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Chen F, He B, Wang Y. Bone metastases among newly diagnosed cancer patients: a population-based study. Postgrad Med J 2024; 100:569-577. [PMID: 38497290 DOI: 10.1093/postmj/qgae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/18/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE (i) To analyze age-adjusted incidence rates of synchronous bone metastases diagnosed alongside primary malignancy from 2010 to 2018 in the US population, (ii) determine the incidence proportions (IPs) and characteristics of synchronous bone metastases among newly diagnosed cancer patients in the USA especially pediatric cases, and (iii) assess the implications of synchronous bone metastases on cancer patient's survival, and identify the survival risk factors for these cancer patients. METHODS Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program (2010-2018), we calculated age-adjusted IPs and annual percentage change (APC), and employed logistic regression and Cox regression models for our analysis. RESULTS 3 300 736 cancer patients were identified. The age-adjusted incidence rates of synchronous bone metastases increased from 2010 (18.04/100 000) to 2018 (20.89/100 000; APC: 2.3, 95% confidence interval [CI], 1.4-3.1), but decreased in lung cancer (average APC: -1.0, 95% CI, -1.8 to -0.3). The highest IPs were observed in pediatric neuroblastoma (43.2%; 95% CI, 39.8%-46.7%) and adult small cell carcinoma (23.1%; 95% CI, 22.7%-23.4%). Multivariate logistic analyses revealed that primary tumor characteristics were correlated with higher bone metastases risk. Survival analyses also showed varied prognostic outcomes based on metastasis sites and demographics among cancer patients. Landmark analyses further indicated among long-term cancer survivors (≥3 and ≥5 years), patients with de novo bone metastases had the poorest survival rates compared with those with other synchronous metastases (P < 0.001). CONCLUSION This study provides a population-based estimation of the incidence and prognosis for synchronous bone metastases. Our findings highlight the need for early identification of high-risk groups and multidisciplinary approaches to improve prognosis of cancer patients with de novo bone metastases.
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Affiliation(s)
- Feng Chen
- Department of Orthopedics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Bo He
- Department of Orthopedics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Yang Wang
- Department of Orthopedics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
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Rahestyningtyas E, Saraswati W. Metastatic endometrial carcinoma presenting as a scapular mass: A case report and literature review. Case Rep Womens Health 2024; 42:e00628. [PMID: 38966122 PMCID: PMC11222812 DOI: 10.1016/j.crwh.2024.e00628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
Bone metastases of endometrial cancers are quite rare, especially in the scapula. Only two previous reports of such cases were found in the literature, and in each case a different approach to diagnosis was used. There are no established recommendations for screening for bone metastases at diagnosis or after initial treatment of endometrial cancers. In the present case, a 55-year-old woman with progressive abdominal distension was diagnosed with a cystic mass. Histopathological analysis revealed grade II synchronous endometrioid carcinoma in both the endometrium and the ovaries. The patient received three cycles of combined paclitaxel and carboplatin chemotherapy. Seven months after the last chemotherapy cycle, a palpable lump was found in the right shoulder, suggesting a lesion in the right scapula. A bone scan revealed heightened radioactivity uptake, highlighting the unpredictable nature of the disease progression. The choice of diagnostic imaging modality remains challenging. This case emphasises the need for ongoing investigation of the mechanisms of distant metastasis and for the development of standardised diagnostic and therapeutic strategies.
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Affiliation(s)
- Eccita Rahestyningtyas
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Wita Saraswati
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Abide Z, Daoud AM, Latib R, Omor Y, Mahdi Y, Khannoussi BEL. Chest wall bone late recurrence of an endometrial adenocarcinoma. Radiol Case Rep 2023; 18:2810-2813. [PMID: 37324553 PMCID: PMC10267434 DOI: 10.1016/j.radcr.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
Among gynecological malignancies, Endometrial cancer stands out as the most prevalent form of carcinoma. However, Adenocarcinoma is the most frequent histological type of Endometrial cancer. Endometrial metastases are generally confined to pelvis, and distant metastases are seen primarily in the lymph nodes, lungs, or liver. bone Endometrial metastases are detected from 2% to 6% at diagnosis. Bones metastasis are generally restricted to the pelvis, vertebrae, and femur. Other locations such as the peripheral skeletal, chest wall, cranium and bone recurrence later after initial treatment are very unusual. In cases of bone recurrence, adenocarcinoma is the most seen. CT and PET/CT scan are the most useful diagnostic modality for the detection of a bone metastasis. Here, we report a chest wall bone late recurrence of an endometrial adenocarcinoma.
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Affiliation(s)
- Zakaria Abide
- Department of Radiology, National Oncology Institute, Avenue Allal El Fassi, 10100, Rabat, Morocco
| | - Ali Mohamed Daoud
- Department of Radiology, National Oncology Institute, Avenue Allal El Fassi, 10100, Rabat, Morocco
| | - Rachida Latib
- Department of Radiology, National Oncology Institute, Avenue Allal El Fassi, 10100, Rabat, Morocco
| | - Youssef Omor
- Department of Radiology, National Oncology Institute, Avenue Allal El Fassi, 10100, Rabat, Morocco
| | - Youssef Mahdi
- Department of Pathology, National Oncology Institute, Avenue Allal El Fassi, 10100, Rabat, Morocco
| | - Basma EL Khannoussi
- Department of Pathology, National Oncology Institute, Avenue Allal El Fassi, 10100, Rabat, Morocco
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Heidinger M, Simonnet E, Koh LM, Frey Tirri B, Vetter M. Therapeutic approaches in patients with bone metastasis due to endometrial carcinoma - A systematic review. J Bone Oncol 2023; 41:100485. [PMID: 37250286 PMCID: PMC10213377 DOI: 10.1016/j.jbo.2023.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Bone metastases (BM) are uncommon in endometrial carcinoma (EC), without information on the optimal oncologic management of patients with BM in EC. Here, we systematically review clinical characteristics, treatment approaches and prognosis in patients with BM in EC. Methods We conducted a systematic literature search until 27th March 2022 on PubMed, MEDLINE, Embase and clinicaltrials.gov. Outcomes included treatment frequency and survival after BM with comparators being treatment approaches (local cytoreductive bone surgery, systemic therapy, and local radiotherapy). Risk of bias was assessed using the NIH Quality Assessment Tool and Navigation Guide methodology. Results We retrieved 1096 records of which 112 retrospective studies (12 cohort studies, 12/12 fair quality; 100 case studies, 100/100 low quality) with a total of 1566 patients were included. The majority had a primary diagnosis of FIGO stage IV, grade 3 endometrioid EC. Singular BM were present in a median of 39.2%, multiple BM in 60.8% and synchronous additional distant metastases in 48.1% of patients respectively. In patients with secondary BM median time to bone recurrence was 14 months. Median survival after BM was 12 months. Local cytoreductive bone surgery was assessed in 7/13 cohorts and performed in a median of 15.8% (interquartile range [IQR] 10.3-43.0) of patients. Chemotherapy was assessed in 11/13 cohorts and administered in a median of 55.5% (IQR 41.0-63.9), hormonal therapy (7/13 cohorts) in 24.7% (IQR 16.3-36.0), and osteooncologic therapy (4/13 cohorts) in 2.7% (IQR 0.0-7.5) of patients respectively. Local radiotherapy was assessed in 9/13 cohorts and performed in a median of 66.7% (IQR 55.6-70.0) of patients. Survival benefits were seen in 2/3 cohorts after local cytoreductive bone surgery, and in 2/7 cohorts after chemotherapy without survival benefits in the remaining cohorts and investigated therapies. Limitations include the lack of controlled intervention studies, the heterogeneity and retrospective nature of the investigated populations. Conclusions This systematic review shows heterogenous therapeutic approaches in clinical practice without clear evidence for optimal oncologic management for patients with BM in EC.
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Affiliation(s)
- Martin Heidinger
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Elisa Simonnet
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Li Mei Koh
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Brigitte Frey Tirri
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Marcus Vetter
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Medical Oncology, Cantonal Hospital Baselland, Medical University Clinic, Muehlemattstrasse 13, 4410 Liestal, Switzerland
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5
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Glavy JC, Peterson SL, Strain J, Byrd K, Flint JH. Metastatic Endometrioid Carcinoma Mimicking a Subungual Melanoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14494. [PMID: 36361369 PMCID: PMC9653594 DOI: 10.3390/ijerph192114494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
CASE We report a case of a 76-year-old female with a stage IB, grade I endometrioid endometrial carcinoma who presented with right-hip pain and an enlarging black, exophytic, subungual lesion on her right-small-finger distal phalanx. Clinically, the distal phalanx lesion was suspicious for a subungual melanoma; however, advanced imaging suggested metastatic disease, with lesions in the acetabulum, lungs, brain, vulva, and vagina. CONCLUSION Partial amputation of the right, small finger and vulvar biopsies confirmed an endometrial carcinoma. To our knowledge, this is the first described case of endometrial adenocarcinoma metastasis to the phalanx of an upper extremity, mimicking a subungual melanoma.
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Affiliation(s)
- Jena C. Glavy
- Department of OBGYN, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Shian L. Peterson
- Department of Orthopedic Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Jonathan Strain
- Department of Pathology, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Kevin Byrd
- Department of OBGYN, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - James H. Flint
- Department of Orthopedic Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
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6
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Wang J, Dai Y, Ji T, Guo W, Wang Z, Wang J. Bone Metastases of Endometrial Carcinoma Treated by Surgery: A Report on 13 Patients and a Review of the Medical Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116823. [PMID: 35682407 PMCID: PMC9180500 DOI: 10.3390/ijerph19116823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to describe the clinicopathological features of endometrial cancer (EC) patients with bone metastases treated with surgery and to systematically review the literature. METHODS We performed a retrospective study to include patients with bone metastases of EC at Peking University People's Hospital from 2000 to 2019. Clinicopathological features and survival outcomes were collected. RESULTS Among the 1662 patients with EC, 14 (0.84%) were identified with bone metastases, and all were treated surgically. Thirteen cases were analyzed. Four had bone metastases when diagnosed, and the remaining nine cases had bone metastases when first relapsed, with a median time to recurrence of 13 months (range, 5-144). The median age of the 13 patients was 58 years old (range, 45-76). Twelve were endometrioid carcinoma. The majority of sites of bone metastases were the pelvis, followed by the spine. The median overall survival (OS) was 57 months. We further combined the 13 patients with another 24 cases identified from literature research. There was no significant difference in clinicopathological characteristics between the patients with bone metastases when diagnosed and when they first relapsed. The median OS was numerically longer for patients with bone metastases when diagnosed than when they first relapsed (57 vs. 36 months, p = 0.084). CONCLUSIONS Patients with bone metastases of EC might benefit from comprehensive treatment based on surgery, as symptoms can be palliated and survival can probably be extended.
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Affiliation(s)
- Jingyuan Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (J.W.); (Y.D.); (J.W.)
| | - Yibo Dai
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (J.W.); (Y.D.); (J.W.)
| | - Tao Ji
- Department of Orthopaedic Oncology, Peking University People’s Hospital, Beijing 100044, China; (T.J.); (W.G.)
| | - Wei Guo
- Department of Orthopaedic Oncology, Peking University People’s Hospital, Beijing 100044, China; (T.J.); (W.G.)
| | - Zhiqi Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (J.W.); (Y.D.); (J.W.)
- Correspondence: ; Tel.: +86-15611808362
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China; (J.W.); (Y.D.); (J.W.)
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7
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Yang F, Zhao R, Huang X, Wang Y. Diagnostic and prognostic factors, and two nomograms for endometrial cancer patients with bone metastasis: A large cohort retrospective study. Medicine (Baltimore) 2021; 100:e27185. [PMID: 34516519 PMCID: PMC8428737 DOI: 10.1097/md.0000000000027185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/19/2021] [Indexed: 01/05/2023] Open
Abstract
Patients with endometrial cancer (EC) who develop bone metastasis (BM) always imply a poorer prognosis. However, reliable predictive models associated with BM from EC are currently limited.We retrospectively analyzed data on 54,077 patients diagnosed with primary EC in the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was used to determine independent predictors of BM from EC. Univariate and multivariate Cox regression analyses were used to determine independent prognostic factors for EC with BM. Based on independent predictors and prognostic factors, we constructed a diagnostic nomogram and prognostic nomogram separately. Besides, calibration curves, receiver operating characteristic curves, and decision curve analysis were used to evaluate the models.A total of 54,077 patients with EC from the Surveillance, Epidemiology, and End Results database were included in this study, 364 of whom had BM. Multivariate analysis in the logistic model showed that lung metastasis, liver metastasis, brain metastasis, N stage, T stage, histologic grade, and race were risk factors for BM from EC. Multivariate analysis in the Cox model showed that liver metastasis, brain metastasis, chemotherapy, surgery, and histologic type had a significant effect on overall survival. Moreover, the receiver operating characteristic curve, calibration curve, and decision curve analysis indicated the good performance of both diagnostic and prognostic nomograms.Two clinical prediction model was constructed and validated to predict individual risk and overall survival for EC with BM, respectively. Diagnostic nomogram and prognostic nomogram are complementary, improving the clinician's ability to assess the patient's prognosis and enhancing prognosis-based decision making.
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Affiliation(s)
- Fengkai Yang
- Department of Postgraduate Medical School, Chengde Medical College, Chengde, Hebei Province, China
| | - Ruhan Zhao
- Department of Oncology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Xiaohui Huang
- Hangzhou Medical College, Hangzhou, Zhejiang Province, China
| | - Yucheng Wang
- Department of Orthopedics, Taizhou Municipal Hospital, Taizhou, Zhejiang Province, China
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Salamanna F, Perrone AM, Contartese D, Borsari V, Gasbarrini A, Terzi S, De Iaco P, Fini M. Clinical Characteristics, Treatment Modalities, and Potential Contributing and Prognostic Factors in Patients with Bone Metastases from Gynecological Cancers: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11091626. [PMID: 34573970 PMCID: PMC8465573 DOI: 10.3390/diagnostics11091626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study is to review the clinical characteristics, treatment modalities, and potential contributing and prognostic factors of bone metastases from gynecological cancers (GCs). A systematic literature search on PubMed, Scopus, Web of Science Core Collection and Cochrane Central Register of Controlled Trials databases was conducted. Thirty-one studies, all retrospective, were included in this review, for a total of 2880 patients with GC bone metastases. Primary tumors leading to bone metastases included endometrial cancer (EC), cervical cancer (CC), ovarian cancer (OC), uterine sarcoma (US) and vulvar cancer (VuC), mainly with an International Federation of Gynecology and Obstetrics (FIGO) Stage of III and IV. The main bone metastatic lesion site was the vertebral column, followed by the pelvic bone and lower extremity bones. The median survival rate after bone metastases diagnosis ranged from 3.0 to 45 months. The most frequent treatments were palliative and included radiotherapy and chemotherapy, followed by surgery. The findings of this review give a first dataset for a greater understanding of GC bone metastases that could help clinicians move toward a more “personalized” and thus more effective patient management.
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Affiliation(s)
- Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (V.B.); (M.F.)
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (P.D.I.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Deyanira Contartese
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (V.B.); (M.F.)
- Correspondence:
| | - Veronica Borsari
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (V.B.); (M.F.)
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (A.G.); (S.T.)
| | - Silvia Terzi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (A.G.); (S.T.)
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.M.P.); (P.D.I.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Milena Fini
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (V.B.); (M.F.)
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Pang X, Zhang X, Huang Y, Qian S. Development and validation of m6A regulators' prognostic significance for endometrial cancer. Medicine (Baltimore) 2021; 100:e26551. [PMID: 34190193 PMCID: PMC8257909 DOI: 10.1097/md.0000000000026551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Endometrial cancer (EC) is the sixth most common cancer in women globally. It has been found that the expression levels of m6A regulators can be potentially used for prognostic stratification in some cancers, but the role of m6A regulators in EC prognosis remains unclear. METHODS The data of 584 EC samples were downloaded from The Cancer Genome Atlas and the mRNA expression profiles of 20 m6A regulators were analyzed, followed by functional enrichment analysis, immune infiltration analysis, and least absolute shrinkage and selection operator method-COX regression analysis. RESULTS The mRNA expression levels of 20 m6A regulators were significantly different between cancer samples across different grades. The 548 EC samples could be clearly divided into 2 clusters. Kaplan-Meier survival analysis proved that these two groups had highly different overall survival probabilities. Besides, the univariate regression analysis further reserved eight genes related to overall survival from the 20 m6A regulators. We established a prognostic signature including two genes, that is, IGF2BP1 and YTHDF3, that showed a strong ability for stratifying prognostically different EC patients. We identified 3239 differentially expressed genes between the high- and low-risk groups, involving in multiple biological processes and signaling pathways. Meanwhile, 6 differentially infiltrated immune cell types between the high- and low-risk groups could effectively distinguish the high- and low-risk EC groups. The expressions of immune checkpoints were different between high- and low-risk EC patients. CONCLUSION We first report the prognostic role of m6A regulators in EC, which should contribute to a better understanding of the underlying mechanisms of EC pathogenesis and progression.
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Hong L, Cristiano L, Peters E, Ioffe Y. Detection of bone metastases in uterine cancer: How common are they and should PET/CT be the standard for diagnosis? Gynecol Oncol Rep 2021; 35:100698. [PMID: 33521220 PMCID: PMC7820478 DOI: 10.1016/j.gore.2021.100698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 12/01/2022] Open
Abstract
Osseous metastasis (OM) were found in 5% of endometrial cancers (EMCA), with predilection for type II histologies. Patients with serous EMCA had significantly higher odds of developing OM when compared to all other histologies. PET/CT appeared superior to conventional CT scans in diagnosing OM.
Objectives Osseous metastases (OM) in endometrial cancer (EMCA) are thought to be rare. This study aimed to address the gap in present knowledge by defining the rate of OM in endometrial cancer (EMCA) as stratified by histology and ascertaining the best diagnostic modality for detection. Methods 435 consecutive cases of EMCA evaluated in tertiary care setting were reviewed. Clinico-pathologic data were abstracted and analyzed. Results 18/403 patients were found to have OM (4.6%). Majority were detected by PET/CT (13/18 (72%)), with conventional CT scans missing the diagnoses otherwise made by PET/CT scans in 2/9 patients. Patients with type II EMCA were at higher risk of developing OM compared with patients with type I EMCA; 2/234 patients with type I EMCA (0.85%) developed OM, as compared to 16/167 patients with type II EMCA (9.58%), OR = 12.3. Patients with serous histology had significantly higher odds of developing OM when compared to patients with non-serous histologies (OR 4, p = 0.001, 95% CI 1.54 to 10.76). Kaplan Myer survival function and log-rank analysis showed that the presence of OM was a significant negative prognosticator of survival, with median overall survival (mOS) of 16 months in OM patients vs. mOS undefined in non-OM patients (p < 0.0001). Discussion Incidence of detected OM was clinically significant, with most cases identified by PET/CT scans. Patients with type II EMCA, and in particular serous histology, were at a significantly higher risk of developing OM. OM when present, is an indicator of aggressive cancer biology and poor prognosis. Further studies are needed to ascertain the mechanism of predisposition to OM formation in serous EMCA and to confirm PET/CT as modality of choice for detection of OM.
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Affiliation(s)
- Linda Hong
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Laurin Cristiano
- Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Eric Peters
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Yevgeniya Ioffe
- Department of Gynecology & Obstetrics, Loma Linda University School of Medicine, 11175 Campus Street, Coleman Pavilion, Room 11105, Loma Linda, CA 92350, USA
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11
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Liu S, Zhou X, Song A, Huo Z, Yao S, Wang Y, Liu Y, Pan LY. Clinical Characteristics and Prognostic Analysis of Gynecologic Cancer with Spinal Metastases: A Single-Center Retrospective Study. Cancer Manag Res 2020; 12:7515-7525. [PMID: 32903851 PMCID: PMC7445528 DOI: 10.2147/cmar.s268075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study is to provide key information on the clinical characteristics, surgical treatment, and potential prognostic factors in patients with metastatic spinal gynecologic cancer (MSGC), with a view to their application in clinical practice. Methods From January 2010 to January 2020, we performed a retrospective analysis of 14 patients with MSGC who underwent surgical treatment in a single center. Surgical treatment was performed on 14 patients, and a total of 14 operations were performed. The survival time of patients after spinal surgery was analyzed by Kaplan–Meier and Cox regression analysis. Results The average age of patients was 51.9 years (range 25‒70). The average time from initial surgery to the discovery of spinal metastasis was 60.3 months (2‒180), and the average follow-up time was 19.2 months (2‒55). Spinal tumor progression was found in 9 patients, and 12 patients (85.7%) died during follow-up. In univariate analysis, extraosseous visceral metastasis (p = 0.024), revised Tokuhashi stage (p = 0.025), Tomita stage (p = 0.005), and number of spinal lesions (p = 0.038) were associated with overall survival (OS). Extraosseous visceral metastasis (p = 0.026), revised Tokuhashi stage (p = 0.014), Tomita stage (p = 0.001), and gynecological cancer type (p = 0.039) were associated with progression-free survival. Conclusion Surgical treatment is an effective treatment for MSGC and relieves pain, restores function and rebuilds stability. Based on our single-center experience, extraosseous visceral metastasis, revised Tokuhashi stage, Tomita stage, and gynecological cancer type may be potential prognostic factors for OS.
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Affiliation(s)
- Shuzhong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xi Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Siyuan Yao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yipeng Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yong Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ling-Ya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People's Republic of China
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12
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Mao W, Wei S, Yang H, Yu Q, Xu M, Guo J, Gao L. Clinicopathological study of organ metastasis in endometrial cancer. Future Oncol 2020; 16:525-540. [PMID: 32148087 DOI: 10.2217/fon-2020-0017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: Our aim was to analyze the clinicopathological features of lung, liver, bone and brain metastasis in patients with endometrial cancer (EC). Patients & methods: We screened patients diagnosed with EC between 2010 and 2015 from the Surveillance, Epidemiology and End Results database. Results: Among 69,027 eligible EC patients, lung metastasis was the most common. Patients with lung or liver metastasis were at higher risk of bone and brain metastases than those without lung and liver metastasis. Brain metastasis has the lowest survival time (5.0 months) in single organ metastasis. Liver and brain metastasis have the highest death rate in two organ metastasis, and lung, liver and brain metastasis had the lowest survival time (1.0 month) in multi-sites metastasis. Conclusion: Lung metastasis was the most common in EC patients. Assessing distant organ metastasis may help clinicians to determine appropriate follow-up strategy for patients with EC.
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Affiliation(s)
- Weipu Mao
- Department of Obstetrics & Gynecology, The People's Hospital of Yingshang, Anhui 236200, PR China
| | - Shaomin Wei
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, PR China
| | - Hui Yang
- Department of General Surgery, Jiuting Hospital, Songjiang District, Shanghai 201600, PR China
| | - Qianqian Yu
- Department of Obstetrics & Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, PR China
| | - Mei Xu
- Department of Obstetrics & Gynecology, The People's Hospital of Yingshang, Anhui 236200, PR China
| | - Jing Guo
- Department of Obstetrics & Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, PR China
| | - Li Gao
- Department of Obstetrics & Gynecology, The People's Hospital of Yingshang, Anhui 236200, PR China
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13
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McEachron J, Chatterton C, Hastings V, Gorelick C, Economos K, Lee YC, Kanis MJ. A clinicopathologic study of endometrial cancer metastatic to bone: Identification of microsatellite instability improves treatment strategies. Gynecol Oncol Rep 2020; 32:100549. [PMID: 32099892 PMCID: PMC7031305 DOI: 10.1016/j.gore.2020.100549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/28/2022] Open
Abstract
Metastasis of endometrial cancer (EC) to bone is rare, occurring in <1.0% of cases. The most common sites of bone metastasis in EC are the spine and hip. Diagnosis of bone metastasis is associated with widely metastatic disease and poor prognosis. The median overall survival following a diagnosis of bone metastasis was 11 months in our series. 87.5% of patients with bone metastasis were found to have microsatellite instability.
Metastasis to bone (BM) is an uncommon manifestation of advanced endometrial cancer (EC). The present study will review the clinicopathologic features of a cohort of patients with EC and BM. We conducted a multi-center retrospective review of patients with EC and BM. Demographic and clinical information was extracted from the medical records. Survival outcomes were determined using Kaplan-Meier Curves. Final analysis included 10 patients. The median age was 65 years (range 31–71). 80% had FIGO stage III/IV disease. The most common site of BM was the spine (66%). All patients presented with extraosseous dissemination at the time of diagnosis of BM and 70% were found to have multiple sites of BM. 80% of patients were diagnosed with BM in the recurrent setting. The median time to diagnosis of bone recurrence was 14 months (range: 0–44). Median survival after diagnosis of BM was 11 months (range: 1–22 months). Patients with endometrioid histology and single site of bone metastasis experienced improved survival (p = 0.04 and p = 0.05, respectively). Eight patients had immunohistochemistry or molecular tumor profiles available for review. Seven of these patients (87.5%) were found to have microsatellite instability (MSI). The most common mutation was hypermethylation of MLH-1 (43%). To our knowledge, this is the first report demonstrating a correlation between MSI and metastasis to bone. The identification of BM in EC is uncommon, but will alter treatment strategies and dramatically impact prognosis. Molecular tumor profiling should be performed to identify targeted therapy options and optimize adjuvant treatment strategies.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Carolyn Chatterton
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center, West Islip, NY, United States
| | - Victoria Hastings
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Constantine Gorelick
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Katherine Economos
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marguax J Kanis
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
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14
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Liu Y, Chi S, Zhou X, Zhao R, Xiao C, Wang H. Prognostic value of distant metastatic sites in stage IV endometrial cancer: A SEER database study of 2948 women. Int J Gynaecol Obstet 2020; 149:16-23. [PMID: 31833058 DOI: 10.1002/ijgo.13084] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/18/2019] [Accepted: 12/10/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the prognosis of women with distant metastasis at the time of endometrial cancer (EC) diagnosis and identify prognostic factors according to metastatic site. METHODS A retrospective cohort study of women diagnosed with EC according to the SEER database between 2010 and 2014. Univariate and multivariate Cox regression was used to identify variables associated with overall survival. Kaplan-Meier curves were used to compare survival among different groups. RESULTS Overall, 2948 women with stage IV EC were identified. The most common distant metastatic site was the lung. Having a distant metastatic site independently predicted overall survival. Using brain metastasis as a reference, overall survival was longer for liver (P=0.049), lung (P=0.005), and bone (P=0.019) metastasis. Relative to no distant metastasis, overall survival was shorter for women with one (P<0.001) or two or more (P<0.001) sites of distant metastasis. Overall survival was independently influenced by tumor grade, insurance status, and surgery among women with only lung metastasis. CONCLUSION The findings showed that the prognosis of women with stage IV EC differs by distant metastatic site, and identified several predictors of poor survival. They may help clinicians to better predict prognosis for newly diagnosed cases of EC with distant metastasis.
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Affiliation(s)
- Yan Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuqi Chi
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zhou
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengyu Xiao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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McEachron J, Mendoza R, Lee YC, Kanis MJ. Breast metastases: A rare manifestation of advanced uterine serous carcinoma. Gynecol Oncol Rep 2019; 30:100500. [PMID: 31656850 PMCID: PMC6806454 DOI: 10.1016/j.gore.2019.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022] Open
Abstract
Metastasis to the breast is a rare, accounting for <1.0% of all breast tumors. Over 50% of patient with USC will recur despite multimodality treatment. The majority of USC recur locally within the pelvis or abdominal cavity. Hematogenous metastasis to the breast has not been reported in USC. A new breast mass in a patient with USC is more likely to primary breast cancer.
Metastasis of non-mammary tumors to the breast are uncommon, representing <1% of all breast tumors. Breast metastasis are associated with advanced disease and poor prognosis regardless of the origin of the primary tumor. Uterine cancer metastasis to the breast is an extremely rare finding and has not been reported in the case of serous histology. Here, we review two cases of uterine serous carcinoma metastatic to the breast. Both patients presented with breast-specific complaints including pain and palpable mass and were found to have widely metastatic disease. Tissue biopsy and immunohistochemistry consistent with primary uterine serous carcinoma confirmed the diagnosis of metastasis in both cases. Our findings suggest hematogenous metastasis to the breast is a late phenomenon in the course of endometrial carcinoma and associated with the development of disease at multiple sites. This emphasizes the importance of complete evaluation in patients presenting with breast complaints and known history of malignancy, as this may be the only presenting symptoms in patients with widely metastatic disease.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States
| | - Rachel Mendoza
- Division of Pathology, SUNY Downstate Medical Center, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States
| | - Margaux J Kanis
- Division of Gynecologic Oncology, New York-Presbyterian Brooklyn Methodist Hospital, United States
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16
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Dilek ON, Gür EÖ, Acar T, Aydoğmuş S. Chest wall metastasis of endometrial cancer: case report and review of the literature. Acta Chir Belg 2019; 119:243-247. [PMID: 29433406 DOI: 10.1080/00015458.2018.1438557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction: Endometrial cancer is the fourth most common female cancer and also distant metastases to the chest wall associated with these tumors are seen less common. Surgical treatment options for metastases of endometrial cancer are limited. Case: A 57-year-old patient who underwent total abdominal hysterectomy + bilateral salpingo oophorectomy and received adjuvant chemotherapy for endometrioid-type adenocarcinoma of the endometrium and tuba is presented. The patient initially presented with pleural effusion 8 years ago and the tumor was detected while during etiologic screening. The patient had no problems after adjuvant chemotherapy and had been living in another city when she presented with a mass on the chest wall measuring 20 × 15 × 12 cm 8 years after the initial diagnosis and distant organ metastasis due to the first surgery was detected. The mass was first thought to be a sarcoma and the tru-cut biopsy revealed a metastatic lesion that was immunohistochemically similar to the first surgical specimen. The mass was resected with a wide radical excision and 'no touch' technique. The patient was then discharged with no postoperative complications. Conclusion: Here in, a case with a distant organ metastasis due to an endometrioid-type adenocarcinoma is presented accompanied by literature data.
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Affiliation(s)
- Osman Nuri Dilek
- Departments of General Surgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Emine Özlem Gür
- Departments of General Surgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Turan Acar
- Departments of General Surgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Serpil Aydoğmuş
- Departments of Obstetric & Gynecology, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
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17
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Adachi H, Hanakita J, Takahashi T, Kawaoka T, Ohtake Y, Shimizu K, Sagae Y. Precocious Solitary Cervical Metastasis from Endometrial Cancer Presenting as Cervical Radicular Pain. World Neurosurg 2018; 118:162-167. [PMID: 30030186 DOI: 10.1016/j.wneu.2018.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bone metastases from endometrial cancer are rare. To our knowledge, only 2 cases of solitary vertebral metastases from endometrial cancer presenting with osseous and/or neurologic symptoms before the diagnosis of the primary endometrial cancer have been reported; however, in both cases, the metastases were thoracic. Thus, cervical vertebral metastases are extremely rare. CASE DESCRIPTION We describe the case of a 55-year-old woman who presented with right C6 radicular and neck pain. Neurologic imaging showed destruction of the C6 vertebral body by an extradural mass with kyphotic changes in the cervical spine. Fluorodeoxyglucose positron emission tomography showed increased uptake in the enlarged body of the uterus as well as the C6 vertebral body. Additional pelvic magnetic resonance images and endometrial biopsy confirmed endometrial cancer. The patient underwent excision of the cervical tumor with anterior reconstruction and posterior fixation followed 1 month later by semiradical hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymph node dissection. The cervical and endometrial histopathologic findings were similar, and the final diagnosis made was cervical metastatic adenocarcinoma originating from an endometrial cancer. CONCLUSIONS We describe an extremely rare case of a precocious solitary cervical metastasis from an endometrial cancer presenting as cervical radicular pain. In our review of published reports, we found that solitary spinal metastases are significantly associated with longer overall survival than are multiple lesions. Resection of the spinal lesion with rigid spinal reconstruction followed by radical hysterectomy may be beneficial in such patients.
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Affiliation(s)
- Hiromasa Adachi
- Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan.
| | - Junya Hanakita
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Toshiyuki Takahashi
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Taigo Kawaoka
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Yasufumi Ohtake
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Kampei Shimizu
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Yusuke Sagae
- Department of Gynecology, Shizuoka General Hospital, Aoi-ku, Shizuoka, Japan
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18
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Makris GM, Mene J, Battista MJ, Chrelias G, Sergentanis TN, Psyrri A, Chrelias C. Endometrial carcinoma with tibial bone metastasis: a case report and literature review. J OBSTET GYNAECOL 2018; 38:1039-1047. [PMID: 29884070 DOI: 10.1080/01443615.2017.1420759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Jonida Mene
- a Department of Gynecology , Athens Euroclinic Hospital , Athens , Greece
| | - Marco-Johannes Battista
- b Department of Gynecology and Obstetrics , University Hospital of Mainz University of Mainz Medical School , Mainz , Germany
| | - Georgios Chrelias
- c Third Department of Obstetrics and Gynecology , General University Hospital "Attikon", University of Athens , Athens , Greece
| | - Theodoros N Sergentanis
- d Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine , National University of Athens , Athens , Greece
| | - Amanda Psyrri
- e Section of Medical Oncology, Second Department of Internal Medicine , General University Hospital "Attikon", University of Athens , Athens , Greece
| | - Charalampos Chrelias
- c Third Department of Obstetrics and Gynecology , General University Hospital "Attikon", University of Athens , Athens , Greece
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Abstract
Endometrial cancer, a common cancer affecting women, has the tendency to metastasize to the lung and liver. Bone metastases in endometrial cancers are rare and accounts for less than 1% of the overall incidence of metastases. We report a case of a 30-year-old single nulliparous woman with metastatic recurrence of endometrioid adenocarcinoma of the endometrium involving the pelvic bone, and the role of bone scintigraphy in detection and staging of the disease.
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20
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Gao X, Zhao C, He S, Fan T, Xu W, Yang C, Liu T, Xiao J. Treatment and outcomes of 28 patients with spinal metastasis from gynecological cancer. J Neurooncol 2018; 137:387-394. [DOI: 10.1007/s11060-017-2728-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/24/2017] [Indexed: 11/24/2022]
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Söylemez MS, Kemah B, Söylemez UPO, Kılıç B, Ozkan K. Endometrial adenocarcinoma recurrence presenting with tibial metastasis: Report of a case. Int J Surg Case Rep 2017; 36:15-17. [PMID: 28500904 PMCID: PMC5430151 DOI: 10.1016/j.ijscr.2017.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/16/2017] [Accepted: 04/16/2017] [Indexed: 11/24/2022] Open
Abstract
Endometrial adenocarcinoma recurrence in tibia after 2 years of total abdominal hysterectomy and bilateral salpingo-oophorectomy. Endometrial adenocarcinoma metastasis to skeletal system is extremely rare and mostly have been reported to be in axial skeleton. Fresh frozen femoral allograft was used after wide resection for the metastatic adenocancer area of the tibia and provided the bone union. Wide resection and reconstruction with an allograft might be an option to increase survival and possible cure of the patient as seen in our case.
Introduction Metastatic bone disease at extremities is mostly associated with lung, liver, prostat, thyriod or breast malignancies. There for surgeons generally tends to seek for a primary tumor originating from these organs. Herein a case of endometrial adenocarcinoma recurrence that presented with symptoms of tibial pain is described. Presentation of case 59 year-old woman was admitted to our orthopaedic oncology unit with pain, swelling and tenderness at right cruris for two weeks without any trauma history. Her medical history revealed that she had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During follow-ups no recurrence had been detected. Initial X-rays of the right tibia showed a lytic and expansile mass located at the shaft of the tibia suggesting metastasis. A wide resection of the lesion with clear margins was performed two weeks after first admittance. Resected area was replaced by fresh frozen femoral shaft allograft. At postoperative 17th month. X-rays obtained at last follow-up demostrated full healing and integration of allograft. Discussion Endometrial adenocarcinoma is a disease of postmenapousal women with 95% of the cases occurring after the age of 40 years. Patients with advanced or recurrent endometrial cancer often have distant metastases found within the lymph nodes, liver, and/or lung. Conclusion Recurrence of endometrial cancer as a solitary bone lesion is a rare situation. Wide resection and reconstruction with an allograft or an intercalar prosthesis might be an option to increase survival and possible cure of the patient.
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Affiliation(s)
| | - Bahattin Kemah
- Agri State Hospital, Department of Orthopaedics & Traumatology, Agri, Turkey.
| | | | - Bülent Kılıç
- I. Gelisim University School of Health Sciences, Istanbul, Turkey.
| | - Korhan Ozkan
- I. Medeniyet University Göztepe Training and Research Hospital, Orthopaedics and Traumatology Department, Istanbul, Turkey.
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22
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Takeshita S, Todo Y, Matsumiya H, Okamoto K, Yamashiro K, Kato H. A prediction model of survival for patients with bone metastasis from uterine corpus cancer. Jpn J Clin Oncol 2016; 46:973-978. [PMID: 27655906 DOI: 10.1093/jjco/hyw120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to establish a predictive model of survival period after bone metastasis from endometrial cancer. METHODS A total of 28 patients with bone metastasis from uterine corpus cancer were included in the study. Data at the time of bone metastasis diagnosis, which included presence of extraskeletal metastasis, performance status, history of any previous radiation/chemotherapy and the number of bone metastases, were collected. Survival data were analyzed using Kaplan-Meier methods and Cox proportional hazard models. RESULTS The most common site of bone metastasis was the pelvis (50.0%), followed by lumbar spine (32.1%), thoracic spine (25.0%) and rib bone (17.9%). The median survival period after bone metastasis was 25 weeks. The overall rate of survival after bone metastasis of the entire cohort was 75.0% at 13 weeks, 46.4% at 26 weeks and 42.9% at 52 weeks. Performance status of 3-4 was confirmed as an independent prognostic factor (Hazard ratio, 3.5; 95% confidence interval, 1.41-8.70) and multiple bone metastases tended to be associated with poor prognosis (Hazard ratio, 2.4; 95% confidence interval, 0.95-5.97). A prognostic score was calculated by adding up the number of these two factors. The 26-week survival rates after bone metastasis were 88.9% for those with a score of 0, 45.5% for those with a score of 1 and 0% for those with a score of 2 (P = 0.0006). CONCLUSIONS This scoring system can be used to determine the optimal treatment for patients with bone metastasis from endometrial cancer.
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Affiliation(s)
- Sho Takeshita
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Shiroishi-ku, Sapporo
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Shiroishi-ku, Sapporo
| | - Hiroko Matsumiya
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Shiroishi-ku, Sapporo
| | - Kazuhira Okamoto
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Shiroishi-ku, Sapporo
| | - Katsushige Yamashiro
- Division of Pathology, National Hospital Organization, Hokkaido Cancer Center, Shiroishi-ku, Sapporo, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Shiroishi-ku, Sapporo
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Devdas SK, Digumarti L, Digumarti R, Patro KC, Nutakki R. Isolated humeral recurrence in endometrial carcinoma. Indian J Med Paediatr Oncol 2016; 37:199-201. [PMID: 27688615 PMCID: PMC5027794 DOI: 10.4103/0971-5851.190363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Isolated skeletal metastasis in endometrial carcinoma at recurrence is very rare. We report a 52-year-old woman diagnosed to have FIGO Stage 1b, Grade 1 endometrioid adenocarcinoma, presenting with isolated distal humerus metastasis, 2 years after surgery and adjuvant radiotherapy for primary disease. Imaging, bone scintigraphy, and cytology confirmed the diagnosis of poorly differentiated metastatic adenocarcinoma. She was treated with local radiotherapy followed by six cycles of paclitaxel and carboplatin chemotherapy along with zoledronic acid, monthly. She is symptom-free after the treatment and at a first follow-up visit after 3 months.
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Affiliation(s)
- Santosh Kumar Devdas
- Department of Medical Oncology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Leela Digumarti
- Department Gynaecological Oncology and Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Raghunadharao Digumarti
- Department Gynaecological Oncology and Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Kunha Charan Patro
- Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital and Research Centre, MVP Colony, Visakhapatnam, Andhra Pradesh, India
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Takeshita S, Todo Y, Okamoto K, Minobe S, Kato H. Thoracic laminectomy with spinal fixation in a nonambulatory patient with metastatic vertebral tumor from endometrial carcinoma. J Obstet Gynaecol Res 2016; 42:1395-1399. [PMID: 27277163 DOI: 10.1111/jog.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 03/15/2016] [Accepted: 04/09/2016] [Indexed: 11/27/2022]
Abstract
Vertebral metastasis from endometrial cancer is a rare event and requires emergency treatment at the onset of neurologic symptoms caused by spinal cord compression. We report a case of a metastatic vertebral tumor, according to the International Federation of Gynecology and Obstetrics classification, of stage IVb endometrial cancer with multiple lung metastases. Emergency irradiation to the spinal tumor was conducted as a result of a loss of ambulation. Thoracic laminectomy with spinal fixation was subsequently performed because the patient remained nonambulatory and her neurological function deteriorated. Spinal decompression surgery enabled her to regain the ability to walk. Complete remission was achieved by subsequent pelvic surgery followed by combined chemotherapy consisting of docetaxel and carboplatin. Finally, the patient had no evidence of disease 45 months after the initial treatment. Early recognition and expeditious treatment is crucial for neurological recovery from metastatic spinal cord compression.
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Affiliation(s)
- Sho Takeshita
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Kazuhira Okamoto
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Shinichiro Minobe
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
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25
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Kimyon G, Karalok A, Basaran D, Ureyen I, Celik M, Tasci T, Tulunay G, Turan T. Bone recurrence rarely seen in endometrial cancer and review of the literature. J Obstet Gynaecol Res 2016; 42:602-11. [PMID: 27074755 DOI: 10.1111/jog.12960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/20/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the clinical findings and treatment results of patients with endometrial cancer (EC) who experienced initial recurrence or progression in bones. METHODS Ten EC patients experiencing initial recurrence or disease progression in bones were included in the study. Disease recurrences located in a single bone and in more than one bone were defined as single localization bone recurrence (BR) and multiple localization BR, respectively. Time from initial surgery to BR was determined as disease-free interval (DFI) and time from BR to death or last contact with a patient was described as post-recurrence survival (PRS). RESULTS Seven of 10 patients were asymptomatic. The median DFI was 13 months (range: 2-68). While eight patients had isolated BR, two patients also had concurrent extraosseous recurrences. Five patients had single and four patients had multiple localization BR. The most common sites for BR were the femur (55.5%) and vertebra (44.4%). Two-year PRS was 37.5% in all patients and 50% in patients with endometrioid EC. None of the patients with non-endometrioid type EC survived. In patients with multiple localization BR and with recurrence only occurred in the bones, two-year PRS was 75% and 50%, respectively. None of the patients with BR with extraosseous involvement survived beyond two years. Two-year PRS was 50% in patients without extraosseous dissemination, independent from localization. CONCLUSION The BR rate was remarkable in asymptomatic EC survivors. A single bone was frequently involved. Little is known of the optimal treatment for metastatic bone disease in EC, thus, management should be individualized and patients should be encouraged to participate in clinical trials.
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Affiliation(s)
- Gunsu Kimyon
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Alper Karalok
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Derman Basaran
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Isin Ureyen
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Mehmet Celik
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Tolga Tasci
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Gokhan Tulunay
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
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Liu A, Sankey EW, Goodwin CR, Kosztowski TA, Elder BD, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sciubba DM. Postoperative survival and functional outcomes for patients with metastatic gynecological cancer to the spine: case series and review of the literature. J Neurosurg Spine 2015; 24:131-44. [PMID: 26360144 DOI: 10.3171/2015.3.spine15145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal metastases from gynecological cancers are rare, with few cases reported in the literature. In this study, the authors examine a series of patients with spinal metastases from gynecological cancer and review the literature. METHODS The cases of 6 consecutive patients who underwent spine surgery for metastatic gynecological cancer between 2007 and 2012 at a single institution were retrospectively reviewed. The recorded demographic, operative, and postoperative factors were reviewed, and the functional outcomes were determined by change in Karnofsky Performance Scale and the American Spine Injury Association (ASIA) score during follow-up. A systematic review of the literature was also performed to evaluate outcomes for patients with similar gynecological metastases to the spine. RESULTS In this series, details regarding metastatic gynecological cancers to the spine are as follows: 2 patients with cervical cancer (both presented at age 46 years, mean postoperative survival of 32 months), 2 patients with endometrial cancer (mean age of 40 years, mean postoperative survival of 26 months), and 2 patients with leiomyosarcoma (mean age of 44 years, mean postoperative survival of 20 months). All patients presented with pain, and no complications were noted following surgery. All patients with known follow-up had stable or improved neurological outcomes, performance status, and improved pain, without local recurrence of tumor. Overall median survival after diagnosis of metastatic spine lesions for all cases in the literature as well as those treated by the authors was 15 months. When categorized by type, median survival of patients with cervical cancer (n = 2), endometrial cancer (n = 26), and leiomyosarcoma (n = 16) was 32, 10, and 22.5 months, respectively. CONCLUSIONS Gynecological cancers metastasizing to the spine are rare. In this series, overall survival following diagnosis of spinal metastasis and surgery was 27 months, with cervical cancer, endometrial cancer, and leiomyosarcoma survival being 32, 26, and 20 months, respectively. Combined with literature cases, survival differs depending on primary histology, with decreasing survival from cervical cancer (32 months) to leiomyosarcoma (22.5 months) to endometrial cancer (10 months). Integrating such information with other patient factors may more accurately guide decision making regarding management of such spinal lesions.
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Affiliation(s)
- Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eric W Sankey
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - C Rory Goodwin
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Benjamin D Elder
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Ziya L Gokaslan
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Lunardi P, Vidal F, Accadbled F, Leguevaque P, Soule-Tholy M, Beauval JB, Motton S. Bilateral femur metastases in low-grade endometrial carcinoma. Clin Case Rep 2015; 3:582-6. [PMID: 26273447 PMCID: PMC4527801 DOI: 10.1002/ccr3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/25/2015] [Accepted: 02/26/2015] [Indexed: 11/20/2022] Open
Abstract
Lower-limb bone metastases are uncommon in low-grade endometrial carcinoma, and are mostly located on the axial skeleton. Here, we present a rare case of bilateral femur metastases in low-grade endometrial carcinoma and performed a review of the current literature.
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Affiliation(s)
- Pierre Lunardi
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil Toulouse, France
| | - Fabien Vidal
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | | | - Pierre Leguevaque
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | - Marc Soule-Tholy
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | - Jean Baptiste Beauval
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil Toulouse, France
| | - Stéphanie Motton
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
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Longo R, Gamelon-Benichou C, Elias-Matta C, Platini C, Eid N, Yacoubi M, Quétin P. An Unusual Solitary Metatarsal Metastasis from an Endometrioid Endometrial Adenocarcinoma. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:473-7. [PMID: 26193447 PMCID: PMC4514294 DOI: 10.12659/ajcr.893978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 62 Final Diagnosis: Metatarsal metastasis from an endometroid endometrial adenocarcinoma Symptoms: Painful • swelling hard mass • fixed to the underlying bone of the left foot Medication: — Clinical Procedure: Clinical and Gynecological examination • CT scan • left foot MRI • percutaneous core biopsy Specialty: Oncology
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Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
| | - Claire Gamelon-Benichou
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
| | - Clémence Elias-Matta
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
| | - Christian Platini
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
| | - Nada Eid
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
| | - Mohammed Yacoubi
- Division of Radiotherapy, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
| | - Philippe Quétin
- Division of Radiotherapy, Centre Hospitalier Régional (CHR) Metz-Thionville, Metz-Thionville, France
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Luedke C, Crawford WS, Payne J, Sanchez HB. Metastatic endometrial carcinoma invading bilateral total knee arthroplasties. Arthroplast Today 2015; 1:31-35. [PMID: 28326366 PMCID: PMC4926824 DOI: 10.1016/j.artd.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 10/27/2022] Open
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Boukhar SA, Kaneshiro R, Schiller A, Terada K, Tauchi-Nishi P. Tibial bone metastasis as an initial presentation of endometrial carcinoma diagnosed by fine-needle aspiration cytology: A case report and review of the literature. Cytojournal 2015; 12:11. [PMID: 26085835 PMCID: PMC4453162 DOI: 10.4103/1742-6413.157507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/27/2014] [Indexed: 12/13/2022] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in the United States. However, bony metastasis is infrequent and exceptionally rare as the initial presentation. We report a case of a 77-year-old female with a clinically silent endometrial carcinoma who presented with a left tibial metastasis as the first manifestation of her disease. Ours is only the third case diagnosed by fine-needle aspiration (FNA) cytology, and the first to detail the cytomorphologic features of metastatic endometrial cancer to bone. These microscopic findings, including three-dimensional cohesive clusters with cellular overlapping and cuboidal to columnar cells exhibiting low nuclear: cytoplasmic ratios and partially vacuolated cytoplasm, differ significantly from those of endometrial carcinoma on a Papanicolaou test. The tumor bore similarity to the more commonly encountered metastatic colon cancer, but immunohistochemical staining enabled reliable distinction between these entities. A review of osseous metastases of endometrial cancer demonstrates a predilection for bones of the lower extremity and pelvis with a predominance of the endometrioid histologic subtype. In about a quarter of the cases, the bony metastasis was the first manifestation of the cancer. FNA was an effective diagnostic modality for this unusual presentation of a common malignancy. Awareness of this entity and its differential diagnosis is essential for accurate and timely diagnosis.
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Affiliation(s)
| | - Ricky Kaneshiro
- Address: Department of Pathology, University of Hawaii, Honolulu, HI, United States
| | - Alan Schiller
- Address: Department of Pathology, University of Hawaii, Honolulu, HI, United States
| | - Keith Terada
- Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, HI, United States
| | - Pamela Tauchi-Nishi
- Address: Department of Pathology, University of Hawaii, Honolulu, HI, United States
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Cecchi PC, Kluge R, Schwarz A. Calvarial metastasis from endometrial carcinoma: Case report and review of the literature. Asian J Neurosurg 2015; 9:242. [PMID: 25685234 PMCID: PMC4323981 DOI: 10.4103/1793-5482.146648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hematogenous bone metastases from endometrial carcinoma are not frequent and their treatment is a matter of debate. We describe an extremely rare case of calvarial metastasis from endometrial carcinoma in an 80-year-old woman treated by means of one-step surgical radical resection and heterologous cranioplasty, along with a review of the literature regarding epidemiology, clinico-radiological features, prognosis, and management of skull metastases.
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Affiliation(s)
| | - Reinhard Kluge
- Service of Pathology, Regional General Hospital, Bolzano, Italy
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Foerster R, Habermehl D, Bruckner T, Bostel T, Schlampp I, Welzel T, Debus J, Rief H. Spinal bone metastases in gynecologic malignancies: a retrospective analysis of stability, prognostic factors and survival. Radiat Oncol 2014; 9:194. [PMID: 25182126 PMCID: PMC4163163 DOI: 10.1186/1748-717x-9-194] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 08/31/2014] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this retrospective study was to evaluate the stability of spinal metastases in gynecologic cancer patients (pts) on the basis of a validated scoring system after radiotherapy (RT), to define prognostic factors for stability and to calculate survival. Methods Fourty-four women with gynecologic malignancies and spinal bone metastases were treated at our department between January 2000 and January 2012. Out of those 34 were assessed regarding stability using the Taneichi score before, 3 and 6 months after RT. Additionally prognostic factors for stability, overall survival, and bone survival (time between first day of RT of bone metastases and death from any cause) were calculated. Results Before RT 47% of pts were unstable and 6 months after RT 85% of pts were stable. Karnofsky performance status (KPS) >70% (p = 0.037) and no chemotherapy (ChT) (p = 0.046) prior to RT were significantly predictive for response. 5-year overall survival was 69% and 1-year bone survival was 73%. Conclusions RT is capable of improving stability of osteolytic spinal metastases from gynecologic cancer by facilitating re-ossification in survivors. KPS may be a predictor for response. Pts who received ChT prior to RT may require additional bone supportive treatment to overcome bone remodeling imbalance. Survival in women with bone metastases from gynecologic cancer remains poor.
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Affiliation(s)
| | | | | | | | | | | | | | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Gonzalez-Benitez C, De Santiago J, Herrera-Muela M, Zapardiel I. Scalp and cranial vault fulminant relapse from an endometrial carcinoma. J OBSTET GYNAECOL 2014; 34:744. [PMID: 24911920 DOI: 10.3109/01443615.2014.920311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bone Metastasis in Primary Endometrial Carcinoma: Features, Outcomes, and Predictors. Int J Gynecol Cancer 2014; 24:107-12. [DOI: 10.1097/igc.0000000000000015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThis study aimed to describe the clinicopathologic characteristics and outcomes and to assess the predictors associated with prognosis in endometrial carcinoma that developed bone metastasis.MethodsA retrospective review of medical records was performed to identify the patients with endometrial carcinoma who developed bone metastasis between October 1994 and May 2012.ResultsOf the 1185 patients with endometrial carcinoma, 22 (1.8%) were identified with bone metastasis, and 21 patients were analyzed in the study. Seventeen (80.9%) patients had advanced-stage disease (2009 International Federation of Gynecologists and Obstetricians stages III-IV). Four (19.0%) patients had a bone lesion at the diagnosis of endometrial cancer. The median time of recurrence to the bone in 17 patients was 9 months (range, 2–43 months). The median overall survival (OS) and survival after bone metastasis of the entire cohort were 33 months (range, 9–57 months) and 15 months (range, 12–17 months), respectively. The patients with bone metastasis at recurrence had significantly longer OS than those patients with bone metastasis at diagnosis of endometrial cancer (36 vs 13 months; P = 0.042). Metastasis to extrapelvic bone was significantly associated with longer OS (46 vs 19 months; P = 0.001) and longer survival after bone metastasis (25 vs 12 months; P = 0.002). Isolated bone recurrence without extraosseous metastases and extrapelvic bone metastasis revealed independent predictors for survival after bone metastasis (hazard ratio, 0.09; 95% confidence interval, 0.01–0.67; P = 0.019 and hazard ratio, 0.07; 95% confidence interval, 0.01–0.53; P = 0.01).ConclusionsIn endometrial carcinoma that develops bone metastasis, isolated bone recurrence and extrapelvic bone metastasis are significant predictors of prolonged survival after the diagnosis of bone metastasis. Further researches on the optimal treatment modality and factors that have the clinical implications are warranted.
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Primary bone metastasis as initial presentation of endometrial cancer (stage IVb). Arch Gynecol Obstet 2013; 288:739-46. [PMID: 23900727 DOI: 10.1007/s00404-013-2956-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Endometrial cancer is the most common malignancy among females in developed countries. Abnormal uterine bleeding is the leading symptom in approximately 90 % of cases. The incidence of stage IV disease is approximately 5-10 % with a 5-year overall survival of less than 10 %. MATERIALS AND METHODS A rare case presented with femoral pathological fracture and underlying endometrial cancer. We discuss the diagnosis, management and literature review for this extremely rare entity which can be present even in the absence of vaginal bleeding. RESULTS Literature search revealed 28 cases with primary bone metastasis and all were symptomatic at the time of diagnosis. Eighty percent of them had tumour on the lower limb and the majority did not have vaginal bleeding. The predominant histopathological type was endometrioid (72.4 %) and grade 1-2 (59 %). Treatment had been individualised and 57 % of the cases underwent surgery with removal of uterus and adnexa and only three patients (10.7 %) received pelvic radiotherapy. Bone tumour was treated with radiotherapy in 80 % of the cases, alone (28 %), or combined with primary surgery (12 %) or chemotherapy (40 %). Overall, 54 % of patients received chemotherapy and 46 % received hormone therapy. The mean survival of patients who presented with single-bone metastasis was significantly better than those with multiple extrauterine metastatic sites: mean 85.7 months (SE: 9.2) versus 22.9 months (SE: 5.2), p < 0.003, CI 95 %. These two different survival patterns are more likely to reflect two different biological disease behaviours. Those with advanced local and widespread disease progress quicker, in contrast to those with a single-bone extrauterine metastatic site and local disease limited to the uterus, which continues to behave as early stage endometrial cancer. CONCLUSIONS Although extremely rare, endometrial cancer can present as initial bone pathology. Endometrial biopsy should be included in the patient's workup when investigating for metastatic bone adenocarcinoma of unknown origin, even when gynaecological symptoms are lacking, as this rare presentation of stage IVb endometrial cancer appears to have good survival outcomes.
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Grade 1 endometrioid endometrial carcinoma presenting with pelvic bone metastasis: a case report and review of the literature. Case Rep Obstet Gynecol 2013; 2013:807205. [PMID: 23710391 PMCID: PMC3654698 DOI: 10.1155/2013/807205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022] Open
Abstract
Most grade 1 endometrioid endometrial cancers are confined to the uterus at the time of diagnosis and confer a good prognosis. Rarely will a grade 1 endometrioid endometrial carcinoma present with distant metastasis, especially to the bone. We present the case of a 56-year-old woman with postmenopausal bleeding and right hip pain due to metastatic grade 1 endometrioid uterine cancer invading into the right ischium. We discuss treatment options as well as provide a review of prior published reports on bony metastasis in grade 1 endometrioid endometrial cancers. To date, this case is one of 10 others which demonstrates that even a well-differentiated, low-grade endometrioid endometrial carcinoma can progress in a highly aggressive manner.
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Bone metastases in endometrial cancer: report on 19 patients and review of the medical literature. Gynecol Oncol 2013; 130:474-82. [PMID: 23685013 DOI: 10.1016/j.ygyno.2013.05.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Because few cases of bone metastases of endometrial cancer have been reported, and information is scarce on their incidence, treatment, prognosis, and outcomes, we sought to compile a series of bone metastases of endometrial cancer and to systematically review the medical literature. METHODS We retrospectively reviewed medical records of patients who had osseous metastases of endometrial cancer treated initially at Mayo Clinic (1984-2001), and of all patients who were referred for treatment of primary bone metastases after primary treatment for endometrial cancer elsewhere. RESULTS Of 1632 patients with endometrial cancer, 13 (0.8%) had primary bone dissemination and 6 (0.4%) were referred after initial treatment. Three (15.8%) of these 19 had bone metastases at presentation; in the rest, median time to recurrence was 19.5 months (range, 3-114). The most common sites were the spine and hip. Median survival after metastasis was 12 months (range, 2-267). Median survival after radiotherapy alone vs. multimodal treatment was 20 months (range, 12-119) vs. 33 months (range, 9-267), respectively (P > .99). Of the 87 cases we reviewed from the literature, all but 1 (98.9%) had diagnoses based on symptoms. Multiple bone involvement and extraosseous dissemination were associated with poor prognosis. Type II endometrial cancer (i.e., serous or clear-cell histology) was associated with shorter life expectancy after diagnosis of bone metastasis compared to Type I tumors. CONCLUSIONS The incidence of primary bone metastases of endometrial cancer is < 1%. Single bone metastases without extraosseous spread indicate less aggressive disease. Optimal treatment is unclear.
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Tang YH, Chang HP, Lai CH, Wang CC, Ueng SH, Huang YT, Chao A. Limb salvage treatment in a 25-year-old woman with stage IVB endometrial cancer presenting with hip bone metastasis. Taiwan J Obstet Gynecol 2012; 51:465-8. [PMID: 23040942 DOI: 10.1016/j.tjog.2012.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yun-Hsin Tang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taiwan
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