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Wang M, Li Y, Xu J, Xu S, Wu Y. Prognosis of synchronous endometrial and ovarian cancer based on the PROMISE molecular system. Chin Med J (Engl) 2024:00029330-990000000-01101. [PMID: 38867410 DOI: 10.1097/cm9.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Indexed: 06/14/2024] Open
Affiliation(s)
- Ming Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
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2
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Gan W, Bian C. The research progress on synchronous endometrial and ovarian carcinoma. Front Oncol 2023; 13:1291602. [PMID: 38144530 PMCID: PMC10748788 DOI: 10.3389/fonc.2023.1291602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Synchronous endometrial and ovarian carcinoma (SEOC) is the most common combination of primary double cancer in the female reproductive system. The etiology and pathogenesis of SEOC remain unclear, and clinically, it is often misdiagnosed as metastatic cancer, affecting the formulation of treatment plans and prognosis for patients. This article provides a review of its epidemiology, pathological and clinical characteristics, risk factors, pathogenesis, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Wenli Gan
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gynecology and Obstetrics, Affiliated Hospital of Sichuan Nursing Vocational College (The Third People's Hospital of Sichuan Province), Chengdu, Sichuan, China
| | - Ce Bian
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
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3
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Yumisashi R, Saito R, Togami S, Kobayashi Y, Kitazono I, Tanimoto A, Kobayashi H. Molecular biological analysis revealed a case of synchronous endometrial and ovarian cancer with different histological grade as metastatic ovarian cancer from endometrial cancer: Case report and review of literature. J Obstet Gynaecol Res 2023; 49:2766-2770. [PMID: 37604499 DOI: 10.1111/jog.15773] [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: 04/06/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
The diagnosis of synchronous endometrial and ovarian cancer or metastatic cancer of the same histological type is difficult. In this study, molecular biology analysis was performed to determine ovarian metastasis from endometrial cancer. A 38-year-old woman had pathological evidence of endometrial cancer (endometrioid carcinoma, grade 1) and ovarian cancer (endometrioid carcinoma, grade 3); a disseminated nodule in the serosa uteri was also diagnosed as endometrioid carcinoma (grade 3). Customized panel sequencing revealed a common mutation pattern in ovarian cancer and disseminated nodules. Furthermore, endometrial cancer showed the same mutation patterns for FGFR3 and PTEN as ovarian cancer and disseminated nodules. All tumors were microsatellite instability high. Clinicopathological and molecular biology analyses suggested that the patient had ovarian metastasis from endometrial cancer. The patient underwent adjuvant chemotherapy with paclitaxel and carboplatin, with no recurrence. Molecular biology techniques may enable appropriate treatment based on clinically accurate diagnosis.
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Affiliation(s)
- Riho Yumisashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Saito
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ikumi Kitazono
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akihide Tanimoto
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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4
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Žilovič D, Čiurlienė R, Šidlovska E, Vaicekauskaitė I, Sabaliauskaitė R, Jarmalaitė S. Synchronous endometrial and ovarian cancer: A case report. World J Clin Cases 2023; 11:4341-4349. [PMID: 37449219 PMCID: PMC10337002 DOI: 10.12998/wjcc.v11.i18.4341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Synchronous endometrial and ovarian cancer (SEOC) is a rare genital tract tumor. Precise diagnosis is crucial for the disease management since prognosis and overall survival differ substantially between metastatic endometrial cancer (EC) or OC. In this review we present 2 cases of women who were diagnosed with SEOC, and discuss the clinical characteristic of SEOC, diagnostic and molecular profiling issues. Next generation sequencing of 10 gene panel was performed on cancerous tissue and uterine lavage samples.
CASE SUMMARY In our report patients with SEOC had endometroid type histology with early stage and low-grade histology for both EC and OC. They underwent surgical treatment and staging. Next-generation sequencing of 10 gene-panel identified CTNNB1, PIK3CA, and PTEN gene mutations in ovarian tissue in one case, while none of these genes were mutated in other case. Literature review in support to our data suggest a good prognosis for SEOC diagnosed at early stage.
CONCLUSION Accurate diagnosis of SEOC is essential for disease management and gene mutation analysis can be helpful as a complementary diagnostic and prognostic tool.
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Affiliation(s)
- Diana Žilovič
- Department of Oncogynecology, National Cancer Institute, Vilnius 08406, Lithuania
- Institute of Biosciences, Vilnius University, Vilnius 10222, Lithuania
- Laboratory of Clinical Oncology, National Cancer Institute, Vilnius 08406, Lithuania
| | - Rūta Čiurlienė
- Department of Oncogynecology, National Cancer Institute, Vilnius 08406, Lithuania
| | - Evelina Šidlovska
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius 08406, Lithuania
| | - Ieva Vaicekauskaitė
- Institute of Biosciences, Vilnius University, Vilnius 10222, Lithuania
- Laboratory of Genetic Diagnostic, National Cancer Institute, Vilnius 08406, Lithuania
| | - Rasa Sabaliauskaitė
- Laboratory of Genetic Diagnostic, National Cancer Institute, Vilnius 08406, Lithuania
| | - Sonata Jarmalaitė
- Institute of Biosciences, Vilnius University, Vilnius 10222, Lithuania
- Laboratory of Genetic Diagnostic, National Cancer Institute, Vilnius 08406, Lithuania
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5
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Dellino M, Cerbone M, Laganà AS, Vitagliano A, Vimercati A, Marinaccio M, Baldini GM, Malvasi A, Cicinelli E, Damiani GR, Cazzato G, Cascardi E. Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation? Int J Mol Sci 2023; 24:ijms24119780. [PMID: 37298731 DOI: 10.3390/ijms24119780] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost-benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.
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Affiliation(s)
- Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Marinaccio
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Antonio Malvasi
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
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Suri V, Bansal R, Aggarwal N, Sikka P, Chopra S, Saha SC, Gupta N, Rai B. Successful in vitro fertilization following conservative surgery for synchronous endometrioid tumor of ovary and uterus. J Ovarian Res 2023; 16:63. [PMID: 36991430 DOI: 10.1186/s13048-023-01137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Successful pregnancy outcome in women with synchronous ovarian and endometrial cancers is very rare. We report successful pregnancy outcome in a young woman managed conservatively for synchronous endometrial and ovarian cancer. CASE PRESENTATION Thirty years old nulliparous lady presented following exploratory laparotomy, left salpingo-oophorectomy and hysteroscopic polypectomy for left adnexal mass. Histology revealed endometrioid carcinoma of left ovary and moderately differentiated adenocarcinoma in the resected polyp. She underwent staging laparotomy along with hysteroscopy which confirmed above findings without any evidence of further tumor spread. She was treated conservatively with high dose oral progestin (megestrol acetate, 160 mg) and leuprolide acetate 3.75 mg monthly injections for three months along with four cycles of carboplatin and paclitaxel based chemotherapy followed by monthly injection of leuprolide for further three months. After failure of spontaneous conception, she underwent ovulation induction for six cycles along with intrauterine insemination which failed. She underwent in vitro fertilization with donor egg followed by elective cesarean section at 37 weeks of gestation. She delivered a healthy baby of weight 2.7 kg. Intraoperatively 5 × 6 cm right ovarian cyst was found which drained chocolate coloured fluid on puncture and cystectomy was carried out. Histological examination revealed endometrioid cyst of right ovary. Uterus was spared as she wanted to preserve her fertility. She is being followed periodically and is normal nine months following delivery. She is on injection Depot medroxy progesterone acetate once every three months.
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Affiliation(s)
- Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Bansal
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Chandra Saha
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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7
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Goh SM, Wu YC, Lee RWK. A Presentation of Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma From a Case of Suspected Ruptured Ectopic Pregnancy. J Med Cases 2023; 14:31-35. [PMID: 36755996 PMCID: PMC9881485 DOI: 10.14740/jmc4011] [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: 12/09/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
A 32-year-old woman of child-bearing age who initially underwent surgical laparoscopy for suspected ruptured ectopic pregnancy with elevated serum β-human chorionic gonadotropin (hCG) levels was unexpectedly found to have histologically diagnosed synchronous ovarian and endometrial endometrioid adenocarcinoma. She subsequently underwent another full completion staging surgery and adjuvant chemotherapy as she was unsuitable for fertility-sparing surgery. An elevated serum β-hCG level accompanied by clinical signs of acute abdominal pain, per vaginal bleeding, ultrasound features of abdominal free fluid in the pelvis and an adnexal mass warrants a high clinical suspicion for a ruptured ectopic pregnancy. However, it is important to recognize ovarian malignancy as a rare but differential diagnosis to suspected ectopic pregnancy in patients with acute abdomen. Fertility-sparing surgery may be considered for young patients seeking fertility, without compromising patient survival in women without synchronous gynecological cancers.
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Affiliation(s)
- Siak Ming Goh
- Department of Minimally invasive Surgery Unit, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore,Corresponding Author: Siak Ming Goh, Department of Minimally invasive Surgery Unit, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Yanlin Carly Wu
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 119074, Singapore
| | - Ryan Wai Kheong Lee
- Department of Minimally invasive Surgery Unit, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
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8
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Gul P, Gul K, Altaf MO, Javaid A, Ashraf J. The Accuracy of MRI in the Local Staging of Endometrial Cancer: An Experience From a Tertiary Care Oncology Institute in Pakistan. Cureus 2022; 14:e31053. [DOI: 10.7759/cureus.31053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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9
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Maheshwari E, Nougaret S, Stein EB, Rauch GM, Hwang KP, Stafford RJ, Klopp AH, Soliman PT, Maturen KE, Rockall AG, Lee SI, Sadowski EA, Venkatesan AM. Update on MRI in Evaluation and Treatment of Endometrial Cancer. Radiographics 2022; 42:2112-2130. [PMID: 36018785 DOI: 10.1148/rg.220070] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Although the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is a surgical staging system, contemporary published evidence-based data and expert opinions recommend MRI for treatment planning as it provides critical diagnostic information on tumor size and depth, extent of myometrial and cervical invasion, extrauterine extent, and lymph node status, all of which are essential in choosing the most appropriate therapy. Multiparametric MRI using a combination of T2-weighted sequences, diffusion-weighted imaging, and multiphase contrast-enhanced imaging is the mainstay for imaging assessment of endometrial cancer. Identification of important prognostic factors at MRI improves both treatment selection and posttreatment follow-up. MRI also plays a crucial role for fertility-preserving strategies and in patients who are not surgical candidates by helping guide therapy and identify procedural complications. This review is a product of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel and reflects a multidisciplinary international collaborative effort to summarize updated information highlighting the role of MRI for endometrial cancer depiction and delineation, treatment planning, and follow-up. The article includes information regarding dedicated MRI protocols, tips for MRI reporting, imaging pitfalls, and strategies for image quality optimization. The roles of MRI-guided radiation therapy, hybrid PET/MRI, and advanced MRI techniques that are applicable to endometrial cancer imaging are also discussed. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Ekta Maheshwari
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Stephanie Nougaret
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Erica B Stein
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Gaiane M Rauch
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Ken-Pin Hwang
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - R Jason Stafford
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Ann H Klopp
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Pamela T Soliman
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Katherine E Maturen
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Andrea G Rockall
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Susanna I Lee
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Elizabeth A Sadowski
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Aradhana M Venkatesan
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
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10
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Abuali SM, Asarian A, Xiao P. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac109. [PMID: 35474951 PMCID: PMC9035322 DOI: 10.1093/jscr/rjac109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah M Abuali
- Correspondence address. St. George’s University School of Medicine, True Blue, Grenada WI, USA. Tel: +1-617-800-6664; E-mail:
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Brooklyn, NY, USA
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11
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Liu X, Wu Y, Liu P, Zhang X. Developing a validated nomogram for predicting ovarian metastasis in endometrial cancer patients: a retrospective research. Arch Gynecol Obstet 2021; 305:719-729. [PMID: 34495379 DOI: 10.1007/s00404-021-06214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore risk factors and develop a prediction model for ovarian metastasis in endometrial cancer (EC), as well as providing provide a reference for clinical ovarian preservation. METHODS We conducted a retrospective observational study enrolling 1496 EC patients having received complete staging surgery from Qilu Hospital of Shandong University from 2012 to 2018. These patients were randomly divided into two cohorts: training cohort (n = 1046) and validation cohort (n = 448). A nomogram prediction model was developed based on univariate, least absolute shrinkage and selection operator (Lasso), and multivariate logistic regression. Then, the nomogram model's performance was evaluated in discrimination, calibration, and clinical utility three aspects. RESULTS Parametrium invasion, lymph node metastasis, and oviduct metastasis were finally contained in the nomogram prediction model. The AUC of the model in the training cohort was 0.85 compared with 0.72 in the validation cohort. It also behaved well in calibration and had good clinical utility. With a threshold probability of 20% ~ 80%, the nomogram increased the net benefit by 0 ~ 13.6 per 100 patients than surgery for all patients upon validation. CONCLUSIONS We develop a nomogram with good performances for predicting ovarian metastasis in EC patients, which may help clinicians identify candidate patients appropriate for ovarian preservation in premenopausal EC patients.
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Affiliation(s)
- Xiaodie Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100029, China
| | - Yaohai Wu
- Department of Urology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,Department of Urology, Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, People's Republic of China
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
| | - Xiaolei Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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12
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Molecular evidence for a clonal relationship between synchronous uterine endometrioid carcinoma and ovarian clear cell carcinoma: a new example of "precursor escape"? J Mol Med (Berl) 2021; 99:959-966. [PMID: 33768299 DOI: 10.1007/s00109-021-02064-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 02/08/2023]
Abstract
Synchronous endometrial and ovarian carcinomas (SEOCs) that share the same endometrioid histology are generally considered as the result of metastatic spread from one organ to another. However, SEOCs with different histologies are regarded as distinct primary lesions that arise independently from each other. This study was undertaken to compare the mutational landscape of SEOCs with different histologies to confirm or refute the hypothesis of an independent origin. Four patients with synchronous uterine endometrioid carcinoma (UEMC) and ovarian clear cell carcinoma (OCCC) were examined. UEMCs were accompanied by endometrial hyperplasia/endometrioid intraepithelial neoplasia, whereas endometriosis was evident in two cases. Paired UEMC and OCCC specimens were subjected to mutation analysis with massively parallel sequencing. Surprisingly, we found that 50% (2/4) of paired SEOCs with different histologies shared the same somatic mutations, some of which localized in cancer driver genes. Clonality analyses indicated that these tumors were clonally related to each other. Notably, 75% (3/4) of the study patients had Lynch syndrome. The cancer-specific survival figures of patients with synchronous UEMCs and OCCCs were more favorable than those observed in a historical cohort of patients with isolated stage 2/3 OCCCs. Taken together, we set forth a potential explanation that considers clonally related SEOCs as a result of "precursor escape" - whereby precursor cells of endometrial cancer spread beyond the uterus to reach the pelvis and eventually evolve into an OCCC under an increasing mutational burden. KEY MESSAGES: • SEOCs characterized by different histologies are rare. • All cases of SEOCs were accompanied by endometrial hyperplasia. • Fifty percent of SEOCs were clonally related to each other. • Shared mutations in cancer driver genes were evident among SEOCs. • Clonally related SEOCs may be a result of "precursor escape." • Lynch syndrome is highly prevalent in patients with UEMC and synchronous OCCC. • The prognosis of synchronous UEMC and OCCC was favorable.
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13
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Matsuo K, Mandelbaum RS, Matsuzaki S, Klar M, Roman LD, Wright JD. Ovarian conservation for young women with early-stage, low-grade endometrial cancer: a 2-step schema. Am J Obstet Gynecol 2021; 224:574-584. [PMID: 33412129 DOI: 10.1016/j.ajog.2020.12.1213] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
In 2020, endometrial cancer continues to be the most common gynecologic malignancy in the United States. The majority of endometrial cancer is low grade, and nearly 1 of every 8 low-grade endometrial cancer diagnoses occurs in women younger than 50 years with early-stage disease. The incidence of early-stage, low-grade endometrial cancer is increasing particularly among women in their 30s. Women with early-stage, low-grade endometrial cancer generally have a favorable prognosis, and hysterectomy-based surgical treatment alone can often be curative. In young women with endometrial cancer, consideration of ovarian conservation is especially relevant to avoid both the short-term and long-term sequelae of surgical menopause including menopausal symptoms, cardiovascular disease, metabolic disease, and osteoporosis. Although disadvantages of ovarian conservation include failure to remove ovarian micrometastasis (0.4%-0.8%), gross ovarian metastatic disease (4.2%), or synchronous ovarian cancer (3%-5%) at the time of surgery and the risk of future potential metachronous ovarian cancer (1.2%), ovarian conservation is not negatively associated with endometrial cancer-related or all-cause mortality in young women with early-stage, low-grade endometrial cancer. Despite this, utilization of ovarian conservation for young women with early-stage, low-grade endometrial cancer remains modest with only a gradual increase in uptake in the United States. We propose a framework and strategic approach to identify young women with early-stage, low-grade endometrial cancer who may be candidates for ovarian conservation. This evidence-based schema consists of a 2-step assessment at both the preoperative and intraoperative stages that can be universally integrated into practice.
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14
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Shin W, Park SY, Kang S, Lim MC, Seo SS. How to manage synchronous endometrial and ovarian cancer patients? BMC Cancer 2021; 21:489. [PMID: 33933018 PMCID: PMC8088669 DOI: 10.1186/s12885-021-08220-w] [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] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Backgrounds We aimed to evaluate the prognosis in patients with synchronous endometrial and ovarian cancer (SEOC) by comparing the differences between double primary cancer (DPC) and metastatic cancer (MC). Methods The medical records of 47 patients diagnosed synchronously with endometrial and ovarian cancer between January 2006 and December 2018 were retrospectively reviewed. Twenty-eight and 19 patients were diagnosed with DPC and MC, respectively. Demographics, recurrence-free survival (RFS), and 5-year overall survival (OS) were compared. The clinical factors affecting survival were evaluated using univariate and multivariate analyses. Results The demographics were not different between both groups. Endometrioid histology and the International Federation of Gynecology and Obstetrics grade were higher in the MC group than in the DPC group (42.1% vs. 10.7%; P = 0.018, P = 0.002, respectively). The ratio of post-operative adjuvant therapy was not different in both groups. Recurrence occurred in five patients with DPC and seven with MC. The difference in RFS was not significantly different (P = 0.131) but the OS was different between both groups (P = 0.020). Histology and para-aortic lymph node metastasis were associated wtih RFS in univariate analysis, but no difference was found in multivariate analysis. Conclusions Although DPC patients had longer OS, multivariate analysis did not identify any influential factors. Focus should be placed on defining the appropriate adjuvant treatment for high-risk patients, which will improve prognosis, rather than on discriminating between DPC and MC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08220-w.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Department of Obstetrics & Gynecology, Chungnam national university sejong hospital, Sejong, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Common Cancer Branch, Research Institute Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Precision Medicine Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Center for Clinical Trials, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Cancer Healthcare Research Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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15
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Atallah D, El Kassis N, Safi J, El Hachem H, Chahine G, Moubarak M. The use of hysteroscopic endometrectomy in the conservative treatment of early endometrial cancer and atypical hyperplasia in fertile women. Arch Gynecol Obstet 2021; 304:1299-1305. [PMID: 33830345 DOI: 10.1007/s00404-021-06048-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/26/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To illustrate the effectiveness of hysteroscopic endometrial resection in conservative treatment of early endometrial cancer/atypical hyperplasia in women of reproductive age. METHODS Review of outcomes of women of reproductive age who underwent fertility sparing treatment (hysteroscopic superficial endometrectomy followed by progestin therapy) in early endometrial cancer. RESULTS Eight women with Stage I endometrial cancer and three with atypical endometrial hyperplasia underwent hysteroscopic superficial endometrial resection, followed by 1-year treatment with oral megestrol acetate. One patient had a synchronous endometrioid ovarian carcinoma. One patient with Grade 2 carcinoma opted for conservative treatment and had hysterectomy 3 months later for persisting disease. Ten patients showed no evidence of residual disease during a 12-month follow-up period with regular hysteroscopy. Five patients had seven pregnancies without assisted reproductive technology. One patient got pregnant after one attempt of in-vitro fertilization and oocyte donation. Pregnancy rate was 54.5%; two patients had two successful pregnancies and deliveries. Average time to pregnancy was 16 months from the end of treatment. All babies were delivered vaginally. CONCLUSION Total superficial endometrial resection followed by progestin can be considered in patients with early endometrial cancer/atypical hyperplasia who still want to conceive. It does not seem to impair fertility nor pregnancy outcomes in women of reproductive age.
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Affiliation(s)
- David Atallah
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. .,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon.
| | - Nadine El Kassis
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
| | - Joelle Safi
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
| | - Hady El Hachem
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
| | - Georges Chahine
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malak Moubarak
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
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16
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Affiliation(s)
- Se-Ik Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Weon Kim
- Seoul National University College of Medicine, Seoul, South Korea
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17
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Saleh M, Virarkar M, Javadi S, Elsherif SB, de Castro Faria S, Bhosale P. Cervical Cancer: 2018 Revised International Federation of Gynecology and Obstetrics Staging System and the Role of Imaging. AJR Am J Roentgenol 2020; 214:1182-1195. [DOI: 10.2214/ajr.19.21819] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Mohammed Saleh
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Mayur Virarkar
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Sanaz Javadi
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Sherif B. Elsherif
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Silvana de Castro Faria
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Priya Bhosale
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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18
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Son J, Carr C, Yao M, Radeva M, Priyadarshini A, Marquard J, Michener CM, AlHilli M. Endometrial cancer in young women: prognostic factors and treatment outcomes in women aged ≤40 years. Int J Gynecol Cancer 2020; 30:631-639. [PMID: 32213530 DOI: 10.1136/ijgc-2019-001105] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Endometrial cancer in pre-menopausal patients aged ≤40 years is rare and poses both diagnostic and management challenges. The goal of this study was to investigate the clinical and pathologic factors associated with endometrial cancer in this group and their impact on survival. METHODS Patients with endometrial cancer treated between January 2004 and August 2016 were retrospectively reviewed. Patients who underwent either primary surgical treatment or fertility-sparing therapy were included. Exclusion criteria were age >60 years and patients who received neoadjuvant chemotherapy or primary radiation. Age at diagnosis was used to classify patients into two groups: ≤40 and 41-60 years. Clinical and pathologic variables were compared between the groups. Progression-free survival and overall survival were estimated using Cox proportional hazards. RESULTS A total of 551 patients were evaluated, of which 103 (18.7%) patients were ≤40 years and 448 (81.3%) were 41-60 years. Age ≤40 years was associated with higher body mass index (38.8 vs 35.8 kg/m2, p=0.008), non-invasive cancers (54.2% vs 32.6%, p<0.001), lower uterine segment involvement (27.2% vs 22.5%, p<0.001), and less lymphovascular space invasion (16.8% vs 29.1%, p=0.015). The rate of synchronous ovarian cancer was 9.2% vs 0.7% in age 41-60 years (p<0.001), and 19% of women with endometrial cancer aged ≤40 years underwent fertility-sparing therapy. Grade, stage, myometrial invasion, lymphovascular space invasion, and lymph node status were associated with survival, and fertility-sparing therapy adversely affected the recurrence rate of the age ≤40 years cohort. Among all patients aged ≤60 years, mismatch repair deficiency due to MLH1 methylation was associated with worse progression-free survival, 48.6% vs 83.3% (HR 1.98, 95% CI 1.06 to 3.17, p=0.032), and overall survival, 56.5% vs 90.0% (HR 2.58, 95% CI 1.13 to 5.90, p=0.025). CONCLUSIONS Patients aged ≤40 years with endometrial cancer have more favorable prognostic factors and higher rates of synchronous tumors. Fertility-sparing therapy was associated with higher recurrence rates. The prognostic value of MLH1 methylation in this population warrants further investigation.
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Affiliation(s)
- Ji Son
- Women's Health Institute, Department of OBGYN, Cleveland Clinic, Cleveland, Ohio, USA
| | - Caitlin Carr
- Women's Health Institute, Department of OBGYN, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Milena Radeva
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anju Priyadarshini
- Women's Health Institute, Department of OBGYN, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Marquard
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chad M Michener
- Women's Health Institute, Department of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, United States
| | - Mariam AlHilli
- Women's Health Institute, Department of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, United States
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19
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Reijnen C, Küsters-Vandevelde HVN, Ligtenberg MJL, Bulten J, Oosterwegel M, Snijders MPLM, Sweegers S, de Hullu JA, Vos MC, van der Wurff AAM, van Altena AM, Eijkelenboom A, Pijnenborg JMA. Molecular profiling identifies synchronous endometrial and ovarian cancers as metastatic endometrial cancer with favorable clinical outcome. Int J Cancer 2020; 147:478-489. [PMID: 32022266 PMCID: PMC7317735 DOI: 10.1002/ijc.32907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 01/14/2023]
Abstract
Synchronous primary endometrial and ovarian cancers (SEOs) represent 10% of all endometrial and ovarian cancers and are assumed to develop as independent entities. We investigated the clonal relationship between endometrial and ovarian carcinomas in a large cohort classified as SEOs or metastatic disease (MD). The molecular profiles were compared to The Cancer Genome Atlas (TCGA) data to explore primary origin. Subsequently, the molecular profiles were correlated with clinical outcome. To this extent, a retrospective multicenter study was performed comparing patients with SEOs (n = 50), endometrial cancer with synchronous ovarian metastasis (n = 19) and ovarian cancer with synchronous endometrial metastasis (n = 20). Targeted next‐generation sequencing was used, and a clonality index was calculated. Subsequently, cases were classified as POLE mutated, mismatch repair deficient (MMR‐D), TP53‐wild‐type or TP53‐mutated. In 92% of SEOs (46/50), the endometrial and concurrent ovarian carcinoma shared at least one somatic mutation, with a clonality index above 0.95, supporting a clonal origin. The SEO molecular profiles showed striking similarities with the TCGA endometrial carcinoma set. SEOs behaved distinctly different from metastatic disease, with a superior outcome compared to endometrial MD cases (p < 0.001) and ovarian MD cases (p < 0.001). Classification according to the TCGA identified four groups with different clinical outcomes. TP53 mutations and extra‐utero‐ovarian disease were independent predictors for poor clinical outcome. Concluding, SEOs were clonally related in an overwhelming majority of cases and showed a favorable prognosis. Their molecular profile implied a primary endometrial origin. TP53 mutation and extra‐utero‐ovarian disease were independent predictors for outcome, and may impact adjuvant systemic treatment planning. What's new? When primary endometrial and ovarian tumors are found simultaneously in the same patient, it has been assumed that they are separate cancers that developed independently. However, in this study, the authors found that these tumors share a clonal origin 92% of the time. They also found that these “synchronous” cancers tend to have a favorable prognosis, with far better outcomes than metastatic disease. Some subgroups, including TP53 mutations and extra‐utero‐ovarian disease, were independent predictors for poor clinical outcome, which may impact adjuvant treatment planning.
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Affiliation(s)
- Casper Reijnen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Marjolijn J L Ligtenberg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marloes Oosterwegel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Sanne Sweegers
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria C Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Anne M van Altena
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Astrid Eijkelenboom
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Wang Y, Li L, Douville C, Cohen JD, Yen TT, Kinde I, Sundfelt K, Kjær SK, Hruban RH, Shih IM, Wang TL, Kurman RJ, Springer S, Ptak J, Popoli M, Schaefer J, Silliman N, Dobbyn L, Tanner EJ, Angarita A, Lycke M, Jochumsen K, Afsari B, Danilova L, Levine DA, Jardon K, Zeng X, Arseneau J, Fu L, Diaz LA, Karchin R, Tomasetti C, Kinzler KW, Vogelstein B, Fader AN, Gilbert L, Papadopoulos N. Evaluation of liquid from the Papanicolaou test and other liquid biopsies for the detection of endometrial and ovarian cancers. Sci Transl Med 2019; 10:10/433/eaap8793. [PMID: 29563323 DOI: 10.1126/scitranslmed.aap8793] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/14/2018] [Indexed: 12/21/2022]
Abstract
We report the detection of endometrial and ovarian cancers based on genetic analyses of DNA recovered from the fluids obtained during a routine Papanicolaou (Pap) test. The new test, called PapSEEK, incorporates assays for mutations in 18 genes as well as an assay for aneuploidy. In Pap brush samples from 382 endometrial cancer patients, 81% [95% confidence interval (CI), 77 to 85%] were positive, including 78% of patients with early-stage disease. The sensitivity in 245 ovarian cancer patients was 33% (95% CI, 27 to 39%), including 34% of patients with early-stage disease. In contrast, only 1.4% of 714 women without cancer had positive Pap brush samples (specificity, ~99%). Next, we showed that intrauterine sampling with a Tao brush increased the detection of malignancy over endocervical sampling with a Pap brush: 93% of 123 (95% CI, 87 to 97%) patients with endometrial cancer and 45% of 51 (95% CI, 31 to 60%) patients with ovarian cancer were positive, whereas none of the samples from 125 women without cancer were positive (specificity, 100%). Finally, in 83 ovarian cancer patients in whom plasma was available, circulating tumor DNA was found in 43% of patients (95% CI, 33 to 55%). When plasma and Pap brush samples were both tested, the sensitivity for ovarian cancer increased to 63% (95% CI, 51 to 73%). These results demonstrate the potential of mutation-based diagnostics to detect gynecologic cancers at a stage when they are more likely to be curable.
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Affiliation(s)
- Yuxuan Wang
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lu Li
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Christopher Douville
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Cohen
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ting-Tai Yen
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | | | - Karin Sundfelt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg 405 30, Sweden
| | - Susanne K Kjær
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen 2100, Denmark
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ie-Ming Shih
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tian-Li Wang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Robert J Kurman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Simeon Springer
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Janine Ptak
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Maria Popoli
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joy Schaefer
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Natalie Silliman
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lisa Dobbyn
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Edward J Tanner
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Ana Angarita
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Maria Lycke
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg 405 30, Sweden
| | - Kirsten Jochumsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense 5000, Denmark
| | - Bahman Afsari
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ludmila Danilova
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Douglas A Levine
- Department of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Centre, New York University Langone Medical Center, New York, NY 10016, USA
| | - Kris Jardon
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, Oncology, and Pathology, McGill University and McGill University Health Centre, Montreal, Quebec H4A 3J1, Canada
| | - Xing Zeng
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, Oncology, and Pathology, McGill University and McGill University Health Centre, Montreal, Quebec H4A 3J1, Canada
| | - Jocelyne Arseneau
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, Oncology, and Pathology, McGill University and McGill University Health Centre, Montreal, Quebec H4A 3J1, Canada
| | - Lili Fu
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, Oncology, and Pathology, McGill University and McGill University Health Centre, Montreal, Quebec H4A 3J1, Canada
| | - Luis A Diaz
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Rachel Karchin
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Cristian Tomasetti
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Kenneth W Kinzler
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Bert Vogelstein
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. .,Howard Hughes Medical Institute, Baltimore, MD 21287, USA
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
| | - Lucy Gilbert
- Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, Oncology, and Pathology, McGill University and McGill University Health Centre, Montreal, Quebec H4A 3J1, Canada.
| | - Nickolas Papadopoulos
- Ludwig Center for Cancer Genetics and Therapeutics, and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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21
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The prognosis of stage IA synchronous endometrial endometrioid and ovarian carcinomas. Arch Gynecol Obstet 2019; 300:1045-1052. [PMID: 31520260 PMCID: PMC6759754 DOI: 10.1007/s00404-019-05288-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
Introduction Little is known about the prevalence and prognosis of synchronous endometrial and ovarian carcinomas. This report explores the survival outcomes of synchronous stage IA endometrioid endometrial and stage IA ovarian carcinomas in a retrospective cohort study. Methods All cases of pathological confirmed synchronous stage IA endometrial endometrioid and ovarian carcinomas from June 1, 2010, to June 1, 2017, in a teaching hospital were reviewed. Patients were followed up to February 1, 2019. Survival outcomes were compared between patients with and without synchronous carcinomas. Results In total, 841 cases with confirmed FIGO stage IA endometrioid endometrial carcinomas were included in the study; 33 patients (3.9%) had synchronous stage IA ovarian carcinomas, including 27 (81.8%) and 6 (18.2%) cases of endometrioid and mixed endometrioid/clear cell subtypes, respectively. After a median follow-up time of 56.8 months, 829 patients (97.9%) had definitive survival outcomes. Synchronous ovarian carcinomas had no impact on disease-free, overall or cancer-specific overall survival in univariate and multivariate analyses. Conclusion In these patients with stage IA endometrioid endometrial carcinoma, the genuine incidence of synchronous stage IA ovarian carcinoma was very low, and synchronous carcinoma had no significant effects on survival outcomes. Electronic supplementary material The online version of this article (10.1007/s00404-019-05288-5) contains supplementary material, which is available to authorized users.
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22
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Otero-García MM, Mesa-Álvarez A, Nikolic O, Blanco-Lobato P, Basta-Nikolic M, de Llano-Ortega RM, Paredes-Velázquez L, Nikolic N, Szewczyk-Bieda M. Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers. Insights Imaging 2019; 10:19. [PMID: 30758678 PMCID: PMC6375059 DOI: 10.1186/s13244-019-0696-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.
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Affiliation(s)
- María Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain.
| | - Alicia Mesa-Álvarez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Olivera Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Patricia Blanco-Lobato
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Marijana Basta-Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | | | - Laura Paredes-Velázquez
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Nikola Nikolic
- Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Magda Szewczyk-Bieda
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
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23
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Xu X, Li N, Chen Y, Ouyang H, Zhao X, Zhou J. Diagnostic efficacy of MRI for pre-operative assessment of ovarian malignancy in endometrial carcinoma: A decision tree analysis. Magn Reson Imaging 2018; 57:285-292. [PMID: 30580078 DOI: 10.1016/j.mri.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/17/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022]
Abstract
AIM Accurate preoperative assessment of ovarian malignancy in endometrial carcinoma helps in determining the decision to preserve the ovaries in individualized treatment. This study adopted decision tree method to evaluate the diagnostic efficiency of pelvic MRI and clinical data of patients for preoperative identification of endometrial carcinoma-combined ovarian malignancy (EC-OM). MATERIAL AND METHODS This retrospective study included a total of 801 patients, and postoperative pathological examinations identified 58 EC-OM group and 743 endometrial carcinoma cases without ovarian malignancy (EC group). Diagnostic efficiency of pelvic MRI in EC-OM was calculated by comparing the clinical data and imaging features of patients in the two groups. Decision tree analysis was performed to screen out associative indexes and establish a diagnostic model for EC-OM. RESULTS Pelvic MRI showed that, EC-OM group showed deeper invasion into the myometrium, and higher percentages of patients with cervical or cornual involvement, or metastasis of lymph nodes or peritoneum than EC group (P = 0.00). Preoperative pelvic MRI showed a sensitivity of 51.72% and a specificity of 99.87% when detecting ovarian malignancy in endometrial carcinoma. Decision tree model obtained a sensitivity of 89.66%, with an AUC (area under ROC curve) of 0.949 (95% CI 0.906, 0.993, P < 0.001). CONCLUSION Decision tree analysis based on pelvic MRI and clinical data of patients showed that the detection rate of ovarian malignancy could be increased for patients with endometrial carcinoma.
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Affiliation(s)
- Xiaojuan Xu
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yan Chen
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Ouyang
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhou
- Department of Gynecology, The Central Hospital of Karamay, Xinjiang, Uyghur Autonomous Region, China.
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Yoneoka Y, Yoshida H, Ishikawa M, Shimizu H, Uehara T, Murakami T, Kato T. Prognostic factors of synchronous endometrial and ovarian endometrioid carcinoma. J Gynecol Oncol 2018; 30:e7. [PMID: 30479091 PMCID: PMC6304406 DOI: 10.3802/jgo.2019.30.e7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/03/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Gynecologists occasionally encounter synchronous endometrial and ovarian endometrioid carcinoma (SEO-EC) patients who show favorable prognosis than locally advanced or metastatic disease patients. This study aimed to elucidate prognostic factors of SEO-EC and identify patients who have a sufficiently low risk of recurrence without receiving adjuvant chemotherapy. Methods We retrospectively reviewed 46 patients with pathologically confirmed SEO-EC who underwent surgery at the National Cancer Center Hospital between 1997 and 2016. Immunohistochemical evaluation of DNA mismatch repair (MMR) protein expression were performed for both endometrial and ovarian tumors. Patient outcomes were analyzed according to clinicopathologic factors. Results From the multivariate analysis, cervical stromal invasion indicated a worse prognosis for progression-free survival (hazard ratio [HR]=6.85; 95% confidence interval [CI]=1.50–31.1) and overall survival (HR=6.95; 95% CI=1.15–41.8). Lymph node metastasis and peritoneal dissemination did not significantly affect survival. MMR deficiency was observed in 13 patients (28.3%), with both endometrial and ovarian tumors showing the same MMR expression status. MMR deficiency was not significantly associated with survival. Of 23 patients with lesions confined to only the uterine body and adnexa, only 2 had recurrence in the group receiving adjuvant therapy, while none of the 10 patients who did not receive adjuvant therapy had recurrence. Conclusion SEO-EC patients with tumors localized to the uterine body and adnexa lesions had a low risk for recurrence and may not require adjuvant therapy. SEO-EC may have prognostic factors different from those of endometrial and ovarian cancer.
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Affiliation(s)
- Yutaka Yoneoka
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan.,Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Hiroshi Yoshida
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Hanako Shimizu
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Uehara
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
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Matsuo K, Machida H, Blake EA, Holman LL, Rimel BJ, Roman LD, Wright JD. Trends and outcomes of women with synchronous endometrial and ovarian cancer. Oncotarget 2018; 9:28757-28771. [PMID: 29983894 PMCID: PMC6033337 DOI: 10.18632/oncotarget.25550] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/16/2018] [Indexed: 12/20/2022] Open
Abstract
This retrospective observational study examined trends, characteristics, and survival of women with synchronous endometrial and ovarian cancer (SEOC) in the Surveillance, Epidemiology, and End Results Program between 1973 and 2013. Among 235,454 women with primary endometrial cancer, synchronous ovarian cancer was seen in 4,082 (1.7%) women with the proportion being decreased from 2.0% to 1.6% between 1983 and 2013 (P=0.049); and the proportion of concurrent endometrioid tumors in the two cancer sites has increased from 24.2% to 49.9% among SEOC women (P<0.001). When compared to endometrial cancer without synchronous ovarian cancer, endometrioid histology in the two cancer sites was associated with improved cause-specific survival while non-endometrioid histology in the ovarian cancer was associated with decreased cause-specific survival (adjusted-P<0.01). Among 110,063 women with primary epithelial ovarian cancer, synchronous endometrial cancer was seen in 3,940 (3.6%) women with the proportion being increased from 2.2% to 4.4% between 1973 and 2013 (P<0.001); and the proportion of concurrent endometrioid tumors in the two cancer sites had increased from 24.3% to 50.2% among SEOC women (P<0.001). When compared to primary epithelial ovarian cancer without synchronous endometrial cancer, SEOC was associated with better cause-specific survival if ovarian cancer is endometrioid type or if endometrial cancer is endometrioid type (adjusted-P<0.001). Across the two cohorts, the proportion of SEOC reached to the peak in the late-40 years of age and then decreased significantly (P<0.001). In conclusion, our study suggests that synchronous ovarian cancer has decreased among endometrial cancer whereas synchronous endometrial cancer has increased among epithelial ovarian cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laura L Holman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bobbie J Rimel
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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The impact of histological subtype in developing both ovarian and endometrial cancer: A longstanding nationwide incidence study. Eur J Obstet Gynecol Reprod Biol 2017; 221:17-22. [PMID: 29227847 DOI: 10.1016/j.ejogrb.2017.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/06/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To estimate the incidence of ovarian cancer (OC) and endometrial cancer (EC) separately, as well as double cancers diagnosed in the same calendar year, and to relate the occurrences to histological subtype. STUDY DESIGN All cases of epithelial OC and EC diagnosed in the Netherlands in 1989-2009 were related to population data. Histologically specific associations were made using the ratio of observed and expected incidence numbers, calculated with age-specific incidence rates. RESULTS 25,489 OC and 32,729 EC were analyzed, and 649 OC/EC. Life-time risks for OC and EC were 1.8% and 2.4%. Among OC, adenocarcinoma (18%) and serous cancers (33%) were the most prevalent subtypes. In EC, adenocarcinoma (39%) and endometrioid cancer (37%) were highest, with hardly any serous cancers. The observed incidence of OC/EC was 50-fold higher than expected (95% CI, 46-54). For patients aged <55years, the O/E ratio was 274, for the elderly 32, both findings are significant. Of the 2345 OC endometrioid subtype, 294 had EC (12.5%), whereas 1.1 was expected. In EC patients, no particular histological subtype was distinguished with a highly elevated occurrence of OC. The 680 serous EC patients had 11 double cancers (1.6%), of which 8 with the ovarian serous subtype. CONCLUSION Strong relationships exist between malignancies in the ovary and a second primary malignancy in the endometrium, especially for the endometrioid subtype of ovarian cancer. Viewed from the endometrial site, no special subtype was noted, and the influence of endometrial serous adenocarcinoma in developing serous OC is not plausible.
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27
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Matsuo K, Machida H, Frimer M, Marcus JZ, Pejovic T, Roman LD, Wright JD. Prognosis of women with stage I endometrioid endometrial cancer and synchronous stage I endometrioid ovarian cancer. Gynecol Oncol 2017; 147:558-564. [PMID: 28986093 DOI: 10.1016/j.ygyno.2017.09.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Synchronous endometrial and ovarian cancer with endometrioid histology at two cancer sites typically presents with early-stage disease and is thought to have a good prognosis. We examined the survival of women with early-stage endometrioid endometrial cancer who had synchronous early-stage endometrioid ovarian cancer. METHODS This is a retrospective case-control study examining the Surveillance, Epidemiology, and End Result Program between 1973 and 2013. Survival of women with stage I endometrioid endometrial cancer with stage I endometrioid ovarian cancer (n=839) were compared to women with stage I endometrioid endometrial cancer without synchronous ovarian cancer (n=123,692) after propensity score matching. RESULTS Women with synchronous stage I endometrioid ovarian cancer were more likely to be diagnosed recently, be younger, have stage IA disease, grade 1 tumors, to have undergone lymphadenectomy, and were less likely to receive radiotherapy compared to those without synchronous ovarian cancer (all, P<0.001). In a propensity score matched model, the presence of synchronous ovarian cancer was not associated with endometrial cancer-specific survival (10-year rates 96.0% versus 95.3%, P=0.97) or overall survival (85.6% versus 87.2%, P=0.10). Among tumors with concordant grades at the two cancer sites, survival was similar regardless of presence of synchronous ovarian tumors (grade 1 tumors, 10-year rate for overall survival, 88.2% versus 89.1%, P=0.40; and grade 2 tumors, 84.0% versus 85.8%, P=0.78). CONCLUSION Women with stage I endometrioid endometrial cancer with synchronous stage I endometrioid ovarian cancer have a survival outcome similar to those with stage I endometrioid endometrial cancer without synchronous ovarian cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Marina Frimer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Jenna Z Marcus
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tanja Pejovic
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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28
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Makris GM, Manousopoulou G, Battista MJ, Salloum I, Chrelias G, Chrelias C. Synchronous Endometrial and Ovarian Carcinoma: A Case Series. Case Rep Oncol 2017; 10:732-736. [PMID: 28878658 PMCID: PMC5582525 DOI: 10.1159/000479501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 01/10/2023] Open
Abstract
Synchronous ovarian and endometrial cancer (SEOC) is a rare instance but it accounts for 50-70% of all synchronous female genital tract tumors. We report three cases of women who were diagnosed with SEOC and underwent surgical staging. All cases were of the endometrioid subtype, grade 1, both in the ovarian and endometrial component. Two of them were stage Ia/Ia, and the third was stage Ib/Ib. More than 2 years after the diagnosis, all patients were alive and recurrence-free. The present report critically discusses the main characteristics, risk factors, and management of patients with SEOCs.
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Affiliation(s)
| | | | | | - Ioannis Salloum
- Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens, Greece
| | - Georgios Chrelias
- Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens, Greece
| | - Charalampos Chrelias
- Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens, Greece
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29
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Nougaret S, Lakhman Y, Vargas HA, Colombo PE, Fujii S, Reinhold C, Sala E. From Staging to Prognostication. Magn Reson Imaging Clin N Am 2017; 25:611-633. [DOI: 10.1016/j.mric.2017.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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30
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Synchronous endometrial and ovarian carcinomas: predictors of risk and associations with survival and tumor expression profiles. Cancer Causes Control 2017; 28:447-457. [PMID: 28194593 DOI: 10.1007/s10552-017-0855-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Synchronous endometrial and ovarian tumors (SEOs) are diagnosed in 10% of ovarian cancer patients. We examined predictors of SEOs, evaluated associations of SEOs with survival and characterized ovarian tumor profiles using immunohistochemistry. METHODS We included patients with endometrioid (n = 180) and clear cell (n = 165) ovarian carcinoma identified from the Alberta Cancer Registry between 1979 and 2010 for whom we abstracted medical records and constructed tumor tissue microarrays (TMAs). A concurrent diagnosis of endometrial cancer was obtained from the medical chart. We used unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs. Protein expression in ovarian tumors of patients with and without SEOs was evaluated using Fisher's exact test. RESULTS Comparing 52 patients with SEO tumors to 293 patients with endometrioid or clear cell ovarian carcinomas, endometriosis at the ovary (OR = 0.45, 95% CI = 0.23-0.87, p = 0.02) was the strongest predictor of decreased risk in multivariable models. Premenopausal status (OR = 2.17, 95% CI = 0.92-5.13, p = 0.08) and lower pre-treatment CA125 levels (OR = 0.17, 95% CI = 0.02-1.32, p = 0.09) showed weaker associations. There were no significant differences in survival between patients with or without SEO tumors. More patients with SEO tumors compared to endometrioid ovarian carcinoma were deficient in MLH1, PMS2 and PTEN (p ≤ 0.03). CONCLUSIONS Endometriosis may not be the mechanism by which SEO cancers arise. Altered tumor oncoprotein expression between women with and without SEOs indicates important biological differences although this did not translate into prognostic differences.
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31
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Gonthier C, Trefoux-Bourdet A, Luton D, Koskas M. [Fertility-sparing management of endometrial cancer and atypical hyperplasia]. ACTA ACUST UNITED AC 2017; 45:112-118. [PMID: 28368791 DOI: 10.1016/j.gofs.2016.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/21/2016] [Indexed: 01/03/2023]
Abstract
The fertility sparing management of endometrial cancer and atypical hyperplasia concern women in childbearing age with stage 1, grade 1, endometrioid adenocarcinoma confined to endometrium or atypical hyperplasia (simple or complex). These pathologies affecting more frequently postmenopausal women, the number of people involved is relatively low. The main risk factor is hyperestrogenism and these patients often present a history of infertility with a desire for pregnancy. The recommendations for this conservative management are scarce and unclear. The national observatory in the gynecology and obstetrics department of Bichat hospital gives expert advice to help doctors and patients concerned. We present a type of conservative management based on the expertise of the national observatory. Rigorous pre-therapeutic assessment must first be made to avoid missing a more advanced lesion. Hormone therapy is then started to obtain complete remission. In case of remission, fast achieving pregnancy is advised, and the use of assisted reproductive therapy is possible if necessary. Monitoring by hysteroscopy and histological examination is essential during the treatment. Hysterectomy is the last time the conservative management. It is motivated by the risk of recurrence and progression. The probability of remission after conservative treatment is estimated at 78.0 % at 12 months, the probability of recurrence at 29.2 % at 24 months, and the risk of progression at 15 % (stage 1A with myometrial invasion or more on the hysterectomy specimen). In terms of fertility, 32 % of women get at least one pregnancy.
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Affiliation(s)
- C Gonthier
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Trefoux-Bourdet
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - D Luton
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
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Implication of genomic characterization in synchronous endometrial and ovarian cancers of endometrioid histology. Gynecol Oncol 2016; 143:60-67. [PMID: 27498588 DOI: 10.1016/j.ygyno.2016.07.114] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Synchronous endometrial and ovarian carcinomas (SEOCs) present gynecologic oncologists with a challenging diagnostic puzzle: discriminating between double primary cancers and single primary cancer with metastasis. We aimed to determine the clonal relationship between simultaneously diagnosed endometrial and ovarian carcinomas. METHODS Fourteen pairs of SEOCs of endometrioid type and two pairs of SEOCs with disparate histologic types (control for dual primary tumors) were subjected to massively parallel sequencing (MPS) and molecular inversion probe microarrays. RESULTS Thirteen of the 14 pairs of SEOCs harbored somatic mutations shared by both uterine and ovarian lesions, indicative of clonality. High degree of chromosomal instability in the tumors from 10 patients who received adjuvant chemotherapy, of whom 9 had synchronous carcinomas with significantly overlapping copy number alterations (CNAs), suggestive of single primary tumors with metastasis. The clonal relationship determined by genomic analyses did not agree with clinicopathological criteria in 11 of 14 cases. Minimal CNAs were identified in both ovarian and endometrial carcinomas in 4 patients, who did not receive adjuvant chemotherapy and experienced no recurrent diseases. In contrast, two of the 10 patients with chromosomally unstable cancers developed recurrent tumors. CONCLUSION Our findings support a recent paradigm-shifting concept that most SEOCs originate from a single tumor. It also casts doubt on the clinicopathological criteria used to distinguish between dual primary tumors and single primary tumor with metastasis. Testing of CNAs on SEOCs may help determining the need of adjuvant therapy.
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Gutiérrez-Palomino L, Romo-de Los Reyes JM, Pareja-Megía MJ, García-Mejido JA. [Triple synchronous primary gynaecological tumours. A case report]. CIR CIR 2015; 84:69-72. [PMID: 26238592 DOI: 10.1016/j.circir.2015.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 11/03/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Synchronous multiple primary malignancies in the female genital tract are infrequent. From 50 to 70% of them corresponds to synchronous cancers of the endometrium and ovary. To our knowledge, this is only the third case report in the international literature of three concurrent gynaecological cancers of epithelial origin. A case is presented, as well as a literature review due to the infrequency of its diagnosis and the lack of information on the subject. CLINICAL CASE A 49-year-old woman, with previous gynaecological history of ovarian endometriosis. She underwent a hysterectomy and bilateral oophorectomy, as she had been diagnosed with endometrial hyperplasia with atypia. The final histopathology reported synchronous ovarian, Fallopian tube, and endometrial cancer. An extension study and complete surgical staging was performed, both being negative. She received adjuvant treatment of chemotherapy and radiotherapy. She is currently free of disease. CONCLUSIONS The aetiology is uncertain. There is controversy relating to increased susceptibility of synchronous neoplasms to pelvic endometriosis and inherited genetic syndromes. Its diagnosis needs to differentiate them from metastatic disease. Additionally, they are problematical from a clinical, diagnostic, therapeutic, and prognostic point of view. The presentation of more cases of triple synchronous cancers is necessary for a complete adjuvant and surgical treatment.
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Lin KY, Miller DS, Bailey AA, Andrews SJ, Kehoe SM, Richardson DL, Lea JS. Ovarian involvement in endometrioid adenocarcinoma of uterus. Gynecol Oncol 2015; 138:532-5. [PMID: 26186908 DOI: 10.1016/j.ygyno.2015.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/06/2015] [Accepted: 07/09/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Ovarian preservation is an option for some premenopausal patients with early stage endometrial cancer. Studies have shown that ovarian preservation in selected patients does not negatively impact survival outcomes. The objective of this study is to determine the frequency and characteristics of ovarian involvement when endometrial cancer is clinically confined to the uterus. METHODS Patients with endometrioid adenocarcinoma of uterus treated at our institution between 2000 and 2013 were identified. Patients with ovarian metastasis or synchronous primary ovarian cancer were included. Patients were excluded if there was gross extrapelvic disease on examination or imaging. RESULTS Seven hundred and fifty-nine patients were found to have endometrial cancer with the disease confined to the pelvis (stages I, II, and III). Fifteen patients (2%) had ovarian metastasis. Twenty-three patients (3%) had synchronous uterine and ovarian cancer. Most ovarian lesions (32 out of 38) were either enlarged or had abnormal appearing surface involvement. Six patients had microscopic ovarian involvement, accounting for 0.8% of the endometrial cancer patients with pelvis-confined disease. All of the patients were greater than 50 years of age. For those patients with microscopic ovarian metastasis, all had FIGO grade 3 disease, deep myometrial invasion, and extrauterine involvement of either cervix or lymph nodes. CONCLUSIONS Microscopic ovarian involvement occurred in 0.8% of patients with endometrial cancer. For premenopausal patients with endometrial cancer, normal appearing ovaries may be considered for preservation in the absence of extrauterine spread, grade 3 disease and deep myometrial invasion.
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Affiliation(s)
- Ken Y Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - David S Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - April A Bailey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sajan J Andrews
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Siobhan M Kehoe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Debra L Richardson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jayanthi S Lea
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Synchronous ovarian and endometrial cancer--an international multicenter case-control study. Int J Gynecol Cancer 2014; 24:54-60. [PMID: 24300466 DOI: 10.1097/igc.0000000000000019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to compare the prognosis of patients with synchronous endometrial and ovarian cancer (SEOC) to matched controls with either endometrial cancer (EC) or ovarian cancer (OC). METHODS A retrospective case-control study including all patients with SEOC who had been treated at 5 European tertiary gynecologic oncology centers between 1996 and 2011 and patients with either EC or OC matched for age, International Federation of Gynecology and Obstetrics (FIGO) stage, histology, year of diagnosis, and Eastern Cooperative Oncology Group performance score. RESULTS The study cohort comprised 77, 132, and 126 patients with SEOC, EC, and OC, respectively. The patient characteristics confirmed an equal distribution of matching factors, and the median follow-up did not differ (P = 0.44). 48.1% of the patients with SEOC showed early FIGO stage I for both EC and OC. The 5-year PFS rates differed between SEOC and EC (76.3% vs 86.3%; P = 0.047) but not the 5-year overall survival rates (71.6% vs 79.8%; P = 0.12) and did not differ between SEOC and OC (76.3% vs 63.8%; P = 0.19 and 71.6% vs 69.3%; P = 0.61, respectively). After the adjustment for the FIGO stage of the 2 components of SEOC, neither PFS nor overall survival rates were different. CONCLUSIONS Prognosis of patients with SEOC tended to be the same in comparison with matched controls with either one EC or OC. Therefore, it could be considered that patients with SEOC may be eligible for clinical trials of the advanced tumor component if no additional therapy is indicated for the other component.
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Lan C, Huang X, Huang Y, Xi S, Huang H, Feng Y, Liu J. The outcome and efficacy of adjuvant chemotherapy alone in patients with stage IIIA endometrial carcinoma with solitary adnexal involvement: a retrospective single-institution study. Gynecol Oncol 2014; 135:446-50. [PMID: 25158035 DOI: 10.1016/j.ygyno.2014.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/12/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The appropriate adjuvant therapy for patients with endometrial carcinoma with solitary adnexal involvement is unclear. We conducted a retrospective single-institution study to evaluate the outcome and efficacy of adjuvant chemotherapy alone in this population. METHODS All patients with endometrial carcinoma who received primary surgical treatment between January 1999 and May 2010 were reviewed. The patients who were diagnosed with stage IIIA disease based only on isolated adnexal involvement and treated with surgical procedures followed by adjuvant chemotherapy alone were included. Demographic, clinicopathologic, treatment and outcome data were collected. Recurrence and survival were analyzed. RESULTS Among 1453 reviewed patients, 67 patients were identified. The median age was 48 years. All patients were treated with platinum-based adjuvant chemotherapy, with the majority (36/67, 53.7%) receiving paclitaxel plus carboplatin. The total number of cycles of chemotherapy administered was 305 (median four cycles/person). Most of the chemotherapy related toxicities were mild or moderate. The median follow-up time was 76 months. Eight patients experienced recurrence. The majority of initial relapses were distant (7/8, 87.5%), characterized by liver metastases (3/8, 37.5%). The 5-year disease-free survival (DFS) and overall survival (OS) rates were 89.6% and 91.9%, respectively. Multivariate analysis confirmed that grade 3 tumor was an independent predictor of worse DFS and OS (HR=5.19, P=0.048; HR=6.55, P=0.037, respectively). CONCLUSION Patients with stage IIIA endometrial carcinoma with solitary adnexal involvement have favorable outcomes. Adjuvant chemotherapy alone may be effective and feasible for these patients.
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Affiliation(s)
- Chunyan Lan
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Xin Huang
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Yongwen Huang
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Shaoyan Xi
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Pathology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - He Huang
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Yanling Feng
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Jihong Liu
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China; Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.
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Abstract
Context.—Endometrial carcinoma is a disease of older postmenopausal women, and is relatively uncommon in patients younger than 40 years. Endometrial carcinomas in this age group may be familial, associated with Lynch syndrome, or sporadic.
Objectives.—To present our current knowledge of endometrial carcinomas in women younger than 40 years.
Data Sources.—The review is based on previously published articles on this topic.
Conclusions.—Most endometrial carcinomas that occur in this age group are associated with estrogen excess. They are usually low-grade endometrioid carcinomas that present at low stages and are associated with favorable clinical outcomes. Tumors associated with mismatch repair abnormalities and Lynch syndrome appear to be distinct, with worse prognostic factors and, possibly, clinical behavior. Conservative hormonal therapy and ovarian conservation are reasonable considerations in the management of these young patients, but carry the risk of tumor progression, recurrence, and an occult synchronous or metachronous ovarian carcinoma.
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Affiliation(s)
- Karuna Garg
- From the Department of Pathology, University of California San Francisco (Dr Garg); and the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Soslow)
| | - Robert A. Soslow
- From the Department of Pathology, University of California San Francisco (Dr Garg); and the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Soslow)
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Lai CH, Wang CJ, Chao A. The Clinical Management of Endometrial Cancer in Young Women. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2012. [DOI: 10.1007/s13669-012-0032-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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