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Davies KD, Smith LP, Guimaraes-Young A, Corr BR, Fisher CM, Guntupalli SR, Berning AA, Post MD, Pino D, Aisner DL, Wolsky RJ. Prospective Clinical Prognostication of Endometrial Carcinomas Based on Next-Generation Sequencing and Immunohistochemistry-Real-World Implementation and Results at a Tertiary Care Center. Int J Gynecol Pathol 2024; 43:335-348. [PMID: 37922951 DOI: 10.1097/pgp.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Based on findings from The Cancer Genome Atlas and the Proactive Molecular Risk Classifier for Endometrial Cancer algorithm, endometrial carcinoma can now be stratified into 4 prognostically distinct subgroups based on molecular alterations and immunohistochemical (IHC) aberrations. In this study, we describe the de novo adoption and clinical reporting of prognostic subgroup classification based on next-generation sequencing (NGS) and IHC analyses of all endometrial carcinoma resections at a single institution, framed by the Exploration, Preparation, Implementation, and Sustainment model. Results from the first 13 months show 188 tumors underwent analysis by a combination of IHC and a medium-sized (56 analyzed genes) NGS-based assay. All cases were assigned as either POLE ( POLE -mutated) (5.3%), mismatch repair deficient (27.7%), no specific molecular profile (45.7%), or p53 abnormal (21.3%) inclusive of multiple-classifier cases. NGS-based analysis revealed additional distinctions among the subgroups, including reduced levels of PI3K pathway activation in the p53 abnormal subgroup, an increased rate of CTNNB1 activating mutation in the no specific molecular profile subgroup, and lower TP53 mutation variant allele frequencies in POLE and mismatch repair deficient subgroups compared with the p53 abnormal subgroup. Overall, we describe the testing protocol, reporting, and results of a combination of NGS and IHC to prospectively prognosticate endometrial carcinomas at a single tertiary care center.
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Akdöner A, Kurt S, Yavuz O, Bayram E, Üresin M, Ulukuş EÇ. Effect of low uterine segment involvement on prognosis of early stage endometrial cancer. J Obstet Gynaecol Res 2024; 50:991-1001. [PMID: 38575743 DOI: 10.1111/jog.15933] [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: 10/03/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
AIM Our aim is to investigate the effect of uterine lower segment involvement on prognosis of early-stage endometrial cancer cases diagnosed and treated in our clinic. MATERIALS AND METHODS The file records of 316 cases reviewed retrospectively.Only stage I (a and b, n=209) cases were investigated, because they were more homogeneous group. RESULTS The lymphovascular invasion rate was found to be higher in patients with stage Ia and uterine lower segment involvement (p < 0.001). Adjuvant treatment requirement was higher in patients with stage Ia and uterine lower segment involvement (p < 0.001). Among stage Ia cases, the recurrence rate between 1 and 3 years was found to be higher in cases with uterine lower segment involvement (p = 0.001). Among the stage Ib cases, lymphovascular invasion was found to be higher in cases with uterine lower segment involvement (p < 0.001). The recurrence rate between 1 and 3 years was found to be higher in stage Ib compared to Ia (p = 0.01). Uterine lower segment involvement was found to be associated with high lymphovascular invasion rate in all stage I cases (p < 0.001). It was determined that the need for adjuvant treatment was higher in cases with uterine lower segment involvement (p < 0.001). It was determined that the probability of recurrence between 1 and 3 years was higher in cases with uterine lower segment involvement (p = 0.007). CONCLUSION Uterine lower segment involvement is associated with increased lymphovascular invasion even in the early stages. It is an important risk factor for systemic spread such as lymphovascular invasion, myometrial invasion, and lymph node involvement.
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Affiliation(s)
- Aslı Akdöner
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Sefa Kurt
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Onur Yavuz
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Emre Bayram
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Merve Üresin
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
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Jiao S, Wei L, Zou L, Wang T, Hu K, Zhang F, Hou X. Prognostic values of tumor size and location in early stage endometrial cancer patients who received radiotherapy. J Gynecol Oncol 2024; 35:35.e84. [PMID: 38606825 DOI: 10.3802/jgo.2024.35.e84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE To investigate the correlation between tumor size, tumor location, and prognosis in patients with early-stage endometrial cancer (EC) receiving adjuvant radiotherapy. METHODS Data of patients who had been treated for stage I-II EC from March 1999 to September 2017 in 13 tertiary hospitals in China was screened. Cox regression analysis was performed to investigate associations between tumor size, tumor location, and other clinical or pathological factors with cancer-specific survival (CSS) and distant metastasis failure-free survival (DMFS). The relationship between tumor size as a continuous variable and prognosis was demonstrated by restricted cubic splines. Prognostic models were constructed as nomograms and evaluated by Harrell's C-index, calibration curves and receiver operating characteristic (ROC) curves. RESULTS The study cohort comprised 805 patients with a median follow-up of 61 months and a median tumor size of 3.0 cm (range 0.2-15.0 cm). Lower uterine segment involvement (LUSI) was found in 243 patients (30.2%). Tumor size and LUSI were identified to be independent prognostic factors for CSS. Further, tumor size was an independent predictor of DMFS. A broadly positive relationship between poor survival and tumor size as a continuous variable was visualized in terms of hazard ratios. Nomograms constructed and evaluated for CSS and DMFS had satisfactory calibration curves and C-indexes of 0.847 and 0.716, respectively. The area under the ROC curves for 3- and 5-year ROC ranged from 0.718 to 0.890. CONCLUSION Tumor size and LUSI are independent prognostic factors in early-stage EC patients who have received radiotherapy. Integrating these variables into prognostic models would improve predictive ability.
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Affiliation(s)
- Shuning Jiao
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (the Fourth Military Medical University), Xi'an, People's Republic of China
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Tiejun Wang
- Department of Radiation Oncology, The Second Hospital Affiliated by Jilin University, Changchun, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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Davidesko S, Meirovitz M, Shaco-Levy R, Yarza S, Samueli B, Kezerle Y, Kessous R. The significance of lower uterine segment involvement in endometrial cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108007. [PMID: 38382274 DOI: 10.1016/j.ejso.2024.108007] [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: 07/12/2023] [Revised: 11/19/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Limited data suggests lower uterine segment involvement (LUSI) in endometrial cancer may be associated with other poor prognostic factors. We assessed the unclear impact of LUSI on prognosis in endometrial cancer. METHOD ology: A revision of pathological samples following surgical staging between the years 2002-2022 was performed and clinical data collected from patients' records. Characteristics and outcomes of women with and without LUSI were compared and analysed. Kaplan Meyer survival curves compared overall survival (OS) and progression-free survival (PFS). RESULTS 429 women were included, of which 45 (10.5%) had LUSI. No differences were found between the groups regarding demographic or clinical characteristics. LUSI was significantly associated with lympho-vascular space invasion (40% vs. 22% p = 0.01), lymph node involvement (6.4% vs. 9.1%, p = 0.05), shorter PFS (4 vs. 5.5 years, p = 0.01) and OS (5.6 vs. 11.5 years, p = 0.03). Multivariate analysis showed higher hazard ratios for OS and PFS (1.55 95%CI 0.79-3.04 and 1.29 95%CI 0.66-2.53, respectively) but these were insignificant even in a sub-analysis of endometrioid histology (1.76 95%CI 0.89-3.46 and 1.35 95%CI 0.69-2.65, respectively). A trend towards decreased PFS and OS was demonstrated in the Kaplan Meyer survival curves for all cases (log rank test p = 0.5 and 0.29 respectively), endometrioid histology (log rank test p = 0.06 and 0.51 respectively) and early-stage disease (log rank test p = 0.63 and 0.3 respectively). CONCLUSION LUSI may be related to poorer outcome of endometrial cancer and may represent an additional factor to consider when contemplating adjuvant treatment, especially in endometrioid-type and early-stage disease.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mihai Meirovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruthy Shaco-Levy
- Department of Pathology, Barzilai University Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Shaked Yarza
- Clinical Research Center, Soroka University Medical Center, Israel
| | - Benzion Samueli
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yarden Kezerle
- Department of Pathology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roy Kessous
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Brower JV, Bregar AJ, Klopp AH. Path to Precision: Refining Radiation Therapy Guidelines for Early Stage Endometrial Cancer Through Incorporation of Primary Tumor Size, Lower Uterine Segment Invasion, and Molecular Markers. Pract Radiat Oncol 2024; 14:154-160. [PMID: 38048989 DOI: 10.1016/j.prro.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Jeffrey V Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Radiation Oncology Associates-New England, Manchester, New Hampshire.
| | - Amy J Bregar
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Giordano G, Ferioli E, Guareschi D, Tafuni A. Dedifferentiated Endometrial Carcinoma: A Rare Aggressive Neoplasm-Clinical, Morphological and Immunohistochemical Features. Cancers (Basel) 2023; 15:5155. [PMID: 37958329 PMCID: PMC10647464 DOI: 10.3390/cancers15215155] [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: 10/09/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Dedifferentiated endometrioid adenocarcinoma is characterised by the coexistence of an undifferentiated carcinoma and a low-grade endometrioid adenocarcinoma. The low-grade component in this subtype of endometrial carcinoma is Grade 1 or 2 according to the Federation of Gynaecology and Obstetrics (FIGO) grading system. The coexistence of low-grade endometrial carcinoma and solid undifferentiated carcinoma can cause diagnostic problems on histological examination. In fact, this combination can often be mistaken for a more common Grade 2 or Grade 3 endometrial carcinoma. Therefore, this subtype of uterine carcinoma can often go under-recognised. An accurate diagnosis of dedifferentiated endometrial carcinoma is mandatory because of its poorer prognosis compared to Grade 3 endometrial carcinoma, with a solid undifferentiated component that can amount to as much as 20% of the entire tumour. The aim of this review is to provide clinical, immunohistochemical, and molecular data to aid with making an accurate histological diagnosis and to establish whether there are any findings which could have an impact on the prognosis or therapeutic implications of this rare and aggressive uterine neoplasm.
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Affiliation(s)
- Giovanna Giordano
- Department of Medicine and Surgery, Pathology Unit, University of Parma, Viale A. Gramsci, 14, 43126 Parma, Italy; (E.F.); (A.T.)
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Wang W, Li X, Gao Y, Zheng H, Gao M. A nomogram prediction model for the TP53mut subtype in endometrial cancer based on preoperative noninvasive parameters. BMC Cancer 2023; 23:720. [PMID: 37528420 PMCID: PMC10394813 DOI: 10.1186/s12885-023-11234-1] [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: 12/23/2022] [Accepted: 07/27/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The molecular subtypes of endometrial carcinoma are significantly correlated with survival outcomes and can guide surgical methods and postoperative adjuvant therapy. Among them, the TP53mut subtype has the worst prognosis and can only be determined by detection after surgery. Therefore, identifying preoperative noninvasive clinical parameters for early prediction of the TP53mut subtype would provide important guidance in choosing the appropriate surgical method and early warning for clinicians. Our study aimed to establish a model for the early prediction of the TP53mut subtype by using preoperative noninvasive parameters of endometrial cancer and screen out potential TP53mut patients. METHODS Information and pathological specimens of 376 patients who underwent surgery for FIGO stage I-IV endometrial cancer in the Department of Gynecology, Peking University Cancer Hospital, from June 2011 to July 2020 were collected, and 178 cases were finally included in the study as the training dataset (part A). Thirty-six cases from January 2022 to March 2023 were collected as the validation dataset (part B). Molecular subtyping was performed using a one-stop next-generation sequencing (NGS) approach. Compared with the TP53mut subtype, the POLE EDM, MSI-H and TP53 wild-type subtypes were defined as non-TP53mut subtypes. Univariate Cox regression analysis and multivariate logistic analysis were performed to determine the preoperative clinical parameters associated with the TP53mut subtype. A nomogram prediction model was established using preoperative noninvasive parameters, and its efficacy in predicting TP53mut subtype and survival outcomes was verified. RESULTS The TP53mut subtype was identified in 12.4% of the part A and 13.9% of the part B. Multivariate logistic regression analysis showed that HDL-C/LDL-C level, CA125 level, and cervical or lower uterine involvement were independent influencing factors associated with the TP53mut subtype (p = 0.016, 0.047, <0.001). A TP53mut prognostic model (TPMM) was constructed based on the factors identified in the multivariate analysis, namely, TPMM = -1.385 × HDL-C/LDL-C + 1.068 × CA125 + 1.89 × CI or LUI, with an AUC = 0.768 (95% CI, 0.642 to 0.893) in the part A. The AUC of TPMM for predicting TP53mut subtype in the part B was 0.781(95% CI, 0.581 to 0.980). The progression-free survival (PFS) and overall survival (OS) of patients with the TP53mut subtype were significantly worse than those of patients with the non-TP53mut subtype, as predicted by the model in the part A. CONCLUSIONS TP53mut prediction model (TPMM) had good diagnostic accuracy, and survival analysis showed the model can identify patients with different prognostic risk.
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Affiliation(s)
- Wei Wang
- Department of Gynecologic Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Hai Dian District, Beijing, 100142, China
| | - Xiaoting Li
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Hai Dian District, Beijing, 100142, China
| | - Yunong Gao
- Department of Gynecologic Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Hai Dian District, Beijing, 100142, China
| | - Hong Zheng
- Department of Gynecologic Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Hai Dian District, Beijing, 100142, China
| | - Min Gao
- Department of Gynecologic Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Hai Dian District, Beijing, 100142, China.
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Matias-Guiu X, Selinger CI, Anderson L, Buza N, Ellenson LH, Fadare O, Ganesan R, Ip PPC, Palacios J, Parra-Herran C, Raspollini MR, Soslow RA, Werner HMJ, Lax SF, McCluggage WG. Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S90-S118. [PMID: 36305536 DOI: 10.1097/pgp.0000000000000901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometrial cancer is one of the most common cancers among women. The International Collaboration on Cancer Reporting (ICCR) developed a standardized endometrial cancer data set in 2011, which provided detailed recommendations for the reporting of resection specimens of these neoplasms. A new data set has been developed, which incorporates the updated 2020 World Health Organization Classification of Female Genital Tumors, the Cancer Genome Atlas (TCGA) molecular classification of endometrial cancers, and other major advances in endometrial cancer reporting, all of which necessitated a major revision of the data set. This updated data set has been produced by a panel of expert pathologists and an expert clinician and has been subject to international open consultation. The data set includes core elements which are unanimously agreed upon as essential for cancer diagnosis, clinical management, staging, or prognosis and noncore elements which are clinically important, but not essential. Explanatory notes are provided for each element. Adoption of this updated data set will result in improvements in endometrial cancer patient care.
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Hasan F, Hussein Z. The Association between Lower Uterine Segment Involvement in Corpus Located Endometrioid Adenocarcinoma with the (International Federation of Gynecology and Obstetrics) Grade and Stage. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Although lower uterine segment (LUS) is regarded as an anatomically defined part that possess some histological differences, it is involvement by carcinoma have not been included in the criteria for definition in the staging system for endometrial carcinoma and there are few conflicting data focused on the effect of LUS involvement as a prognostic factor in endometrial cancer.
AIM: To find the association between LUS involvement in corpus located endometrioid carcinoma with the grading and staging system established by the international federation of gynecology and obstetrics (FIGO).
METHODS: This was a retrospective study involving data collected from achieves of histopathology departments of teaching laboratories within successive 4 years period in Medical City complex at Bagdad. Pathological analysis of 70 hysterectomy specimens of corpus located endometriod adenocarcinoma was done, histological sections from each case of endometrioid adenocarcinoma carcinoma were microscopically reviewed for appropriate grading and staging, in addition, meticulous search was applied for histological finding consistent with LUS involvement. The statistical comparison between the results was done using either independent sample t-test (for continuous data; mean ± SD) or Chi-square test at a significant p < 0.05.
RESULTS: The study enrolled 70 histological samples of endometrioid adenocarcinoma, the majority of the samples were of low grade and stage at presentation. Of total sample, 46 (65.71%) showed LUS involvement by tumor cells. There was a significant statistical relationship between LUS involvement and FIGO stage while a non-significant statistical association with FIGO grade was found.
CONCLUSION: LUS involvement by corpus located endometrioid adenocarcinoma is associated with an advanced FIGO stage at presentation while non-significant relationship was found between patient age and tumor grade.
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Corr B, Cosgrove C, Spinosa D, Guntupalli S. Endometrial cancer: molecular classification and future treatments. BMJ MEDICINE 2022; 1:e000152. [PMID: 36936577 PMCID: PMC9978763 DOI: 10.1136/bmjmed-2022-000152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/15/2022] [Indexed: 12/31/2022]
Abstract
The treatment for endometrial cancer is rapidly evolving with the development of molecular analysis and novel strategies. Surgical resection, cytotoxic chemotherapy, endocrine or hormonal treatment, and radiation have been the staples of treatment for decades. However, precision based approaches for tumours are rapidly becoming a part of these strategies. Biomarker driven treatments are now a part of primary and recurrent treatment algorithms. This review aims to describe the current state of molecular analysis and treatment for endometrial cancer as well as to elucidate potential approaches for the near future.
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Perri T, Levin G, Helpman L, Eitan R, Vaknin Z, Lavie O, Ben Arie A, Amit A, Levy T, Namazov A, Ben Shachar I, Atlas I, Bruchim I, Kogan L, Gemer O. Minimally invasive approach in endometrial cancer with lower uterine segment involvement in stage ≥ II: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2021; 268:43-47. [PMID: 34800816 DOI: 10.1016/j.ejogrb.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 11/06/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare oncological outcomes in women with lower uterine segment involvement (LUSI) in endometrial carcinoma (EC) stage ≥ II - staged by a minimally invasive surgery (MIS) versus laparotomy. STUDY DESIGN A retrospective multi-center cohort study. Univariate analysis, Kaplan-Meier survival and Cox proportional hazard analysis were performed to compare between women staged by MIS and those staged by laparotomy. RESULTS Over a median follow-up period of 3 years (interquartile range, 1.5-6 years) 212 women were included, 68 (32.1%) were surgically staged by MIS. Stages of disease did not vary between MIS and laparotomy and were 32.1%, 51.9%, and 16.0%, in stages II, III and IV - respectively. Adjuvant radiation and chemotherapy rate did not differ between groups. Overall recurrence rate was comparable (p = 0.084). Locoregional recurrence rate was higher in the MIS group odds ratio 2.17, 95% confidence interval 1.19-4.20). Overall and progression free survival were similar in both groups (log rank test p = 0.08 and p = 0.912 respectively). In Cox regression model adjusting for age, comorbidities, tumor grade, stage and adjuvant therapy, route of surgery (MIS vs. laparotomy) was not associated with overall survival (p = 0.169). CONCLUSIONS In women with advanced EC and LUSI, although MIS is associated with locoregional recurrences, survival is comparable to laparotomy.
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Affiliation(s)
- Tamar Perri
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel.
| | - Limor Helpman
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ram Eitan
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Peta Tikva, Israel
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Tzrifin, Israel; Tel Aviv University, Ramat-Aviv, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Tzrifin, Israel; Tel Aviv University, Ramat-Aviv, Israel
| | - Alon Ben Arie
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University, Rehovot, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Tally Levy
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Sackler School of Medicine, Tel-Aviv University, Holon, Israel
| | - Ahmet Namazov
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
| | - Inbar Ben Shachar
- Department of Obstetrics and Gynecology, Ziv Medical Center, Zfat, Israel
| | - Ilan Atlas
- Department of Obstetrics and Gynecology, Poriya Medical Center, Bar Ilan University, Tiberia, Israel
| | - Ilan Bruchim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion, Hedera, Israel
| | - Liron Kogan
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Ofer Gemer
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
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Tal O, Eitan R, Gemer O, Helpman L, Vaknin Z, Leytes S, Lavie O, Ben-Arie A, Amit A, Namazov A, Ben Shahar I, Atlas I, Bruchim I, Levy T. Prognostic significance of pretreatment thrombocytosis in endometrial cancer: an Israeli Gynecologic Oncology Group study. Int J Gynecol Cancer 2021; 31:1437-1442. [PMID: 34725243 DOI: 10.1136/ijgc-2021-002810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/14/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Endometrial cancer prognosis is related to stage, histology, myometrial invasion, and lymphovascular space invasion. Several studies have examined the association between pretreatment thrombocytosis and patient outcomes with contrasting results regarding prognosis. Our aim was to evaluate the association of pretreatment platelet count with outcomes in endometrial cancer patients. METHODS This is an Israeli Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer, who underwent surgery between January 2002 and December 2014. Patients were grouped as low risk (endometrioid G1-G2 and villoglandular) and high risk (endometrioid G3, uterine serous papillary carcinoma, clear cell carcinoma, and carcinosarcoma). Those with stage I disease were compared with stages II-IV. Disease stages were reviewed and updated to reflect International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. All patients underwent pelvic washings for cytology and total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Pelvic lymph node assessment was performed in patients with tumors of moderate-high risk histology or deep myometrial invasion. Para-aortic sampling was performed at the surgeon's discretion. Patients were categorized by pretreatment platelet count into two groups: ≤400×109/L and >400×109/L (defined as thrombocytosis). Clinical and pathological features were compared using Student t-test, χ2 or Fisher's exact test. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations. RESULTS Of the 1482 patients included, most had stage I disease (961; 74.8%) and most had endometrioid histology (927; 64.1%). A total of 1392 patients (94%) had pretreatment platelet counts ≤400×109/L and 90 (6%) had pretreatment thrombocytosis. Patients with thrombocytosis had a significantly higher rate of high-grade malignancy, advanced stage, lymphovascular space invasion, low uterine segment involvement, and lymph node metastases. They also had shorter 5 year disease-free survival (65% vs 80%, p=0.003), disease-specific survival (63% vs 83%, p<0.05) and overall survival (59% vs 77%, p<0.05). On multivariate analysis, an elevated pretreatment thrombocyte count remained a significant independent predictor for disease-specific survival and overall survival. CONCLUSIONS Pretreatment thrombocytosis is an independent prognostic factor for decreased disease-specific survival and overall survival among patients with endometrial cancer, and can serve as a predictor of poor outcome.
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Affiliation(s)
- Ori Tal
- Edith Wolfson Medical Center, Holon, Israel
| | - Ram Eitan
- Rabin Medical Center, Petah Tikva, Israel
| | - Ofer Gemer
- Barzilai Medical Centre Ashkelon, Ashkelon, Southern, Israel
| | - Limor Helpman
- Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | | | | | - Ofer Lavie
- Lady Davies Carmel Medical Center, Haifa, Haifa, Israel
| | | | | | - Ahmet Namazov
- Barzilai Medical Centre Ashkelon, Ashkelon, Southern, Israel
| | | | | | | | - Tally Levy
- Edith Wolfson Medical Center, Holon, Israel
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Chen JLY, Huang CY, Huang YS, Hsu CY, Lan KH, Shih IL, Cheng WF, Chen CA, Sheu BC, Kuo SH. Real-World Evaluation of Modern Adjuvant Radiotherapy in Women with Stage IB Endometrial Cancer. Cancers (Basel) 2021; 13:1386. [PMID: 33803915 PMCID: PMC8003240 DOI: 10.3390/cancers13061386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
The optimal adjuvant treatment for stage IB endometrial cancer remains undefined. We investigated the benefit of modern adjuvant radiotherapy for women with stage IB endometrial cancer. We retrospectively reviewed patients with surgically staged, pure stage IB endometrioid adenocarcinoma (2010 to 2018). Adjuvant modern radiotherapy consists of external-beam radiotherapy (EBRT) by intensity, volumetric-modulated arc radiotherapy, or image-guided vaginal brachytherapy (VBT). The study included 180 stage IB patients. Patients with grade 3 diseases had frequent aggressive histology patterns (lymphovascular space invasion (LVSI); low uterine segment involvement) and experienced significantly shorter recurrence-free survival (RFS) and overall survival (OS) than patients with grade 1/2 diseases. Adjuvant modern radiotherapy decreased the incidence of acute/chronic grade ≥2 gastrointestinal toxicity. In IB grade 1/2 patients, EBRT significantly lengthened survival (RFS/OS); patients with age >60 years, myometrial invasion beyond the outer third, or LVSI benefited the most from EBRT. EBRT also significantly improved survival (RFS/OS) in IB grade 3 patients, where patients with bulky tumors or LVSI benefited the most from EBRT. Therefore, EBRT may be beneficial for all stage IB patients.
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Affiliation(s)
- Jenny Ling-Yu Chen
- Department of Radiology, National Taiwan University College of Medicine, Taipei 100, Taiwan; (J.L.-Y.C.); (Y.-S.H.); (I.-L.S.)
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
- Cancer Center, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chao-Yuan Huang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
- Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu 300, Taiwan
| | - Yu-Sen Huang
- Department of Radiology, National Taiwan University College of Medicine, Taipei 100, Taiwan; (J.L.-Y.C.); (Y.-S.H.); (I.-L.S.)
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Che-Yu Hsu
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
| | - Keng-Hsueh Lan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
| | - I-Lun Shih
- Department of Radiology, National Taiwan University College of Medicine, Taipei 100, Taiwan; (J.L.-Y.C.); (Y.-S.H.); (I.-L.S.)
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-F.C.); (C.-A.C.); (B.-C.S.)
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-F.C.); (C.-A.C.); (B.-C.S.)
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-F.C.); (C.-A.C.); (B.-C.S.)
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
- Cancer Center, College of Medicine, National Taiwan University, Taipei 100, Taiwan
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Yamazaki H, Takeshita S, Todo Y, Matsumiya H, Shimada C, Minobe S, Tsuruta T, Kato H. Imaging-based definition of lower uterine segment carcinoma to improve the detection sensitivity of probable Lynch syndrome. Jpn J Clin Oncol 2020; 50:270-275. [PMID: 31958127 DOI: 10.1093/jjco/hyz162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 10/05/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate a magnetic resonance imaging-based definition of lower uterine segment carcinoma. METHODS We retrospectively reviewed 587 consecutive patients with endometrial cancer who underwent hysterectomy. Lower uterine segment carcinoma was determined through pathological examination and magnetic resonance imaging assessment. For imaging assessment, the location of the inner lining of the uterus was classified into four equal parts on a sagittal section image. A tumor was defined as lower uterine segment carcinoma when its thickest part was located in the second or the third part from the uterine fundus. Lower uterine segment carcinoma was further divided into lower uterine segment in a narrow sense, upon which diagnosis was exclusively based on pathological findings, and lower uterine segment in a broad sense that were the remaining lower uterine segment carcinomas except lower uterine segment carcinomas in a narrow sense. The relationship between lower uterine segment carcinoma and probable Lynch syndrome was investigated. Patients with loss of MSH2, MSH6, and PMS2 expression or those with tumors with loss of MLH1 and absence of MLH1 promoter methylation were diagnosed as probable Lynch syndrome. RESULTS Lower uterine segment carcinoma was identified in 59 (10.2%) patients. Twenty-eight (47.5%) patients were categorized as lower uterine segment in a narrow sense and 31 (52.5%) as lower uterine segment in a broad sense. Among them, probable Lynch syndrome was identified in 12 (20.3%) cases. There was no difference in clinical profiles, including the prevalence of probable Lynch syndrome between the two categories. CONCLUSIONS A magnetic resonance imaging-based expanded definition of lower uterine segment carcinoma is likely to secure characteristics equivalent to a conventional pathology-based definition of lower uterine segment carcinoma. The novel definition of lower uterine segment carcinoma might improve the detection of probable Lynch syndrome.
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Affiliation(s)
- Hiroyuki Yamazaki
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
| | - Sho Takeshita
- Department of Obstetrics and Gynecology, Ichinomiya municipal hospital, Ichinomiya, Aichi, Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
| | - Hiroko Matsumiya
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
| | - Chisa Shimada
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
| | - Shinichiro Minobe
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
| | - Tomohiko Tsuruta
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido, Japan, and
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Retrospective Analysis of Intravaginal Brachytherapy in Adjuvant Treatment of Early Endometrial Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7924153. [PMID: 29682556 PMCID: PMC5841031 DOI: 10.1155/2018/7924153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/20/2017] [Accepted: 12/28/2017] [Indexed: 01/30/2023]
Abstract
The aim of this study was to determine the role of adjuvant endovaginal brachytherapy HDR (High Dose Rate) or observation, as well as identification of risk factors of tumor recurrence. The study included 178 women after radical hysterectomy. All patients belonged to the group of low- and medium-risk stage I FIGO. Analysis consisted of 3-, 5-, and 10-year OS, DFS, and LRFS in both groups. Follow-up was more than 6.5 years. The 5-OS, 5-DFS, and 5-LRFS were 93%, 96%, and 98% in the treated group and 95%, 94%, and 96% in the observed group, respectively. These differences were not statistically significant. There was a statistically significant difference in 5-OS in the treated group, between low- and medium-risk subgroups (100% versus 87.55%, p = 0.018). There was a better prognosis among the patients with FIGO IA compared to FIGO IB (5-DFS, 97 versus 86%, p = 0.047). Among the risk factors, there were only statistically significant differences in the 5-OS, between the ages of ≤ 70 years and >70 years. Use of brachytherapy may affect the reduction in the number of local recurrences at the vaginal stump (6% versus 2%). This is particularly noticeable in the low-risk subgroup (9% versus 0%).
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Investigation of the clinical features of lower uterine segment carcinoma: association with advanced stage disease and indication of poorer prognosis. Arch Gynecol Obstet 2017; 297:193-198. [PMID: 29116461 DOI: 10.1007/s00404-017-4576-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/10/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We retrospectively analyzed the differential clinical features and prognosis of endometrial carcinomas arising from the lower uterus, which are reported to have a poorer prognosis than those arising from the upper uterus. METHODS 246 patients with endometrial carcinoma who underwent surgery were entered as subjects. RESULTS Twenty-three were classified as having lower uterine segment carcinomas (LUSC); the remaining 223 were upper uterine segment carcinomas (UUSC). LUSC cases were associated with a more advanced FIGO stage than UUSC (p < 0.001). Deep myometrial invasion and lymph node metastasis were more common in LUSC than in UUSC (p = 0.006 and p < 0.001, respectively). LUSC cases demonstrated significantly shorter overall survival (OS) and progression-free survival (PFS) than UUSC (p = 0.02 and p < 0.001, respectively). Multivariate cox proportional hazards analysis demonstrated that the hazard ratio for LUSC was 1.769 for OS and 3.479 for PFS. For endometrial carcinoma survival, FIGO stage and histological type were extracted as independent variables. CONCLUSIONS LUSC is a high-risk indicator for poorer prognosis for endometrial carcinoma because it is associated with more advanced stage disease, deep myometrial invasion and lymph node metastasis, and indicates a significantly worsened PFS probability. Our analysis concludes that LUSC is FIGO stage-dependent and an important factor for OS.
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Identifiable Risk Factors for Lymph Node Metastases in Grade 1 Endometrial Carcinoma. Int J Gynecol Cancer 2017; 27:1694-1700. [DOI: 10.1097/igc.0000000000001070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Erkaya S, Öz M, Topçu HO, Şirvan AL, Güngör T, Meydanli MM. Is lower uterine segment involvement a prognostic factor in endometrial cancer? Turk J Med Sci 2017; 47:300-306. [PMID: 28263506 DOI: 10.3906/sag-1602-137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/26/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The purpose of this study is to investigate the prognostic significance of lower uterine segment (LUS) involvement in endometrial cancer (EC). MATERIALS AND METHODS We reviewed the patients who were operated at our institution between July 2007 and March 2015 with the diagnosis of EC. Tumors localized in the corpus and involving the LUS or localized entirely in the LUS formed Group A, while tumors in the uterine corpus without LUS involvement formed Group B. Clinicopathological characteristics and survival of the patients were compared in both groups. RESULTS A total of 500 patients were included in the study. There were 139 patients who had tumors involving the LUS and formed Group A, while 361 patients with endometrial tumors in the uterine corpus without LUS involvement formed Group B. We did not detect a significant difference between survival of the patients in group A and group B (78 months vs. 87 months, respectively; P > 0.05). CONCLUSION We found that LUS involvement was not an independent prognostic factor for poor survival, but it is associated with other poor prognostic factors such as deep myometrial invasion, uterine serosal involvement, lymphovascular space invasion, lymph node metastasis and higher FIGO grade.
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Affiliation(s)
- Salim Erkaya
- Department of Gynecology and Obstetrics, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Murat Öz
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Hasan Onur Topçu
- Department of Gynecology and Obstetrics, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ali Levent Şirvan
- Department of Pathology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Tayfun Güngör
- Department of Gynecology and Obstetrics, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Affiliation(s)
- Debra S. Heller
- Departments of Pathology and Laboratory Medicine, Rutgers–New Jersey Medical School, Newark, NJ
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Iavazzo C, Gkegkes ID, Vrachnis N. Early recurrence of early stage endometrioid endometrial carcinoma: possible etiologic pathways and management options. Maturitas 2014; 78:155-9. [PMID: 24815295 DOI: 10.1016/j.maturitas.2014.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/17/2022]
Abstract
The majority of endometrial cancers is early stage and of the endometrioid histological type, as the symptoms (mainly vaginal bleeding) of the disease lead to an early diagnosis. Close follow-up is nevertheless essential in such cancers staged early on, in which the rate of recurrence is relatively low. We retrieved the studies included in our narrative review after performing a systematic electronic search in the PubMed, Scopus and Cochrane databases. The incidence or recurrence of disease in such patients could be up to 2.6%, with the main sites of recurrence being the vaginal vault or metastases in distant parts of the body. Genetic factors such as p53 overexpression, inactivation of 14-3-3-sigma, KRAS amplification and KRAS mRNA expression, microsatellite instability and Lynch syndrome genes could be associated with such a recurrence. Black race is also correlated, as well as lymphovascular space involvement, lower uterine segment involvement and DNA aneuploidy. Longer hysteroscopy duration was not found to be associated. Close follow-up is suggested for early detection of recurrences, while surgical excision of isolated disease or exenteration of local disease as well as radiotherapy and chemotherapy are the main treatment options. This narrative review investigated the possible mechanisms of early recurrence in patients with endometrioid endometrial cancer as well as the further management of them.
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Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, United Kingdom
| | - Ioannis D Gkegkes
- 1st Department of Surgery, General Hospital of Attica "KAT", Athens, Greece.
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece
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Inoue K, Tsubamoto H, Hori M, Ogasawara T, Takemura T. A case of endometrioid adenocarcinoma developing 8 years after conservative management for atypical polypoid adenomyoma. GYNECOLOGIC ONCOLOGY CASE REPORTS 2014; 8:21-3. [PMID: 24707458 DOI: 10.1016/j.gynor.2014.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
•Endometrioid adenocarcinoma may develop during the long-term follow-up of APA.•Atypical polypoid adenomyoma is a precursor of endometrioid adenocarcinoma.•Careful follow-up is needed for the conservative management of APA.
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Affiliation(s)
- Kayo Inoue
- Department of Obstetrics and Gynecology, Meiwa General Hospital, 4-31 Kaminaruo-Cho, Nishinomiya, Hyogo 663-8186, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Masateru Hori
- Department of Obstetrics and Gynecology, Meiwa General Hospital, 4-31 Kaminaruo-Cho, Nishinomiya, Hyogo 663-8186, Japan
| | - Toshitada Ogasawara
- Department of Obstetrics and Gynecology, Okubo Hospital, 2095-1, Okubo-cho Okubo, Akashi, Hyogo 674-0051, Japan
| | - Tadashi Takemura
- Takemura Ladies Clinic, 19-3, Koshien-Rokubancho, Nishinomiya, Hyogo, Japan
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