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Inoue K, Yasuda M, Hasegawa K, Kajihara T, Kozawa E. A case of ovarian endometrioid carcinoma: Atypical MR imaging. Radiol Case Rep 2024; 19:2245-2248. [PMID: 38523718 PMCID: PMC10957519 DOI: 10.1016/j.radcr.2024.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Endometrioid carcinoma is the second most common ovarian tumor, classified as an epithelial-stromal ovarian tumor, and is usually characterized by a cystic tumor with partial solid components on magnetic resonance (MR) images. In this case report, we discuss an 81-year-old female who presented with atypical genital bleeding and distended abdomen, for which she underwent abdominal computed tomography and MR imaging. Solid endometrioid carcinoma of the ovary is very rare but was confirmed in our patient during the histological examination after surgery.
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Affiliation(s)
- Kaiji Inoue
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
| | - Masanori Yasuda
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takeshi Kajihara
- Department of Obstetrics and gynecology, Saitama Medical University Hospital, Saitama, Japan
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
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Kashihara Y, Sekiyama K, Abe A, Yamamura A, Kozono Y, Okuda A, Yoshioka Y, Higuchi T. Successful fertility preservation in stage II endometrial carcinoma with long-term progestin therapy: A case report. Gynecol Oncol Rep 2024; 52:101357. [PMID: 38469132 PMCID: PMC10925927 DOI: 10.1016/j.gore.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
Progestin therapy is a fertility-sparing treatment option for well-differentiated stage IA endometrioid carcinomas without myometrial invasion. Here, we present a case of successful pregnancy and live birth following long-term progestin therapy in a patient with stage II well-differentiated endometrioid carcinoma. A 30-year-old nulliparous woman with an unremarkable medical history presented with abnormal uterine bleeding. A 45 mm mass was identified in the lower uterine segment. An endometrial biopsy revealed grade 1 endometrioid carcinoma, leading to a diagnosis of stage II uterine corpus cancer based on hysteroscopic findings. The patient refused surgical treatment and underwent oocyte retrieval and cryopreservation at another hospital. A subsequent endometrial biopsy revealed a marked reduction in the Ki-67 index from approximately 60 % to less than 10 %, suggesting the possibility of a hormone-sensitive tumor. The patient persistently refused surgery. Therefore, progestin therapy with medroxyprogesterone acetate (MPA) at a dose of 400 mg/day was initiated as a temporary measure until the patient would accept surgery. The tumor gradually reduced in size and eventually disappeared after 9 months. The MPA therapy was discontinued uneventfully after 20 months. Sixteen months after the discontinuation of MPA therapy, atypical endometrial hyperplasia was detected, and a second round of MPA therapy was initiated. Progestin retreatment was successful and was discontinued at 6 months. Four years after the initial treatment, the patient achieved pregnancy through timed intercourse and delivered a healthy baby at 38 weeks of gestation.
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Affiliation(s)
- Yuki Kashihara
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
- Department of Gynecology and Obstetrics, Kyoto University Hospital, Kyoto, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akiko Abe
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akitoshi Yamamura
- Department of Gynecology and Obstetrics, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
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Pla-Juher H, Pardo M, Izquierdo ÀJ, Darder E, Carbó A, Munté E, Torres-Esquius S, Balmaña J, Lázaro C, Brunet JM, Barretina-Ginesta MP. Risk of endometrial cancer after RRSO in BRCA 1/2 carriers: a multicentre cohort study. Clin Transl Oncol 2024; 26:1033-1037. [PMID: 37682500 PMCID: PMC10981602 DOI: 10.1007/s12094-023-03312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To know the risk of endometrial cancer (EC) in a population of women with BRCA 1/2 pathogenic or likely pathogenic variants after risk-reducing salpingo-oophorectomy (RRSO). METHODS The study cohort included data from 857 women with BRCA mutations who underwent RRSO visited four hospitals in Catalonia, Spain, from January 1, 1999 to April 30, 2019. Standardized incidence ratio (SIR) of EC was calculated in these patients using data from a regional population-based cancer registry. RESULTS After RRSO, eight cases of EC were identified. Four in BRCA 1 carriers and four in BRCA2 carriers. The expected number of cases of EC was 3.67 cases, with a SIR of 2.18 and a 95% CI (0.93-3.95). CONCLUSIONS In our cohort, the risk of EC in BRCA1/2 carriers after RRSO is not greater than expected. Hysterectomy is not routinely recommended for these patients.
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Affiliation(s)
- Helena Pla-Juher
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain.
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain.
- Department of Epidemiology and Cancer Register, Girona, Spain.
| | - Marta Pardo
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Àngel J Izquierdo
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Esther Darder
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Anna Carbó
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Elisabet Munté
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Barcelona, Spain
| | | | - Judith Balmaña
- Department of Medical Oncology, Vall d'Hebrón Hospital, Barcelona, Spain
| | - Concepción Lázaro
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, Madrid, Spain
| | - Joan M Brunet
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Maria-Pilar Barretina-Ginesta
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
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Travaglino A, Arciuolo D, Santoro A, Fulgione C, Piermattei A, Martinelli M, Onori ME, Minucci A, Raffone A, Inzani F, Zannoni GF. Ovarian endometrioid carcinoma with a sex cord-like pattern: a morphological, immunohistochemical, and molecular analysis. Virchows Arch 2024:10.1007/s00428-024-03743-6. [PMID: 38418687 DOI: 10.1007/s00428-024-03743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
Sex cord-like endometrioid carcinoma (SCLEC) is an uncommon entity which may constitute a diagnostic challenge. This study aimed to perform a clinicopathological, immunohistochemical, and molecular reappraisal of ovarian SCLEC. Consecutive ovarian SCLECs cases from a single institution were reviewed during a 13-year period. Twenty-three immunohistochemical markers were tested; 10 genes were analyzed by next-generation sequencing. Nine cases of ovarian SCLEC were identified. Mean patient age was 65.7 years; three cases showed extraovarian extension. Architectural pattern included sertoliform (n = 2), granulosa-like (n = 2), and mixed granulosa-like/sertoliform (n = 5). Eosinophilic changes accompanied by increased nuclear atypia were observed in four tumors. Endometrioid features (glands, squamous/morular differentiation) were observed in six cases. Most tumors were positive for cytokeratin-7 (8/9), EMA (9/9), estrogen and progesterone receptor (9/9), CD10 (7/9, including a luminal pattern reminiscent of mesonephric neoplasms), nuclear β-catenin (8/9), and CDX2 (8/9). A minority of cases showed block-type p16 pattern (2/9), PAX8-positivity (3/9), and non-diffuse positivity for WT1 (1/9), inhibin (1/9), chromogranin (1/9), and synaptophysin (2/9). All cases were negative for GATA3, TTF1, calretinin, and SF1. Ki67 range was 15-90%. Six cases showed CTNNB1 exon 3 mutation. Eight cases were of "no specific molecular profile" (NSMP) and one was p53-abnormal. In conclusion, SCLECs frequently exhibit a mixed sertoliform/granulosa-like architecture and express epithelial markers, hormone receptors, nuclear β-catenin, and CDX2, with luminal CD10 positivity and CTNNB1 mutations. PAX8 expression is often lost, while other mesonephric, sex cord, and neuroendocrine markers are negative.
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Affiliation(s)
- Antonio Travaglino
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Damiano Arciuolo
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Angela Santoro
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Caterina Fulgione
- Gynecology and Obstetrics Unit, Department of Neurociences, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - Alessia Piermattei
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Manuela Martinelli
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Elisabetta Onori
- Departmental Unit of Molecular and Genomic Diagnostics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Minucci
- Departmental Unit of Molecular and Genomic Diagnostics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria Di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Frediano Inzani
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Pathology Institute, Catholic University of Sacred Heart, Rome, Italy.
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Radzynski L, Boyer L, Kossai M, Mouraire A, Montoriol PF. Pictorial essay: MRI evaluation of endometriosis-associated neoplasms. Insights Imaging 2023; 14:144. [PMID: 37673827 PMCID: PMC10482819 DOI: 10.1186/s13244-023-01485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/08/2023] [Indexed: 09/08/2023] Open
Abstract
Endometriosis is a frequent pathology mostly affecting women of young age. When typical aspects are present, the diagnosis can easily be made at imaging, especially at MRI. Transformation of benign endometriosis to endometriosis-associated neoplasms is rare. The physiopathology is complex and remains controversial. Endometrioid carcinoma and clear cell carcinoma are the main histological subtypes. Our goal was to review the main imaging characteristics that should point to an ovarian or extra-ovarian endometriosis-related tumor, especially at MRI, as it may be relevant prior to surgical management.Key points• Transformation of benign endometriosis to endometriosis-associated neoplasms is rare.• MRI is useful when displaying endometriosis lesions associated to an ovarian tumor.• Subtraction imaging should be used in the evaluation of complex endometriomas.
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Affiliation(s)
- Louise Radzynski
- Department of Radiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Louis Boyer
- Department of Radiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Myriam Kossai
- Department of Pathology, Cancer Center of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Mouraire
- Department of Pathology, Cancer Center of Clermont-Ferrand, Clermont-Ferrand, France
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Cao F, Zhong M, Liu CR. [Uterine POLE mutant endometrioid carcinoma combined with human papilloma virus-associated cervical adenocarcinoma: A case report and literature review]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:370-374. [PMID: 37042153 PMCID: PMC10091252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Independent primary uterine and cervical adenocarcinoma are rare and difficult to identify their origins, which makes treatment decision difficult. A 46-year-old female with endometrioid carcinoma and adenocarcinoma, human papilloma virus (HPV)-associated of the uterine cervix was reported. The patient presented with increased menstrual flow, contact bleeding and watery leucorrhea for more than one year, and the imaging findings showed abnormal uterine morphology, irregular margins, and multiple abnormal signals in uterine cavity and myometrium, which suggested multiple leiomyomas of the uterus. The signal intensity in the right muscle layer was markedly enhanced, suggesting a smooth muscle tumor of uncertain malignant potential. A large number of cystic hypointensity was seen in the cervix, and multiple cysts were considered. The initial preoperative diagnosis was multiple leiomyoma of the uterus, and a hysterectomy operation was planned. During the operation, the uterus was sent for frozen sections. There was a mass in the endometrium of the fundus, with a soft grayish-red cut surface and a clear border with the myometrium, and there was a grayish-white nodule in the cervix with a hard grayish-white cut surface. The two masses were well demarcated from each other, and the distance between them was 30 mm. The result of the frozen sections indicated the malignant tumor of the endometrium, and the extended hysterectomy+pelvic lymphadenectomy+partial resection of the greater omentum was performed. After the operation, the paraffin sections were sent to the Department of Pathology of the Peking University Third Hospital for histochemistry, POLE gene sequencing and HPV RNAscope tests, and the final diagnosis was a synchronous endometrioid carcinoma (POLE-mutant according to the WHO classification) and an adenocarcinoma, HPV-associated of the uterine cervix. Now the patient had been treated with 2 cycles of chemotherapy and her condition was fine. Through the analysis of the histological, immunohistochemical and molecular detection results of this case, the importance of applying HPV RNAscope and TCGA molecular typing in the diagnosis of cervical adenocarcinomas and endometrial carcinomas was emphasized. At the same time, gynecologists should not blindly rely on intraoperative frozen sections, and should pay attention to preoperative pathological examination, and make appropriate operation methods according to the results in order to prevent passivity in the surgery.
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Affiliation(s)
- F Cao
- Department of Pathology, Hunan Cancer Hospital, Changsha 410000, China
- Department of Pathology, Peking University School of Basic Medical Sciences/Peking University Third Hospital, Beijing 100191, China
| | - M Zhong
- Tai'an Center Hospital, Tai'an 271000, Shandong, China
| | - C R Liu
- Department of Pathology, Peking University School of Basic Medical Sciences/Peking University Third Hospital, Beijing 100191, China
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McGary CT, Boyum R. Educational Case: Serous endometrial intraepithelial carcinoma and endometrial cancer. Acad Pathol 2023; 10:100077. [PMID: 37101898 PMCID: PMC10123333 DOI: 10.1016/j.acpath.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 01/12/2023] [Accepted: 02/11/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Carl T. McGary
- Corresponding author. University of Minnesota Medical School – Duluth Campus, Department of Biomedical Sciences, DMED 239, 1035 University Drive, Duluth, MN, 55812-3031, USA.
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8
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Inzani F, Arciuolo D, Monterossi G, Quagliozzi L, Travaglino A, Santoro A, Valente M, D'Alessandris N, Scaglione G, Sfregola S, Cianfrini F, Zannoni GF. One biopsy, two tumors: A case report of collision tumor consisting in breast and endometrioid carcinoma detected on bioptic sample of peritoneal carcinomatosis. Pathol Res Pract 2023; 243:154378. [PMID: 36812738 DOI: 10.1016/j.prp.2023.154378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023]
Abstract
Collision tumors are rare and very few cases were described in which collision was revealed in a metastatic lesion. Herein we report a case of woman with a peritoneal carcinomatosis underwent to bioptic procedure in correspondence of a nodule of Douglas peritoneum with clinical suspect of ovarian/uterine origin. Histologic examination revealed two different colliding epithelial neoplasms: an endometrioid carcinoma and a ductal breast carcinoma, the latter not suspected at the time of biopsy. Morphology and immunohistochemistry, in particular GATA3 and PAX8, defined clearly the two different colliding carcinomas.
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9
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Morito S, Kawasaki M, Nishiyama M, Sakumoto T, Hashiguchi M, Narita T, Kawaguchi A, Toda S, Aoki S. Microenvironmental elements singularity synergistically regulate the behavior and chemosensitivity of endometrioid carcinoma. Hum Cell 2023; 36:1147-1159. [PMID: 36853404 DOI: 10.1007/s13577-023-00886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
The importance of the microenvironment is widely recognized as it regulates not only malignant cell behavior but also drug sensitivity. The cancer cell microenvironment is composed of biological, physical and chemical elements, and simultaneous reproduction of these three elements are important conditions investigated in cancer research. In the present study, we focused on the epidemiological and anatomical specificities of endometrioid carcinoma, obesity (biological), fluid flow (physical) and anticancer agents (chemical) to target the specific microenvironmental elements of endometrioid carcinoma. To elucidate the individual effects of these elements on endometrioid carcinoma and to investigate the relationships between these factors, we developed an adipose tissue fragments (ATFs)-embedded cell disc under a rotational culture method to generate carcinoma-stroma interactions and to create fluid flow. ATFs and fluid flow individually or synergistically influenced proliferative cellular behavior and the morphological changes underlying endometrioid carcinoma. ATFs and fluid flow also governed the expression of extracellular signal-regulated kinase and p38 signaling synergistically or individually, depending on the endometrioid carcinoma cell type. Adipose tissue induced chemoresistance to cis-diamminedichloro-platinum (CDDP) in endometrioid cancer, but the resistance effect was abolished by fluid flow. Thus, a simple reconstructed model was established to investigate three elements of the microenvironment of endometrioid carcinoma in vitro. This culture model unequivocally demonstrated the individual and synergistic effects of the three elements on endometrioid carcinoma. This new culture model is a promising tool for elucidating the mechanisms underlying endometrioid carcinoma and for developing further treatment strategies.
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Affiliation(s)
- Sayuri Morito
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Maki Kawasaki
- Department of Urology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Megumi Nishiyama
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Takehisa Sakumoto
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Mariko Hashiguchi
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Takayuki Narita
- Department of Chemistry and Applied Chemistry, Faculty of Science and Engineering, Saga University, 1 Honjo, Saga, 840-8502, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Shuji Toda
- Department of Pathology, Takagi Hospital, Okawa, Fukuoka, 831-8501, Japan
| | - Shigehisa Aoki
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
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10
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Lu J, Zhao S, Ma F, Li H, Li Y, Qiang J. Whole-tumor ADC histogram analysis for differentiating endometriosis-related tumors: seromucinous borderline tumor, clear cell carcinoma and endometrioid carcinoma. Abdom Radiol (NY) 2023; 48:724-732. [PMID: 36401131 DOI: 10.1007/s00261-022-03742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the feasibility of whole-tumor apparent diffusion coefficient (ADC) histogram analysis for improving the differentiation of endometriosis-related tumors: seromucinous borderline tumor (SMBT), clear cell carcinoma (CCC) and endometrioid carcinoma (EC). METHODS Clinical features, solid component ADC (ADCSC) and whole-tumor ADC histogram-derived parameters (volume, the ADCmean, 10th, 50th and 90th percentile ADCs, inhomogeneity, skewness, kurtosis and entropy) were compared among 22 SMBTs, 42 CCCs and 21 ECs. Statistical analyses were performed using chi-square test, one-way ANOVA or Kruskal-Wallis test, and receiver operating characteristic curves. RESULTS A significantly higher ADCSC and smaller volume were associated with SMBT than with CCC/EC. The ADCmean was significantly higher in CCC than in EC. The 10th percentile ADC was significantly lower in EC than in SMBT/CCC. The 50th and 90th percentile ADCs were significantly higher in CCC than in SMBT/EC. For differentiating SMBT from CCC, AUCs of the ADCSC, volume, and 50th and 90th percentile ADCs were 0.97, 0.86, 0.72 and 0.81, respectively. For differentiating SMBT from EC, AUCs of the ADCSC, volume and 10th percentile ADC were 0.97, 0.71 and 0.72, respectively. For differentiating CCC from EC, AUCs of the ADCmean and 10th, 50th and 90th percentile ADCs were 0.79, 0.72, 0.81 and 0.85, respectively. CONCLUSION Whole-tumor ADC histogram analysis was valuable for differentiating endometriosis-related tumors, and the 90th percentile ADC was optimal in differentiating CCC from EC.
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Affiliation(s)
- Jing Lu
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Shuhui Zhao
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.,Department of Radiology, Xinhua Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Fenghua Ma
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.,Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai, 200011, People's Republic of China
| | - Haiming Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.,Department of Radiology, Shanghai Cancer Center, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Yong'ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.
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Guo X, Lin C, Zhao J, Tang M. Development of a novel predictive model for lymph node metastasis in patients with endometrial endometrioid carcinoma. BMC Cancer 2022; 22:1333. [PMID: 36539714 PMCID: PMC9764687 DOI: 10.1186/s12885-022-10437-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Globally, the burden of endometrial endometrioid carcinoma (EEC) increases annually. However, the histological grade of EEC remains unelucidated. We developed a novel model for predicting lymph node metastasis (LNM) in patients with endometrioid carcinoma (EC), which has not been well established. METHODS A total of 344 patients with EEC were classified into training (n = 226) and validation (n = 118) cohorts. To develop a nomogram to predict LNM, independent predictors were defined using univariate and multivariate regression analyses. The calibration curve, area under the decision curve analysis (DCA), and receiver operating characteristic curve were used to evaluate the performance of the nomogram. RESULTS Independent predictors of LNM in EC were identified in the univariate analysis, including mitosis; microcystic, elongated, and fragmented patterns; lymphovascular invasion (LVI); necrosis; and high-grade pattern. Mitosis, LVI, and high-grade pattern remained independent predictors of LNM in multivariate analysis. An LNM nomogram that was constructed by incorporating the five predictors showed reliable discrimination and calibration. DCA showed that the LNM nomogram scoring system had significant clinical application value. In addition, a high nomogram score (score > 150) was a significant prognosticator for survival in both LNM-positive and LNM-negative ECs. CONCLUSIONS Our novel predictive model for LNM in patients with EC has the potential to assist surgeons in making optimal treatment decisions.
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Affiliation(s)
- Xingdan Guo
- Department of Pathology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Chunhua Lin
- Department of Pathology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Jing Zhao
- Department of Gynecological Oncology and Cervical Lesion, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Mi Tang
- Department of Pathology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
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12
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Barnes D, Mohammad N, Hoang L, Anglesio M, Hollis RL, Gourley C, Stuart HC, Carey MS, Stuart GC. Multisite gynecologic endometrioid adenocarcinomas: Can mutation profiling be used to distinguish synchronous primary cancers from metastases? Gynecol Oncol Rep 2022; 44:101076. [PMID: 36299398 PMCID: PMC9589011 DOI: 10.1016/j.gore.2022.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
It is well recognized that some patients with endometrioid gynecological cancers have tumors arising in multiple sites (ovary, endometrium, and endometriosis) at the time of diagnosis. Molecular analysis has helped discern whether these multisite cancers represent synchronous primary tumors or alternatively metastatic disease. We present a complex case of a patient with endometrioid carcinomas arising in multiple sites. We discuss the use of mutation profiling to discern clonality and highlight how this information may inform the clinical management of such cases.
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Affiliation(s)
- Dominique Barnes
- Department of Obstetrics and Gynecology, University of British Columbia, Canada,Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, 2775 Laurel Street, 6th Floor, DHCC, Vancouver, BC V5Z 1M9, Canada.
| | - Nissreen Mohammad
- Department of Pathology, Vancouver General Hospital and the University of British Columbia, Canada
| | - Lien Hoang
- Department of Pathology, Vancouver General Hospital and the University of British Columbia, Canada
| | - Michael Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia, Canada
| | - Robert L. Hollis
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Charlie Gourley
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Heather C. Stuart
- Department of Surgery, Vancouver General Hospital, and the University of British Columbia, Canada
| | - Mark S. Carey
- Department of Obstetrics and Gynecology, University of British Columbia, Canada
| | - Gavin C.E. Stuart
- Department of Obstetrics and Gynecology, University of British Columbia, Canada
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13
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Maragliano R, Libera L, Carnevali I, Pensotti V, De Vecchi G, Testa M, Amaglio C, Leoni E, Formenti G, Sessa F, Furlan D, Uccella S. Mixed Neuroendocrine/Non-neuroendocrine Neoplasm (MiNEN) of the Ovary Arising from Endometriosis: Molecular Pathology Analysis in Support of a Pathogenetic Paradigm. Endocr Pathol 2022; 33:400-410. [PMID: 34342838 PMCID: PMC9420090 DOI: 10.1007/s12022-021-09689-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/19/2022]
Abstract
Primary ovarian neuroendocrine neoplasms (Ov-NENs) are infrequent and mainly represented by well-differentiated forms (neuroendocrine tumors - NETs - or carcinoids). Poorly differentiated neuroendocrine carcinomas (Ov-NECs) are exceedingly rare and only few cases have been reported in the literature. A subset of Ov-NECs are admixed with non-neuroendocrine carcinomas, as it occurs in other female genital organs, as well (mostly endometrium and uterine cervix), and may be assimilated to mixed neuroendocrine/non-neuroendocrine neoplasms (MiNENs) described in digestive and extra-digestive sites. Here, we present a case of large cell Ov-NEC admixed with an endometrioid carcinoma of the ovary, arising in the context of ovarian endometriosis, associated with a uterine endometrial atypical hyperplasia (EAH). We performed targeted next-generation sequencing analysis, along with a comprehensive immunohistochemical study and FISH analysis for TP53 locus, separately on the four morphologically distinct lesions (Ov-NEC, endometrioid carcinoma, endometriosis, and EAH). The results of our study identified molecular alterations of cancer-related genes (PIK3CA, CTNNB1, TP53, RB1, ARID1A, and p16), which were present with an increasing gradient from preneoplastic lesions to malignant proliferations, both neuroendocrine and non-neuroendocrine components. In conclusion, our findings underscored that the two neoplastic components of this Ov-MiNEN share a substantially identical molecular profile and they progress from a preexisting ovarian endometriotic lesion, in a patient with a coexisting preneoplastic proliferation of the endometrium, genotypically and phenotypically related to the ovarian neoplasm. Moreover, this study supports the inclusion of MiNEN in the spectrum ovarian and, possibly, of all gynecological NENs, among which they are currently not classified.
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Affiliation(s)
- Roberta Maragliano
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
- Dept. of Pathology, ASST Dei Sette Laghi, Varese, Italy
| | - Laura Libera
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | | | | | | | - Margherita Testa
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Cristina Amaglio
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Eleonora Leoni
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Giorgio Formenti
- Dept. of Obstetrics and Gynecology, ASST Dei Sette Laghi, Varese, Italy
| | - Fausto Sessa
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Daniela Furlan
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Silvia Uccella
- Pathology Unit, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy.
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14
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Fujimori M, Takahashi T, Furukawa Y, Takanashi A, Iizawa Y, Jimbo M, Soeda S, Fujimori K, Takeichi K. Synchronous bilateral primary ovarian cancer with right endometroid carcinoma and left high-grade serous carcinoma: a case report and literature review. BMC Womens Health 2022; 22:103. [PMID: 35382809 PMCID: PMC8981734 DOI: 10.1186/s12905-022-01684-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/27/2022] [Indexed: 12/07/2022] Open
Abstract
Background Epithelial ovarian cancer is the most frequent gynecologic malignancy; it has a poor prognosis and often occurs bilaterally. Most cases of synchronous bilateral ovarian cancer (SBOC) are metastases from the other ovary, while bilateral primary ovarian cancer is rare. Case presentation The patient was a 47-year-old Japanese woman with a complaint of abdominal pain for 1 month. Imaging results revealed bilateral ovarian tumors with suspicion of malignancy. The patient underwent a laparotomy with total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, and resection of suspected dissemination in the peritoneum. Histopathological and immunohistochemical studies showed that the right ovarian tumor was an endometrioid carcinoma (G2) and had no association with endometriotic lesions. However, the left ovarian tumor was a high-grade serous carcinoma (HGSC). The final staging was stage 1 right endometrioid carcinoma and stage IIb left HGSC. Six courses of adjuvant chemotherapy with paclitaxel, docetaxel, and carboplatin were administered. The patient showed no signs of recurrence 24 months postoperatively. Conclusions To the best of our knowledge, the combination of histological types in this case may be the first report of primary bilateral ovarian cancer. In SBOC, it is important to differentiate the subtypes of histology using immunostaining, in addition to morphopathology.
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Affiliation(s)
- Mimori Fujimori
- Department of Obstetrics and Gynecology, Aidu Chuo Hospital, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan.
| | - Yuka Furukawa
- Department of Obstetrics and Gynecology, Aidu Chuo Hospital, Fukushima, Japan
| | - Atsuhiro Takanashi
- Department of Obstetrics and Gynecology, Aidu Chuo Hospital, Fukushima, Japan
| | - Yoshiyuki Iizawa
- Department of Obstetrics and Gynecology, Aidu Chuo Hospital, Fukushima, Japan
| | - Masatoshi Jimbo
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazuyuki Takeichi
- Department of Obstetrics and Gynecology, Aidu Chuo Hospital, Fukushima, Japan
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15
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Yan BC, Ma FH, Li Y, Fan YF, Huang ZL, Ma XL, Wen XT, Qiang JW. An MRI radiomics nomogram improves the accuracy in identifying eligible candidates for fertility-preserving treatment in endometrioid adenocarcinoma. Am J Cancer Res 2022; 12:1056-1068. [PMID: 35411235 PMCID: PMC8984890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023] Open
Abstract
It is difficult to identify eligible candidates for fertility-preserving treatment (FPT) among endometrioid adenocarcinoma (EAC) and atypical hyperplasia (AH) patients. Therefore, new approaches for improving the accuracy of candidate selection are warranted. From December 2014 to January 2020, 236 EAC/AH patients (age <50 and premenopausal) were retrospectively reviewed and randomly divided into the primary group (n=158) and validation group 1 (n=78). From February 2020 to December 2021, 51 EAC/AH patients were prospectively enrolled and formed the validation group 2. From the primary group, 385 features were extracted using pyradiomics from multiparameter magnetic resonance imaging (MRI) (including T2-weighted imaging, diffusion-weighted imaging, apparent diffusion coefficient, and contrast enhancement sequences) and 13 radiomics features were selected using a least absolute shrinkage and selection operator. A clinical model based on clinical information (myometrial invasion on MRI and tumor grade in curettage) and a radiomics nomogram by integrating clinical information with the radiomics features was developed to identify eligible candidates of FPT. For identifying eligible candidates of FPT, the areas under the receiver operating characteristic curve (AUCs) were 0.63 (95% confidence interval [CI]: 0.53-0.73) in the primary group, and 0.62 (95% CI: 0.45-0.78) and 0.69 (95% CI: 0.53-0.86) in validation groups 1 and 2, respectively, for the clinical model; were 0.86 (95% CI: 0.80-0.93) in the primary group, and 0.82 (95% CI: 0.71-0.93) and 0.94 (95% CI: 0.87-1.0) in validation groups 1 and 2, respectively, for the radiomics nomogram. With the help of radiomics nomogram, the treatment decision determined from the clinical model was revised in 45 EAC/AH patients. The net reclassification index (NRI) was 0.80 and integrated discrimination improvement (IDI) was 0.17, indicating that the nomogram could improve the accuracy in identifying eligible EAC/AH candidates for FPT.
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Affiliation(s)
- Bi-Cong Yan
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital600 Yi Shan Road, Shanghai 200233, China
- Department of Radiology, Jinshan Hospital, Fudan University1508 Longhang Road, Shanghai 201508, China
| | - Feng-Hua Ma
- Department of Radiology, Obstetrics & Gynecology Hospital, Fudan University128 Shenyang Road, Shanghai 200090, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University1508 Longhang Road, Shanghai 201508, China
| | - Yan-Feng Fan
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital600 Yi Shan Road, Shanghai 200233, China
| | - Zhi-Long Huang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital600 Yi Shan Road, Shanghai 200233, China
| | - Xiao-Liang Ma
- Department of Radiology, Jinshan Hospital, Fudan University1508 Longhang Road, Shanghai 201508, China
- Department of Radiology, Obstetrics & Gynecology Hospital, Fudan University128 Shenyang Road, Shanghai 200090, China
| | - Xue-Ting Wen
- Department of Radiology, Jinshan Hospital, Fudan University1508 Longhang Road, Shanghai 201508, China
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University1508 Longhang Road, Shanghai 201508, China
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16
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Wu P, Lv Q, Guan J, Shan W, Chen X, Zhu Q, Luo X. Clinical implications of morular metaplasia in fertility-preserving treatment for atypical endometrial hyperplasia and early endometrial carcinoma patients. Arch Gynecol Obstet 2022; 306:1135-1146. [PMID: 35246715 PMCID: PMC9470654 DOI: 10.1007/s00404-021-06382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
Objective Morular metaplasia (MM) is a benign epithelial metaplasia that sometimes appears in atypical endometrial hyperplasia (AEH) and endometrioid endometrial carcinoma (EEC). However, the clinical implications of MM for fertility-preserving treatment in AEH and EEC patients are unclear. This study investigated the clinical features and impact of MM on the efficacy of fertility-preserving treatment. Methods We retrospectively studied 427 AEH and EEC patients who received fertility-preserving treatment. Clinical features, treatment efficacy, and onco-fertility results were compared between patients with and without MM. Results MM appeared in 147 of 427 (34.4%) patients. Among them, 49 (33.3%) had MM only before treatment (BEF group), 32 (21.8%) had sustained MM before and during treatment (SUS group), and 66 (44.9%) had MM only during treatment (DUR group). The BEF group had a higher 12-month CR rate (98.0% vs 85.7%, p = 0.017) and shorter therapeutic duration to achieve CR (4.0 vs 5.7 months, p = 0.013) than the non-MM group had. In comparison with the non-MM group, the SUS and DUR groups had a lower CR rate after 7 months of treatment (SUS vs non-MM, 37.5% vs 61.1%, p = 0.010; DUR vs non-MM 33.3% vs. 61.1%, p < 0.001), and a longer median therapeutic duration to achieve CR (SUS vs non-MM, 7.6 vs. 4.0 months, p = 0.037; DUR vs non-MM, 7.9 vs. 4.0 months, p < 0.001). Conclusion Appearance of MM only before treatment was positively correlated with outcome of fertility-preserving treatment, while sustained MM or appearance of MM only during treatment implied poorer outcome of fertility-preserving treatment in AEH and EEC patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-021-06382-3.
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Affiliation(s)
- Pengfei Wu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China
| | - Qiaoying Lv
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China
| | - Jun Guan
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China
| | - Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China
| | - Qin Zhu
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Xuezhen Luo
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China. .,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China.
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17
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Monk BJ, Smith G, Lima J, Long GH, Alam N, Nakamura H, Meulendijks D, Ghiorghiu D, Banerjee S. Real-world outcomes in patients with advanced endometrial cancer: A retrospective cohort study of US electronic health records. Gynecol Oncol 2021; 164:325-332. [PMID: 34952707 DOI: 10.1016/j.ygyno.2021.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To characterize clinical outcomes of women with advanced/recurrent endometrial cancer (AEC) in routine practice using electronic health records from a real-world database. METHODS Adult women diagnosed with AEC (stage III/IV, or early stage with locoregional/distant recurrence) between January 1, 2013 and September 30, 2020, inclusive, were eligible provided they received platinum-based chemotherapy at any time following diagnosis and had ≥2 clinical visits. Follow-up was from initiation of systemic treatment after advanced diagnosis (index) until March 30, 2021, last available follow-up, or death, whichever occurred first. Outcomes, by histological subtype, included Kaplan-Meier estimates of overall survival (OS) and time to first subsequent therapy or death (TFST). RESULTS Of the 2202 women with AEC, most were treated in a community setting (82.7%) and presented with stage III/IV disease at initial diagnosis (74.0%). The proportion with endometrioid carcinoma, uterine serous carcinoma (USC), and other AEC subtypes was 59.8%, 25.0%, and 15.2%, respectively. The most common first systemic treatment following advanced/recurrent diagnosis was platinum-based combination chemotherapy (82.0%). Median OS (95% CI) from initiation of first systemic treatment was shorter with USC (31.3 [27.7-34.3] months) and other AECs (29.4 [21.4-43.9] months) versus endometrioid carcinoma (70.8 [60.5-83.2] months). Similar results were observed for TFST. Black/African American women had worse OS and TFST than white women. CONCLUSIONS Women with AEC had poor survival outcomes, demonstrating the requirement for more effective therapies. To our knowledge, this is the most comprehensive evaluation of contemporary treatment of AEC delivered in a community setting to date.
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Affiliation(s)
- Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona, Creighton University, Phoenix, AZ, USA.
| | - Gabriella Smith
- University of Arizona College of Medicine, Phoenix, AZ, USA.
| | - Julianne Lima
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
| | | | - Naufil Alam
- AstraZeneca Pharmaceuticals LP, Cambridge, UK.
| | | | | | - Dana Ghiorghiu
- Global Medicines Development, AstraZeneca, Cambridge, UK.
| | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
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18
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Ruz-Caracuel I, López-Janeiro Á, Heredia-Soto V, Ramón-Patino JL, Yébenes L, Berjón A, Hernández A, Gallego A, Ruiz P, Redondo A, Peláez-García A, Mendiola M, Hardisson D. Clinicopathological features and prognostic significance of CTNNB1 mutation in low-grade, early-stage endometrial endometrioid carcinoma. Virchows Arch 2021; 479:1167-1176. [PMID: 34420090 PMCID: PMC8724178 DOI: 10.1007/s00428-021-03176-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 12/28/2022]
Abstract
Low-grade and early-stage endometrioid endometrial carcinomas (EECs) have an overall good prognosis but biomarkers identifying patients at risk of relapse are still lacking. Recently, CTNNB1 exon 3 mutation has been identified as a potential risk factor of recurrence in these patients. We evaluate the prognostic value of CTNNB1 mutation in a single-centre cohort of 218 low-grade, early-stage EECs, and the correlation with beta-catenin and LEF1 immunohistochemistry as candidate surrogate markers. CTNNB1 exon 3 hotspot mutations were evaluated by Sanger sequencing. Immunohistochemical staining of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6), p53, beta-catenin, and LEF1 was performed in representative tissue microarrays. Tumours were also reviewed for mucinous and squamous differentiation, and MELF pattern. Nineteen (8.7%) tumours harboured a mutation in CTNNB1 exon 3. Nuclear beta-catenin and LEF1 were significantly associated with CTNNB1 mutation, showing nuclear beta-catenin a better specificity and positive predictive value for CTNNB1 mutation. Tumours with CTNNB1 exon 3 mutation were associated with reduced disease-free survival (p = 0.010), but no impact on overall survival was found (p = 0.807). The risk of relapse in tumours with CTNNB1 exon 3 mutation was independent of FIGO stage, tumour grade, mismatch repair protein expression, or the presence of lymphovascular space invasion. CTNNB1 exon 3 mutation has a negative impact on disease-free survival in low-grade, early-stage EECs. Nuclear beta-catenin shows a higher positive predictive value than LEF1 for CTNNB1 exon 3 mutation in these tumours.
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Affiliation(s)
- Ignacio Ruz-Caracuel
- Department of Pathology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
- Department of Pathology, Hospital Universitario Ramón Y Cajal, IRYCIS, 28034, Madrid, Spain
| | - Álvaro López-Janeiro
- Department of Pathology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
| | - Victoria Heredia-Soto
- Translational Oncology Research Laboratory, Hospital La Paz Institute for Health Research (IdiPAZ), 28046, Madrid, Spain
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, 28046, Madrid, Spain
| | - Jorge L Ramón-Patino
- Department of Medical Oncology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
- Department of Medical Oncology, Hospital Universitario Rey Juan Carlos, Móstoles, 28933, Madrid, Spain
| | - Laura Yébenes
- Department of Pathology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
- Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Alberto Berjón
- Department of Pathology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
- Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Alicia Hernández
- Department of Obstetrics & Gynecology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - Alejandro Gallego
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, 28046, Madrid, Spain
- Department of Medical Oncology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
| | - Patricia Ruiz
- Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Andrés Redondo
- Department of Medical Oncology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - Alberto Peláez-García
- Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Marta Mendiola
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, 28046, Madrid, Spain.
- Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - David Hardisson
- Department of Pathology, Hospital Universitario La Paz, IdiPAZ, 28046, Madrid, Spain.
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, 28046, Madrid, Spain.
- Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain.
- Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain.
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Sato K, Miyamoto M, Takano M, Tsuda H. MicroRNA-21 expression in cancer cells is an independent biomarker of progression-free survival of endometrioid endometrial carcinoma. Virchows Arch 2021; 479:883-891. [PMID: 34331128 DOI: 10.1007/s00428-021-03171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/27/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Endometrial carcinoma is one of the most common gynecological cancers. MicroRNA-21 (miR-21) is the most consistently overexpressed miRNA in almost all human cancer types, and it might be a useful clinical biomarker and therapeutic target. However, its precise localization and significance in endometrial carcinoma have not been clarified. This study aimed to examine miR-21 expression in endometrial carcinoma and reveal its clinicopathological importance. We investigated miR-21 expression by in situ hybridization (ISH) using locked nucleic acid (LNA)-modified probes in 230 endometrial carcinoma patients. We evaluated miR-21 expression in cancer cells and stroma separately. High miR-21 expression in cancer cells was significantly associated with higher histological grade and lymph node metastasis. In Kaplan-Meier analysis, high miR-21 expression in cancer cells was significantly associated with poor progression-free survival. In particular, in endometrioid carcinoma, high miR-21 expression in cancer cells was an independent prognostic factor associated with poor progression-free survival, as well as older age and higher International Federation of Gynecology and Obstetrics (FIGO) stage.
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Affiliation(s)
- Kimiya Sato
- Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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20
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Just PA, Genestie C. [Endometrial carcinomas in 2021: What to say and what to do?]. Ann Pathol 2021; 42:104-112. [PMID: 34340872 DOI: 10.1016/j.annpat.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
The treatment of endometrial carcinomas relies on histopathological data such as tumor type, grade, stage, and lymphovascular invasion. We herein present the recent advances in the pathological appreciation of these criteria, relying in the last 2020 WHO classification of female genital tumours. Furthermore, molecular typing of endometrial carcinoma has become a rule with strong prognostic and therapeutic implications. The TP53-mutated/serous-like and hypermutated/dMMR groups can be easily identified by the pathologist using immunohistochemistry. The ultramutated/POLE-mutated group identification requires sequencing technologies. We herein explain how easily incorporate this novel histomolecular classification, now included in scholarly society recommendations, in the pathologist routine.
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Affiliation(s)
- Pierre-Alexandre Just
- Université de Paris, APHP.Centre, site Cochin, service de Pathologie, 27, rue du Faubourg Saint-Jacques, 75014 Paris cedex 14, France.
| | - Catherine Genestie
- Gustave Roussy, département de biologie et pathologie médicales, 114, rue Édouard Vaillant, 94800 Villejuif, France
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Yu J, Fan Q, Li L. The MCM3AP-AS1/miR-126/VEGF axis regulates cancer cell invasion and migration in endometrioid carcinoma. World J Surg Oncol 2021; 19:213. [PMID: 34256796 PMCID: PMC8278665 DOI: 10.1186/s12957-021-02316-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Long non-coding RNA (lncRNA) MCM3AP-AS1 plays an oncogenic role in several malignancies, but its role in endometrioid carcinoma (EC) is unclear. This study was carried out to explore the role of MCM3AP-AS1 in EC. METHODS A total of 60 EC patients were enrolled in this study. Expression levels of MCM3AP Antisense RNA 1 (MCM3AP-AS1), microRNA-126 (miR-126), and vascular endothelial growth factor (VEGF) in tissues and transfetced cells were measured by RT-qPCR. Cell transfections were performed to explore the interaction among MCM3AP-AS1, miR-126 and VEGF. Transwell assays were perfromed to evaluate the invasion and migration abilities of HEC-1 cells after transfection. RESULTS MCM3AP-AS1 was upregulated in EC and predicted poor survival. MCM3AP-AS1 directly interacted with miR-126. In EC cells, overexpression of MCM3AP-AS1 and miR-126 did not significantly affect the expression of each other. In addition, overexpression of MCM3AP-AS1 increased the expression levels of VEGF, a target of miR-126. Moreover, overexpression of MCM3AP-AS1 and VEGF increased the migration and invasion rates of EC cells, while overexpression of miR-126 suppressed these cell behaviors. Overexpression of MCM3AP-AS1 attenuated the role of miR-126 in cell invasion and migration. CONCLUSIONS Therefore, MCM3AP-AS1 may serve as a competing endogenous RNA (ceRNA) of miR-126 to upregulate VEGF, thereby regulating cancer cell behaviors in EC.
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Affiliation(s)
- Jie Yu
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, 266003, People's Republic of China
| | - Qiqi Fan
- Department of Liver Diseases, The Sixth People's Hospital of Qingdao, Qingdao City, Shandong Province, 266000, People's Republic of China
| | - Lingling Li
- Department of Reproductive Medicine, Qingdao Municipal Hospital, No.5 Donghai Road Shinan District, Qingdao City, Shandong Province, 266071, People's Republic of China.
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Abstract
Diffuse adenomyosis, focal adenomyosis, ovarian endometrioma, superficial endometriosis and deep infiltrating adenomyosis are all defined by the presence of an endometrioid tissue in an ectopic location that is at distance from the endometrium. Although frequently associated, these lesions represent different clinico-pathological entities that the pathologist should recognized. Herein, we review the clinical and pathological features of these entities, as well as related current physiopathological understandings and differential diagnoses that could be raised by some morphological variants. The statistical association between endometriosis and several ovarian tumors, mainly endometrioid and clear cell carcinomas and seromucinous borderline tumors is well established and we present some molecular and morphological features that support this transformation potential.
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Affiliation(s)
- Pierre-Alexandre Just
- Université de Paris, service de pathologie, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Sandrine Moret
- Université de Paris, service de pathologie, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Bruno Borghese
- Université de Paris, service de gynécologie obstétrique 2 et médecine de la reproduction, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Charles Chapron
- Université de Paris, service de gynécologie obstétrique 2 et médecine de la reproduction, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Abstract
Background Endometrioid-type endometrial carcinoma is the most common malignancy of the female genital tract in developed countries. The prognosis greatly depends on the grade and stage of the disease. Aims In some patients, the disease recurs in a short time after the surgical/medical therapy. Hence, it is important to predict the patients who will have worse prognosis at the beginning, to choose the appropriate treatment; resuming the search of new prognostic markers. Therefore, our study aimed to detect trophoblast cell surface antigen 2 (TROP2) as a new prognostic marker. Settings and Design The patients who underwent a hysterectomy and diagnosed with endometrioid-type endometrial carcinoma were evaluated retrospectively and TROP2 immunostain was performed to their tumoral slides. Materials and Methods We evaluated TROP2 expressions in 102 patients immunohistochemically who underwent hysterectomy with the diagnosis of endometrioid-type endometrial carcinoma histopathologically and correlated them with the other generally accepted prognostic parameters. Statistical Analysis The Kolmogorov-Smirnov test and Q-Q plot test were used to verify the normality of the distribution of continuous variables. The Chi-square/Fisher's exact tests were used for categorical variables. Analyses were performed with SPSS Statistics for Windows, Version 20. Results High overexpression of TROP2 was seen in larger, higher-grade, deeper-invasive tumors, tumors with vascular invasion, and pelvic-lymph-node metastasis. These results were statistically significant (P ≤ 0.05). Conclusion Overexpression of TROP2 in endometrioid-type endometrial carcinoma seems to be a poor prognostic factor; it may be useful in determining the biologically more aggressive tumors before the treatment. This early determination is very important to choose the appropriate surgery, adjuvant-treatments, and follow-up.
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Affiliation(s)
- Serkan Y Celik
- Department of Pathology, Faculty of Medicine, Sıtkı Kocman University, Muğla, Turkey
| | - Özgür İlhan Çelik
- Department of Pathology, Faculty of Medicine, Sıtkı Kocman University, Muğla, Turkey
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Elsherif SB, Bhosale PR, Lall C, Menias CO, Itani M, Butler KA, Ganeshan D. Current update on malignant epithelial ovarian tumors. Abdom Radiol (NY) 2021; 46:2264-80. [PMID: 34089360 DOI: 10.1007/s00261-021-03081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023]
Abstract
Epithelial ovarian cancer (EOC) represents the most frequently occurring gynecological malignancy, accounting for more than 70% of ovarian cancer deaths. Preoperative imaging plays an important role in assessing the extent of disease and guides the next step in surgical decision-making and operative planning. In this article, we will review the multimodality imaging features of various subtypes of EOC. We will also discuss the role of imaging in the staging, management, and surveillance of EOC.
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25
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Kato MK, Yoshida H, Uehara T, Uno M, Ishikawa M, Miyasaka N, Kato T. Unique prognostic features of grade 3 endometrioid endometrial carcinoma: Findings from 101 consecutive cases at a Japanese tertiary cancer center. Taiwan J Obstet Gynecol 2021; 60:238-44. [PMID: 33678322 DOI: 10.1016/j.tjog.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The prognosis of and optimal treatment for grade 3 endometrioid endometrial carcinoma (G3EEC) currently remain unclear. This study aimed to clarify the baseline recurrence risk in patients with early-stage (stage I-II) G3EEC without adjuvant therapy and the prognosis of patients with advanced-stage (stage III-IV) G3EEC. MATERIALS AND METHODS A total of 101 patients with pathologically confirmed G3EEC from 1997 to 2018 were identified. Their clinicopathological characteristics and survival outcomes were reviewed retrospectively. Disease-free survival and overall survival values were estimated according to the Kaplan-Meier method and compared using a log-rank test. RESULTS Recurrence was observed in eight (13%) of 63 patients with early-stage G3EEC, none of whom had received adjuvant therapy. The 5-year disease-free survival and 5-year overall survival rates for these patients were 86.7% and 96.4%, respectively. Recurrence was also observed in 12 (41%) of 29 patients with stage III G3EEC. The 5-year overall survival rates for stage III patients who underwent adjuvant chemotherapy and adjuvant radiotherapy were 85.6% and 42.9%, respectively. The 3-year overall survival rate among stage IVB patients was only 12.7% despite multidisciplinary treatment provision. CONCLUSION Our study newly demonstrates that patients with early-stage G3EEC have a favorable prognosis and a low recurrence rate in the absence of adjuvant therapy. In patients with stage III G3EEC, adjuvant chemotherapy was more beneficial than adjuvant radiotherapy. The poor prognosis of patients with stage IV G3EEC indicates the need for more effective treatments. Unique therapeutic approaches based on staging are recommended for treatment of G3EEC.
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Sao CH, Lai WA, Lin SC, Chang CM, Chen YJ, Wang PH. Endometriosis-associated epithelial ovarian cancer: Primary synchronous different cellular type on each ovary. Taiwan J Obstet Gynecol 2021; 59:460-463. [PMID: 32416900 DOI: 10.1016/j.tjog.2020.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Endometriosis-associated epithelial ovarian cancer (EOC) is a specific category of EOC, containing either endometrioid or clear cell carcinoma subtype. The characteristic of endometriosis-associated EOC includes an early stage at the diagnosis, presence of single histology type, and better prognosis. The synchronous two subtypes of endometriosis-associated EOC and presentation of far-advanced stage status at the initial diagnosis is rarely reported. CASE REPORT We reported a 60-year-old postmenopausal woman with FIGO IA endometriosis-associated endometrioid carcinoma at right ovary and FIGO IVA endometriosis-associated clear cell carcinoma at left ovary, right tube, omentum, lymph node and cytology of pleural effusion and ascites treated with optimal debulking surgery and dose-intensity taxane/platinum based chemotherapy. CONCLUSION This case report confirms the long-term concept that clear cell carcinoma has much more aggressive behavior than endometrioid cell carcinoma does, regardless of association of endometriosis or not.
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Affiliation(s)
- Chih-Hsuan Sao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-An Lai
- Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Chieh Lin
- Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Ming Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Female Cancer Foundation, Taipei, Taiwan.
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27
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Hagemann IS, Deng W, Zaino RJ, Powell MA, Gunderson C, Cosgrove C, Mathews C, Pearl ML, Waggoner S, Ghebre R, Lele S, Guntupalli S, Secord AA, Ioffe O, Park K, Rasty G, Singh M, Soslow R, Creasman W, Mutch DG. The presence of an endometrioid component does not alter the clinicopathologic profile or survival of patients with uterine serous cancer: A gynecologic oncology group (GOG/NRG) study of 934 women. Gynecol Oncol 2021; 160:660-668. [PMID: 33423806 DOI: 10.1016/j.ygyno.2020.12.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While most cases of endometrial cancer can readily be classified as pure endometrioid, pure serous, or another type, others show an apparent mixture of serous and endometrioid components, or indeterminate serous versus endometrioid features. Since serous histology carries a worse prognosis than endometrioid, Gynecologic Oncology Group protocol GOG-8032 was established to examine whether the presence of a non-serous component is a favorable feature in an otherwise serous cancer. METHODS 934 women with serous cancer were prospectively identified among a larger group enrolled in GOG-0210. Six expert gynecologic pathologists classified each case as pure serous (SER, n=663), mixed serous and endometrioid (SER-EM-M, n=138), or indeterminate serous v. endometrioid (SER-EM-I, n=133) by H&E morphology. Follow-up data from GOG-0210 were analyzed. RESULTS The subgroups did not differ on BMI, race, ethnicity, lymphovascular invasion, cervical invasion, ovary involvement, peritoneal involvement, omental involvement, FIGO stage, or planned adjuvant treatment. SER-EM-M patients were younger (p=0.0001) and less likely to have nodal involvement (p=0.0287). SER patients were less likely to have myoinvasion (p=0.0002), and more likely to have adnexal involvement (p=0.0108). On univariate analysis, age, serous subtype, race, and components of FIGO staging predicted both progression-free and overall survival. On multiple regression, however, serous subtype (SER, SER-EM-M, or SER-EM-I) did not significantly predict survival. CONCLUSIONS There were few clinicopathologic differences between cases classified as SER, SER-EM-M, and SER-EM-I. Cases with a mixture of serous and endometrioid morphology, as well as cases with morphology indeterminate for serous v. endometrioid type, had the same survival as pure serous cases. NCT#: NCT00340808.
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Affiliation(s)
- Ian S Hagemann
- Washington University School of Medicine, St. Louis, MO, USA.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | | | | | - Camille Gunderson
- University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, USA.
| | - Casey Cosgrove
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | | | - Michael L Pearl
- Stony Brook University Medical Center, Stony Brook, NY, USA.
| | | | - Rahel Ghebre
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | | | | | | | - Olga Ioffe
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Kay Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | | | - Robert Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - William Creasman
- Medical University of South Carolina Medical Center, Charleston, SC, USA.
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA.
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Han J, Kim HS. Abdominopelvic Metastasis of Endometrial Serous Carcinoma Initially Misdiagnosed as Early-Stage Low-Grade Endometrioid Carcinoma: The Importance of Recognizing Minimal Uterine Serous Carcinoma. Case Rep Oncol 2020; 13:1537-1544. [PMID: 33564295 PMCID: PMC7841739 DOI: 10.1159/000511701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 11/24/2022] Open
Abstract
Minimal uterine serous carcinomas (MUSCs) include serous carcinomas with invasion confined to the endometrium (superficial serous carcinoma) and those without stromal invasion (serous endometrial intraepithelial carcinoma). Although these tumors are confined to the endometrium proper, they have highly metastatic potential for disseminating to extra-uterine sites. We report here a case of MUSC that was initially misdiagnosed as early-stage low-grade endometrioid carcinoma but later metastasized to the abdominopelvic peritoneum. The patient was a 61-year-old woman who was diagnosed with grade 1 endometrioid carcinoma of the endometrium and underwent total hysterectomy. Because the tumor was confined to the endometrium (International Federation of Gynecology and Obstetrics stage IA), no further treatment was performed. However, several metastatic tumor masses were detected in the vaginal stump and abdominopelvic peritoneum 7 years after the surgery. Histologically, the metastatic tumor tissues showed high-grade carcinoma. A review of previous hysterectomy slides showed multiple separate foci of atypical glandular proliferation measuring up to 0.8 cm in the greatest dimension and consisting of markedly atypical cells involving the surface and atrophic glands. The tumor showed a predominantly glandular architecture without evident papillary growth or stromal invasion. However, it had large, pleomorphic nuclei showing a high nuclear-to-cytoplasmic ratio, conspicuous eosinophilic nucleoli, and numerous mitotic figures. Characteristically, the tumor showed marked nuclear atypia immediately appreciated at low magnification in the background of well-formed glandular structures, indicating a significant discordance between nuclear and architectural features. On immunostaining, both the uterine and metastatic tumor tissues exhibited diffuse and strong p16 expression and mutant pattern of p53 expression, confirming the diagnosis of serous carcinoma. In summary, the case findings support that failure to preoperatively recognize high-risk endometrial carcinoma is associated with worse outcomes. Complete surgical staging and accurate pathological diagnosis are critical for patients with serous carcinoma even at the early clinical stage.
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Affiliation(s)
- Jiheun Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Hwang I, Lee J, Choi KH, Han J, Kim HS. Superficially Spreading Endocervical Adenocarcinoma in situ with Multifocal Microscopic Involvement of the Endometrial Surface: A Case Report with Emphasis on the Potential for Misdiagnosis Based on Endometrial Curettage Specimens. Case Rep Oncol 2020; 13:1530-1536. [PMID: 33564294 PMCID: PMC7841731 DOI: 10.1159/000511568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
Misdiagnosis of endocervical adenocarcinoma (EAC) as endometrial endometrioid carcinoma (EEC) is one of the major concerns when evaluating endometrial curettage specimens. It is difficult to differentiate EAC involving the endometrium from EEC, particularly when the specimens have only a few small tumor fragments. We report a case of endocervical adenocarcinoma in situ (AIS) with multifocal microscopic involvement of the endometrium. The endometrial curettage specimen obtained from an 82-year-old woman consisted of a large volume of blood and fibrin, with small endometrial tissue fragments showing microscopic foci of atypical glandular proliferation. Based on the presence of complex glands with stratified mucin-poor columnar epithelium and intermediate-grade nuclear atypia, a preoperative diagnosis of grade 1 EEC was made. However, the hysterectomy specimen revealed an endocervical AIS involving the endocervix and low uterine segment. Frequent mitotic figures and apoptotic bodies, characteristic of AIS, were present. The endometrium showed a few microscopic foci of atypical glandular proliferation involving the surface only. Their histological features were similar to those of the endocervical AIS. Immunohistochemically, the atypical glands exhibited block p16 positivity. The final diagnosis was a superficially spreading endocervical AIS with multifocal microscopic involvement of the endometrial surface epithelium. In summary, small tumor tissues in an endometrial curettage may lead to misdiagnosis of AIS or EAC as EEC, especially when the pathologists are unaware of the possibility of microscopic endometrial involvement of AIS or EAC. The origin of the tumor can be correctly determined based on a combination of histological features and immunostaining. Endocervical AIS involving the endometrium should be included in the differential diagnosis of neoplastic glandular lesions in endometrial curettage specimens. An accurate diagnosis in these cases is important because of its significant implications for clinical management.
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Affiliation(s)
- Inwoo Hwang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jiyeon Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyue-Hee Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jiheun Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Romero I, Rubio MJ, Medina M, Matias-Guiu X, Santacana M, Schoenenberger JA, Guerra EM, Cortés A, Minig L, Coronado P, Cueva JF, Gómez L, Malfettone A, Sampayo M, Llombart-Cussac A, Poveda A. An olaparib window-of-opportunity trial in patients with early-stage endometrial carcinoma: POLEN study. Gynecol Oncol 2020; 159:721-31. [PMID: 32988624 DOI: 10.1016/j.ygyno.2020.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Olaparib is a potent inhibitor of poly(ADP-ribose) polymerase (PARP)-1, 2, and 3 with potential activity in endometrial cancer (EC). METHODS In this window-of-opportunity trial, women with operable type 1 EC received olaparib oral tablets (300mg) twice daily for 28days before surgery. The primary objective was to evaluate the effects of olaparib on EC in tissue samples taken at baseline and at treatment completion. Signal of activity was defined as significant changes in the expression of the cell cycle-related proteins cyclin D1, Ki67, and cleaved caspase-3. RESULTS A total of 31 patients were included in the biomarker analysis. The median time of olaparib exposure was 24 days (1-39). Significant inhibition was found for cyclin D1 (p < 0.01), but not for Ki67 and active caspase 3 immunostaining. PARP-1 levels positively correlated with cyclin D1 levels (rho = 0.661, p = 0.0001). Both PARP-1 and cyclin D1 levels were significantly lower (p = 0.022 and p = 0.004, respectively) in patients with ARID1A[-] tumors than ARID1A[+] tumors. A significant relationship between plasma olaparib concentrations and decreased GLUT1 activity was observed (r = -0.5885; p < 0.05). Drug-related toxicity consisted mostly of gastrointestinal and grade 1 or 2 adverse events. CONCLUSIONS Olaparib reduced expression of cyclin D1, which positively correlated with PARP-1 levels. This effect was more evident in ARID1A-deficient tumors. Olaparib further induced inhibition of GLUT1 plasma activity. Our findings could have noteworthy implications in predicting which patients with EC would benefit from olaparib-based strategies.
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31
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Taga Y, Chigusa Y, Minamiguchi S, Kido A, Horikawa N, Horie A, Hamanishi J, Kondoh E, Mandai M, Yamaguchi K. Three cases of seromucinous carcinoma of the ovary arising in endometriotic cysts. Int Cancer Conf J 2021; 10:46-53. [PMID: 33489701 DOI: 10.1007/s13691-020-00447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022] Open
Abstract
Ovarian seromucinous carcinoma (SMC) is an uncommon neoplasia and is composed predominantly of serous and endocervical-type mucinous epithelium. Due to its low frequency and difficult diagnosis, the natural history, characteristic imaging findings, and pathological features of SMC have not been adequately described in the literature thus far. We herein report three cases of ovarian SMC along with magnetic resonance imaging (MRI) findings. The diagnosis of SMC was made after staging laparotomy in all cases, and systemic chemotherapy was performed in two cases. No recurrence was observed in any of the cases. The MRI findings in SMC were so varied that characteristic imaging features useful for diagnosis were not found. In two cases, MRI suggested endometriotic cysts, and endometriosis and seromucinous borderline tumors (SMBTs) were detected concurrently in all cases by histological examination. Thus, it was suggested that SMC develops in multiple stages via endometriosis and SMBT. The cooccurrence of endometriosis and SMBT could also make the diagnosis of SMC more convincing.
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32
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Kageyama S, Mori N, Mugikura S, Tokunaga H, Takase K. Gaussian mixture model-based cluster analysis of apparent diffusion coefficient values: a novel approach to evaluate uterine endometrioid carcinoma grade. Eur Radiol 2021; 31:55-64. [PMID: 32725334 DOI: 10.1007/s00330-020-07047-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/01/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of our study was to perform Gaussian mixture model (GMM)-based cluster analysis of the apparent diffusion coefficient (ADC) data of patients with endometrioid carcinoma, and to evaluate the relationship between histological grade and the ratios of the different clusters in each patient. METHODS This retrospective study enrolled 122 patients (training: n = 63; and validation: n = 59) imaged between May 2015 and February 2020. In the training cohort, manual segmentation was performed on the ADC maps to obtain the ADC data of each patient, and these ADC data were summated to obtain the "All-patient" ADC data. Cluster analysis (three clusters) was performed on this All-patient ADC data, and the ADC ranges of each cluster were defined as follows: cluster 1, 490-699 × 10-6 mm2/s; cluster 2, 700-932 × 10-6 mm2/s; and cluster 3, over 933 × 10-6 mm2/s. In the training and validation cohorts, the ADC data of each patient was classified into three clusters according to these ADC ranges. The cluster ratios of each patient were calculated and compared with histological grade. RESULTS In the training cohort, a significant positive correlation was found between the cluster 1 ratio and histological grade (ρ = 0.34, p = 0.0059). The cluster 1 ratios of high-grade lesions (grade 3) were significantly higher than those of low-grade lesions (grades 1 and 2) (p = 0.0084). A similar significant positive correlation was found between the cluster 1 ratio and histological grade in the validation cohort (ρ = 0.44, p = 0.0006). CONCLUSIONS The cluster 1 ratio containing voxels with low ADC was significantly correlated with the histological grade of endometrioid carcinoma. KEY POINTS • We performed Gaussian mixture model (GMM)-based cluster analysis of the apparent diffusion coefficient (ADC) data of patients with endometrioid carcinoma. • The cluster 1 ratio, which included low ADC values, was significantly positive correlated with histological grade in the training and validation cohorts. • The GMM-based cluster analysis of voxel-based ADC data was effective for grading endometrioid carcinoma.
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Wei XX, He YM, Jiang W, Li L. Ovarian endometrioid carcinoma resembling sex cord-stromal tumor: A case report. World J Clin Cases 2020; 8:2623-2628. [PMID: 32607341 PMCID: PMC7322421 DOI: 10.12998/wjcc.v8.i12.2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/06/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ovarian endometrioid carcinoma resembling sex cord-stromal tumor (ECSCSs) is rare.
CASE SUMMARY We present a rare case of primary ECSCSs in the left ovary. A 39-year-old female patient had persistent dull pain in the lower abdomen for more than 1 mo, and she was initially diagnosed with pelvic inflammatory disease at a hospital. The patient received transabdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymph node dissection at our hospital and finally diagnosed with ECSCSs. After the operation, the patient received eight courses of cisplatinum + etoposide + bleomycin chemotherapy treatment and no evidence of tumor recurrence or metastasis was found in a 2-year follow-up period.
CONCLUSION Ovarian endometrioid carcinoma is similar to the ovary sex cord-stromal tumor, especially when the cord-like structure is obvious. The clinical diagnosis for this tumor is difficult before surgery and pathology examination. The necessary immunohistochemical markers are of positive significance for assisting diagnosis and differential diagnosis.
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Affiliation(s)
- Xiao-Xia Wei
- Department of Pathology, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu 610041, Sichuan Province, China
| | - Yan-Mei He
- Department of Pathology, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu 610041, Sichuan Province, China
| | - Wei Jiang
- Department of Pathology, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu 610041, Sichuan Province, China
| | - Lei Li
- Department of Pathology, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu 610041, Sichuan Province, China
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Rekhi B, Menon S, Deodhar KK, Ghosh J, Chopra S, Maheshwari A. Clinicopathological features of 50 mismatch repair (MMR)-deficient endometrial carcinomas, tested by immunohistochemistry: A single institutional feasibility study, India. Ann Diagn Pathol 2020; 47:151558. [PMID: 32619922 DOI: 10.1016/j.anndiagpath.2020.151558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/30/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022]
Abstract
There are few comprehensive studies from Asia on clinicopathologic features of mismatch repair (MMR)-deficient endometrial carcinomas, including rarely from our country. One hundred and four cases of endometrial carcinomas were tested for four MMR proteins by immunohistochemistry. Among 50 MMR-deficient (MMRd) tumors(48%), age-range was 27-68 years(median = 53) and tumor size(n = 34) varied from 1.2-10 cm(average = 4.6). Lower uterine segment(LUS) was involved in 21/31 cases(67.7%). Histopathologically, all cases were endometrioid adenocarcinomas(EMACs), of FIGO grade 2(low-grade)(18 cases) and 3(high-grade)(32 cases), displaying de-differentiated, undifferentiated and lymphoepithelioma(LE)-like patterns, in 24 cases(48%). Tumor infiltration ≥ half of myometrium was seen in 30/44 cases (68.1%); lymphovascular emboli in 19/43 cases(44.1%); and lymph node metastasis in 7/22(31.8%) cases. Uncommonly, clear cell component(n = 2) and focal neuroendocrine differentiation (n = 2) were observed. Immunohistochemically, tumor cells showed paired loss of MLH1 and PMS2 in 33(66%) and MSH2 and MSH6 in 14(28%) cases, along with loss of MSH2 and PMS2, in two and a single case, respectively. Nine patients(18%) were treated for another cancer and 9/33(27.2%) disclosed familial history of cancer. MSH2 was the most frequently lost MMR protein in those cases. Additionally, tumor cells displayed ER positivity in 41/50 cases(82%), PR in 38/41cases(92.6%) and wild-type p53 staining in 24/28 cases(85.7%). Tumor with LE-pattern showed PDLI immunoexpression. Certain clinicopathologic features suggestive for MMRd associated ECs, such as relatively large-sized tumors, involving LUS; especially high-grade, infiltrative EMACs, with undifferentiated/de-differentiated, and LE-like patterns; showing deep muscle invasion, frequent PR immunoexpression and invariably, wild-type p53 immunostaining can be useful in screening cases of Lynch syndrome. This constitutes the first report on these tumors from our country.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India.
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Kedar K Deodhar
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Supriya Chopra
- Department of Surgical Oncology (Gynecology), Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Amita Maheshwari
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
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Bedell S, Chang Z, Burt C, Khalifa MA, Argenta PA. Incisional carcinoma of Mullerian Origin: A case report and review of literature. Gynecol Oncol Rep 2020; 33:100588. [PMID: 32490125 PMCID: PMC7262414 DOI: 10.1016/j.gore.2020.100588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022] Open
Abstract
Incisional carcinoma is a rare, often delayed, complication of surgery. Primary incisional carcinoma can occur in the presence or absence of endometriosis. Translocation of benign cells surgery may be a common mode of development.
Primary incisional carcinoma (PIC) is a rare, delayed complication of surgery, usually attributed to the malignant transformation of endometriosis. We report a case of incisional carcinoma with nodal metastases in a 55-year-old woman, 18 years after cesarean section. She underwent extirpative surgery, including hysterectomy and bilateral salpingo-oophorectomy, without intraperitoneal disease identifed. Adjuvant treatment included sandwiched platinum-based chemotherapy (carboplatin and paclitaxel) and radiation. She remains disease-free 8 months after completing therapy. We identified 46 additional reported cases. Of these, >90% had undergone an “endometrium-exposing” surgery, most commonly cesarean section; while no cases followed adnexal-only surgery. The median time between antecedent surgery and presentation was 18 years. At presentation, tumors were often large (median 8 cm), and symptomatic with pain (63%) and/or mass (26%). Serum CA125 levels were commonly, albeit slightly, elevated (median 57U/ml (IQR 22–96, Range 6–1690)). Lymph node metastases were common (35%), with most following a vulvar-type spread pattern (inguinal first). Most patients (63%) were treated with chemotherapy +/− radiation. Approximately 50% of patients recurred promptly (median < 6 months), but long-term survival was reported following combined chemotherapy/radiation. Lymph node metastases portended a shorter disease-free interval, with 73% of cases recurring (median 5 months) despite chemotherapy-based treatment. These data suggest that some incisional carcinomas may result from displacement of healthy endometrium followed by delayed malignant transformation. Chemotherapy-only and radiation-only treatments are attended by modest prognosis. Taken together, these data suggest there is both need and potential avenues for improved prevention, detection, and treatment of this condition.
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Affiliation(s)
- Sabrina Bedell
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Zenas Chang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Cassaundra Burt
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Mahmoud A Khalifa
- Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Peter A Argenta
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
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Nisar M, Mushtaq S, Hassan U, Akhtar N, Azma M. Androgen Receptor Expression In Endometrial Carcinoma And Its Correlation With Estrogen Receptor And Progesterone Receptor And Clinicopathological Findings. J Ayub Med Coll Abbottabad 2020; 32:160-164. [PMID: 32583986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The objective of the study is to analyze the expression of androgen, estrogen and progesterone receptor in different types of endometrial carcinomas and to correlate the androgen receptor expression with estrogen and progesterone receptor and the clinicopathological parameters like lymphovascular invasion, grade of the tumour, size of tumour and extent of myometrial invasion.. METHODS It is a cross-sectional analytical study design with a simple random sample of a total of 54 cases of different types of endometrial carcinomas from the year 2017. Immunohistochemical stains androgen receptor, estrogen receptor, and Progesterone receptor were applied in all the cases. The Pearson Chi-square test of independence was applied to measure association and P-value is calculated to check the significance of the results. RESULTS Androgen receptor expression was observed in 73% of low-grade endometrioid carcinomas, 62.5% of high-grade endometrioid carcinomas, 62% of serous, 20% of clear cell and 18% of carcinosarcomas, respectively. Androgen positive tumours were also positive for estrogen and progesterone in most of the cases, except 3 serous carcinomas and one low-grade endometrioid carcinoma. However, no significant relation was observed between androgen expression and prognostic parameters like the lymphovascular invasion, size of the tumour and myometrial invasion. CONCLUSIONS Maximum expression of androgen receptor was observed in endometrioid and serous carcinomas, while carcinosarcomas and clear cell carcinomas showed minimum expression with no significant correlation between androgen receptor expression and clinicopathological parameters.
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Affiliation(s)
- Maryam Nisar
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Sajid Mushtaq
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Usman Hassan
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Noreen Akhtar
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Muhammad Azma
- Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
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Sato K, Miyamoto M, Takano M, Tsuda H. Correlation of high LAT1 expression with the prognosis of endometrioid carcinoma of the uterine corpus. Virchows Arch 2020; 477:421-7. [PMID: 32144539 DOI: 10.1007/s00428-020-02781-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 01/29/2023]
Abstract
The expression of L-type amino acid transporter 1 (LAT1) has been described to play essential roles in cancer cell growth and survival. To determine the significance of LAT1 in the prognosis of endometrial endometrioid carcinoma, we investigated LAT1 expression in 353 endometrioid carcinoma patients by immunohistochemical analysis using tissue microarray. The tumors in which stained tumor cells made up more than 25% of the tumor were graded as high expression. High expression of LAT1 was detected in 29 (8.2%) of patients. The ratio of high LAT1 expression did not significantly differ by age (< 60 vs. ≥ 60), FIGO stage (stage I/II vs. III/IV), histological grade (grade 1 vs. grade 2/3), or lymph node metastasis (positive vs. negative). However, high LAT1 expression in endometrioid carcinoma was associated with a poorer progression-free survival and overall survival, as per the results of the log-rank test (P = 0.0263 and 0.0404, respectively). Cox univariate and multivariate analyses revealed that high LAT1 expression is an independent marker of poor progression-free survival (hazard ratio = 2.598, P = 0.0137), in addition to a higher age (≥ 60 years vs. < 60 years), FIGO stage (stage III/IV vs. I/II), and histological grade (grade 2/3 vs. grade 1). In conclusion, we demonstrate that LAT1 is associated with a poor prognosis of endometrioid carcinoma of the uterine corpus.
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Abstract
This review is an appraisal of the current state of knowledge of 2 enigmatic histotypes of ovarian carcinoma: endometrioid and clear cell carcinoma. Both show an association endometriosis and the hereditary nonpolyposis colorectal cancer (Lynch) syndrome, and both typically present at an early stage. Pathologic and immunohistochemical features that distinguish these tumors from high-grade serous carcinomas, each other, and other potential mimics are discussed, as are staging, grading, and molecular pathogenesis.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA, USA.
| | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, 20 York Street, EP2-607, New Haven, CT 06510, USA
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Abstract
This review discusses select fallopian tube entities and their associated mimics. It first focuses on adenomatoid tumors, the most common benign tumor of the fallopian tube. High-grade serous carcinoma and its precursor, serous tubal intraepithelial carcinoma, are then addressed. Finally, attention is turned to endometrioid proliferations of the fallopian tube. A diagnostic approach is provided for these lesions, with an emphasis on differential diagnoses and situations in which a benign lesion may appear malignant, and vice-versa.
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Affiliation(s)
- David L Kolin
- Division of Women's and Perinatal Pathology, Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Matsubayashi H, Higashigawa S, Kiyozumi Y, Horiuchi Y, Hirashima Y, Kado N, Abe M, Ohishi T, Ohnami S, Urakami K, Yamaguchi K. Metachronous ovarian endometrioid carcinomas in a patient with a PTEN variant: case report of incidentally detected Cowden syndrome. BMC Cancer 2019; 19:1014. [PMID: 31664961 PMCID: PMC6819610 DOI: 10.1186/s12885-019-6272-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Somatic PTEN mutation occurs in a proportion of ovarian endometrioid carcinomas. However, these cancers have seldom been reported in diseases associated with germline PTEN variants, such as Cowden syndrome (CS). Case presentation The present case was a 39-year-old woman with a left ovarian carcinoma who demonstrated a germline splice variant of PTEN (c.1026 + 1G > T) following genome-wide whole exome sequencing of her germline DNA. Histology of her resected tumor revealed endometrioid carcinoma of the same type as a right ovarian cancer resected eight years previously. These tumors showed null immunostaining for PTEN. She was genetically diagnosed with CS. Despite her clinical examinations had demonstrated several characteristic findings of CS, including mammary fibroma, esophageal and skin papilloma, colonic hamartoma, uterine myoma, and lipoma, the clinicians could not approach this diagnosis. Conclusion Ovarian endometrioid carcinoma is generally thought to develop from endometrial tissue menstruated from the uterus and implanted on the ovary. To date, ovarian cancers have not been listed as CS-related cancers; however, ovarian endometrioid cancer can have a potential association with CS in endometriosis cases.
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Affiliation(s)
- Hiroyuki Matsubayashi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan. .,Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, Japan.
| | - Satomi Higashigawa
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Yoshimi Kiyozumi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Yasue Horiuchi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Yasuyuki Hirashima
- Division of Gynecology Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Nobuhiro Kado
- Division of Gynecology Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Masato Abe
- Division of Pathology Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Takuma Ohishi
- Division of Pathology Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Sumiko Ohnami
- Research Institution of Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Kenichi Urakami
- Research Institution of Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Ken Yamaguchi
- Research Institution of Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
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Höhn AK, Brambs CE, Opitz S, Erber R, Hartmann A, Horn LC. [Un- and dedifferentiated endometrial carcinoma : A rare entity with a wide range of differential diagnosis]. Pathologe 2019; 40:609-618. [PMID: 31578630 DOI: 10.1007/s00292-019-00670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dedifferentiated endometrial carcinomas (ECs) are composed of undifferentiated EC and a FIGO grade 1 or 2 endometrioid carcinoma. The undifferentiated component represents a malignant epithelial neoplasm with no obvious differentiation and immunohistochemical loss of PAX8, E‑cadherin and focal expression of EMA and/or CK18 and the predominant presence of nuclear staining for INI1 (SMARCB1) and BRG1 (SMARCA4). The main differential diagnoses include poorly differentiated endometrioid EC, neuroendocrine carcinoma, lymphoma, plasmocytoma, high-grade endometrial stromal sarcomas, undifferentiated uterine sarcomas (UUS), carcinosarcomas, and metastases to the endometrium. The histogenesis is not yet fully understood and molecular data are still limited. Some tumors represent a loss of MHL1 and PMS2 staining due to MLH1-promotor methylation. Rare cases are associated with Lynch syndrome or POLE mutation. The un- or dedifferentiated EC represents a high-grade endometrial carcinoma that requires extended surgery and indicates a poor prognosis. In cases with mismatch repair protein deficiency or POLE mutation, immuno-oncological treatment with checkpoint inhibitors are a therapeutic option.
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Affiliation(s)
- A K Höhn
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - C E Brambs
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
| | - S Opitz
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
| | - R Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Hartmann
- Pathologisches Institut, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - L-C Horn
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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Abstract
The 2014 WHO classification distinguishes between endometrial hyperplasia without atypia (EH) and atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (AEH/EIN). AEH/EIN is characterized by crowded glands with cytologically atypical epithelium separated by little intervening stroma. Cellular atypia is characterized by nuclear enlargement and rounding, pleomorphism, loss of polarity, and presence of nucleoli. The diagnosis of atypia is facilitated by comparison with areas of adjacent normal and non-atypical glands, respectively. AEH/EIN is often associated with squamous but also secretory and mucinous metaplasia. Loss of PTEN and/or PAX2 immunoreactivity occurs in up to two thirds of AEH/EIN. In contrast, invasive low-grade endometrioid carcinoma shows confluent growth with loss of stroma and formation of labyrinth-like or cribriform structures. Differential diagnosis includes different forms of metaplasias, papillary proliferations, and hyperplastic polyps. Epithelial metaplasia may be present in various benign endometrial lesions as well as in endometrioid adenocarcinoma. AEH/EIN may also occur in endometrial polyps. Progestin therapy of AEH/EIN has low level of evidence but frequently leads to complete regression. Serous intraepithelial carcinoma (SEIC) is characterized by high-grade cellular atypia and polymorphism, detachment of cells, a mutant immunoreactive pattern for the P53 and an increased Ki67 labeling index. Although designated as precursor of serous carcinoma of the endometrium, biologically it is considered a non-invasive serous carcinoma since it may already be associated with massive extrauterine spread.
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Affiliation(s)
- S F Lax
- Institut für Klinische Pathologie und Molekularpathologie, LKH Graz II, Standort West, Akademisches Lehrkrankenhaus der Medizinischen Universität Graz, Göstinger Straße 22, 8020, Graz, Österreich.
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Horn LC, Emons G, Aretz S, Bock N, Follmann M, Lax S, Nothacker M, Steiner E, Mayr D. [S3 guidelines on the diagnosis and treatment of carcinoma of the endometrium : Requirements for pathology]. Pathologe 2019; 40:21-35. [PMID: 30756154 DOI: 10.1007/s00292-019-0574-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The present article summarises the relevant aspects of the S3 guidelines on endometrioid carcinomas. The recommendations include the processing rules of fractional currettings as well as for hysterectomy specimens and lymph node resections (including sentinel lymph nodes). Besides practical aspects, the guidelines consider the needs of the clinicians for appropriate surgical and radiotherapeutic treatment of the patients. Carcinosarcomas are assigned to the endometrial carcinoma as a special variant. For the first time, an algorithmic approach for evaluation of the tumour tissue for Lynch syndrome is given. Prognostic factors based on morphologic findings are summarised.
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Affiliation(s)
- L-C Horn
- Abteilung Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 24, 04103, Leipzig, Deutschland.
| | - G Emons
- Frauenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S Aretz
- Institut für Humangenetik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - N Bock
- Frauenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - M Follmann
- Deutsche Krebsgesellschaft, Berlin, Deutschland
| | - S Lax
- Institut für Pathologie, Landeskrankenhaus Graz West, Graz, Österreich
| | - M Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin, Deutschland
| | - E Steiner
- Frauenklinik, GPR Klinikum Rüsselsheim, Rüsselsheim, Deutschland
| | - D Mayr
- Pathologisches Institut, Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
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Yano M, Shintani D, Katoh T, Hamada M, Ito K, Kozawa E, Hasegawa K, Yasuda M. Coexistence of endometrial mesonephric-like adenocarcinoma and endometrioid carcinoma suggests a Müllerian duct lineage: a case report. Diagn Pathol 2019; 14:54. [PMID: 31174566 PMCID: PMC6556029 DOI: 10.1186/s13000-019-0830-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background Endometrial mesonephric-like adenocarcinomas exhibit classical histologic features of mesonephric carcinoma; however, it remains unclear whether these tumors represent mesonephric (Wolffian) carcinoma or endometrioid (Müllerian) carcinomas that closely mimic mesonephric carcinoma. Case presentation A 32-year-old Japanese primigravida presented with atypical vaginal bleeding. An endometrial biopsy suggested low-grade endometrioid carcinoma, and she was administered medroxyprogesterone acetate. Her tumor recurred 6 years later, and she underwent hysterectomy, salpingo-oophorectomy, and omentectomy, at which point she was diagnosed with mesonephric-like adenocarcinoma of the uterine endometrium. Retrospective pathological review of the initial biopsy confirmed coexisting low-grade endometrioid carcinoma and mesonephric-like adenocarcinoma of the uterine endometrium. On immunohistochemistry, the endometrioid carcinoma component was diffuse positive for estrogen and progesterone receptors but negative for thyroid transcription factor 1. However, the mesonephric-like adenocarcinoma component exhibited a mixture of estrogen receptor- and thyroid transcription factor 1-positive cells within the same glands. Conclusions We encountered a patient with coexisting endometrial mesonephric-like adenocarcinoma and low-grade endometrioid carcinoma, which was treated using medroxyprogesterone acetate therapy, resulting in recurrence of mesonephric-like adenocarcinoma alone. These clinicopathological findings support the prevailing notions that mesonephric-like adenocarcinoma is a Müllerian adenocarcinoma exhibiting mesonephric differentiation.
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Affiliation(s)
- Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.,Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita, 879-5593, Japan
| | - Daisuke Shintani
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, 350-1298, Japan
| | - Tomomi Katoh
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Mei Hamada
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Kozue Ito
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Eito Kozawa
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, 350-1298, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, 350-1298, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
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Ju UC, Kang WD, Kim SM. The effect of concurrent endometriosis on the prognosis of women with ovarian clear cell or endometrioid carcinoma. Int J Gynaecol Obstet 2019; 146:177-183. [PMID: 31081117 DOI: 10.1002/ijgo.12861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/17/2018] [Accepted: 05/10/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate features of ovarian clear cell carcinoma (CCC) and endometrioid carcinoma (EC) by presence of endometriosis among women with endometriosis-associated ovarian cancer (EAOC). METHODS A retrospective review of the medical records of 578 women diagnosed and treated for ovarian cancer at a university hospital in Korea between July 2004 and December 2016. Clinical and prognostic features of ovarian CCC and EC were compared between women with endometriosis and those without. RESULTS Ovarian CCC and EC were diagnosed at an earlier FIGO stage for women with endometriosis than for those without (P=0.033). The 5-year disease-free survival (DFS) and overall survival (OS) were 77.6% vs 65.0% (P=0.038) and 80.3% vs 70.9% (P=0.048), respectively. In univariate analysis, advanced stage, higher grade, bilateral tumors, lymph node metastasis, residual tumor greater than 1 cm, and non-concurrent endometriosis were related to shorter DFS and OS; however, residual tumor greater than 1 cm was the only independent predictor in multivariate analysis (DFS: hazard ratio (HR), 9.83; 95% confidence interval (CI), 4.84-19.93; OS: HR, 5.07; 95% CI, 2.33-11.03). No factors affected survival after stratification by stage. CONCLUSION No association was found between the presence of endometriosis and the prognosis of ovarian CCC or EC.
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Affiliation(s)
- U Chul Ju
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woo Dae Kang
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
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Abstract
Traditionally, the management of epithelial ovarian cancer has been approached using a one-size-fits-all mentality. This strategy does not acknowledge the differences in epidemiology and clinical behavior of many of the histologic and molecular subgroups of ovarian cancer, specifically the rare histologies. While cytoreductive surgery followed by adjuvant platinum and taxane-based chemotherapy is the mainstay of primary treatment of epithelial ovarian cancer as a group, further investigation of novel therapeutics is critical for improving outcomes of these rare histologies. This article focuses on the management of non-high grade serous histologies of ovarian cancer.
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Turashvili G, Gómez-Hidalgo NR, Flynn J, Gonen M, Leitao MM, Soslow RA, Murali R. Risk-based stratification of carcinomas concurrently involving the endometrium and ovary. Gynecol Oncol 2018; 152:38-45. [PMID: 30413340 DOI: 10.1016/j.ygyno.2018.10.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determining whether carcinomas concurrently involving endometrium and ovary are independent primary tumors (IPTs) or endometrial carcinomas with ovarian metastases (at least stage IIIA endometrial cancers, IIIA-EC) using clinicopathologic criteria is often challenging. Recent genomic studies showed that most such tumors are clonally related. We sought to identify clinicopathologic features associated with clinical outcomes, and to separate women with these tumors into clinically low-risk and high-risk groups. METHODS We reviewed clinical and pathologic data from 74 women who, between 1993 and 2014, underwent primary surgery for endometrial cancer and had concurrent ovarian involvement. RESULTS The endometrial carcinomas were endometrioid (EECs, n = 41) or non-endometrioid (ENECs, n = 33). Nineteen (26%) cases were originally classified as IPTs using clinicopathologic criteria. Multivariate analysis revealed that lymph node involvement (hazard ratio (HR) = 2.38, 95% CI 1.13-5.02, p = 0.023) and non-endometrioid endometrial tumor histology (HR = 6.27, 95% CI 2.6-15.13, p < 0.001) were associated with poorer progression-free survival (PFS). Multivariate analysis of 65 women with known lymph node status revealed two prognostically distinct groups: a high-risk group comprising ENECs with ≥50% myometrial invasion irrespective of lymph node status (n = 21; median PFS 12.7 months, 95% CI, 9.24-19.8); and a low-risk group consisting of all EECs, as well as lymph node-negative ENECs with <50% myometrial invasion (n = 44, median PFS not reached). The risk-based classification was superior to the original classification of endometrial cancers as IPTs vs. IIIA-EC for predicting PFS (log-rank test, p < 0.001 vs. p = 0.07). CONCLUSION Our proposed risk-based stratification enables categorization of women with concurrent endometrial and ovarian tumors according to their likely clinical outcomes.
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Affiliation(s)
- Gulisa Turashvili
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Hemedez CAT, Lomme M, Ruhul Quddus M. Mullerian carcinosarcoma in the colon of a patient with history of endometrial carcinoma: A case report and insight into possible pathogenesis. Gynecol Oncol Rep 2018; 26:49-52. [PMID: 30294656 PMCID: PMC6171370 DOI: 10.1016/j.gore.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/21/2018] [Accepted: 09/23/2018] [Indexed: 11/28/2022] Open
Abstract
Mullerian carcinosarcoma can occur in extragenital sites. Malignant transformation of endometriosis is common in the rectosigmoid area. MLH1 hypermethylation has been implicated in endometriosis-associated carcinomas. Adequate sampling is essential in determining the etiology of colonic tumors.
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Affiliation(s)
| | - Michele Lomme
- Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA
| | - M Ruhul Quddus
- Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA
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Patel V, Kipp B, Schoolmeester JK. Corded and hyalinized mesonephric-like adenocarcinoma of the uterine corpus: report of a case mimicking endometrioid carcinoma. Hum Pathol 2019; 86:243-8. [PMID: 30172914 DOI: 10.1016/j.humpath.2018.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/06/2023]
Abstract
Mesonephric-like adenocarcinoma is a recently described adenocarcinoma of the uterine body and ovary with overlapping features of mesonephric adenocarcinoma and endometrioid carcinoma. It is thought to be a mullerian adenocarcinoma that has differentiated along mesonephric lines. A 71-year-old woman had a 3-cm endometrial mass that invaded the myometrium without gross or microscopic evidence of cervical involvement. The tumor had a variety of architectural patterns and produced prominent stromal hyalinization containing embedded cords and trabeculae of tumor cells. No squamous or mucinous differentiation or associated mesonephric remnants or hyperplasia was identified. The tumor was positive for TTF1 and GATA3, very focally and weakly positive for estrogen receptor and negative for progesterone receptor and nuclear expression of β-catenin. An unusual inverse pattern of TTF1 and GATA3 immunoreactivity was observed. DNA analysis by digital droplet polymerase chain reaction and quantitative polymerase chain reaction identified an activating KRAS (G12A) mutation. The tumor was interpreted as corded and hyalinized mesonephric-like adenocarcinoma that mimicked corded and hyalinized endometrioid carcinoma.
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50
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Park JK, Otsuka N, Tomaru U, Suzuki H, Azuma M, Okamoto K, Yamashiro K, Kasahara M. Clinicopathological significance of PSF3 expression in uterine endometrial carcinomas. Hum Pathol 2018; 80:104-112. [PMID: 29936059 DOI: 10.1016/j.humpath.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 01/03/2023]
Abstract
PSF3 (Partner of SLD Five 3) is a member of the heterotetrameric complex termed GINS. Previous studies have shown that PSF3 is up-regulated in several cancers and is associated with tumor malignancy. However, the clinicopathological significance of PSF3 expression in endometrial lesions is still poorly understood. To investigate whether PSF3 could serve as a useful biomarker for endometrial carcinomas, we performed immunohistochemical analysis of PSF3 expression. In 155 cases of endometrial carcinomas (ECs), the mean tumor proportion score of PSF3 expression was 30.7% in G1 endometrioid carcinoma, 55.0% in G2 endometrioid carcinoma, 59.0% in G3 endometrioid carcinoma, and 58.9% in nonendometrioid carcinomas. In 25 cases of atypical hyperplasia, the mean tumor proportion score of PSF3 expression was significantly lower (10.4%). High expression of PSF3 was associated with more advanced pathologic T stage (P = .000), lymphatic invasion (P = .001), and poor clinical outcomes such as shorter relapse-free survival (P = .000) and overall survival (P = .001). When we compared the immunostaining of PSF3 and Ki-67, the proportions of PSF3-positive cells in tumor epithelial cells were comparable to those of Ki-67-positive cells. However, PSF3-positive cells were selectively found in tumor cells, whereas Ki-67-positive cells were also found in tumor stromal cells. These results demonstrated that PSF3 immunostaining was valuable as a histopathologic marker for differential diagnosis between atypical hyperplasia and ECs, for tumor histologic grading, and for determining a patient's prognosis. PSF3 may play a crucial role in tumor progression in EC.
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Affiliation(s)
- Jong Kun Park
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan; Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Noriyuki Otsuka
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
| | - Utano Tomaru
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hiroaki Suzuki
- Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Manabu Azuma
- Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Kazuhira Okamoto
- Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Katsushige Yamashiro
- Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Masanori Kasahara
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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