Table of Contents
1
UI - 11544839
AU - Adamian RT
TI -
[Therapy of atypical hyperplasia and adenocarcinoma of the endometrium
with the combination of progestins and anticoagulants]
SO - Vopr Onkol 2001;47(3):359-62
AD - V.A. Fanarjyan Center for Cancer Research, Ministry of Health of the
Republic of Armenia, Yerevan.
The data on clinical trials of newly-developed hormonotherapy of
atypical hyperplasia (AH) and cervical adenocarcinoma (CAC) are
presented. The study included 34 patients with histologically--confirmed
AH and 86--CAC (stage I-II and III-IV). All patients were given
preoperative "shock therapy" with a combination of progestins and
anticoagulants: 500 mg, i.v., 10 days--(AH) and well-differentiated cell
CAC; 20 days--moderately- and poorly-differentiated cell CAC. Total dose
was 5 g and 10 g, respectively. Fibrolysin, pelentan and aspirin
(antiaggregant of thrombocytes) were used as anticoagulants. For
comparison, identical numbers of AH and CAC patients received similar
preoperative progestin therapy without anticoagulants. The study was
randomized. Hormonal pathomorphosis in tumor was identified after
surgery and relevant characteristics of bioptical and resected material
were compared. It was found that hormonotherapy used in conjunction with
anticoagulants reinforced significantly all features of hormonal
pathomorphosism both in AH and CAC stage I-II while, in
well-differentiated cell adenocarcinoma, the difference from control was
significant (p < 0.05).
2
UI - 11813151
AU - Chadha M
TI -
Gynecologic brachytherapy-II: Intravaginal brachytherapy for carcinoma
of the endometrium.
SO - Semin Radiat Oncol 2002 Jan;12(1):53-61
AD - Department of Radiation Oncology, Beth Israel Medical Center, New York,
NY 10003, USA.
Brachytherapy plays a significant role in the management of endometrial
cancer. In the adjuvant setting, based on pathologic risk factors,
intravaginal brachytherapy alone, external radiation therapy alone, or a
combination of the two is recommended. For patients who are medically
inoperable, brachytherapy with or without external beam therapy is the
mainstay of treatment. In recurrent disease, to achieve improved local
regional control interstitial and/or intravaginal brachytherapy is used
as a boost. This article will highlight the indications and technical
aspects of postoperative intravaginal brachytherapy, which is the most
common application of brachytherapy in endometrial cancer. Copyright
2002 by W.B. Saunders Company
3
UI - 11830547
AU - Dai D; Wolf DM; Litman ES; White MJ; Leslie KK
TI -
Progesterone inhibits human endometrial cancer cell growth and
invasiveness: down-regulation of cellular adhesion molecules through
progesterone B receptors.
SO - Cancer Res 2002 Feb 1;62(3):881-6
AD - The Division of Maternal-Fetal Medicine, Department of Obstetrics and
Gynecology, University of New Mexico Health Sciences Center, 2211 Lomas
Boulevard NE, Albuquerque, New Mexico 87131-5286, USA.
Progesterone is a critical steroid hormone that controls cell
proliferation and differentiation in the female reproductive tract.
Progesterone acts through two nuclear receptor isoforms, progesterone
receptors A and B (PRA and PRB, respectively), each with unique cellular
effects. Loss of PRB has recently been linked to the development of
poorly differentiated endometrial tumors, a lethal form of cancer. To
study the molecular effects of progesterone, progesterone receptors were
introduced into Hec50co endometrial cancer cells by adenoviral vectors
encoding either PRA or PRB. Progesterone induced the cyclin-dependent
kinase inhibitors p21 and p27, thereby significantly reducing the
percentage of proliferating cells. Cancer cell invasion was also
markedly inhibited as measured by Matrigel invasion studies. Similarly,
a differentiated, secretory phenotype was induced by progesterone in
cells expressing PRB. However, replicative senescence was induced by
progesterone only in cells expressing PRA. Expression array analysis
followed by confirmatory semiquantitative reverse transcription-PCR
experiments demonstrated a significant progesterone-dependent inhibition
of expression of a cadre of cellular adhesion molecules, including
fibronectin, integrin alpha3, integrin beta1, integrin beta3, and
cadherin 6. The level of down-regulation of adhesion molecule expression
was significantly greater in the presence of the B isoform,
demonstrating that progesterone acts principally through B receptors to
inhibit cancer cell invasiveness modulated by adhesion molecules.
4
UI - 11744954
AU - Ghourab S
TI -
Synchronous endometrioid carcinoma of the ovary and endometrium
associated with ovulation induction.
SO - Saudi Med J 2001 Oct;22(10):914-6
AD - Department of Obstetrics and Gynecology, King Khalid University
Hospital, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of
Saudi Arabia. sghourab@ksu.edu.sa
Over the last 2 decades great concern about the possible association
between ovarian cancer and ovulation induction has been raised. Between
the first reported case in 1982 and the end of year 2000, there have
been 44 cases of ovarian carcinoma reported to occur in women previously
treated with ovulation induction drugs. Most of these tumors were of the
serous type with low malignant potential. In the present case, the
patient had secondary anovulatory infertility and previous left
cystoophorectomy for ovarian endometrioma. She was treated with human
menopausal gonadotrophin alone or in combination with clomiphene citrate
for 13 cycles prior to presentation. Screening ultrasound revealed
multicystic right ovarian mass (15 x 9 x 6 cm). Hysterectomy and right
salpingo-oophorectomy were carried out. Intraoperative and histological
examinations showed stage 1A endometrioid ovarian cancer and
well-differentiated endometrial adenoacanthoma with minimal myometrial
invasion. A brief but critical review of published literature regarding
the association of ovulation induction and increased risk of ovarian
cancer is presented.
5
UI - 11840823
AU - Makarov OV; Patrushev LI; Ignatchenko OIu; Ozolinia LA; Dzhobava EM
TI -
[Microsatellites instability--actuality and clinical significance in
hyperplastic processes and endometrium neoplasm (review of literature)]
SO - Klin Lab Diagn 2001 Dec;(12):16-22
6
UI - 11857027
AU - Santin AD; Bellone S; Ravaggi A; Roman JJ; Pecorelli S; Parham GP;
TI -
Cannon MJ
Induction of tumour-specific CD8(+) cytotoxic T lymphocytes by tumour
lysate-pulsed autologous dendritic cells in patients with uterine serous
papillary cancer.
SO - Br J Cancer 2002 Jan 7;86(1):151-7
AD - Department of Obstetrics and Gynecology, UAMS Medical Center, Division
of Gynecologic Oncology, University of Arkansas, 4301 W. Markham, Little
Rock, Arkansas AR 72205-7199, USA. santinalessandrod@uams.edu
Uterine serous papillary carcinoma is a highly aggressive variant of
endometrial cancer histologically similar to high grade ovarian cancer.
Unlike ovarian cancer, however, it is a chemoresistant disease from
onset, with responses to combined cisplatinum-based chemotherapy in the
order of 20% and an extremely poor prognosis. In this study, we
demonstrate that tumour lysate-pulsed autologous dendritic cells can
elicit a specific CD8(+) cytotoxic T lymphocyte response against
autologous tumour target cells in three patients with uterine serous
papillary cancer. CTL from patients 1 and 2 expressed strong cytolytic
activity against autologous tumour cells, did not lyse autologous
lymphoblasts or autologous EBV-transformed cell lines, and were variably
cytotoxic against the NK-sensitive cell line K-562. Patient 3 CD8(+) T
cells expressed a modest but reproducible cytotoxicity against
autologous tumour cells only at the time of the first priming. Further
priming attempts with PBL collected from patient 3 after tumour
progression in the lumboaortic lymph nodes were unsuccessful.
Cytotoxicity against autologous tumour cells could be significantly
inhibited by anti-HLA class I (W6/32) and anti-LFA-1 MAbs. Highly
cytotoxic CD8(+) T cells from patients 1 and 2 showed a heterogeneous
CD56 expression while CD56 was not expressed by non-cytotoxic CD8(+) T
cells from patient 3. Using two colour flow cytometric analysis of
intracellular cytokine expression at the single cell level, a striking
dominance of IFN-gamma expressors was detectable in CTL populations of
patients 1 and 2 while in patient 3 a dominant population of CD8(+) T
cells expressing IL-4 and IL-10 was consistently detected. Taken
together, these data demonstrate that tumour lysate-pulsed DC can be an
effective tool in inducing uterine serous papillary cancer-specific
CD8(+) CTL able to kill autologous tumour cells in vitro. However, high
levels of tumour specific tolerance in some patients may impose a
significant barrier to therapeutic vaccination. These results may have
important implications for the treatment in the adjuvant setting of
uterine serous papillary cancer patients with active or adoptive
immunotherapy.
7
UI - 11857302
AU - Emoto M; Tamura R; Shirota K; Hachisuga T; Kawarabayashi T
TI -
Clinical usefulness of color Doppler ultrasound in patients with
endometrial hyperplasia and carcinoma.
SO - Cancer 2002 Feb 1;94(3):700-6
AD - Department of Obstetrics and Gynecology, Fukuoka University School of
Medicine, Fukuoka, Japan. me230@cam.ac.uk
BACKGROUND: The objective of this study was to examine the usefulness of
transvaginal color Doppler ultrasound (TV-CDU) in differentiating
between endometrial hyperplasia (EH) and endometrial carcinoma (EC) and
in predicting tumor spread in patients with EC. METHODS: Seventy-one
postmenopausal patients were enrolled with either EH or EC that had been
diagnosed by endometrial biopsy. The presence or absence of intratumoral
blood flow was assessed by TV-CDU. The intratumoral blood flow
characteristics were analyzed using the resistance index (RI),
pulsatility index (PI), and peak systolic velocity (PSV). The
endometrial thickness also was measured in all patients by gray-scale
sonography. The correlation of these sonographic findings with
histologic type, tumor grade, surgical stage, myometrial invasion, or
the presence or absence of pelvic lymph node metastasis was then
evaluated in patients with EC. RESULTS: Although there were no patients
with EC with endometrial thickness measuring < 5 mm, no significant
difference was found in the mean value of endometrial thickness between
patients with EH (n = 18 patients; 16.2 mm +/- 15.9 mm) and patients
with EC (n = 53 patients; 18.7 mm +/- 17.1 mm). Intratumoral blood flow
was detected in significant numbers of patients who had EC (71.7%; 38 of
53 patients) compared with patients who had EH (5.6%; 1 of 18 patients;
P < 0.0001). Thus, no patients with EH showed any blood flow in the
endometrial lesions, except for one patient who had EH complicated by
pyometra. In patients with EC, the positive rate of intratumoral blood
flow was correlated significantly with myometrial invasion, tumor grade,
and pelvic lymph node metastasis (P < 0.05; Cochran-Armitage trend
test). No associations were found between RI, PI, or PSV and the
clinicopathologic parameters examined, including surgical stage.
CONCLUSIONS: TV-CDU may be more useful in differentiating between EH and
EC than measuring endometrial thickness by transvaginal gray-scale
sonography. For patients with EC, the detection of intratumoral blood
flow may be helpful in distinguishing between low-grade and high-grade
tumors and predicting myometrial invasion. However, intratumoral blood
flow analysis using RI, PI, or PSV may not be useful for predicting
tumor spread before surgery. Copyright 2002 American Cancer Society. DOI
10.1002/cncr.10208
8
UI - 11859980
AU - Klee M; Machin D
TI -
Health-related quality of life of patients with endometrial cancer who
are disease-free following external irradiation.
SO - Acta Oncol 2001;40(7):816-24
AD - Department of Oncology, The Finsen Center, Rigshospitalet, Copenhagen.
kleeo@dadlnet.dk
Health-related quality of life (HQoL) is assessed through the patients'
own evaluation of the impact that a disease and its treatment may have
on some of the physical, psychological and social aspects of their
lives. The purpose of this study is to describe the HQoL of patients
with endometrial cancer who are free of disease after undergoing
external irradiation. An HQoL questionnaire was designed and validated,
and consisted of the EORTC QLQ-C30 and 80 additional questions. The
patients provided self-reported assessments at the end of radiotherapy,
and 1, 3, 6, 12, 18 and 24 months later. Forty-nine out of 66 potential
subjects participated in the study, which was confined to the period
during which the, women were disease free. Most patients experience
physical side effects at the end of treatment and up to 6 months
thereafter; 10% of the patients have chronic local symptoms and a large
number of the patients think about their treatment even two years later.
The patients' overall evaluation of their quality of life is lower than
that of a matched population of healthy women.
9
UI - 11859985
AU - Mogren I; Stenlund H; Hogberg U
TI -
Long-term impact of reproductive factors on the risk of cervical,
endometrial, ovarian and breast cancer.
SO - Acta Oncol 2001;40(7):849-54
AD - Department of Clinical Science, Umea University, Sweden.
ingrid.mogren@obstgyn.umu.se
The influence of maternal age, parity, low or high birthweight, multiple
births, and pre-eclampsia on the risk of cervical, endometrial, ovarian
and breast cancers was studied. Data on 40951 women and the outcomes of
their deliveries between 1955 and 1995 were obtained from birth
registers. For the mothers, data from the Swedish Cancer Registry and
the Cause of Death Register were added. The sample was evaluated using
Cox's regression in univariate and bivariate analyses where the relative
risk and its 95% confidence interval were calculated. Increasing
maternal age at first birth was associated with an increasing relative
risk of endometrial, ovarian, and breast cancers, and with a decreased
risk of cervical cancer. Multiparity was a protective factor for all
gynaecological cancers, including cervical and breast cancers. Multiple
births were associated with an increased risk of endometrial cancer.
10
UI - 11872295
AU - Jereczek-Fossa BA; Jassem J; Badzio A
TI -
Relationship between acute and late normal tissue injury after
postoperative radiotherapy in endometrial cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):476-82
AD - Department of Oncology and Radiotherapy, Medical University of Gdansk,
Gdansk, Poland. barbara.fossa@ieo.it
PURPOSE: To evaluate the relationship between acute and late normal
tissue reactions in 317 consecutive endometrial cancer patients treated
with surgery and adjuvant radiotherapy (RT). METHODS: The data of 317
patients (staging according to the International Federation of
Gynecology and Obstetrics) treated with postoperative RT were analyzed.
Both low-dose-rate brachytherapy and external beam RT were applied in
247 patients (78%); brachytherapy only in 49 (15%) and external beam
irradiation only in 21 (7%). The median follow-up was 7.3 years (range
4-21). The European Organization for Research and Treatment of Cancer,
Radiation Therapy Oncology Group system with elements of the late
effects of normal tissue, subjective, objective, management, analytic
(LENT/SOMA) scale was used to score the RT reactions. The correlation
between the occurrence and severity of acute and late bowel and bladder
toxicity, as well as the relationship between the severity of acute
effects and time to occurrence of late reactions, were assessed using
linear and logistic regression analyses. RESULTS: Of the 317 patients,
268 (85%) experienced acute RT reactions of any grade. Severe acute
bowel reactions were observed in 15 patients (5%), urinary bladder
complications in 1 patient (0.5%), cutaneous in 1 patient (0.5%), and
vaginal in 1 patient (0.5%). Severe acute hematologic toxicity was seen
in 3 patients (1%). A total of 158 patients (51%) experienced late RT
reactions of any grade. Severe late bowel reactions were observed in 19
patients (6%), urinary bladder in 5 (2%), vaginal in 3 (1%), and bone in
10 (4%). When all toxic events were considered, there was a highly
significant correlation between the acute and late bowel reactions (p
<0.001), but the acute and late urinary bladder reactions did not
correlate (p = 0.64). The grade of acute toxicity was found to predict
the grade of late toxicity for the bowel but not for the bladder (p
<0.001 and p = 0.47, respectively). The severity of acute bowel and
bladder toxicity did not correlate with the time to occurrence of late
toxicity in these locations (p = 0.34 and p = 0.47, respectively).
CONCLUSION: Patients with increased acute bowel toxicity during
postoperative RT for endometrial cancer have an increased risk of late
bowel injury. A higher grade of acute bowel complications correlated
with more severe late events, but was not predictive for its latency
time. These findings suggest the possibility of an early indication of
patients with an increased risk of late toxicity in whom preventive
measures might be attempted.
11
UI - 11846711
AU - Epstein E; Ramirez A; Skoog L; Valentin L
TI -
Dilatation and curettage fails to detect most focal lesions in the
uterine cavity in women with postmenopausal bleeding.
SO - Acta Obstet Gynecol Scand 2001 Dec;80(12):1131-6
AD - Department of Obstetrics and Gynecology, University of Lund, University
Hospital, Malmo, Sweden. elisabeth.epstein@obst.mas.lu.se
OBJECTIVE: To determine the prevalence of focally growing lesions in the
uterine cavity in women with postmenopausal bleeding and endometrium >
or = 5 mm and the extent to which such lesions can be correctly
diagnosed by D&C. METHODS: In a prospective study, 105 women with
postmenopausal bleeding and endometrium > or = 5 mm at transvaginal
ultrasound examination underwent diagnostic hysteroscopy, D&C and
hysteroscopic resection of any focally growing lesion still left in the
uterine cavity after D&C. Twenty-four women also underwent hysterectomy.
If the histological diagnosis differed between specimens from the same
patient, the most relevant diagnosis was considered the final one.
RESULTS: Eighty percent (84/105) of the women had pathology in the
uterine cavity, and 98% (82/84) of the pathological lesions manifested a
focal growth pattern at hysteroscopy. In 87% of the women with focal
lesions in the uterine cavity, the whole or parts of the lesion remained
in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of
hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19)
of endometrial cancers. The agreement between the D&C diagnosis and the
final diagnosis was excellent (94%) in women without focally growing
lesions at hysteroscopy. CONCLUSION: If there are focal lesions in the
uterine cavity, hysteroscopy with endometrial resection is superior to
D&C for obtaining a representative endometrial sample in women with
postmenopausal bleeding and endometrium > or = 5 mm.
12
UI - 11812073
AU - Russell AH
TI -
No regrets, no illusions.
SO - Gynecol Oncol 2002 Feb;84(2):191-3
13
UI - 11812074
AU - Straughn JM Jr; Huh WK; Kelly FJ; Leath CA 3rd; Kleinberg MJ; Hyde J Jr;
TI -
Numnum TM; Zhang Y; Soong SJ; Austin JM Jr; Partridge EE; Kilgore LC;
Alvarez RD
Conservative management of stage I endometrial carcinoma after surgical
staging.
SO - Gynecol Oncol 2002 Feb;84(2):194-200
AD - Division of Gynecologic Oncology, University of Alabama at Birmingham,
Birmingham, Alabama 35249, USA. jmstraughn@yahoo.com
OBJECTIVE: The aim of this study was to determine the outcomes of Stage
I endometrial carcinoma patients who are managed without adjuvant
radiation after comprehensive surgical staging. METHODS: A computerized
hospital database identified women diagnosed with adenocarcinoma of the
endometrium from 1993 to 1998. A chart review identified 864 women as
having primary surgery for adenocarcinoma of the endometrium. A total of
670 of 864 patients (78%) underwent comprehensive surgical staging with
total hysterectomy, bilateral salpingo-oophorectomy, pelvic/para-aortic
lymphadenectomy, and peritoneal cytology. After 57 patients with
high-risk histologic subtypes were excluded, 613 patients remained for
analysis. RESULTS: A total of 321 of 325 Stage IB patients (99%) did not
receive adjuvant radiation. Fifteen of 321 patients (5%) recurred; 9
recurred in the pelvis or vagina. All 9 local recurrences were salvaged
with whole pelvic radiation (XRT) and brachytherapy (BT). Seventy-seven
patients were diagnosed with Stage IC disease; 53 (69%) received no
adjuvant therapy. Four patients (8%) recurred, of which 2 recurred in
the vagina. Three of 4 patients (75%) were salvaged, 2 with XRT/BT and 1
with surgery and chemotherapy. For all Stage I patients, the 5-year
disease-free survival was 93% and the 5-year overall survival was 98%.
CONCLUSIONS: Surgically staged patients with endometrial carcinoma
confined to the uterine corpus have a small risk of recurrence and the
majority of these recurrences can be salvaged with radiation therapy.
Conservative management of Stage I endometrial carcinoma patients is an
effective treatment strategy. B)2001 Elsevier Science.
14
UI - 11812081
AU - Plaxe SC; Blessing JA; Husseinzadeh N; Webster KD; Rader JS; Dunton CJ
TI -
Phase II trial of pyrazoloacridine in patients with persistent or
recurrent endometrial carcinoma: a Gynecologic Oncology Group Study.
SO - Gynecol Oncol 2002 Feb;84(2):241-4
AD - Division of Gynecologic Oncology, University of California at San Diego,
San Diego, California 92103, USA.
OBJECTIVES: The aims of this study were to determine the response rate
of pyrazoloacridine (PZA) in patients with recurrent or persistent
endometrial carcinoma and to describe the nature and degree of toxicity
in this population. METHODS: PZA was initially administered at a dose of
750 mg/m(2) intravenously over 3 h every 3 weeks but, due to toxicity,
was subsequently reduced to 560 mg/m(2) at the same schedule. RESULTS:
Among 23 evaluable patients, 11 of whom had had prior chemotherapy,
there was 1 (4.3%) partial response and no complete responses.
Forty-eight percent of patients had grade 4 neutropenia. There was 1
treatment-related death, in a patient who had prior chemotherapy and
radiotherapy. CONCLUSION: This dose and schedule of PZA has
insignificant activity in this population. The optimal PZA dose appears
to vary between different populations and may be related to prior
therapy. B)2001 Elsevier Science.
15
UI - 11812084
AU - Alcazar JL; Galan MJ; Jurado M; Lopez-Garcia G
TI -
Intratumoral blood flow analysis in endometrial carcinoma: correlation
with tumor characteristics and risk for recurrence.
SO - Gynecol Oncol 2002 Feb;84(2):258-62
AD - Department of Obstetrics and Gynecology, University of Navarra,
Pamplona, Spain. jlalcazar@unav.es
OBJECTIVE: The aim of this study was to correlate intratumoral blood
flow as assessed by transvaginal color Doppler ultrasound with tumor
histopathologic characteristics, tumoral stage, and risk for recurrence
in endometrial carcinoma. METHODS: Forty-five patients (mean age: 58.2
years, range: 30 to 83 years) with surgically treated endometrial
carcinoma preoperatively evaluated with transvaginal color Doppler
ultrasound were included in this retrospective study. The lowest
arterial resistance index (RI) and highest peak systolic velocity (PSV)
were used for intratumoral blood flow analysis. Individual tumor
characteristics evaluated were tumor growth pattern, tumor size,
histologic type, tumor grade, myometrial infiltration depth, cervical
involvement, lymph node metastasis, and lymph-vascular space invasion
(LVSI). Tumoral stage and risk for recurrence were also evaluated.
RESULTS: Significantly lower RI was found in tumors with the following
characteristics: infiltrative growth pattern (P = 0,013), grade 3 (P =
0.001), infiltrating >or=50% of the myometrium (P = 0.006), cervical
involvement (P = 0.009), LVSI (P = 0.008), lymph-node metastasis (P =
0.049), stage >or=Ic (P = 0.004), and high risk for recurrence (P =
0.001). Significantly higher PSV was found in tumors that were grade 3
(P = 0.034), infiltrating >or=50% of the myometrium (P = 0.029), stage
>or=Ic (P = 0.015), and with a high risk for recurrence (P = 0.002).
CONCLUSIONS: Our data indicate that a correlation between intratumoral
blood flow features and histopathological characteristics, tumor stage,
and risk for recurrence exists in endometrial cancer. Further
prospective studies are needed to determine the clinical usefulness of
preoperative assessment of tumor vascularization in these carcinomas.
(c)2002 Elservier Science
16
UI - 11812096
AU - Mekhail TM; Markman M
TI -
Acanthosis nigricans with endometrial carcinoma: case report and review
of the literature.
SO - Gynecol Oncol 2002 Feb;84(2):332-4
AD - Department of Hematology and Medical Oncology, Cleveland Clinic
Foundation, Cleveland, Ohio 44195, USA. Mekhait@CCF.ORG
BACKGROUND: Acanthosis nigricans is classified into benign and malignant
forms on the basis of clinical associations. The main interest in
acanthosis nigricans has been based on its association with malignancy
because of the dramatic clinical appearance of the skin lesions and the
usually rapidly fatal nature of the underlying disease. "Tripe palms" is
a descriptive term of acanthosis nigricans of the palms. It more often
is associated with internal malignancy. Most importantly, it often
precedes the diagnosis of a new or recurrent tumor. Malignant acanthosis
nigricans is most commonly associated with intra-abdominal malignancies.
There are very few reports in the literature of malignant acanthosis
nigricans associated with gynecological malignancies. Only five cases of
endometrial carcinoma associated with acanthosis nigricans and/or tripe
palms have been reported in the literature. CASE: A 69-year-old
African-American female presented with skin changes consistent with the
diagnosis of acanthosis nigricans and tripe palms. More than 14 months
later she was found to have endometrial carcinoma. She subsequently
underwent total abdominal hysterectomy and salpingo-oophorectomy
followed by chemotherapy with paclitaxel and carboplatin. During
treatment of the underlying malignancy the skin condition dramatically
improved. CONCLUSION: Tripe palms can be associated with endometrial
carcinoma and may be the first sign of malignancy. Malignant acanthosis
nigricans may improve with treatment of the underlying malignancy.
Patients who present with tripe palms may need to undergo workup to
search for underlying malignancy. B)2001 Elsevier Science.
17
UI - 11848551
AU - Bellino R; Arisio R; D'Addato F; Alba E; Attini R; Colla F; Leotta E;
TI -
Tersiev P; Grio R
Pathologic features of endometrial carcinoma in elderly women.
SO - Anticancer Res 2001 Sep-Oct;21(5):3721-4
AD - Department of Gynecology and Obstetrics, Sant'Anna Hospital, University
of Turin, Italy.
It has been estimated that more than two-thirds of cancers occur in
people over 65 years of age: endometrial cancer (EC) is the most common
gynaecologic cancer in the U.S. and represents the fourth most common
malignancy in women. Some authors have reported that EC in elderly women
was more aggressive, histologically less-differentiated and often
non-endometrioid when compared with EC in the younger population. The
purpose of this retrospective study is to evaluate the pathologic
features of EC in women 70 years old or over compared with those of
younger patients. Between 1987 and 1997, 174 patients with EC were
surgically treated: 52 women were 70 years old or over. Two-thirds of
both groups had surgical Stage I tumors: 54% of surgical Stage I tumors
in the elderly had myometrial invasion more than 50% compared with 32%
in the younger group (p<0.01). On the whole 37% of elderly patients had
Stage IC tumors compared with 21% in younger women (p<0.01).
Seventy-five percent of elderly women had Grade 2 or 3 tumors compared
with 55% of younger patients (p<0.005). The majority of EC was
endometrioid in both groups: 8% of elderly patients had clear-cell
carcinomas compared with 4% of younger women (p not significant). No
elderly patients showed nodal metastasis (0 out of 10): 9% of younger
women had pelvic or para-aortic metastasis. The median follow-up was 78
months. The overall survival in the elderly and in the younger group was
80% and 93%, respectively (p<0.01): in elderly women overall survival
significantly varied according to histotype and depth of myometrial
invasion in Stage I tumors. In conclusion patients 70 years old or over
have a high probability of surgical Stage I EC but a significantly
higher probability of deep myometrial invasion and less-differentiated
tumors than younger women: the prognosis w as good but poorer than for
younger patients.
18
UI - 11813332
AU - Karim BO; Burroughs FH; Rosenthal DL; Ali SZ
TI -
Endometrial-type cells in cervico-vaginal smears: clinical significance
and cytopathologic correlates.
SO - Diagn Cytopathol 2002 Feb;26(2):123-7
AD - John K. Frost Cytopathology Laboratory, Department of Pathology, The
Johns Hopkins Hospital, Baltimore, MD 21287-6417, USA.
This study assessed the significance of endometrial-type cells (ETC) in
cervico-vaginal (CV) smears in patients 45 yr and older by evaluating
quantitatively and qualitatively the relationship of ETC to subsequent
endometrial pathology. In a 3-yr period (1997-1999) at the Johns Hopkins
Cytopathology Laboratory, 1,162 CV smears with ETC were found in
patients 45 yr and older. In all cases with positive follow-up by tissue
biopsy/resection, i.e., endometrial hyperplasia (EHP) and endometrial
adenocarcinoma (EACA), the CV smears were reevaluated and compared to
the control group (i.e., patients with normal endometrial biopsies). The
following cytologic characteristics were recorded: quantity of ETC, type
of ETC (epithelial, stromal/histiocyte-type, or mixed), cellular
atypism, presence of inflammation, smear background, and associated
estrogen effect. Of the 1,162 patients with ETC, 432 cases (37%) had
tissue follow-up as follows: EACA, 18 (4.2%); EHP, 20 (4.6%);
leiomyomata, 17 (3.9%); endometrial polyp, 21 (4.9%); benign/within
normal limits (WNL), 339 (78.5%); nondiagnostic, 17 (3.9%). Cytologic
characteristics of ETC showed subtle but definite quantitative and
qualitative differences in the major pathologic groups examined. All
instances of cancers and hyperplasia occurred in postmenopausal (PM)
women. Abnormal vaginal bleeding was the presenting complaint in 66.7%
of EACA, 45% of EHP, and 28.6% of benign endometrium. ETC in PM CV
smears are associated with significant endometrial lesions (carcinoma,
hyperplasia) in less than 9% of the patients. It is concluded that the
distinction between EACA and EHP can be difficult. The presence of a
large number of ETC, predominantly of epithelial or a mixed (epithelial
and stromal) type, is more often associated with EACA or EHP than with
benign endometrium. The presence of cytologic atypia and/or diathesis is
additionally helpful for the diagnosis of EACA.
19
UI - 11854630
AU - Volker P; Grundker C; Schmidt O; Schulz KD; Emons G
TI -
Expression of receptors for luteinizing hormone-releasing hormone in
human ovarian and endometrial cancers: frequency, autoregulation, and
correlation with direct antiproliferative activity of luteinizing
hormone-releasing hormone analogues.
SO - Am J Obstet Gynecol 2002 Feb;186(2):171-9
AD - Department of Obstetrics and Gynecology, Georg-August-University
Gottingen, Germany.
OBJECTIVE: Several recent reports have demonstrated the expression of
luteinizing hormone-releasing hormone receptors by human ovarian and
endometrial cancers. Controversy persists on the relevance of this
finding, in particular whether these receptors mediate direct
antiproliferative effects of luteinizing hormone-releasing hormone
analogues. We correlated the expression of luteinizing hormone-releasing
hormone receptors by well-characterized ovarian and endometrial cancer
cell lines with the ability of luteinizing hormone-releasing hormone
analogues to reduce their proliferation and studied the autoregulation
of luteinizing hormone-releasing hormone receptor expression by
luteinizing hormone-releasing hormone agonist triptorelin and antagonist
cetrorelix. The expression of luteinizing hormone-releasing hormone
receptors was assessed in a series of specimens from primary ovarian and
endometrial cancers. STUDY DESIGN: Luteinizing hormone-releasing hormone
receptor expression was assessed by semiquantitative reverse
transcriptase-polymerase chain reaction and radioligand binding assay.
Antiproliferative effects were ascertained by proliferation assays in
the absence or presence of luteinizing hormone-releasing hormone
analogues. RESULTS: Ovarian (4/6 cell lines) and endometrial (5/6 cell
lines) cancer cell lines expressed luteinizing hormone-releasing hormone
receptors. The proliferation of these luteinizing hormone-releasing
hormone receptor-positive cell lines was dose- and time-dependently
reduced by agonistic and antagonistic luteinizing hormone-releasing
hormone analogues. Luteinizing hormone-releasing hormone receptor
density was reduced to 80% of controls (control, 100 %; P <.001) by
luteinizing hormone-releasing hormone analogues. Seventy percent of
primary ovarian cancers and 83% of primary endometrial cancers expressed
luteinizing hormone-releasing hormone receptors. CONCLUSION: These
findings suggest that luteinizing hormone-releasing hormone receptors
that are expressed by human ovarian and endometrial cancer cell lines
mediate direct antiproliferative effects of luteinizing
hormone-releasing hormone analogues. Because most respective primary
cancers expressed luteinizing hormone-releasing hormone receptors, these
receptors might be used for novel antiproliferative therapeutic
approaches and should be further evaluated.
20
UI - 11791079
AU - Naftolin F; Silver D
TI -
Is progestogen supplementation of ERT really necessary?
SO - Menopause 2002 Jan-Feb;9(1):1-2
21
UI - 11728663
AU - Holub Z; Jabor A; Kliment L; Voracek J; Lukac J; Barany B
TI -
Laparoscopic staging of endometrial cancer using laparosonic
instruments: comparison with electrosurgery.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Dec 10;100(1):81-6
AD - Endoscopic Training Center, Department of Gynecology and Obstetrics,
Baby Friendly Hospital, Vancurova 1548, 27258 Kladno, Czech Republic.
holubz@senam.cz
OBJECTIVE: To compare perioperative parameters in two groups of women
with different laparoscopic operative techniques in surgical staging of
endometrial cancer (EC). STUDY DESIGN: Thirty randomly allocated and
laparoscopically treated women with EC. Fifteen patients were operated
by electrosurgery, 15 patients by laparosonic operative technique.
Differences between the two groups were determined by the Wilcoxon
rank-sum test. Probability (P) of less than 0.05 was considered
significant. SETTING: Department of Gynecology and Obstetrics,
Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech
Republic. RESULTS: Laparoscopy was successfully completed in 29
patients. Laparoscopy-assisted surgical staging of EC was performed
based on the tumor grade and the depth of myoinvasion. In both groups,
in total 18 and 5 women underwent pelvic lymphadenectomy (PLN) and
infra-aortic lymph node sampling (IALS), respectively. Three patients
had metastases in pelvic lymph nodes. In the electrosurgical hemostasis
and laparosonic group the mean total time required to finish the whole
operative procedure were 132.1 and 138.3 min, respectively, with no
statistically significant difference (P=0.96). There were no significant
differences between the groups in any intraoperative or postoperative
follow-up variables, except for the number of excised lymph nodes where
the difference between electrosurgery and laparosonic group (12.7 versus
18) was statistically significant (P=0.05). In one patient with
intraoperative venous bleeding the laparosonic hemostasis was
ineffective (successful procedure rate 93.3%). One patient from the
electrosurgery group was converted to laparotomy due to injury to the
epigastric vessels. This complication had no connection with the
surgical techniques studied. CONCLUSION: It is concluded that both
operative technique variants in laparoscopy-assisted surgical staging
appear to be feasible and effective for patients with EC.
22
UI - 10502434
AU - Chadha M; Nanavati PJ; Liu P; Fanning J; Jacobs A
TI -
Patterns of failure in endometrial carcinoma stage IB grade 3 and IC
patients treated with postoperative vaginal vault brachytherapy.
SO - Gynecol Oncol 1999 Oct;75(1):103-7
AD - Department of Radiation Oncology, Beth Israel Medical Center, New York,
New York, 10003, USA.
OBJECTIVE: The vagina is the most common site of locoregional failure in
surgical stage IB, IC, and II (occult) endometrial adenocarcinoma. The
objective of this study is to evaluate the therapeutic efficacy of
vaginal vault brachytherapy alone for surgical stage I patients with
high-risk features. MATERIALS AND METHODS: The study group consists of
high-risk stage I patients with either stage IB grade (G) 3 or any grade
endometrial carcinoma were treated postoperatively with high-dose-rate
vaginal vault brachytherapy as the only adjuvant treatment. All patients
were surgically staged. Among them, 38 patients were identified as high
risk. Twelve patients had stage IBG3, 14 had ICG1, 9 had ICG2, and 3 had
ICG3 disease. The median age was 67 years (range 41 to 86 years). A dose
of 21 Gy in three fractions of 7 Gy each was delivered to a prescription
depth of 0.5 cm from the surface of the vaginal applicator using
high-dose-rate brachytherapy. RESULTS: The median follow-up was 30
months (range 7 to 91 months). No patient has developed a vaginal or
pelvic recurrence. Three patients developed tumor recurrence in the
upper abdomen at 11, 18, and 37 months. Two of the three patients with
recurrent disease also had history of breast cancer. In one patient,
breast cancer was diagnosed 4.8 years prior and in the second 3 years
subsequent to the diagnosis of endometrial cancer. The 5-year actuarial
overall survival and disease-free survival are 93 and 87%, respectively.
There was no treatment-related grade 3 or 4 morbidity observed.
CONCLUSIONS: For patients with surgical stage IBG3 and IC, excellent
local control and minimal morbidity has been observed with the selective
use of vaginal brachytherapy alone. Further studies and longer follow-up
are warranted. Copyright 1999 Academic Press.
23
UI - 10502417
AU - Naumann RW; Higgins RV; Hall JB
TI -
The use of adjuvant radiation therapy by members of the Society of
Gynecologic Oncologists.
SO - Gynecol Oncol 1999 Oct;75(1):4-9
AD - Carolinas Medical Center, Charlotte, North Carolina, 28232, USA.
OBJECTIVES. The aim of this study was to determine the attitudes of the
members of the Society of Gynecologic Oncologists with respect to the
use of adjuvant radiation therapy in women with endometrial cancer.
METHODS: An anonymous survey concerning the use of adjuvant radiation
therapy in endometrial cancer was mailed to all members of the Society
of Gynecologic Oncologists listed in the 1998 directory. RESULTS: Of the
767 listed members, 325 (42%) returned completed surveys. Less than 20%
of respondents recommended adjuvant radiation therapy in stage IA grade
1 or 2 and stage IB grade 1 endometrial cancer. Adjuvant radiation is
recommended by 40 to 50% of respondents in women with stage IA grade 3
and IB grade 2 tumors. Most recommend adjuvant radiation for all women
with >50% myometrial invasion or grade 3 tumors with any myometrial
invasion. Lymph node sampling is attempted in all cases by 48% of
respondents. For those familiar with Gynecologic Oncology Group (GOG)
Study No. 99, 20% stated that they were more likely to recommend
adjuvant radiation and 27% stated that they were less likely to
recommend adjuvant radiation based on the preliminary results. Except in
stage IA grade 1 tumors, the chance of recommending further therapy in
women with all stages and grades was significantly less if a complete
staging procedure including lymph node dissection had been performed.
CONCLUSIONS: Complete staging appears to decrease the chance that
postoperative therapy will be recommended. The use of adjuvant radiation
therapy seem to have declined slightly as a result of GOG Study No. 99.
Future studies in women with endometrial cancer that do not require
lymph node sampling should evaluate the frequency of adjuvant therapy in
the absence of complete staging. Copyright 1999 Academic Press.
24
UI - 11036892
AU - Bergman L; Beelen ML; Gallee MP; Hollema H; Benraadt J; van Leeuwen FE
TI -
Risk and prognosis of endometrial cancer after tamoxifen for breast
cancer. Comprehensive Cancer Centres' ALERT Group. Assessment of Liver
and Endometrial cancer Risk following Tamoxifen.
SO - Lancet 2000 Sep 9;356(9233):881-7
AD - Department of Epidemiology, Netherlands Cancer Institute, Amsterdam.
BACKGROUND: Tamoxifen increases the risk of endometrial cancer. However,
few studies have produced reliable risk estimates by duration, dose, and
recency of use, or addressed the prognosis of endometrial cancers in
tamoxifen-treated women. METHODS: We did a nationwide case-control study
on the risk and prognosis of endometrial cancer after tamoxifen use for
breast cancer. Information on tamoxifen use and other risk factors for
endometrial cancer was obtained from 309 women with endometrial cancer
after breast cancer (cases), and 860 matched controls with breast cancer
but without endometrial cancer. For 276 cases, we obtained tissue blocks
of endometrial cancer to review the diagnosis, and used
immunohistochemistry to examine hormone-receptor status and
overexpression of p53. FINDINGS: Tamoxifen had been used by 108 (36.1%)
of 299 cases and 245 (28.5%) controls (relative risk 1.5 [95% CI
1.1-2.0]). Risk of endometrial cancer increased with longer duration of
tamoxifen use (p < 0.001), with relative risks of 2.0 (1.2-3.2) for 2-5
years and 6.9 (2.4-19.4) for at least 5 years compared with non-users.
Endometrial cancers of stage III and IV occurred more frequently in
long-term tamoxifen users (> or = 2 years) than in non-users (17.4% vs
5.4%, p=0.006). Long-term users were more likely than non-users to have
had malignant mixed mesodermal tumours or sarcomas of the endometrium
(15.4% vs 2.9%, p < or = 0.02), p53-positive tumours (31.4% vs 18.2%,
p=0.05), and negative oestrogen-receptor concentrations (60.8% vs 26.2%,
p < or = 0.001). 3-year endometrial-cancer-specific survival was
significantly worse for long-term tamoxifen users than for non-users
(76% for > or = 5 years, 85% for 2-5 years vs 94% for non-users,
p=0.02). INTERPRETATION: Long-term tamoxifen users have a worse
prognosis of endometrial cancers, which seems to be due to less
favourable histology and higher stage. However, the benefit of tamoxifen
on breast-cancer survival far outweighs the increased mortality from
endometrial cancer. Nevertheless, we seriously question widespread use
of tamoxifen as a preventive agent against breast cancer in healthy
women.
25
UI - 11104626
AU - Ng TY; Perrin LC; Nicklin JL; Cheuk R; Crandon AJ
TI -
Local recurrence in high-risk node-negative stage I endometrial
carcinoma treated with postoperative vaginal vault brachytherapy.
SO - Gynecol Oncol 2000 Dec;79(3):490-4
AD - Queensland Centre for Gynaecological Cancer, Queensland Radium
Institute, Queensland, 4001, Australia.
OBJECTIVES: The aim of this study is to examine the patterns of failure
after extended surgical staging and postoperative vaginal vault
brachytherapy as the only adjuvant treatment in high-risk surgical Stage
I patients with endometrial carcinoma. METHODS: The records of all
patients with endometrial carcinoma (adenocarcinoma or adenosquamous)
receiving vaginal vault brachytherapy as the only adjuvant treatment
patients were found. Of these, 133 had extended surgical staging. The
study group consists of 77 surgical Stage I patients with Substages IBG3
and any grade IC. Recurrences were recorded as in the vagina, pelvis, or
distant. RESULTS: The mean follow-up interval was 45 months (range 14 to
96 months). Eleven patients had recurrence (14%). Median time to
recurrence was 15 months (range 6 to 56 months). Recurrences occurred in
the vagina in 7, pelvis in 1, and distantly in 3 patients. Five of 7
vaginal recurrences occurred within 2 years. All patients with distant
recurrence died from disease. One patient with pelvic recurrence is
alive with disease. Only 1 patient with vaginal recurrence died from
disease. Six patients with isolated recurrences in the vagina were
successfully treated with radiotherapy with or without local excision.
All 6 have no evidence of disease at follow-up (median survival 29
months, range 20 to 71 months). CONCLUSIONS: The vagina remains the most
common site of recurrence for high-risk surgical Stage I patients
treated with postoperative vaginal vault brachytherapy. Close follow-up
in the first 2 years is essential to detect isolated vaginal
recurrences. These are amenable to salvage treatment with good
disease-free survival. Copyright 2000 Academic Press.
26
UI - 11197376
AU - Narod SA; Pal T; Graham T; Mitchell M; Fyles A
TI -
Tamoxifen and risk of endometrial cancer.
SO - Lancet 2001 Jan 6;357(9249):65-6; discussion 67
27
UI - 11197379
AU - Lasset C; Bonadona V; Mignotte H; Bremond A
TI -
Tamoxifen and risk of endometrial cancer.
SO - Lancet 2001 Jan 6;357(9249):66-7
28
UI - 11197380
AU - Dickson MJ; Pandiarajan T
TI -
Tamoxifen and risk of endometrial cancer.
SO - Lancet 2001 Jan 6;357(9249):67-8
29
UI - 11197381
AU - Kairies P
TI -
Tamoxifen and risk of endometrial cancer.
SO - Lancet 2001 Jan 6;357(9249):68
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