Eftekharzadeh S, Ebrahimi N, Samaei M, Mohebi F, Mohajer B, Sheidaei A, Gohari K, Saeedi Moghaddam S, Ahmadi N, Mohammadi Fateh S, Ramezani Tehrani F, Farzadfar F. National and Subnational Trends of Incidence and Mortality of Female Genital Cancers in Iran; 1990-2016. Arch Iran Med 2020; 23:434-444. [PMID: 32657594 DOI: 10.34172/aim.2020.40] [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] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The present study aims to assess the incidence and mortality rates of gynecological cancers and their changes from 1990 to 2016 at national and subnational levels in Iran. METHODS Annual estimates of incidence and mortality for gynecological cancers from 1990 to 2016 at national and subnational levels were generated as part of a larger project entitled National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD). After the precise processing of data extracted from the Iran Cancer Registry, annual age-standardized incidence and mortality rates were calculated for each cancer, province, year and age group during the period of the study. RESULTS In 2016, gynecological cancers constituted 8.0% of new cancer cases among women of all ages compared to 3.7% of new cases of cancer among women in 1990. The incidence rate of gynecological cancers has increased from 2.5 (0.9-5.6) per 100000 women in 1990 to 12.3 (9.3-15.7) per 100000 women in 2016, and the most common gynecological cancer has changed from cervical cancer in 1990 to corpus uteri cancer in 2016. Age-standardized incidence rates of ovarian, corpus uteri and vulvovaginal cancers increased from 1.3 (0.5-2.4), 1.7 (0.6-3.0), and 0.3 (0.0-0.7) in 1990 to 4.4 (3.6-5.2), 9.9 (6.8-13.4), and 0.6 (0.2-1.0) in 2016, respectively, showing a 3.3, 5.8 and 1.7-fold increase during this period. Age-standardized incidence rate of cervical cancer was 2.4 (1.7-3.3) cases per 100000 women in 2016 and did not differ significantly from the beginning of the study. An overall reduction was seen in national mortality to incidence ratios (MIR) from 2000 to 2015. CONCLUSION The incidence rates of all gynecological cancers in different provinces have shown a converging trend that could indicate that attempts toward health equality have been effective. The declining trend of MIR could be interpreted as advancements in detection of cancer in its early stages and also improvements in treatments, in turn reflecting improvements in access to and quality of care.
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Affiliation(s)
- Sahar Eftekharzadeh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Samaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnam Mohebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohajer
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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21
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Elshaikh MA, Modh A, Jhingran A, Biagioli MC, Coleman RL, Gaffney DK, Harkenrider MM, Heskett K, Jolly S, Kidd E, Lee LJ, Li L, Portelance L, Sherertz T, Venkatessan AM, Wahl AO, Yashar CM, Small W. Executive summary of the American Radium Society® Appropriate Use Criteria for management of uterine carcinosarcoma. Gynecol Oncol 2020; 158:460-466. [PMID: 32475772 DOI: 10.1016/j.ygyno.2020.04.683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/11/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Uterine carcinosarcomas (UCS) represent a rare but aggressive subset of endometrial cancers, comprising <5% of uterine malignancies. To date, limited prospective trials exist from which evidence-based management of this rare malignancy can be developed. METHODS The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines developed by a multidisciplinary expert panel for management of women with UCS. An extensive analysis of current medical literature from peer-reviewed journals was performed. A well-established methodology (modified Delphi) was used to rate the appropriate use of imaging and treatment procedures for the management of UCS. These guidelines are intended for the use of all practitioners who desire information about the management of UCS. RESULTS The majority of patients with UCS will present with advanced extra uterine disease, with 10% presenting with metastatic disease. They have worse survival outcomes when compared to uterine high-grade endometrioid adenocarcinomas. The primary treatment for non-metastatic UCS is complete surgical staging with total hysterectomy, salpingo-oophorectomy and lymph node staging. Patients with UCS appear to benefit from adjuvant multimodality therapy to reduce the chance of tumor recurrence with the potential to improve overall survival. CONCLUSION Women diagnosed with uterine UCS should undergo complete surgical staging. Adjuvant multimodality therapies should be considered in the treatment of both early- and advanced stage patients. Long-term surveillance is indicated as many of these women may recur. Prospective clinical studies of women with UCS are necessary for optimal management.
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Affiliation(s)
| | - Ankit Modh
- Henry Ford Cancer Institute, Detroit, MI, United States of America
| | - Anuja Jhingran
- University of Texas, MD Anderson Cancer Center, Houston, TX, United States of America
| | | | - Robert L Coleman
- University of Texas, MD Anderson Cancer Center, Houston, TX, United States of America
| | - David K Gaffney
- University of Utah Medical Center, Salt Lake City, UT, United States of America
| | | | - Karen Heskett
- University of California San Diego, San Diego, CA, United States of America
| | - Shruti Jolly
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | | | - Larissa J Lee
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Linna Li
- Main Line Health System, United States of America
| | - Lorraine Portelance
- Miller School of Medicine University of Miami, Miami, FL, United States of America
| | - Tracy Sherertz
- Washington Permanente Medical Group, Kaiser Capitol Hill, Seattle, WA, United States of America
| | | | - Andrew O Wahl
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Catheryn M Yashar
- University of California San Diego, San Diego, CA, United States of America
| | - William Small
- Stritch School of Medicine, Loyola University Chicago, IL, United States of America
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Khazaei Z, Goodarzi E, Sohrabivafa M, Naemi H, Mansori K. Association between the incidence and mortality rates for corpus uteri cancer and human development index (HDI): a global ecological study. Obstet Gynecol Sci 2020; 63:141-9. [PMID: 32206653 DOI: 10.5468/ogs.2020.63.2.141] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/12/2019] [Accepted: 10/28/2019] [Indexed: 01/21/2023] Open
Abstract
Objective The aim of this study was to determine the association between the incidence of and mortality due to corpus uteri cancer (CUC) and the human development index (HDI) across the world. Methods This was an ecological study. The incidence and mortality rates of CUC along with HDI data were extracted from the Global Cancer Data in 2018. Subsequently, correlation coefficient and linear regression model were used to determine the association between the incidence and mortality rates of CUC and the HDI. STATA-14 was used for data analysis. Results There was a positive and significant correlation between the incidence (r=0.693; P<0.001) and mortality (r=0.284; P<0.001) rates of uterine cancer and the HDI. A positive and significant correlation was also observed between the incidence rate and the gross national income per 1,000 capita (r=0.440; P<0.001), mean years of schooling (MYS) (r=0.740; P<0.001), life expectancy at birth (LEB) (r=0.590; P<0.001), and expected years of schooling (r=0.650; P<0.001). The results of the linear regression model showed a significant statistical association between MYS and the incidence of CUC (β=1.10; 95% confidence interval [CI], 0.60-1.70) and LEB and mortality due to uteri cancer (β=0.40; 95% CI, 0.10-0.90). Conclusion The results of this study suggest a significant statistical association between the incidence and mortality rates of CUC and the HDI.
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23
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Gao W, Ding L, Song ZC, Feng MJ, Liu CL, Li XX, Song L, Lyu YJ, Wang JT. [The role of human papillomavirus 16 early genes E2 and E6 and heterogeneous nuclear ribonucleoprotein E2 in cervical carcinogenesis and their interaction effect]. Zhonghua Yu Fang Yi Xue Za Zhi 2020; 54:92-98. [PMID: 31914575 DOI: 10.3760/cma.j.issn.0253-9624.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the role of human papillomavirus (HPV) 16 early genes E2 and E6 and heterogeneous nuclear ribonucleoprotein (hnRNP) E2 and their interaction effects in the progression of the cervical cancer. Methods: Women with normal cervix (NC), low cervical intraepithelial neoplasia (CIN Ⅰ) and high cervical intraepithelial neoplasia (CIN Ⅱ/Ⅲ) from the cervical lesions cohort in Jiexiu County of Shanxi Province from June 2014 to September 2014, and patients with cervical squamous cell carcinoma (SCC) treated at the Second Hospital of Shanxi Medical University in the same period were enrolled in this study. There were 257 participants, about 67 NC cases (26.07%), 69 CIN Ⅰ cases (26.85%), 68 CIN Ⅱ/Ⅲ cases (26.46%), and 53 SCC cases (20.62%), respectively. The information of demographic characteristics, life health habits and cervical lesions were collected by using the structured questionnaire. Cervical exfoliated cells and cervical biopsy tissues were collected to detect the infection of HPV16 and the protein expression levels of hnRNP E2, HPV16 E2 and E6. According to the median-value of the protein expression levels of hnRNP E2, HPV16 E2 and E6 and E2/E6 ratio in the NC group, the study participants were divided into the high and low expression groups/ratio groups. The multivariate logistic regression model was used to analyze the correlation between HPV16 early gene E2 and E6, hnRNP E2 and cervical cancer. The interaction effect was analyzed by using the generalized multifactor dimensionality reduction (GMDR) model. Results: The ages of NC, CIN Ⅰ, CIN Ⅱ/Ⅲ and SCC groups were (47.00±9.07), (47.64±7.35), (46.37±8.67) and (51.26±8.03) years old, respectively. The multivariate logistic regression model analysis showed that the HPV16 E2 low expression, E6 high expression and E2/E6 low ratio could increase the risk of CIN Ⅱ/Ⅲ, about OR (95%CI) values 11.11 (1.63-75.56), 8.00 (1.28-50.04), and 9.75 (1.22-77.72), respectively and SCC, about OR (95%CI) values 14.22 (2.11-95.88), 10.33 (1.67-64.00), and 12.38 (1.56-97.91), respectively. The hnRNP E2 low expression could increase the risk of CIN Ⅱ/Ⅲ and SCC, about OR (95%CI) values 3.35 (1.39-8.10) and 5.53 (1.54-19.88). The result of GMDR showed that there were interaction effects of the hnRNP E2 low expression, HPV16 E2 low expression and HPV16 E6 high expression in both CIN Ⅱ/Ⅲ and SCC groups. Conclusion: The HPV16 E2 low expression, HPV16 E6 high expression and hnRNP E2 low expression could increase the risk of high-grade cervical intraepithelial neoplasia and cervical cancer, and they might have an important interaction effect in the progression of the cervical cancer.
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Affiliation(s)
- W Gao
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
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Soljačić Vraneš H, Djaković I, Vrljičak M, Đurić Orsag N, Kuna K, Kraljević Z, Leniček T, Brlečić I. HISTOPATHOLOGIC FINDINGS IN WOMEN UNDERGOING HYSTEROSCOPIC RESECTION OF ENDOMETRIAL POLYPS AND UTERINE MYOMAS. Acta Clin Croat 2019; 58:627-631. [PMID: 32595247 PMCID: PMC7314300 DOI: 10.20471/acc.2019.58.04.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/24/2022] Open
Abstract
The aim of our study was to determine the prevalence of endometrial premalignant and malignant lesions in women undergoing hysteroscopy and to identify anthropologic factors related to the presence of malignancy. Data on 3470 women with submucosal myomas or endometrial polyps suspected on ultrasound were retrospectively analyzed. Hysteroscopy was performed in all these women in order to make a more precise diagnosis. Histologic analysis of endometrial samples obtained during hysteroscopy was used to confirm the diagnosis. Statistical analysis was performed using the SPSS 20.0.0 software. The mean age of study women was 49.1±13.3 years. The number of procedures performed due to the referral diagnosis of endometrial or submucosal myoma significantly increased over the 16-year study period. A significantly higher number of women had a benign histopathologic diagnosis. Histologic analysis revealed malignancy in 67 women. The youngest woman and oldest woman with malignant findings was aged 32 and 75, respectively. A significantly higher number of women with atypical hyperplasia and malignancy were in menopause. A comparable number of women with different histologic findings lived in urban and rural areas. There were a significantly larger proportion of widows among women with the histologic diagnosis of atypical hyperplasia or malignancy. The prevalence rate of malignancy in women having undergone hysteroscopy for polyps and myoma found by ultrasound was 1.93%. Postmenopausal status and older age were associated with an increased risk of malignancies, but premalignant changes and malignancies were also found in young and premenopausal women. Therefore, diagnostic hysteroscopy can be recommended in women of all age groups.
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Affiliation(s)
| | - Ivka Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marija Vrljičak
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nives Đurić Orsag
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Krunoslav Kuna
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Zdenko Kraljević
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tanja Leniček
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Brlečić
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Rijeka, Rijeka, Croatia; 3Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Kommoss FKF, Stichel D, Schrimpf D, Kriegsmann M, Tessier-Cloutier B, Talhouk A, McAlpine JN, Chang KTE, Sturm D, Pfister SM, Romero-Pérez L, Kirchner T, Grünewald TGP, Buslei R, Sinn HP, Mechtersheimer G, Schirmacher P, Schmidt D, Lehr HA, Sahm F, Huntsman DG, Gilks CB, Kommoss F, von Deimling A, Koelsche C. DNA methylation-based profiling of uterine neoplasms: a novel tool to improve gynecologic cancer diagnostics. J Cancer Res Clin Oncol 2019; 146:97-104. [PMID: 31768620 DOI: 10.1007/s00432-019-03093-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Uterine neoplasms comprise a broad spectrum of lesions, some of which may pose a diagnostic challenge even to experienced pathologists. Recently, genome-wide DNA methylation-based classification of central nervous system tumors has been shown to increase diagnostic precision in clinical practice when combined with standard histopathology. In this study, we describe DNA methylation patterns of a diverse set of uterine neoplasms and test the applicability of array-based DNA methylation profiling. METHODS A multicenter cohort including prototypical epithelial and mesenchymal uterine neoplasms was collected. Tumors were subject to pathology review and array-based DNA methylation profiling (Illumina Infinium HumanMethylation450 or EPIC [850k] BeadChip). Methylation data were analyzed by unsupervised hierarchical clustering and t-SNE analysis. RESULTS After sample retrieval and pathology review the study cohort consisted of 49 endometrial carcinomas (EC), 5 carcinosarcomas (MMMT), 8 uterine leiomyomas (ULMO), 7 uterine leiomyosarcomas (ULMS), 15 uterine tumor resembling ovarian sex cord tumors (UTROSCT), 17 low-grade endometrial stromal sarcomas (LGESS) and 9 high-grade endometrial stromal sarcomas (HGESS). Analysis of methylation data identified distinct methylation clusters, which correlated with established diagnostic categories of uterine neoplasms. MMMT clustered together with EC, while ULMO, ULMS and UTROSCT each formed distinct clusters. The LGESS cluster differed from that of HGESS, and within the branch of HGESS, we observed a notable subgrouping of YWHAE- and BCOR-rearranged tumors. CONCLUSION Herein, we describe distinct DNA methylation signatures in uterine neoplasms and show that array-based DNA methylation analysis holds promise as an ancillary tool to further characterize uterine neoplasms, especially in cases which are diagnostically challenging by conventional techniques.
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Affiliation(s)
- Felix K F Kommoss
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Basile Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Jessica N McAlpine
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Dominik Sturm
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Romero-Pérez
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas Kirchner
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas G P Grünewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Rolf Buslei
- Institute of Pathology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Gunhild Mechtersheimer
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Peter Schirmacher
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany
| | | | - Hans-Anton Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, INF 224, 69120, Heidelberg, Germany.
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Bi R, Yu L, Tu XY, Ge HJ, Cheng YF, Chang B, Cai X, Jiang WH, Yang WT. [Expression of SMARCA4(BRG1) and SMARCB1(INI1) in dedifferentiated and undifferentiated endometrial carcinomas and their correlations with clinicopathological features]. Zhonghua Bing Li Xue Za Zhi 2019; 48:590-595. [PMID: 31422588 DOI: 10.3760/cma.j.issn.0529-5807.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the expression of SMARCA4 (BRG1) and SMARCB1 (INI-1) protein in endometrial dedifferentiated carcinoma (DDC) and undifferentiated carcinoma (UDC), and their correlation with clinicopathologic features. Methods: Clinicopathological information was gathered for 26 cases of DDC and UDC and consulting hospitals from January, 2006 to December, 2018 in Fudan University Shanghai Cancer Center, including 10 cases of DDC and 16 cases of UDC. Morphologic features and diagnosis were reviewed by two pathologists. Immunohistochemistry for expression of BRG1 and INI1 protein was performed. The correlations with clinicopathologic features were analyzed. Results: BRG1 and INI1 loss were present in 14 of 26 cases of DDC/UDC, including 12 BRG1-deficient cases and 2 INI1-deficient cases, respectively. Six cases demonstrated variable amounts of rhabdoid cells in 14 BRG1/INI1-deficient cases, and only 1 case showed rhabdoid cells in the 12 intact expression cases. However, there was no significantly statistical difference (P=0.060). Age, invasive depth, lymph node status and FIGO stage were not associated with the expression of the BRG1 and INI1 (P=0.437, P=0.672, P=0.242, P=0.348). Remarkably, the BGR1/INI1-deficient patients had worse survival than those with intact expression (4.7 vs. 22.9, P=0.033). Conclusion: BRG1/INI1-deficient is observed in approximately half of DDC and UDC. Identification of these tumors is clinically relevant due to their more aggressive behavior and poor prognosis. Hence, BRG1 and INI1 immunohistochemical stains should be performed for DDC and UDC in order to help the pathologists to distinguish these tumors from other carcinomas, and to predict the clinical prognosis.
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Affiliation(s)
- R Bi
- Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Abstract
Intravenous leiomyomatosis (IVLM) is an unusual neoplasm derived from uterine smooth muscle cells seen in patients with uterine leiomyomas. The typical histological features of IVLM consist of benign smooth muscle cells present within venous vascular spaces of the uterine wall. Increasing intravascular and intracardial spread of IVLM may lead to life-threatening clinical complications. Thorough pathological study of routine hysterectomy specimens may lead to the diagnosis of IVLM. Most affected patients will be cardiologically asymptomatic at the time of diagnosis. Herein, the relatively unknown clinical and morphological aspects of IVLM are presented and discussed.
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Abstract
OBJECTIVE To provide a modern overview for radiologists of the unique radiological, pathological, and clinical features of uterine carcinosarcoma (UCS). RESULTS UCS is a unique gynecological malignancy that continues to present diagnostic and therapeutic challenges to the field of oncology. The classification and clinical understanding of this malignancy have evolved in recent years, yielding a modern conceptualization of a neoplastic entity that has been well studied but incompletely understood. As UCS causes a significant proportion of deaths secondary to uterine cancer, developing a familiarity with the imaging and clinical features of this entity is critical. In addition to summarizing the modern understanding of this tumor variant, an overview of the common imaging features of UCS will be presented. The role of radiological staging, imaging findings on presentation and follow-up imaging, and modern treatment paradigms will be discussed. Lastly, the current treatment paradigms and surveillance recommendations for UCS will be summarized. CONCLUSION Knowledge of the modern understanding of uterine carcinosarcoma, including its relevant imaging and clinical features, is critical for radiologists.
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Soljačić Vraneš H, Djaković I, Kraljević Z, Nakić Radoš S, Leniček T, Kuna K. CLINICAL VALUE OF TRANSVAGINAL ULTRASONOGRAPHY IN COMPARISON TO HYSTEROSCOPY WITH HISTOPATHOLOGIC EXAMINATION IN DIAGNOSING ENDOMETRIAL ABNORMALITIES. Acta Clin Croat 2019; 58:249-254. [PMID: 31819320 DOI: 10.20471/acc.2019.58.02.07] [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] [Indexed: 01/25/2023] Open
Abstract
The aim of our retrospective study was to compare the performance of transvaginal sonography in relation to histologic diagnosis of samples obtained by hysteroscopy through analysis of data collected over 16 years. Data on suspected formation of endometrial polyp or submucosal fibroid found on ultrasound examination were extracted. The study included a total of 3679 women examined during the 2000-2015 period. All women underwent ultrasound examination preoperatively for better planning the type and scope of operation to be performed. The study included only women with samples for histopathologic analysis collected during the operation. Ultrasound diagnosis of polyps compared with histology showed 89.6% sensitivity and 39.1% specificity. For submucosal myomas, sensitivity was 69.2% and specificity 91.3%. In conclusion, ultrasound is not reliable method for definitive diagnosis but it is an excellent orientation method.
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Affiliation(s)
| | - Ivka Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Zdenko Kraljević
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandra Nakić Radoš
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tanja Leniček
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Krunoslav Kuna
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Wang SY, Xue Q, Zhou YF, Yin L. [Effects of metformin on the expression of estrogen synthetase and ER mRNA in uterine leiomyoma tissues]. Zhonghua Fu Chan Ke Za Zhi 2019; 54:249-254. [PMID: 31006191 DOI: 10.3760/cma.j.issn.0529-567x.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To elucidate whether metformin could regulate the mRNA expression level of estrogen synthetase and ER in human uterine leiomyoma tissues. Methods: (1) Seventeen pairs of uterine leiomyoma tissues and adjacent myometrium (>2 cm) were collected from patients underwent hysterectomy in Peking University First Hospital between December 2016 and January 2017. Real-time PCR was used to measure the mRNA expression level of estrogen synthetase [including cytochrome P450 cholesterol side chain cleavage enzyme (P450scc), cytochrome P450 17α-hydroxylase (P450c17), 3-beta-hydroxysteroid dehydrogenase type 2 (3β-HSD-2), 17-beta-hydroxysteroid dehydrogenase type 1 (17β-HSD-1) and aromatase cytochrome P450 (P450arom)] and ER (including ERα and ERβ) in the uterine leiomyoma tissues and adjacent myometrium. (2) Uterine leiomyoma cells derived from uterine leiomyoma tissues were identified by immunocytochemistry method and cultured to the third generation. The treatment groups were cultured with different concentrations of metformin (10, 50 and 100 μmol/L) for 48 hours, and the control group was cultured with deionized water for 48 hours. The mRNA expression level of estrogen synthetase and estrogen receptor subtypes were measured by real-time PCR. Results: (1) P450scc, P450c17, 3β-HSD-2, 17β-HSD-1, P450arom mRNA median expression levels were 112, 4, 13, 42 and 194 in the uterine leiomyoma tissues, and were respectively 114, 5, 11, 32 and 6 in the myometrium. Compared to those of the myometrium, 3β-HSD-2 and P450arom mRNA expression levels in the uterine leiomyoma tissue were significantly higher (P<0.05), while there were no significant change of mRNA expression levels among P450scc, P450c17 and 17β-HSD-1 (P>0.05). ERα and ERβ mRNA median expression levels were 208 and 116 in the uterine leiomyoma tissues, and were 24 and 95 in the myometrium. Compared to that of the myometrium, ERα mRNA level in the uterine leiomyoma tissue was significantly higher (P=0.001), while there were no significant change of ERβ mRNA level (P=0.193). (2) After cultured with different concentrations of metformin (10, 50 and 100 μmol/L), the P450arom mRNA levels in the uterine leiomyoma tissues were 9±4, 8±5 and 8±3 respectively in the treatment groups and was 16±5 in the control group. Compared to that of the control group, P450arom mRNA expression levels in the treatment groups were significantly declined (P<0.05). There were no significant different change of mRNA expression levels among 3β-HSD-2, ERα and ERβ between the treatment groups and the control group (P>0.05). Conclusions: Metformin could down-regulate the mRNA expression level of aromatase in the uterine leiomyoma cells. These results indicate that metformin may inhibit the local estrogen synthesis and therefore suppress the development of uterine leiomyoma.
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Affiliation(s)
- S Y Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
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Barrera-Castillo M, Fernández-Peña R, Del Valle-Gómez MDO, Fernández-Feito A, Lana A. [Social integration and gynecologic cancer screening of immigrant women in Spain]. Gac Sanit 2019; 34:468-473. [PMID: 30929951 DOI: 10.1016/j.gaceta.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/10/2019] [Accepted: 01/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the association between immigrant status and performance of pap-smear and mammography, and to study the potential effect of social integration on that association. METHOD Secondary analysis of the National Health Survey of Spain 2012. Individual data from 8944 women aged 18-75 were analyzed. Dependent variables were the performance of pap-smear tests and mammographies according to the guidelines of the state of residence. The level of integration in Spain was estimated through perceived social support (Duke-UNC scale) and the number of years living in Spain. Logistic regressions were used in order to obtain odds ratios (OR) and their 95% confidence intervals (95%CI), adjusted for confounders (sociodemographic and health-status). RESULTS Compared to natives, immigrant women were more likely to not adhere to cervical cancer screening (OR: 1.31; 95%CI: 1.06-1.63) or breast cancer screening (OR:=3.13; 95%CI: 2.14-4.58). Additional adjustment by social support and length of residence in Spain attenuated the association, consequently losing statistical significance (OR: 1.08, 95%CI: .77-1.52 for pap-smear; OR: 1.62, 95%CI: .97-2.74 for mammographies). CONCLUSIONS The probability of participating in the screening programs for gynecological cancer was lower if women were born abroad. Perceived social support and time living in Spain of immigrant women explained to a large extent the differences between immigrants and natives.
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Affiliation(s)
| | - Rosario Fernández-Peña
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Cantabria, Santander, España; Grupo de Investigación SALBIS, León, España; Grupo de Investigación en Enfermería IDIVAL, Santander, España
| | | | - Ana Fernández-Feito
- Departamento de Medicina, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo/ISPA, Oviedo, España
| | - Alberto Lana
- Grupo de Investigación SALBIS, León, España; Departamento de Medicina, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo/ISPA, Oviedo, España.
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Bao HL, Zhao ZP, Zhang M, Wang LM, Cong S, Fang LW, Wang LH. [The impact of five-year Chinese rural area cervical cancer screening program on screening rate]. Zhonghua Yu Fang Yi Xue Za Zhi 2019; 52:260-264. [PMID: 29973004 DOI: 10.3760/cma.j.issn.0253-9624.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the impact of Chinese Cervical Cancer Screening Program for Rural Area (NACCSPRA) on population-based screening rates. Methods: The subjects were selected from 2013-2014 Chinese Chronic Diseases and Risk Factors Surveillance (CDRFS2013), which adopting multi-stage stratified cluster sampling from 31 provinces. A total of 169 632 participants aged 18 years and older in 297 surveillance points were interviewed, of whom 65 476 women aged 35-64 years were included in the analysis. The surveillance points in CDRFS 2013 were divided into the screening areas and the control areas by matching points in CDRFS2014 with counties in NACCSPRA. The difference in socioeconomic status between areas was compared. The screening rates and 95% confidence interval (95%CI) were estimated by Tylar series variance method. The Propensity Score was evaluated for individuals by multivariate logistic regression and the greedy matching method based on propensity score value was used to conduct 1∶1 matching sample for the screening areas and the control areas. After matching, multivariate conditional logistic regression model was fitted to assess the impact of national cervical cancer screening intervention on the likelihood of undergoing cervical cancer screening at population level. Results: Among 65 476 subjects, 48.6% (n=31 794) was in the screening areas. Before matching, in the rural area the screening rate in the screening areas (24.0% (4 763/19 838), 95%CI: 21.8%-26.3%) was higher than that in the control areas (15.6% (2 331/14 942), 95%CI: 13.4%-17.8%); whereas in the urban area the screening rate in the screening areas (28.5% (3 413/11 956), 95%CI: 26.1%-31.0%) was similar to that in the control areas (26.3% (4 923/18 740), 95%CI: 24.1%-28.4%). After matching, in rural area the screening rate in the screening areas (23.2% (3 454/14 875), 95% CI: 20.9%-25.5%) was higher than that in the control areas (15.6% (2 315/14 875), 95% CI: 13.3%-17.8%); in urban area the screening rate in the screening areas (28.7% (3 202/11 146), 95% CI: 26.2%-31.2%) was higher than that in the control areas (23.1% (2 571/11 146), 95%CI: 20.9%-25.3%). Multivariate conditional logistic regression model showed that the cervical cancer screening rates in intervention areas significantly increased among women aged 35-64 years both in urban areas (OR=1.44, 95%CI: 1.34-1.54) and rural areas (OR=1.78, 95%CI: 1.67-1.90) as compared with those in control areas. Conclusion: The implementation of Chinese cervical cancer screening program during the five years substantially increased the population-based screening rates both in urban and rural areas.
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Affiliation(s)
- H L Bao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Jørgensen SL, Mogensen O, Petersen MA, Wu CS, Jensen PT. New insights into early recovery after robotic surgery for endometrial cancer. Gynecol Oncol 2019; 153:271-6. [PMID: 30808516 DOI: 10.1016/j.ygyno.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess early recovery of physical health after robotic minimally invasive surgery (RMIS) for early-stage endometrial cancer using the European Organisation of Research and Treatment of Cancer Computer Adaptive Test Core questionnaire (EORTC CAT Core). The EORTC CAT Core provides individualised measurements while maintaining comparability. A hypothesis of individual complete recovery to baseline within three post-surgical weeks was evaluated. METHODS Ninety-four women who underwent RMIS for early-stage endometrial cancer were included consecutively. The EORTC CAT Core was distributed before surgery and prospectively every week during the first post-operative month. Repeated measures models were fitted for each of the four domains (physical functioning, role function, fatigue, and pain) and tested for impact of age, ASA score, minor/major surgery, and the individual baseline scores (poorest, intermediate, best). RESULTS Women with the lowest physical functioning, lowest role function, highest fatigue level, and highest pain level at baseline all recovered within three weeks. Women with the highest physical functioning, highest role function, lowest level of fatigue, and lowest level of pain at baseline did not reach their individual baselines within the first post-operative month but had the most favourable domain-scores three weeks post-operatively. CONCLUSION The individual woman's physical health baseline score is predictive for her postoperative recovery following RMIS for early-stage endometrial cancer. Women with the best physical health had the best postoperative functions and lowest level of symptoms; however their recovery to baseline was prolonged. Computer adaptive testing may be a valuable tool for individualised pre-operative information and supportive care during surveillance.
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Wang Y, Yu M, Yang JX, Cao DY, Zhang Y, Shen K, You Y. [Clinicopathologic and survival analysis of synchronous primary endometrial and ovarian cancer]. Zhonghua Fu Chan Ke Za Zhi 2018; 53:816-22. [PMID: 30585019 DOI: 10.3760/cma.j.issn.0529-567x.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To demonstrate the clinicopathological characteristics and determine the prognostic factors for women with synchronous primary endometrial and ovarian cancer (SEOC) . Methods: A retrospective analysis of 63 pathologically proven cases of SEOC diagnosed in Peking Union Medical College Hospital from January 2000 to May 2018 was carried out. Results: (1) Clinical features: mean age at diagnosis was (48.3±10.0) years, and the mean body mass index (BMI) was (23.4±3.7) kg/m(2). The most common presenting symptom was abnormal uterine bleeding with a ratio of 73% (46/63). Forty-three patients (68%, 43/63) were premenopausal, and 30% (19/63) were nulliparous. (2) Pathological features: for the endometrial cancer, 90% patients were diagnosed at stage Ⅰ, and 81% were low grade tumors (G(1)-G(2)). The histological type of endometrial cancer was mainly endometrioid carcinoma (86%) and majority (81%) of patients were proved without or with superficial myometrial invasion. For the ovarian cancer, 70% patients were diagnosed at stage Ⅰ and 65% were low grade tumors (G(1)-G(2)). Sixty-two percent of ovarian cancers were endometrioid carcinoma and 68% of patients had unilateral involvement of the ovaries. (3) Treatment and prognosis: all patients underwent surgery, of which 56 (89%) underwent staging surgery including retroperitoneal lymphadenectomy, and 57 (90%) received postoperative adjuvant therapy. The median follow-up time was 48.0 months (range, 2-176 months) , and 13% of the patients experienced tumor recurrence during the follow-up period. The median time to recurrence was 38.5 months, and 6 patients (10%) died of tumor recurrence. The 5-year progression-free survival (PFS) and 5-year overall survival (OS) for all patients were 69% and 80%, respectively. (4) Prognostic factors: univariate analysis showed that the presence of lymphovascular space invasion (LVSI) , non-endometrioid histology of ovarian cancer and stage of ovarian cancer above stage Ⅰ were associated with significantly worse PFS (P<0.05). LVSI, high grade of endometrial cancer, and above stage Ⅰ of ovarian cancer were associated with significantly worse OS (P<0.05). On multivariate analysis, LVSI, non-endometrioid type ovarian cancer and stage of ovarian cancer above stage Ⅰwere associated with significantly worse PFS (P<0.05). In addition, LVSI and stage of ovarian cancer above stage Ⅰ were also associated with significantly worse OS (P<0.05) . Conclusions: Women with SEOC are young, premenopausal and have a favorable overall prognosis. Presence of LVSI, non-endometrioid type ovarian cancer and stage of ovarian cancer above stage Ⅰ are independent prognostic factors for PFS, and stage of ovarian cancer above stage Ⅰare independent prognostic factors for OS.
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Wang KL, Guo RX, Yuan ZF, Li AJ, Li LX, Zhao ML, Chu DX. [Clinical analysis of leiomyomatosis peritonealis disseminate after laparoscopic uterine myomectomy in ten cases]. Zhonghua Fu Chan Ke Za Zhi 2018; 52:533-538. [PMID: 28851170 DOI: 10.3760/cma.j.issn.0529-567x.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinicopathological features, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD). Methods: A total of 10 patients suffered from LPD after laparoscopic uterine myomectomy were collected in the First Affiliated Hospital of Zhengzhou University from September 2012 to September 2016, and all clinical database were retrospectively analyzed. Results: (1)Clinical features: the age of 10 cases was 25-50 years old, and 8 cases of them were in child-bearing age, while 2 cases were in perimenopausal period. Of 10 cases, 2 cases manifested as discontinuous lower abdominal pain, and the other cases were seen the doctor for the examinations found tumors of pelvis or abdomen. All 10 cases had a history of laparoscopic uterine myomectomy under went power morcellation with an average of (4.0±2.2) years (range 1.3 to 8.1 years), 2 cases of them had a history of oral hormone treatment after the first myoma morcellation. (2) Treatment methods and postoperative pathologic diagnosis: during intraoperative exploration, LPD nodules were most distributed in Douglas pouch (10 cases), and next in mesentery (7 cases), abdominal peritoneum (6 cases) and omentum majus (4 cases), etc. Seven of the 8 cases of child-bearing age were performed laparoscopic LPD nodules removal, 1 case gone combined with laparotomy and resecting LPD nodules; 2 cases in perimenopausal period done laparotomy oophorotomy and resected all LPD nodules and omentum. (3) Postoperative relapse and reproductive outcomes: the follow-up time of all cases was 2.8 years, and no recurrence was found during the follow-up period; 2 cases had natural conception and term vaginal birth during the follow-up period. Conclusions: LPD is mainly related to iatrogenic planting and spreading, which is a benign disease and characterized by multiple smooth muscle nodules throughout abdominopelvic cavity, and the nodules of LPD is commonly located in Douglas pouch, mesenteric and omentaum majus, etc. The preferred method of LPD should be individual operative treatment according to different situations, and in which patients may be have better prognosis.
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Affiliation(s)
- K L Wang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Cheng CH, Su B, Ding DC. Rare case of undifferentiated uterine sarcoma with neuroectodermal differentiation and osteoclast-like giant cells. Taiwan J Obstet Gynecol 2018; 57:442-446. [PMID: 29880181 DOI: 10.1016/j.tjog.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/30/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We describe the first case of a rare undifferentiated uterine sarcoma exhibiting both neuroectodermal differentiation and osteoclast-like giant cells, and elaborate its morphology. CASE REPORT A 54-year-old woman presented with suprapubic pain, frequent urination, and perimenopausal abnormal vaginal bleeding. Computed tomography revealed a large heterogeneous uterine mass and multiple lung nodules. She received a staging surgery. The tumor pathology examination revealed an undifferentiated uterine sarcoma (UUS) with neuroectodermal differentiation and osteoclast-like giant cells (OGCs). The patient was managed with palliative hospice care; however, she died within 1.5 months of diagnosis. CONCLUSION UUSs are rare high-grade tumors observed in elderly women. These women typically present with postmenopausal bleeding and extrauterine diseases and have a poor prognosis. Neuroectodermal differentiation in UUSs has a müllerian origin. The presence of OGCs may suggest a poor prognosis; however, further studies are necessary to determine the exact nature of such neoplasms.
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Affiliation(s)
- Chiu-Hsuan Cheng
- Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien City, Hualien, Taiwan
| | - Borcherng Su
- Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien City, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Janda M, McGrath S, Obermair A. Challenges and controversies in the conservative management of uterine and ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2018; 55:93-108. [PMID: 30243603 DOI: 10.1016/j.bpobgyn.2018.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022]
Abstract
Uterine cancer is the fifth most common cancer in women worldwide with an estimated 320,000 annual diagnoses. Its most common form, endometrioid adenocarcinoma of the endometrium (endometrial adenocarcinoma [EAC]), is thought to develop through excessive proliferation of endometrial glands, and then increasing steadily in incidence. The current standard treatment for EAC is hysterectomy, which is often curative. However, it may be unacceptably expensive for women with severe medical comorbidities, those who are at risk of intra- and postoperative adverse events and those who desire fertility. Ovarian cancer is the most malignant of all gynaecological cancers, but patients with disease limited to one ovary and patients with non-epithelial tumours may expect a good prognosis. A selected group of young patients who desire fertility may be well treated with conservative surgery. This chapter reviews patient selection, diagnosis, pre-treatment evaluation, treatment options, surveillance and risk of relapse.
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Affiliation(s)
- M Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Brisbane, Australia
| | - S McGrath
- Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women's Hospital, 6th Floor Ned Hanlon Building, Herston QLD 4029, Brisbane, Australia
| | - A Obermair
- Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women's Hospital, 6th Floor Ned Hanlon Building, Herston QLD 4029, Brisbane, Australia; Clinical School, Faculty of Medicine, The University of Queensland, Herston QLD 4029, Brisbane, Australia.
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Liang XX, Zhang ZY, Liu CD, Qu H. [Application of DDI in prediction of fertility outcome after laparoscopic myomectomy]. Zhonghua Fu Chan Ke Za Zhi 2018; 53:528-533. [PMID: 30138962 DOI: 10.3760/cma.j.issn.0529-567x.2018.08.004] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the application of difficulty degree index (DDI) in predicting patients's fertility outcome after laparoscopic myomectomy. Methods: A retrospective study was carried out on 118 patients with subserous myoma or intramural myoma undergoing laparoscopic myomectomy from January 2005 to December 2014. The rate of post-operative pregnancy, delivery outcome and disease recurrence were investigated. Logistic regression analysis was used to analyze the impact of DDI, the age of patients undergoing surgery, presence of infertility history etc, on the patients' reproductive outcome following the surgery. Results: Follow-up for 1 to 10 years,118 cases were included in the study, the rate of post-operative pregnancy, live birth, vaginal delivery were 72.9% (86/118) , 52.5% (62/118) and 24.2% (15/62) respectively. No cases of uterine rupture and obstetric complications occurred. Univariate analysis showed that the independent variables of post-operative pregnancy rate were DDI, patient's age at the time of surgery, presence of infertility history and myoma recurrence (all P<0.05) . In multivariate analysis, the factors of post-operative pregnancy rate were DDI (OR=3.131, 95%CI:1.012-8.894) , patient's age at the time of surgery (OR=2.722, 95%CI:1.048-7.067) and presence of infertility history (OR=8.509, 95%CI: 2.102-34.445) . Conclusions: DDI could be applied to predict post-operative pregnancy rate, with the increasing of DDI the post-operative pregnancy rate decreasing. The patients with high DDI scores, age>35 years old or presence of infertility history should get ready for pregnancy positively.
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Affiliation(s)
- X X Liang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Yegin Akcay GF, Tas EE, Yavuz AF. Is postmenopausal endometrial fluid collection alone a risk factor for endometrial cancer? Pak J Med Sci 2018; 34:54-57. [PMID: 29643878 PMCID: PMC5857029 DOI: 10.12669/pjms.341.13990] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the usefulness of single-layer, ultrasonographic measurement of endometrial fluid collection (EFC) volume to predict endometrial pathology in asymptomatic postmenopausal patients. Methods One hundred fifty asymptomatic postmenopausal women were analysed retrospectively from January 2012 to December 2016. After patients with endometrial hyperplasia/neoplasia were included in Group-I, and those with insufficient tissue, endometrial atrophy, or endometritis were included in Group-II; Groups one and two were compared with respect to primary (correlations between endometrial thickness and EFC volume) and secondary (correlations between demographic characteristics and EFC volume) outcomes. Results There was no correlation between EFC volume and single-layer endometrial thickness (P = 0.36). Likewise, demographic characteristics were not related to EFC (P > 0.05). However, both EFC volume and single-layer endometrial thickness were thicker in Group-I compared to Group-II (4.8 ± 1.9 mm vs. 3.7 ± 2.5 mm; and 5.7 ± 9.4 mm vs. 2.7 ± 2.5 mm, respectively) (P values were < 0.05). Conclusion Although a cutoff value for endometrial thickness and EFC volume could not be recommended based on our study findings, it should be noted that 2% is a clinically significant rate of malignancy. Thus, postmenopausal patients with EFC should be evaluated for endometrial sampling.
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Affiliation(s)
- Gulin Feykan Yegin Akcay
- Gulin Feykan Yegin Akcay, MD. Department of Gynecology and Obstetrics, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Emre Erdem Tas
- Emre Erdem Tas, Assistant Professor, Department of Gynecology and Obstetrics, Yildirim Beyazit University, Ankara, Turkey
| | - Ayse Filiz Yavuz
- Prof. Ayse Filiz Yavuz, Department of Gynecology and Obstetrics, Yildirim Beyazit University, Ankara, Turkey
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Iversen ML, Dueholm M. Complex non atypical hyperplasia and the subsequent risk of carcinoma, atypia and hysterectomy during the following 9-14 years. Eur J Obstet Gynecol Reprod Biol 2018; 222:171-175. [PMID: 29413816 DOI: 10.1016/j.ejogrb.2018.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the long-term risk of developing atypical hyperplasia/endometrial cancer or having a hysterectomy after being diagnosed with complex non-atypical hyperplasia (CH). MATERIAL AND METHOD A historic cohort study of 114 women diagnosed with CH between January 1st 2000 and December 31st 2005. All patient records and pathologic reports were reviewed with complete follow up on all patients in the national pathologic database until September 1st 2014. Kaplan-Meier analysis was used to determine (1) no hysterectomy and (2) no diagnosis of endometrial cancer or atypia after the CH diagnosis. RESULTS 15% (n = 17) were diagnosed with endometrial cancer and 7% (n = 8) with atypia, most during the first year (10 cancer, 7 atypia). 9% (8/85) of the remaining women at risk developed cancer or atypia in the follow-up period after one year. By Kaplan-Meier the five-year risk for cancer or atypia was 20% (CI; 14-21). The risk of having undergone hysterectomy within five years was 30% (CI; 22-39). CONCLUSION The long-term risk of being diagnosed with atypia or cancer after a CH diagnose is not insignificant, when disregarding patients having undergone hysterectomy. More than half the women with atypia or cancer are diagnosed or operated during the first year. This could indicate the presence of concomitant but unidentified cancer or atypia at the time of initial sampling. This study reinforces the importance of follow up or treatment of women with CH - especially, but not only during the first year. KEY MESSAGE The risk of having a hysterectomy or diagnosed with atypical hyperplasia/cancer endometrie is high after a diagnosis of complex hyperplasia without atypia.
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Affiliation(s)
- Maja Lundegaard Iversen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.
| | - Margit Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
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Wang XQ, Zhu L, Xu T, Zhang L, Lyu T, Chen R. [Validation of the Chinese version of the uterine fibroid symptom and health-related quality of life]. Zhonghua Fu Chan Ke Za Zhi 2017; 52:455-460. [PMID: 28797152 DOI: 10.3760/cma.j.issn.0529-567x.2017.07.005] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To evaluate the reliability and validity of the Chinese version of the uterine fibroid symptom and health-related quality of life (UFS-QOL) in patients with uterine fibroid. Methods: The original English UFS-QOL was translated into Chinese and linguistically validated following the cross-cultural adaptation of health-related quality of life measures. Patients recruited randomly from Peking Union Medical College Hospital from June 2013 to December 2016 were scheduled for two visits with 2 weeks apart, and they were surveyed through the Chinese version of UFS-QOL and short-form 12-item health survey (SF-12). The reliability and validity of the Chinese version of UFS-QOL were evaluated. Results: A total of 190 uterine fibroid patients who met the criteria participated this study. The Chinese version of UFS-QOL had a high internal consistency (Cronbach's α, uterine fibroid symptom severity scale:0.912, health-related quality of life scale: 0.976) and high test-retest reliability (intraclass correlation coefficient, 0.572-0.951, P<0.01). The symptom severity scores and SF-12 scores were negatively correlated (r=-0.813, P<0.01); the health-related quality of life scores and SF-12 scores were positively correlated (r=0.620, P<0.01). The factor analysis showed good construct validity. Conclusion: Psychometric testing supports the reliability and validity of the Chinese version of UFS-QOL as an disease-specific measure of health-related quality of life.
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Affiliation(s)
- X Q Wang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
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Abstract
The differential diagnosis of lesions arising in the broad ligament is quite large. Many of these lesions can be clinically interpreted before surgery as adnexal or uterine neoplasms. Although some lesions are similar to those arising in other müllerian sites, there are unique lesions as well. The lesions are uncommon and may prove challenging to clinicians. The purpose was to review the scope of lesions affecting the broad ligament. A literature review was conducted. A Medline search was performed using the terms broad ligament, mesosalpinx, and mesovarium. A review of the scope of broad ligament lesions is presented to assist in developing a differential diagnosis if a patient with such a lesion is encountered.
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Affiliation(s)
- Debra S Heller
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
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Gungorduk K, Ozdemir A, Ertas IE, Gokcu M, Telli E, Oge T, Sahbaz A, Sayhan S, Sanci M, Harma M, Ozalp S. Adjuvant treatment modalities, prognostic predictors and outcomes of uterine carcinosarcomas. Cancer Res Treat 2014; 47:282-9. [PMID: 25358384 PMCID: PMC4398122 DOI: 10.4143/crt.2014.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 01/08/2014] [Accepted: 02/18/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study is to evaluate the clinicopathological characteristics, treatment, and prognosis of uterine carcinosarcoma (UC). Materials and Methods A retrospective review of three cancer registry databases in Turkey was conducted for identification of patients diagnosed with UC between January 1, 1996, and December 31, 2012. We collected clinicopathological data in order to evaluate factors important in disease- free survival (DFS) and overall survival (OS). Results A total of 66 patients with UC with a median age of 65.0 years were included in the analysis. The median survival time of all patients was 37.5 months and the 5-year OS rate was 59.1%. In early stage patients (I-II) who received adjuvant chemotherapy (CT) with radiation therapy (RT), the median DFS and OS was 44 months and 55 months, respectively, compared to 34.5 months and 36 months, respectively, in patients who received adjuvant RT or CT alone (hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.7 to 3.1 for DFS; p=0.23 and HR, 2.2; 95% CI, 0.9 to 5.3 for OS; p=0.03). In advanced stage patients (III-IV), the median DFS and OS of patients receiving adjuvant RT with CT was 25 months and 38 months, respectively, compared to 23.5 months and 24.5 months, respectively, in patients receiving adjuvant RT or CT alone (HR, 3.1; 95% CI, 0.6 to 16.0 for DFS; p=0.03); (HR, 3.3; 95% CI, 0.7 to 15.0 for OS; p=0.01). In multivariate analysis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage and suboptimal surgery showed significant association with poor OS. Conclusion In patients with early or advanced stage UC, adjuvant CT with RT is associated with improved DFS and OS, as compared to CT or RT alone.
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Affiliation(s)
- Kemal Gungorduk
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Aykut Ozdemir
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ibrahim E Ertas
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Elcin Telli
- Department of Gynecologic Oncology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Tufan Oge
- Department of Gynecologic Oncology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Ahmet Sahbaz
- Department of Gynecologic Oncology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Sevil Sayhan
- Department of Pathology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Harma
- Department of Gynecologic Oncology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Sinan Ozalp
- Department of Gynecologic Oncology, Osmangazi University School of Medicine, Eskisehir, Turkey
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Lee JY, Kim EY, Jung KW, Shin A, Chan KKL, Aoki D, Kim JW, Low JJH, Won YJ. Trends in gynecologic cancer mortality in East Asian regions. J Gynecol Oncol 2014; 25:174-82. [PMID: 25045429 PMCID: PMC4102735 DOI: 10.3802/jgo.2014.25.3.174] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 02/14/2014] [Revised: 04/10/2014] [Accepted: 04/13/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate uterine and ovarian cancer mortality trends in East Asian countries. METHODS For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women ≥20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. RESULTS Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized. CONCLUSION Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.
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Affiliation(s)
- Jung-Yun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Yang Kim
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Aesun Shin
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea. ; Molecular Epidemiology Branch, National Cancer Center, Goyang, Korea
| | - Karen K L Chan
- Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeffrey J H Low
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
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Dood RL, Gracia CR, Sammel MD, Haynes K, Senapati S, Strom BL. Endometrial cancer after endometrial ablation vs medical management of abnormal uterine bleeding. J Minim Invasive Gynecol 2014; 21:744-52. [PMID: 24590007 DOI: 10.1016/j.jmig.2014.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To investigate whether endometrial ablation is associated with increased risk or delayed diagnosis of endometrial cancer compared with medical management of abnormal uterine bleeding. DESIGN Multi-centered retrospective cohort study (Canadian Task Force classification II-2). SETTING The study was performed using data from The Health Improvement Network, a representative population-based cohort of patients in 495 outpatient general practitioner practices in the United Kingdom. PATIENTS Women aged >25 years with abnormal uterine bleeding diagnosed between June 1994 and September 2010. INTERVENTIONS Endometrial ablation, medical management, or both. MEASUREMENTS AND MAIN RESULTS A total of 234 721 women met study inclusion and exclusion criteria, 4776 of whom underwent endometrial ablation and the remaining 229 945 received medical management. Cox models compared endometrial cancer rates between ablation and medical management groups using hazard ratios. To investigate a possible diagnostic delay, the median time from bleeding diagnosis to endometrial cancer diagnosis in women in whom endometrial cancer developed was compared using the Mann-Whitney U test. All statistical tests were 2-tailed, with α = .05. During a median observation period of 4.07 years (interquartile range [IQR], 1.88-7.17), endometrial cancer developed in 3 women in the ablation group and 601 women in the medical management group (ablation hazard ratio, 0.45; 95% confidence interval, 0.15-1.40; p = .17). Median time to diagnosis was 237 in the ablation group, and 299 days in the medical management group (ablation IQR, 155-1350; medical management IQR, 144-1133.5; p = .99). Adjusted and sensitivity analyses did not change the results. CONCLUSIONS No difference was observed in endometrial cancer rates, and there was no delay in diagnosis when comparing endometrial ablation vs medical management. Further studies are needed to investigate the effect of previous ablation exposure on histology or cancer stage at manifestation of endometrial cancer.
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Affiliation(s)
- Robert L Dood
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia.
| | - Clarisa R Gracia
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia
| | - Mary D Sammel
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Suneeta Senapati
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Oliveira L, Ramos S. Anesthetic approach for a clinical case of intravenous leiomyomatosis: Case report. Braz J Anesthesiol 2014; 63:504-7. [PMID: 24565349 DOI: 10.1016/j.bjane.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/20/2013] [Accepted: 04/01/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to describe the anesthetic approach in a case of intravenous leiomyomatosis with invasion of the inferior vena cava and extension to the right atrium, successfully treated with surgical approach. CASE REPORT Female patient, 45 years old, apparently stable until two weeks before the admission to the emergency department with complaints of fatigue and dyspnea. Echocardiogram was performed, which detected an intracardiac mass. Therefore, elective tumorectomy was performed in the vena cava-right atrium and right ventricle transition. Histological examination of the specimen suggested uterine leiomyoma. Subsequently, to assess the extent, computed tomography was done and showed extension to the inferior vena cava and left ovary. Hysterectomy, left adnexectomy and right salpingectomy, removal of intravenous leiomyoma, and permanent filter placement in the inferior vena cava were proposed. In this article, we describe the anesthetic approach with particular emphasis on the correction of fluid requirements, as well as postoperative evolution, and we highlight possible contributions to future approach of similar cases. CONCLUSIONS Preoperative diagnosis of intravenous leiomyomatosis is extremely difficult. Treatment consists of surgical removal. This procedure involves major blood loss and, therefore, preoperative preparation was conditioned: intraoperative fluid therapy was central and invasive monitoring considered predominant to assist in fluid and electrolyte balance of the patient; the existence of a clinical laboratory accessible and with rapid response and blood gas assessment was crucial; the intensive care unit equipped with ventilator for postoperative care proved to be another requirement resulting from this case.
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Affiliation(s)
- Luís Oliveira
- Department of Anesthesiology, Hospital de Santa Maria, Lisboa, Portugal
| | - Samuel Ramos
- Department of Anesthesiology, Hospital de Santa Maria, Lisboa, Portugal.
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Sonoda Y. Surgical treatment for apparent early stage endometrial cancer. Obstet Gynecol Sci 2014; 57:1-10. [PMID: 24596812 DOI: 10.5468/ogs.2014.57.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/28/2013] [Accepted: 10/28/2013] [Indexed: 01/27/2023] Open
Abstract
Most experts would agree that the standard surgical treatment for endometrial cancer includes a hysterectomy and bilateral salpingo-oophorectomy; however, the benefit of full surgical staging with lymph node dissection in patients with apparent early stage disease remains a topic of debate. Recent prospective data and advances in laparoscopic techniques have transformed this disease into one that can be successfully managed with minimally invasive surgery. This review will discuss the current surgical management of apparent early stage endometrial cancer and some of the new techniques that are being incorporated.
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Abstract
Uterine leiomyoma is one of the most common gynecological tumor, whereas acute torsion of the uterine leiomyoma is very rare. We report a case of subserosal leiomyoma that was first detected by ultrasonography, and further confirmed as torsion of subserosal leiomyoma by laparoscopic surgery.
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Affiliation(s)
- Hwi-Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ook-Hwan Choi
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
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Chu CY, Tang YK, Chan TSA, Wan YH, Fung KH. Diagnostic challenge of lipomatous uterine tumors in three patients. World J Radiol 2012; 4:58-62. [PMID: 22423320 PMCID: PMC3304095 DOI: 10.4329/wjr.v4.i2.58] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 11/18/2011] [Accepted: 11/25/2011] [Indexed: 02/06/2023] Open
Abstract
Lipomatous uterine tumors are uncommon benign neoplasms, with incidence ranging from 0.03% to 0.2%. They can generally be subdivided into two types: pure or mixed lipomas. A third group of malignant neoplasm has been proposed, which is liposarcoma; however, this is very rare. In this article, we report three patients having lipomatous uterine tumors, including one uterine lipoma and two uterine lipoleiomyomas. All our patients are postmenopausal women, which is the typical presenting age group. They did not have any symptoms and the tumors were only found incidentally on imaging. However, in some patients, symptoms may uncommonly occur. If symptoms occur, these are similar to those of leiomyoma. We illustrate the imaging features of the tumors in our patients with ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI). The tumor typically appears as a well-defined homogenously hyperechoic lesion on ultrasound. It shows fat density on CT scan and signal intensity of fat on MRI. MRI is the modality of choice because of its multiplanar capability and its ability to demonstrate fat component of the lesion, as illustrated in our cases. We also discuss the importance of differentiating lipomatous uterine tumors from other lesions, especially ovarian teratoma which requires surgical intervention. Despite the rarity and the common asymptomatic nature of the tumors, we believe that this series of three cases demonstrates a review of a rare tumor which provides important knowledge for patient management.
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Jeong NH, Lee JM, Lee SK. Current status in the management of uterine corpus cancer in Korea. J Gynecol Oncol 2010; 21:151-62. [PMID: 20922137 DOI: 10.3802/jgo.2010.21.3.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 06/03/2010] [Accepted: 06/27/2010] [Indexed: 01/29/2023] Open
Abstract
Uterine corpus cancer has increased in prevalence in Korean women over the last decade. Recently, elegant studies have been reported from many institutes. To improve treatment strategies, a review of our own data is warranted. This work will discuss the risks and prognostic factors for uterine corpus cancer, and the radiologic evaluation, prediction of lymph node metastasis, systematic lymphadenectomy, minimally invasive surgery, ovarian-saving surgery, fertility-sparing treatment, and adjuvant treatment in women with uterine cancer.
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Affiliation(s)
- Nan-Hee Jeong
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
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