National Cancer Institute®
Last Modified: January 1, 2002
UI - 11332078
AU - Biesterfeld S; Leitloff M; Rath W; Schroder W
TI - DNA image cytometry in the differential diagnosis of endometrial hyperplasia and adenocarcinoma.
SO - Anal Quant Cytol Histol 2001 Apr;23(2):123-8
AD - Institute of Pathology and Department of Obstetrics and Gynecology, Technical University of Aachen, Aachen, Germany. email@example.com
OBJECTIVE: To test the value of DNA image cytometry in the differential diagnosis of hyperplastic endometrial lesions and endometrial carcinoma on a series of 153 cases of simple hyperplasia (n = 71), complex hyperplasia (n = 28), complex atypical hyperplasia (n = 11) and endometrial adenocarcinoma (n = 43). STUDY DESIGN: Monolayer smears were prepared from three 50-micron-thick sections by a cell separation technique and were stained according to Feulgen. The DNA content of 250 epithelial cells, chosen randomly, was determined using a TV image analysis system (CM-1, Hund, Wetzlar, Germany). The DNA content of 30 lymphocytes served as an internal standard for the normal diploid value in every case. Different DNA cytometric parameters and the mean nuclear area were calculated. RESULTS: Cases of adenocarcinoma and complex atypical hyperplasia (n = 54) were defined as clinically "positive" as these patients are normally treated by hysterectomy. The remaining cases of simple and complex hyperplasia (n = 99) were interpreted as clinically "negative" as conservative therapy is usually preferred. Requesting a specificity of > 90%, high sensitivity rates were calculated for ploidy imbalance (94%), mean ploidy (91%), diploid deviation quotient (91%), DNA stemline ploidy (87%) and 2c deviation index (85%), based on suitable thresholds. Entropy (76%), 5c exceeding events (63%), mean nuclear area (48%) and 9c exceeding events (6%) revealed lower sensitivity values. 5c Exceeding events (P = .0117) and mean nuclear area (P = .0392) were helpful in differentiating between atypical hyperplasia and endometrial carcinoma as the data distribution was significantly different with the U test. CONCLUSION: Our results indicate that DNA single cell cytometry is a highly relevant tool in the differential diagnosis of endometrial lesions and could be used as a complementary diagnostic method, especially in histomorphologically difficult cases.
UI - 11332081
AU - Garcia FA; Davis JR; Alberts DS; Hatch K; Weyn B; Thompson D; Bartels PH
TI - Nuclear chromatin patterns in normal, hyperplastic and atypical endometrium.
SO - Anal Quant Cytol Histol 2001 Apr;23(2):144-50
AD - Arizona Cancer Center and Optical Sciences Center, University of Arizona, Tucson, Arizona, USA.
OBJECTIVE: To characterize the nuclei of endometrial lesions for the diagnostic categories of normal glandular tissue, simple hyperplasia, atypical hyperplasia and adenocarcinoma of the endometrium, with the specific goal of probing for heterogeneity. STUDY DESIGN: For each diagnostic category the images of 360 nuclei were recorded on a high-resolution video microphotometer. Features descriptive of the statistical and spatial distribution of nuclear chromatin were computed for each nucleus. A nonsupervised learning algorithm, P-index, was employed to establish subsets of nuclei within each diagnostic category and to determine whether these subsets were statistically significantly different in the nuclear chromatin pattern. RESULTS: Lesions from cases of hyperplasia, atypical hyperplasia and adenocarcinoma of the endometrium each contained several subsets of nuclei with statistically significantly different chromatin patterns. For one such subset from each diagnostic category, a clear trend of progression toward adenocarcinoma could be demonstrated. CONCLUSION: The nuclei in endometrial lesions represent a highly heterogeneous set. Any measure of lesion progression or regression due to chemopreventive intervention, in an individual case, will have to examine the proportion of nuclei in each of these subsets as well as measures of deviation from normal for each subset.
UI - 11411456
AU - Committee on Gynecologic Practice, The American College of Obstetricians
TI - and Gynecologists ACOG committee opinion: Tamoxifen and endometrial cancer.
SO - Int J Gynaecol Obstet 2001 Apr;73(1):77-9
UI - 11396634
AU - Agoff SN; Grieco VS; Garcia R; Gown AM
TI - Immunohistochemical distinction of endometrial stromal sarcoma and cellular leiomyoma.
SO - Appl Immunohistochem Mol Morphol 2001 Jun;9(2):164-9
AD - Department of Cytopathology, University of Washington Medical Center, Seattle, USA. firstname.lastname@example.org
Distinguishing low grade endometrial stromal sarcoma (ESS) from benign smooth muscle proliferations like cellular leiomyoma (CL) can be problematic; because of differing treatments and prognosis, this distinction is important. The authors tested the hypothesis that low grade ESS could be distinguished from CL by immunohistochemistry using a panel of antibodies that have not previously been used in this setting. Antibodies to calponin, smooth muscle myosin heavy chain (SMM-HC), the Wilms tumor gene product (WT-1), and CD10 were applied to 14 cases of ESS (10 low grade, 4 high grade) and 9 CL. Among low grade ESS, 3 of 10, 3 of 10, 9 of 10, and 10 of 10 were positive for expression of calponin, SMM-HC, WT-1, and CD10, respectively. Of CL, all 9 were positive for calponin, SMM-HC, and WT-1, whereas 3 of 9 marked with antibodies to CD10. Overall, SMM-HC and calponin were expressed strongly in CL but weakly expressed in ESS; the converse was true for CD10. Expression of WT-1 and the reticulin-staining pattern do not discriminate between these two tumors. Antibodies to SMM-HC, CD10, and calponin can reliably distinguish ESS from CL.
UI - 11474654
AU - Chadwick RB; Pyatt RE; Niemann TH; Richards SK; Johnson CK; Stevens MW;
TI - Meek JE; Hampel H; Prior TW; de la Chapelle A Hereditary and somatic DNA mismatch repair gene mutations in sporadic endometrial carcinoma.
SO - J Med Genet 2001 Jul;38(7):461-6
UI - 11444198
AU - Czernobilsky B; Gabbiani G; Prus D; Lifschitz-Mercer B
TI - Alpha-smooth muscle actin-positive myofibroblasts in endometrial stroma are not a reliable criterion for the diagnosis of well differentiated endometrioid adenocarcinoma in small tissue samples.
SO - Int J Gynecol Pathol 2001 Jul;20(3):232-8
AD - Laboratory of Pathology, Patho-Lab, Ness-Ziona, Israel.
Although a desmoplastic stromal reaction in well-differentiated endometrioid adenocarcinoma is considered a major criterion in the differential diagnosis with atypical hyperplasia, this histologic feature has not met with universal approval. Since alpha-smooth muscle (alpha-SM) actin positive myofibroblasts characterize the desmoplastic stromal response in a variety of neoplasms, the present study was undertaken in order to establish whether these cells are also prominent in the stroma of endometrioid carcinoma and if present could be used as a valid criterion in the differential diagnosis between benign and malignant lesions. The present study of 100 endometrial samples showed focal desmoplastic stromal reaction with alpha-SM actin positive myofibroblasts in 30% of small samples and in 50% of hysterectomy specimens with endometrioid carcinoma. In normal endometrium and in benign lesions lacking a desmoplastic reaction, focal stromal alpha-SM actin positivity was a very common finding. Stromal alpha-SM actin-positive cells were also frequently seen in nondesmoplastic stroma of endometrioid carcinoma. Thus the common presence of alpha-SM actin-positive myofibroblasts in normal endometrial stroma and in benign and malignant lesions precludes its usefulness in the diagnosis of well differentiated endometrioid adenocarcinoma, especially in small tissue samples.
UI - 11444203
AU - Guarch R; Puras A; Ceres R; Isaac MA; Nogales FF
TI - Ovarian endometriosis and clear cell carcinoma, leiomyomatosis peritonealis disseminata, and endometrial adenocarcinoma: an unusual, pathogenetically related association.
SO - Int J Gynecol Pathol 2001 Jul;20(3):267-70
AD - Departamento de Anatomia Patologica, Hospital Virgen del Camino, C/Irunlarrea 4, 31008 Pamplona, Spain.
A 42 year-old female with a preoperative clinical diagnosis of ovarian cancer underwent laparotomy which revealed leiomyomatosis peritonealis disseminata (LPD) in the peritoneum and omentum and a left ovarian endometriotic cyst associated with a clear cell carcinoma. A grade 1, superfically invasive villoglandular endometrial endometrioid adenocarcinoma was also found. Microscopically, the endometriotic cyst wall contained an extensive peripheral band-like condensation of stromal cells. These cells were strongly positive for alpha inhibin and may have been the hormonal source responsible for the induction of the simultaneous LPD and endometrial adenocarcinoma. It is proposed that endometriosis is not only a precursor of clear cell carcinoma but, through secondary hormonal induction of the surrounding ovarian stroma, may also provide a hormonal stimulus for diverse proliferative processes.
UI - 11444189
AU - Nunobiki O; Sato M; Taniguchi E; Nakamura Y; Mori I; Kakudo K
TI - Morphometric characterization of endometrial glands using quantitative cytology.
SO - Anal Quant Cytol Histol 2001 Jun;23(3):201-6
AD - Department of Pathology, Wakayama Medical University, Wakayama, Japan.
OBJECTIVE: To determine the usefulness of the combination of confocal laser scanning microscopy (CLSM), image cytometry and three-dimensional (3D) imaging for analyzing architectural changes indicative of endometrial hyperplasia and grade 1 adenocarcinoma. STUDY DESIGN: Papanicolaou-stained endometrial samples (n = 180) were analyzed for specific cellular characteristics and analyzed by CLSM. Confocal images were obtained and then analyzed cytometrically and used for 3D reconstruction. RESULTS: Values obtained after image cytometry and 3D imaging increased significantly (P < .01) with the degree of cellular atypia. CONCLUSION: The combination of CLSM, image cytometry and 3D imaging is a valuable method for differential diagnosis of endometrial hyperplasia and grade 1 adenocarcinoma.
UI - 11446474
AU - Holub Z; Kliment L; Lukac J; Voracek J
TI - Laparoscopically-assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results.
SO - Eur J Gynaecol Oncol 2001;22(2):118-21
AD - Department of Obstetrics and Gynaecology, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic.
OBJECTIVE: To analyse the results of a pilot study and determine the contribution of laparoscopically-assisted lymphatic mapping in patients with endometrial cancer. METHODS AND MATERIALS: In eight cases of early endometrial cancer, patent blue-V was injected laparoscopically into the uterine wall during a surgical staging procedure. RESULTS: A deposition of the blue dye was found in at least one pelvic lymph node in five of eight cases. Blue-colored nodes were observed in a total of 11 lymph nodes. Locations of these nodes included obturator, internal and common iliac sites. Only one blue colored node was positive for disease. An average of 15 lymph nodes were removed in the study group (range, 12-22). Uterine lymphatic vessels with bilateral drainage to the broad and infundibulopelvic ligaments were seen in all cases within 30-60 seconds. CONCLUSION: Our initial experience with laparoscopically-assisted lymphatic mapping confirmed that the use of a minimally invasive technique is feasible. Lymphatic channels in the pelvic areas were seen in every patient. A deposition of blue dye in laparoscopically identifiable lymph nodes was seen only in 62.5% of patients. However, we believe that the lymphatic mapping of the uterine corpus can improve the accuracy of surgical staging in patients with endometrial cancer.
UI - 11446475
AU - Halperin R; Zehavi S; Habler L; Hadas E; Bukovsky I; Schneider D
TI - Comparative immunohistochemical study of endometrioid and serous papillary carcinoma of endometrium.
SO - Eur J Gynaecol Oncol 2001;22(2):122-6
AD - Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
OBJECTIVE: The aim of this study was to determine whether immunohistochemical analysis of molecular parameters can provide an alternative method for classification of endometrial cancer cases according to their aggressiveness. METHODS: Sixty-four cases of endometrial carcinoma were assigned to three groups: group I--28 cases of endometrioid well and moderately differentiated (G1-G2) carcinoma; group II--14 cases of endometrioid poorly differentiated (G3) carcinoma; group III--22 cases of serous papillary endometrial cancer. Immunohistochemistry was used to determine the existence of estrogen receptors (ER), progesterone receptors (PR), and the expression of bcl-2, p53, HER-2/neu and Ki-67. RESULTS: There was a significant difference in the immunohistochemical profile of the studied molecular parameters comparing the three study groups. The endometrioid G1-G2 cases (group I) were characterized by increased immunoreactivity for ER and PR (85.7% and 78.6%, respectively), increased immunoreactivity for bcl-2 (42.8%) and low expression of p53 (14.3%) and HER-2/neu (14.3%). In contrast to group I cases, the serous papillary endometrial cancer cases (group III) were characterized by immunonegativity for ER, PR and bcl-2 and high immunoreactivity for p53 (81.8%) and HER-2/neu (45.4%). The endometrioid G3 cases (group II) demonstrated an intermediate immunoprofile, characterized by immunonegativity for ER, PR and HER-2/neu, low immunoreactivity for bcl-2 (7.1%) and high expression of p53 (57.1%). The expression of Ki-67 did not differ significantly comparing the different cases of endometrial cancer. CONCLUSION: This study provides evidence that the immunohistochemical analysis of endometrial carcinoma differentiates between different grades and histological types, thus being useful in the distinction of high risk cases.
UI - 11446480
AU - Rodolakis A; Papaspyrou I; Sotiropoulou M; Markaki S; Michalas S
TI - Primary squamous cell carcinoma of the endometrium. A report of 3 cases.
SO - Eur J Gynaecol Oncol 2001;22(2):143-6
AD - 1st Department of Obstetrics and Gynecology, Athens University, Greece.
Primary squamous cell carcinoma of the endometrium (PSCCE) is a rare disease of unknown etiology. Diagnosis is based on the identification of squamous cell carcinoma in the endometrium with no coexisting analogous cervical component or endometrial adenocarcinoma. There must also be no connection between the endometrial tumour and the squamous epithelium of the cervix. Although the majority of patients are classified as stage I disease, prognosis is rather dismal. We report two new cases of primary squamous cell carcinoma of the endometrium which fulfill all the above criteria and we discuss another interesting case of squamous cell carcinoma of questionable endometrial origin. Management by abdominal hysterectomy and adjuvant pelvic irradiation resulted in long-term survival of our patients.
UI - 11446483
AU - Pekin T; Yildizhan B; Eren F; Pekin O; Yildizhan R
TI - Adenocarcinoma, adenoacanthoma, and mixed adenosquamous carcinoma of the endometrium.
SO - Eur J Gynaecol Oncol 2001;22(2):151-3
AD - Dept. of Gynecological Oncology, Marmara University Hospital, Istanbul, Turkey.
PURPOSE: To determine the frequency of endometrial adenocarcinoma (AC) with squamous cell differentiation and to compare the histopathologic and clinical characteristics of patients with adenoacanthoma (AA) and adenosquamous carcinoma (AS) to evaluate possible prognostic differences. MATERIALS AND METHODS: Two hundred forty patients with endometrial carcinoma (72.2% AC, 21.25% AA, 6.25% AS) treated at the Department of Gynecologic Oncology of Marmara University Hospital, the diseases were made with fractional D&C, and the definitive therapy for all patients was carried out at the same hospital. Extrafascial hysterectomy + BSO with or without pelvic and para-aortic lymph node dissection, and omentectomy according to the FIGO staging and grading system were performed. RESULTS: AC and AS had median ages around 60 years with a similar percent distribution of postmenopausal patients (around 74%). AA had an earlier median age of 51 years which reflects an incidence of only 50% postmenopausal patients. There was a tendency for AA to be of low-grade malignancy (72%), 51% of AC were of low-grade, while only 20% of AS were low-grade tumors. There was no difference for any of the three pathological entities in survival by FIGO stages. Over 80% of the tumors were Stage I and about 10% were Stage II, with less than 10% in Stages III and IV. CONCLUSION: Considering the more modern and uniform approaches in therapy for these tumors, there seems to be no differences in prognosis for adenocarcinoma with or without squamous elements. The neoplasms AC, AA and AS should be regarded, and consequently approached, as any low-grade adenocarcinoma of the endometrium.
UI - 11484981
AU - Taponeco F; Curcio C; Giuntini A; Nardini V; Fornaciari G; Artini PG;
TI - D'Ambrogio G; Genazzani AR Expression and prognostic significance of urokinase and plasminogen activator inhibitor type-1 in endometrial hyperplasia and cancer.
SO - J Exp Clin Cancer Res 2001 Jun;20(2):239-46
AD - Dept. of Reproductive Medicine and Child Development, University of Pisa, Italy. email@example.com
Proteolytic enzymes, like urokinase (uPA) and plasminogen activator inhibitor type-1 (PAI-1), are involved in remodelling tissues during invasion and metastasis of tumor cells. The purpose of the study is to evaluate the expression and the prognostic significance of these enzymes in endometrial hyperplasia and cancer. We used immunohistochemical staining to localize uPA and PAI-1 antigens and evaluate their expression, and the enzyme-linked immunosorbent assay (ELISA) to measure their levels during the progression of endometrial carcinoma. The results show that the levels of uPA and PAI-1 detection are systematically weak in simplex hyperplasia and are moderate in complex hyperplasia. In the endometrial carcinoma a very strong reaction was observed in the most aggressive variant of epithelial tumors. A positive signal for uPA was found only in the cytoplasm of normal and hyperplastic cells while, in tumors, uPA was present also in the cellular areas surrounding the neoplastic glands and at the apex of the malignant cells. The PAI-1 immunoreactivity was weak to moderate in 95.4% of carcinomas, with a diffuse signal mostly distributed in the cytoplasm of neoplastic cells and tumor stroma. UPA antigen concentrations were significantly higher in endometrial carcinoma than in endometrial hyperplasia (p<0.05) and in normal endometrium (p<0.001). PAI-1 antigen concentrations in carcinoma samples were significantly higher than in normal endometrium (p=0.002), but the difference was not statistically significant with respect to that in endometrial hyperplasia. We did not find any correlation between uPA and PAI-1 concentrations and the standard prognostic parameters for evaluating endometrial carcinoma. In conclusion, this study demonstrates that in hyperplastic endometria and in endometrial carcinoma there is a progressive increase in expression of uPA and PAI-1 than in normal endometrial tissue. In carcinoma tissues, the high expression of uPA is unregulated in the surrounding stroma tissue, particularly in the most aggressive histopathologic variants. UPA and PAI-1 may be factors associated with invasive behavior in endometrial carcinoma independent of other clinicopathological parameters.
UI - 11503919
AU - Kurjak A; Kupesic S; Sparac V; Bekavac I
TI - Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography.
SO - J Ultrasound Med 2001 Aug;20(8):829-40
AD - Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Sveti Duh Hospital, Croatia.
OBJECTIVE: To study a spectrum of systems (two-dimensional transvaginal, transvaginal color Doppler, three-dimensional, three-dimensional power Doppler, and contrast-enhanced three-dimensional power Doppler sonography) for preoperative evaluation of pelvic tumors. METHODS: Two hundred ninety-two patients were evaluated by the 5 complementary methods in preoperative sonographic assessments. We examined adnexal and endometrial morphology, thickness, and volume by two- and three-dimensional sonography and analyzed blood flow by transvaginal color, pulsed Doppler, and three-dimensional power Doppler sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. RESULTS: Morphologic assessment by three-dimensional sonography yielded additional information in 58% of cases compared with two-dimensional sonography. Furthermore, this modality was superior to two-dimensional sonography in accurate depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in patients with malignant disease was significantly different (28.2 +/- 0.02 cm3) from that in those who had hyperplasia (7.81 +/- 0.03 cm3), polyps (3.5 +/- 0.02 cm3), or normal endometria (0.8 +/- 0.02 cm3). With combined morphologic and three-dimensional power Doppler examination of endometrial lesions, sensitivity and specificity reached 89% and 97%, respectively. CONCLUSIONS: Combined morphologic and vascular imaging improves preoperative assessment of gynecologic tumors.
UI - 11501773
AU - Szantho A; Szabo I; Csapo ZS; Balega J; Demeter A; Papp Z
TI - Assessment of myometrial and cervical invasion of endometrial cancer by transvaginal sonography.
SO - Eur J Gynaecol Oncol 2001;22(3):209-12
AD - Department of Obstetrics and Gynecology, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
INTRODUCTION: The aim of this study was to determine the efficiency of transvaginal ultrasonography in the assessment of myometrial invasion and cervical involvement (preoperative staging) of endometrial cancer. MATERIALS AND METHODS: Transvaginal ultrasonography was performed on 52 women to classify endometrial cancer with respect to myometrial invasion and cervical involvement according to the International Federation of Gynaecologists and Obstetricians recommendations for surgical staging of endometrial cancer. Endometrial cancer was diagnosed on the basis of dilatation and curettage and the degree of invasion was evaluated preoperatively by transvaginal ultrasonography. Ultrasonographic findings were compared to the surgical staging and histopathology of the surgical specimen. RESULTS: Myometrial invasion evaluated by transvaginal sonography was accurate in 46 of 52 cases (accuracy 88%, sensitivity 86%, specificity 90%, positive predictive value 92%, negative predictive value 83%). Tumor extension to the cervix was properly diagnosed in seven of ten women in which it was present. CONCLUSION: Transvaginal ultrasonography is a reliable method for assessing myometrial invasion and cervical involvement. This non-invasive method should be included as an important tool in the establishment of individualized treatment programs for women with endometrial cancer.
UI - 11501776
AU - Imai M; Jobo T; Sato R; Kawaguchi M; Kuramoto H
TI - Medroxyprogesterone acetate therapy for patients with adenocarcinoma of the endometrium who wish to preserve the uterus-usefulness and limitations.
SO - Eur J Gynaecol Oncol 2001;22(3):217-20
AD - Department of Clinical Cytology, Graduate School of Medical Sciences Kitasato University, Kanagawa-ken, Japan.
BACKGROUND: To determine the effectiveness of medroxyprogesterone acetate therapy for women with endometrial adenocarcinoma who wish to preserve their uterus. STUDY DESIGN: Fifteen patients with endometrial carcinoma (12 with grade 1 endometrioid adenocarcinoma. 2 with grade 2 adenocarcinoma and 1 with adenoacanthoma) were treated with high-dose medroxyprogesterone acetate alone as primary therapy and their clinical responses evaluated. RESULTS: Seven of the 12 cases (58%) with grade I adenocarcinoma and one of the two (50%) with grade 2 carcinoma responded initially to medroxyprogesterone acetate. The median length of treatment required for regression was 29 weeks. Three patients who initially responded relapsed. Thirteen patients are alive without evidence of months) and one is continuing medroxyprogesterone acetate therapy as a final follow-up. One patient was lost to follow-up. Two patients have conceived having three healthy infants. CONCLUSION: Treatment of endometrial carcinoma with high-dose medroxyprogesterone acetate could be an alternative to hysterectomy, although the successful rate is limited.
UI - 11516808
AU - Coronado PJ; Vidart JA; Lopez-asenjo JA; Fasero M; Furio-bacete V;
TI - Magrina J; Escudero M P53 overexpression predicts endometrial carcinoma recurrence better than HER-2/neu overexpression.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Sep;98(1):103-8
AD - Department of Obstetrics and Gynecology, Hospital Clinico San Carlos, Madrid, Spain. firstname.lastname@example.org
OBJECTIVE: to investigate the prognostic value of p53 and HER-2/neu overexpression in endometrial cancer. STUDY DESIGN: p53 and HER-2/neu immunostaining was performed in 114 paraffin-embedded specimens of endometrial cancer diagnosed and treated between 1990 and 1997. Nuclear p53 and membrane HER-2/neu immunostaining were used. RESULTS: p53 and HER-2/neu overexpression was observed in 17 cases (14.9%) and in 19 cases (16.7%), respectively. In univariate analysis p53 (P<0.001) and HER-2/neu (P=0.018) overexpression had a positive correlation with a high risk of recurrence. In multivariate analysis, age (P<0.001), FIGO stage (P<0.001), differentiation (P=0.013), non-endometrioid subtypes (P<0.001) and p53 overexpression (P<0.001), but not HER-2/neu overexpression, were independent prognostic indicators of recurrence. Simultaneous p53 and HER-2/neu overexpression made worse the prognostic (P<0.001). CONCLUSIONS: p53 overexpression was an independent predictor of recurrent disease in endometrial cancer. HER-2/neu overexpression had a more limited effect but enhance the effect of p53.
UI - 11516816
AU - Malhotra N; Deka D; Takkar D
TI - Ureteric calculi masquerading metastatic lymph nodes in a case of endometrial cancer.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Sep;98(1):133-4
AD - Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, 110026, New Delhi, India. email@example.com
Extensive pelvic lymph node metastasis in the absence of risk factors was noticed at surgical staging for endometrial cancer in a 55-year-old postmenopausal women. On exploration there was a dilemma as to the disappearing lymph nodes which subsequently proved to be asymptomatic ureteric calculi. The need to palpate the pelvic side walls at the time of surgery for endometrial cancer even in cases when no nodal enlargement is detected preoperatively is highlighted.
UI - 11516800
AU - Benshushan A; Paltiel O; Brzezinski A; Tanos V; Barchana M; Shoshani O;
TI - Gordon L; Tsur L; Schenker JG Ovulation induction and risk of endometrial cancer: a pilot study.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Sep;98(1):53-7
AD - Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center, Hebrew University, P.O. Box 12000, IL 91120, Jerusalem, Israel.
OBJECTIVE: To determine whether women with endometrial carcinoma are more likely to have been exposed to fertility drugs, in particular clomiphene, than healthy population controls. STUDY DESIGN: A nationwide case-control, pilot study. About 128 living women 35-64 years old, with a histologically confirmed diagnosis of endometrial carcinoma that was first diagnosed and reported to The Israel Cancer Registry between 1 women from the same dialing areas selected by random digit dialing. A variety of demographic and clinical parameters were compared between cases and controls. A multivariate logistic model, controlling for age, was used to assess the independent effects of factors found to be significantly associated with endometrial cancer on univariate analysis. RESULTS: About 7 women with endometrial carcinoma (5.5%) and 10 healthy controls (3.9%) reported that they had used any fertility drug (crude odds ratio (OR) 1.4; 95% confidence interval (CI) 0.47-4.2). Use of fertility drugs did not meet the criteria for entry into the logistic model. The following parameters were found to be independently associated with endometrial cancer controlling for age, European-American background OR=2.2, (95% CI 1.3-3.7, P=0.004); nulliparity OR=2.7 (95% CI 1.1-6.5, P=0.03); history of infertility OR=1.8 (95% CI 1.0-3.3, P=0.05); BMI> or =27 OR=2.3 (95% CI 1.4-3.9, P=0.001). The use of oral contraceptives and IUD were found to be protective, OR=0.29 and 0.37, respectively, (95% CI 0.14-0.61, P=0.001 and 0.19-0.70, P=0.003, respectively). CONCLUSIONS: We found no evidence that the use of ovulation induction agents, including clomiphene citrate, are associated with a higher risk of endometrial carcinoma. The association between infertility drugs and endometrial carcinoma should be examined in other, larger studies.
UI - 11549315
AU - Noonan FC; Mutch DG; Ann Mallon M; Goodfellow PJ
TI - Characterization of the homeodomain gene EMX2: sequence conservation, expression analysis, and a search for mutations in endometrial cancers.
SO - Genomics 2001 Aug;76(1-3):37-44
AD - Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, Missouri, 63110, USA.
Previous loss-of-heterozygosity studies in endometrial carcinoma mapped a putative tumor suppressor gene to 10q25.3-26.1. An analysis of genomic sequences for the deletion interval showed several expressed sequence tags and the homeodomain gene EMX2, a homologue of Drosophila melanogaster empty spiracles. Expression studies showed that EMX2 transcripts are abundant in the adult uterus and that message levels seem to be inversely correlated with endometrial proliferation. EMX2 RNA was more abundant in quiescent postmenopausal endometrium than in premenopausal endometrium. We found decreased EMX2 expression in a subset of primary endometrial tumors, and four of six endometrial cancer cell lines investigated failed to express EMX2. The predicted protein showed extensive amino acid conservation with EMX2 sequences from several vertebrates. There was also considerable evolutionary conservation in the 3' untranslated region. To examine the potential function of EMX2 in endometrial tumorigenesis, we investigated 20 primary tumors and 6 endometrial cancer cell lines for mutations. Two primary tumors had mutations. Inactivation or reduced expression of EMX2 in cancers, coupled with increased expression in the quiescent endometrium, indicate that this homeodomain gene is involved in maintenance of the differentiated state.
UI - 11574518
AU - Kokawa K; Shikone T; Otani T; Nishiyama R; Ishii Y; Yagi S; Yamoto M
TI - Apoptosis and the expression of Bax and Bcl-2 in hyperplasia and adenocarcinoma of the uterine endometrium.
SO - Hum Reprod 2001 Oct;16(10):2211-8
AD - Department of Obstetrics and Gynecology, Wakayama Medical University, 811-1 Kimidera, Wakayama 641-0012, Japan. firstname.lastname@example.org
BACKGROUND: Apoptosis plays a crucial role in carcinogenesis in various tumours. This study was designed to investigate the occurrence of apoptosis and the expression of Bcl-2 and Bax proteins in endometrial tumours of corpus uteri. METHODS: Endometrial tissues were obtained from 20 patients with endometrioid adenocarcinoma, 16 patients with endometrial hyperplasia, and 4 patients with myoma uteri (which were used as controls). The occurrence of apoptosis was examined by using molecular biochemical techniques. The expression of Bcl-2 and Bax proteins was also investigated using immunohistochemical staining with appropriate antibodies. RESULTS: The labelling of DNA in situ indicated that apoptotic cells were sporadically seen in postmenopausal endometrium (5.2 +/- 2.1, n = 4) and endometrial hyperplasia without atypia (2.6 +/- 0.5, n = 9). In contrast, labelled cells were detected in atypical endometrial hyperplasia (15.9 +/- 2.2, n = 7), and their numbers increased intensely in adenocarcinoma (29.3 +/- 3.7, n = 20). Autoradiographic analysis revealed DNA laddering in many cases of carcinoma. Bcl-2 was highly immunopositive in hyperplasia without atypia (36.2 +/- 6.5%, n = 9), but was decreased in the atypical endometrial hyperplasia (16.3 +/- 4.8%, n = 7). Large fractions of the carcinoma (6.3 +/- 1.8%, n = 20) and normal endometrium (2.8 +/- 1.4%, n = 4) were immunonegative or slightly immunopositive to Bcl-2. In contrast, Bax immunoreactivity was more frequent and stronger in adenocarcinoma (43.6 +/- 4.1%, n = 20) than that in normal endometrium (17.6 +/- 6.7%, n = 4) and hyperplasia (7.2 +/- 2.2%, n = 16). CONCLUSIONS: These results suggest that cells in hyperplasia expressing Bcl-2 might have prolonged survival ability. Neoplastic cells in adenocarcinoma might show apoptosis in association with a decreased expression of Bcl-2 and an increased expression of Bax. Therefore, the frequency of apoptosis and the expression of Bcl-2 and Bax might be correlated with carcinogenesis in the uterine endometrium of humans.
UI - 11574177
AU - Rozenberg S; Auvertin S; Ham H
TI - A survey of physicians' attitude towards women with postmenopausal bleeding.
SO - Maturitas 2001 Sep 28;39(3):189-93
AD - Department of Obstetrics and Gynaecology, CHU St Pierre, Free University of Brussels (ULB), rue Haute 322, B-1000, Brussels, Belgium. email@example.com
OBJECTIVE: To study how gynaecologist manage postmenopausal bleeding in women not using HRT. The impact on the physicians' attitude of risk factors for endometrial cancer and of the endometrial thickness was essentially accounted for. METHODS: Two different case-types were defined by modifying the risk level of developing endometrial cancer. Also the level of endometrial thickness, assessed by ultrasound, was made to vary. In total four case-types were constructed. One case-type was sent at random to each Belgian gynaecologist (n=970). RESULTS: Response rate: 55%. The proportion of physicians who would not investigate the patients' endometrium varied between 2% (high-risk patient with abnormal ultrasound) and 34% (low risk patient, normal ultrasound). Significant differences were observed in relation to the level of risk factors for endometrial cancer and in relation to endometrial thickness. No significant relationship was found between the choice of the method of endometrial investigation and the risk situation or the ultrasound result. CONCLUSIONS: The attitude of Belgian gynaecologists towards postmenopausal bleeding is modified by the presence of risk factors and by the level of endometrium thickness. About one third of physicians would not further investigate the endometrium of a patient with a low risk profile and a normal endometrium as assessed by ultrasound.
UI - 11574186
AU - Foth D; Nawroth F; Schmidt T; Ortmann M; Romer T
TI - Bilateral ovarian fibromas and endometrial adenocarcinoma in a postmenopausal patient with growing uterine myomas.
SO - Maturitas 2001 Sep 28;39(3):259-64
AD - Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Koln, Germany. firstname.lastname@example.org
Bilateral ovarian fibromas are a rare condition. We report a case of bilateral ovarian fibromas with endometrial adenocarcinoma in a postmenopausal woman who clinically showed symptoms of an estrogen-producing tumour. Clinical and histopathological problems in the pre- and intraoperative diagnostics of fibromas are discussed.
UI - 11584939
AU - Sharma DN; Chander S; Gairola M; Kumar L; Parida DK; Pathy S
TI - Medical disorders associated with endometrial carcinoma.
SO - J Assoc Physicians India 2001 Jun;49():630-3
AD - Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.
From January, 1990 to December, 1995, 113 cases of endometrial carcinoma were registered. Of them, 24 patients (20%) had associated medical disorders. A total of 37 medical disorders were found in these 24 patients. The distribution was as follows: diabetes mellitus in 15 patients, hypertension in 13 patients, coronary artery disease in two, asthma in one, RBBB in one and hypothyroidism in five patients. Age of the patients ranged from 48-76 years (Median 62 years). Fifteen patients underwent surgery and rest nine were inoperable due to medical illnesses. Eleven patients received radiotherapy and four received chemotherapy. Of the two failures, one developed metastasis to lung and another to bone. No local recurrence was observed. Median survival was 20 months. Late radia