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Abramson Cancer CenterNCI CANCERLIT® Search: Endometrial Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11332078
AU - Biesterfeld S; Leitloff M; Rath W; Schroder W
TI -
DNA image cytometry in the differential diagnosis of endometrial
hyperplasia and adenocarcinoma.
SO - Anal Quant Cytol Histol 2001 Apr;23(2):123-8
AD - Institute of Pathology and Department of Obstetrics and Gynecology,
Technical University of Aachen, Aachen, Germany.
biesterfeld@pat.rwth-aachen.de
OBJECTIVE: To test the value of DNA image cytometry in the differential
diagnosis of hyperplastic endometrial lesions and endometrial carcinoma
on a series of 153 cases of simple hyperplasia (n = 71), complex
hyperplasia (n = 28), complex atypical hyperplasia (n = 11) and
endometrial adenocarcinoma (n = 43). STUDY DESIGN: Monolayer smears were
prepared from three 50-micron-thick sections by a cell separation
technique and were stained according to Feulgen. The DNA content of 250
epithelial cells, chosen randomly, was determined using a TV image
analysis system (CM-1, Hund, Wetzlar, Germany). The DNA content of 30
lymphocytes served as an internal standard for the normal diploid value
in every case. Different DNA cytometric parameters and the mean nuclear
area were calculated. RESULTS: Cases of adenocarcinoma and complex
atypical hyperplasia (n = 54) were defined as clinically "positive" as
these patients are normally treated by hysterectomy. The remaining cases
of simple and complex hyperplasia (n = 99) were interpreted as
clinically "negative" as conservative therapy is usually preferred.
Requesting a specificity of > 90%, high sensitivity rates were
calculated for ploidy imbalance (94%), mean ploidy (91%), diploid
deviation quotient (91%), DNA stemline ploidy (87%) and 2c deviation
index (85%), based on suitable thresholds. Entropy (76%), 5c exceeding
events (63%), mean nuclear area (48%) and 9c exceeding events (6%)
revealed lower sensitivity values. 5c Exceeding events (P = .0117) and
mean nuclear area (P = .0392) were helpful in differentiating between
atypical hyperplasia and endometrial carcinoma as the data distribution
was significantly different with the U test. CONCLUSION: Our results
indicate that DNA single cell cytometry is a highly relevant tool in the
differential diagnosis of endometrial lesions and could be used as a
complementary diagnostic method, especially in histomorphologically
difficult cases.
2
UI - 11332081
AU - Garcia FA; Davis JR; Alberts DS; Hatch K; Weyn B; Thompson D; Bartels PH
TI -
Nuclear chromatin patterns in normal, hyperplastic and atypical
endometrium.
SO - Anal Quant Cytol Histol 2001 Apr;23(2):144-50
AD - Arizona Cancer Center and Optical Sciences Center, University of
Arizona, Tucson, Arizona, USA.
OBJECTIVE: To characterize the nuclei of endometrial lesions for the
diagnostic categories of normal glandular tissue, simple hyperplasia,
atypical hyperplasia and adenocarcinoma of the endometrium, with the
specific goal of probing for heterogeneity. STUDY DESIGN: For each
diagnostic category the images of 360 nuclei were recorded on a
high-resolution video microphotometer. Features descriptive of the
statistical and spatial distribution of nuclear chromatin were computed
for each nucleus. A nonsupervised learning algorithm, P-index, was
employed to establish subsets of nuclei within each diagnostic category
and to determine whether these subsets were statistically significantly
different in the nuclear chromatin pattern. RESULTS: Lesions from cases
of hyperplasia, atypical hyperplasia and adenocarcinoma of the
endometrium each contained several subsets of nuclei with statistically
significantly different chromatin patterns. For one such subset from
each diagnostic category, a clear trend of progression toward
adenocarcinoma could be demonstrated. CONCLUSION: The nuclei in
endometrial lesions represent a highly heterogeneous set. Any measure of
lesion progression or regression due to chemopreventive intervention, in
an individual case, will have to examine the proportion of nuclei in
each of these subsets as well as measures of deviation from normal for
each subset.
3
UI - 11411456
AU - Committee on Gynecologic Practice, The American College of Obstetricians
TI -
and Gynecologists
ACOG committee opinion: Tamoxifen and endometrial cancer.
SO - Int J Gynaecol Obstet 2001 Apr;73(1):77-9
4
UI - 11396634
AU - Agoff SN; Grieco VS; Garcia R; Gown AM
TI -
Immunohistochemical distinction of endometrial stromal sarcoma and
cellular leiomyoma.
SO - Appl Immunohistochem Mol Morphol 2001 Jun;9(2):164-9
AD - Department of Cytopathology, University of Washington Medical Center,
Seattle, USA. agoff@u.washington.edu
Distinguishing low grade endometrial stromal sarcoma (ESS) from benign
smooth muscle proliferations like cellular leiomyoma (CL) can be
problematic; because of differing treatments and prognosis, this
distinction is important. The authors tested the hypothesis that low
grade ESS could be distinguished from CL by immunohistochemistry using a
panel of antibodies that have not previously been used in this setting.
Antibodies to calponin, smooth muscle myosin heavy chain (SMM-HC), the
Wilms tumor gene product (WT-1), and CD10 were applied to 14 cases of
ESS (10 low grade, 4 high grade) and 9 CL. Among low grade ESS, 3 of 10,
3 of 10, 9 of 10, and 10 of 10 were positive for expression of calponin,
SMM-HC, WT-1, and CD10, respectively. Of CL, all 9 were positive for
calponin, SMM-HC, and WT-1, whereas 3 of 9 marked with antibodies to
CD10. Overall, SMM-HC and calponin were expressed strongly in CL but
weakly expressed in ESS; the converse was true for CD10. Expression of
WT-1 and the reticulin-staining pattern do not discriminate between
these two tumors. Antibodies to SMM-HC, CD10, and calponin can reliably
distinguish ESS from CL.
5
UI - 11474654
AU - Chadwick RB; Pyatt RE; Niemann TH; Richards SK; Johnson CK; Stevens MW;
TI -
Meek JE; Hampel H; Prior TW; de la Chapelle A
Hereditary and somatic DNA mismatch repair gene mutations in sporadic
endometrial carcinoma.
SO - J Med Genet 2001 Jul;38(7):461-6
6
UI - 11444198
AU - Czernobilsky B; Gabbiani G; Prus D; Lifschitz-Mercer B
TI -
Alpha-smooth muscle actin-positive myofibroblasts in endometrial stroma
are not a reliable criterion for the diagnosis of well differentiated
endometrioid adenocarcinoma in small tissue samples.
SO - Int J Gynecol Pathol 2001 Jul;20(3):232-8
AD - Laboratory of Pathology, Patho-Lab, Ness-Ziona, Israel.
Although a desmoplastic stromal reaction in well-differentiated
endometrioid adenocarcinoma is considered a major criterion in the
differential diagnosis with atypical hyperplasia, this histologic
feature has not met with universal approval. Since alpha-smooth muscle
(alpha-SM) actin positive myofibroblasts characterize the desmoplastic
stromal response in a variety of neoplasms, the present study was
undertaken in order to establish whether these cells are also prominent
in the stroma of endometrioid carcinoma and if present could be used as
a valid criterion in the differential diagnosis between benign and
malignant lesions. The present study of 100 endometrial samples showed
focal desmoplastic stromal reaction with alpha-SM actin positive
myofibroblasts in 30% of small samples and in 50% of hysterectomy
specimens with endometrioid carcinoma. In normal endometrium and in
benign lesions lacking a desmoplastic reaction, focal stromal alpha-SM
actin positivity was a very common finding. Stromal alpha-SM
actin-positive cells were also frequently seen in nondesmoplastic stroma
of endometrioid carcinoma. Thus the common presence of alpha-SM
actin-positive myofibroblasts in normal endometrial stroma and in benign
and malignant lesions precludes its usefulness in the diagnosis of well
differentiated endometrioid adenocarcinoma, especially in small tissue
samples.
7
UI - 11444203
AU - Guarch R; Puras A; Ceres R; Isaac MA; Nogales FF
TI -
Ovarian endometriosis and clear cell carcinoma, leiomyomatosis
peritonealis disseminata, and endometrial adenocarcinoma: an unusual,
pathogenetically related association.
SO - Int J Gynecol Pathol 2001 Jul;20(3):267-70
AD - Departamento de Anatomia Patologica, Hospital Virgen del Camino,
C/Irunlarrea 4, 31008 Pamplona, Spain.
A 42 year-old female with a preoperative clinical diagnosis of ovarian
cancer underwent laparotomy which revealed leiomyomatosis peritonealis
disseminata (LPD) in the peritoneum and omentum and a left ovarian
endometriotic cyst associated with a clear cell carcinoma. A grade 1,
superfically invasive villoglandular endometrial endometrioid
adenocarcinoma was also found. Microscopically, the endometriotic cyst
wall contained an extensive peripheral band-like condensation of stromal
cells. These cells were strongly positive for alpha inhibin and may have
been the hormonal source responsible for the induction of the
simultaneous LPD and endometrial adenocarcinoma. It is proposed that
endometriosis is not only a precursor of clear cell carcinoma but,
through secondary hormonal induction of the surrounding ovarian stroma,
may also provide a hormonal stimulus for diverse proliferative
processes.
8
UI - 11444189
AU - Nunobiki O; Sato M; Taniguchi E; Nakamura Y; Mori I; Kakudo K
TI -
Morphometric characterization of endometrial glands using quantitative
cytology.
SO - Anal Quant Cytol Histol 2001 Jun;23(3):201-6
AD - Department of Pathology, Wakayama Medical University, Wakayama, Japan.
OBJECTIVE: To determine the usefulness of the combination of confocal
laser scanning microscopy (CLSM), image cytometry and three-dimensional
(3D) imaging for analyzing architectural changes indicative of
endometrial hyperplasia and grade 1 adenocarcinoma. STUDY DESIGN:
Papanicolaou-stained endometrial samples (n = 180) were analyzed for
specific cellular characteristics and analyzed by CLSM. Confocal images
were obtained and then analyzed cytometrically and used for 3D
reconstruction. RESULTS: Values obtained after image cytometry and 3D
imaging increased significantly (P < .01) with the degree of cellular
atypia. CONCLUSION: The combination of CLSM, image cytometry and 3D
imaging is a valuable method for differential diagnosis of endometrial
hyperplasia and grade 1 adenocarcinoma.
9
UI - 11446474
AU - Holub Z; Kliment L; Lukac J; Voracek J
TI -
Laparoscopically-assisted intraoperative lymphatic mapping in
endometrial cancer: preliminary results.
SO - Eur J Gynaecol Oncol 2001;22(2):118-21
AD - Department of Obstetrics and Gynaecology, Endoscopic Training Center,
Baby Friendly Hospital, Kladno, Czech Republic.
OBJECTIVE: To analyse the results of a pilot study and determine the
contribution of laparoscopically-assisted lymphatic mapping in patients
with endometrial cancer. METHODS AND MATERIALS: In eight cases of early
endometrial cancer, patent blue-V was injected laparoscopically into the
uterine wall during a surgical staging procedure. RESULTS: A deposition
of the blue dye was found in at least one pelvic lymph node in five of
eight cases. Blue-colored nodes were observed in a total of 11 lymph
nodes. Locations of these nodes included obturator, internal and common
iliac sites. Only one blue colored node was positive for disease. An
average of 15 lymph nodes were removed in the study group (range,
12-22). Uterine lymphatic vessels with bilateral drainage to the broad
and infundibulopelvic ligaments were seen in all cases within 30-60
seconds. CONCLUSION: Our initial experience with
laparoscopically-assisted lymphatic mapping confirmed that the use of a
minimally invasive technique is feasible. Lymphatic channels in the
pelvic areas were seen in every patient. A deposition of blue dye in
laparoscopically identifiable lymph nodes was seen only in 62.5% of
patients. However, we believe that the lymphatic mapping of the uterine
corpus can improve the accuracy of surgical staging in patients with
endometrial cancer.
10
UI - 11446475
AU - Halperin R; Zehavi S; Habler L; Hadas E; Bukovsky I; Schneider D
TI -
Comparative immunohistochemical study of endometrioid and serous
papillary carcinoma of endometrium.
SO - Eur J Gynaecol Oncol 2001;22(2):122-6
AD - Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center,
Zerifin, Israel.
OBJECTIVE: The aim of this study was to determine whether
immunohistochemical analysis of molecular parameters can provide an
alternative method for classification of endometrial cancer cases
according to their aggressiveness. METHODS: Sixty-four cases of
endometrial carcinoma were assigned to three groups: group I--28 cases
of endometrioid well and moderately differentiated (G1-G2) carcinoma;
group II--14 cases of endometrioid poorly differentiated (G3) carcinoma;
group III--22 cases of serous papillary endometrial cancer.
Immunohistochemistry was used to determine the existence of estrogen
receptors (ER), progesterone receptors (PR), and the expression of
bcl-2, p53, HER-2/neu and Ki-67. RESULTS: There was a significant
difference in the immunohistochemical profile of the studied molecular
parameters comparing the three study groups. The endometrioid G1-G2
cases (group I) were characterized by increased immunoreactivity for ER
and PR (85.7% and 78.6%, respectively), increased immunoreactivity for
bcl-2 (42.8%) and low expression of p53 (14.3%) and HER-2/neu (14.3%).
In contrast to group I cases, the serous papillary endometrial cancer
cases (group III) were characterized by immunonegativity for ER, PR and
bcl-2 and high immunoreactivity for p53 (81.8%) and HER-2/neu (45.4%).
The endometrioid G3 cases (group II) demonstrated an intermediate
immunoprofile, characterized by immunonegativity for ER, PR and
HER-2/neu, low immunoreactivity for bcl-2 (7.1%) and high expression of
p53 (57.1%). The expression of Ki-67 did not differ significantly
comparing the different cases of endometrial cancer. CONCLUSION: This
study provides evidence that the immunohistochemical analysis of
endometrial carcinoma differentiates between different grades and
histological types, thus being useful in the distinction of high risk
cases.
11
UI - 11446480
AU - Rodolakis A; Papaspyrou I; Sotiropoulou M; Markaki S; Michalas S
TI -
Primary squamous cell carcinoma of the endometrium. A report of 3 cases.
SO - Eur J Gynaecol Oncol 2001;22(2):143-6
AD - 1st Department of Obstetrics and Gynecology, Athens University, Greece.
Primary squamous cell carcinoma of the endometrium (PSCCE) is a rare
disease of unknown etiology. Diagnosis is based on the identification of
squamous cell carcinoma in the endometrium with no coexisting analogous
cervical component or endometrial adenocarcinoma. There must also be no
connection between the endometrial tumour and the squamous epithelium of
the cervix. Although the majority of patients are classified as stage I
disease, prognosis is rather dismal. We report two new cases of primary
squamous cell carcinoma of the endometrium which fulfill all the above
criteria and we discuss another interesting case of squamous cell
carcinoma of questionable endometrial origin. Management by abdominal
hysterectomy and adjuvant pelvic irradiation resulted in long-term
survival of our patients.
12
UI - 11446483
AU - Pekin T; Yildizhan B; Eren F; Pekin O; Yildizhan R
TI -
Adenocarcinoma, adenoacanthoma, and mixed adenosquamous carcinoma of the
endometrium.
SO - Eur J Gynaecol Oncol 2001;22(2):151-3
AD - Dept. of Gynecological Oncology, Marmara University Hospital, Istanbul,
Turkey.
PURPOSE: To determine the frequency of endometrial adenocarcinoma (AC)
with squamous cell differentiation and to compare the histopathologic
and clinical characteristics of patients with adenoacanthoma (AA) and
adenosquamous carcinoma (AS) to evaluate possible prognostic
differences. MATERIALS AND METHODS: Two hundred forty patients with
endometrial carcinoma (72.2% AC, 21.25% AA, 6.25% AS) treated at the
Department of Gynecologic Oncology of Marmara University Hospital,
the diseases were made with fractional D&C, and the definitive therapy
for all patients was carried out at the same hospital. Extrafascial
hysterectomy + BSO with or without pelvic and para-aortic lymph node
dissection, and omentectomy according to the FIGO staging and grading
system were performed. RESULTS: AC and AS had median ages around 60
years with a similar percent distribution of postmenopausal patients
(around 74%). AA had an earlier median age of 51 years which reflects an
incidence of only 50% postmenopausal patients. There was a tendency for
AA to be of low-grade malignancy (72%), 51% of AC were of low-grade,
while only 20% of AS were low-grade tumors. There was no difference for
any of the three pathological entities in survival by FIGO stages. Over
80% of the tumors were Stage I and about 10% were Stage II, with less
than 10% in Stages III and IV. CONCLUSION: Considering the more modern
and uniform approaches in therapy for these tumors, there seems to be no
differences in prognosis for adenocarcinoma with or without squamous
elements. The neoplasms AC, AA and AS should be regarded, and
consequently approached, as any low-grade adenocarcinoma of the
endometrium.
13
UI - 11446488
AU - Bonte J
TI -
Recent data about endometrial carcinoma: potential of anti-aromatase
agents.
SO - Eur J Gynaecol Oncol 2001;22(2):96-8
14
UI - 11484981
AU - Taponeco F; Curcio C; Giuntini A; Nardini V; Fornaciari G; Artini PG;
TI -
D'Ambrogio G; Genazzani AR
Expression and prognostic significance of urokinase and plasminogen
activator inhibitor type-1 in endometrial hyperplasia and cancer.
SO - J Exp Clin Cancer Res 2001 Jun;20(2):239-46
AD - Dept. of Reproductive Medicine and Child Development, University of
Pisa, Italy. carm.curcio@tiscalinet.it
Proteolytic enzymes, like urokinase (uPA) and plasminogen activator
inhibitor type-1 (PAI-1), are involved in remodelling tissues during
invasion and metastasis of tumor cells. The purpose of the study is to
evaluate the expression and the prognostic significance of these enzymes
in endometrial hyperplasia and cancer. We used immunohistochemical
staining to localize uPA and PAI-1 antigens and evaluate their
expression, and the enzyme-linked immunosorbent assay (ELISA) to measure
their levels during the progression of endometrial carcinoma. The
results show that the levels of uPA and PAI-1 detection are
systematically weak in simplex hyperplasia and are moderate in complex
hyperplasia. In the endometrial carcinoma a very strong reaction was
observed in the most aggressive variant of epithelial tumors. A positive
signal for uPA was found only in the cytoplasm of normal and
hyperplastic cells while, in tumors, uPA was present also in the
cellular areas surrounding the neoplastic glands and at the apex of the
malignant cells. The PAI-1 immunoreactivity was weak to moderate in
95.4% of carcinomas, with a diffuse signal mostly distributed in the
cytoplasm of neoplastic cells and tumor stroma. UPA antigen
concentrations were significantly higher in endometrial carcinoma than
in endometrial hyperplasia (p<0.05) and in normal endometrium (p<0.001).
PAI-1 antigen concentrations in carcinoma samples were significantly
higher than in normal endometrium (p=0.002), but the difference was not
statistically significant with respect to that in endometrial
hyperplasia. We did not find any correlation between uPA and PAI-1
concentrations and the standard prognostic parameters for evaluating
endometrial carcinoma. In conclusion, this study demonstrates that in
hyperplastic endometria and in endometrial carcinoma there is a
progressive increase in expression of uPA and PAI-1 than in normal
endometrial tissue. In carcinoma tissues, the high expression of uPA is
unregulated in the surrounding stroma tissue, particularly in the most
aggressive histopathologic variants. UPA and PAI-1 may be factors
associated with invasive behavior in endometrial carcinoma independent
of other clinicopathological parameters.
15
UI - 11503919
AU - Kurjak A; Kupesic S; Sparac V; Bekavac I
TI -
Preoperative evaluation of pelvic tumors by Doppler and
three-dimensional sonography.
SO - J Ultrasound Med 2001 Aug;20(8):829-40
AD - Department of Obstetrics and Gynecology, Medical School, University of
Zagreb, Sveti Duh Hospital, Croatia.
OBJECTIVE: To study a spectrum of systems (two-dimensional transvaginal,
transvaginal color Doppler, three-dimensional, three-dimensional power
Doppler, and contrast-enhanced three-dimensional power Doppler
sonography) for preoperative evaluation of pelvic tumors. METHODS: Two
hundred ninety-two patients were evaluated by the 5 complementary
methods in preoperative sonographic assessments. We examined adnexal and
endometrial morphology, thickness, and volume by two- and
three-dimensional sonography and analyzed blood flow by transvaginal
color, pulsed Doppler, and three-dimensional power Doppler sonography in
all examined patients. In 89 patients with complex adnexal lesions of
uncertain malignancy, contrast-enhanced three-dimensional power Doppler
sonography was performed. RESULTS: Morphologic assessment by
three-dimensional sonography yielded additional information in 58% of
cases compared with two-dimensional sonography. Furthermore, this
modality was superior to two-dimensional sonography in accurate
depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined
morphology and vascular indexing reached sensitivity of 97% and
specificity of 99%. Endometrial volume in patients with malignant
disease was significantly different (28.2 +/- 0.02 cm3) from that in
those who had hyperplasia (7.81 +/- 0.03 cm3), polyps (3.5 +/- 0.02
cm3), or normal endometria (0.8 +/- 0.02 cm3). With combined morphologic
and three-dimensional power Doppler examination of endometrial lesions,
sensitivity and specificity reached 89% and 97%, respectively.
CONCLUSIONS: Combined morphologic and vascular imaging improves
preoperative assessment of gynecologic tumors.
16
UI - 11501773
AU - Szantho A; Szabo I; Csapo ZS; Balega J; Demeter A; Papp Z
TI -
Assessment of myometrial and cervical invasion of endometrial cancer by
transvaginal sonography.
SO - Eur J Gynaecol Oncol 2001;22(3):209-12
AD - Department of Obstetrics and Gynecology, Semmelweis University, Faculty
of Medicine, Budapest, Hungary.
INTRODUCTION: The aim of this study was to determine the efficiency of
transvaginal ultrasonography in the assessment of myometrial invasion
and cervical involvement (preoperative staging) of endometrial cancer.
MATERIALS AND METHODS: Transvaginal ultrasonography was performed on 52
women to classify endometrial cancer with respect to myometrial invasion
and cervical involvement according to the International Federation of
Gynaecologists and Obstetricians recommendations for surgical staging of
endometrial cancer. Endometrial cancer was diagnosed on the basis of
dilatation and curettage and the degree of invasion was evaluated
preoperatively by transvaginal ultrasonography. Ultrasonographic
findings were compared to the surgical staging and histopathology of the
surgical specimen. RESULTS: Myometrial invasion evaluated by
transvaginal sonography was accurate in 46 of 52 cases (accuracy 88%,
sensitivity 86%, specificity 90%, positive predictive value 92%,
negative predictive value 83%). Tumor extension to the cervix was
properly diagnosed in seven of ten women in which it was present.
CONCLUSION: Transvaginal ultrasonography is a reliable method for
assessing myometrial invasion and cervical involvement. This
non-invasive method should be included as an important tool in the
establishment of individualized treatment programs for women with
endometrial cancer.
17
UI - 11501776
AU - Imai M; Jobo T; Sato R; Kawaguchi M; Kuramoto H
TI -
Medroxyprogesterone acetate therapy for patients with adenocarcinoma of
the endometrium who wish to preserve the uterus-usefulness and
limitations.
SO - Eur J Gynaecol Oncol 2001;22(3):217-20
AD - Department of Clinical Cytology, Graduate School of Medical Sciences
Kitasato University, Kanagawa-ken, Japan.
BACKGROUND: To determine the effectiveness of medroxyprogesterone
acetate therapy for women with endometrial adenocarcinoma who wish to
preserve their uterus. STUDY DESIGN: Fifteen patients with endometrial
carcinoma (12 with grade 1 endometrioid adenocarcinoma. 2 with grade 2
adenocarcinoma and 1 with adenoacanthoma) were treated with high-dose
medroxyprogesterone acetate alone as primary therapy and their clinical
responses evaluated. RESULTS: Seven of the 12 cases (58%) with grade I
adenocarcinoma and one of the two (50%) with grade 2 carcinoma responded
initially to medroxyprogesterone acetate. The median length of treatment
required for regression was 29 weeks. Three patients who initially
responded relapsed. Thirteen patients are alive without evidence of
months) and one is continuing medroxyprogesterone acetate therapy as a
final follow-up. One patient was lost to follow-up. Two patients have
conceived having three healthy infants. CONCLUSION: Treatment of
endometrial carcinoma with high-dose medroxyprogesterone acetate could
be an alternative to hysterectomy, although the successful rate is
limited.
18
UI - 11516808
AU - Coronado PJ; Vidart JA; Lopez-asenjo JA; Fasero M; Furio-bacete V;
TI -
Magrina J; Escudero M
P53 overexpression predicts endometrial carcinoma recurrence better than
HER-2/neu overexpression.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Sep;98(1):103-8
AD - Department of Obstetrics and Gynecology, Hospital Clinico San Carlos,
Madrid, Spain. pcoronadom@sego.es
OBJECTIVE: to investigate the prognostic value of p53 and HER-2/neu
overexpression in endometrial cancer. STUDY DESIGN: p53 and HER-2/neu
immunostaining was performed in 114 paraffin-embedded specimens of
endometrial cancer diagnosed and treated between 1990 and 1997. Nuclear
p53 and membrane HER-2/neu immunostaining were used. RESULTS: p53 and
HER-2/neu overexpression was observed in 17 cases (14.9%) and in 19
cases (16.7%), respectively. In univariate analysis p53 (P<0.001) and
HER-2/neu (P=0.018) overexpression had a positive correlation with a
high risk of recurrence. In multivariate analysis, age (P<0.001), FIGO
stage (P<0.001), differentiation (P=0.013), non-endometrioid subtypes
(P<0.001) and p53 overexpression (P<0.001), but not HER-2/neu
overexpression, were independent prognostic indicators of recurrence.
Simultaneous p53 and HER-2/neu overexpression made worse the prognostic
(P<0.001). CONCLUSIONS: p53 overexpression was an independent predictor
of recurrent disease in endometrial cancer. HER-2/neu overexpression had
a more limited effect but enhance the effect of p53.
19
UI - 11516816
AU - Malhotra N; Deka D; Takkar D
TI -
Ureteric calculi masquerading metastatic lymph nodes in a case of
endometrial cancer.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Sep;98(1):133-4
AD - Department of Obstetrics and Gynaecology, All India Institute of Medical
Sciences, 110026, New Delhi, India. malhotraneena@indiatimes.com
Extensive pelvic lymph node metastasis in the absence of risk factors
was noticed at surgical staging for endometrial cancer in a 55-year-old
postmenopausal women. On exploration there was a dilemma as to the
disappearing lymph nodes which subsequently proved to be asymptomatic
ureteric calculi. The need to palpate the pelvic side walls at the time
of surgery for endometrial cancer even in cases when no nodal
enlargement is detected preoperatively is highlighted.
20
UI - 11516800
AU - Benshushan A; Paltiel O; Brzezinski A; Tanos V; Barchana M; Shoshani O;
TI -
Gordon L; Tsur L; Schenker JG
Ovulation induction and risk of endometrial cancer: a pilot study.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Sep;98(1):53-7
AD - Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical
Center, Hebrew University, P.O. Box 12000, IL 91120, Jerusalem, Israel.
OBJECTIVE: To determine whether women with endometrial carcinoma are
more likely to have been exposed to fertility drugs, in particular
clomiphene, than healthy population controls. STUDY DESIGN: A nationwide
case-control, pilot study. About 128 living women 35-64 years old, with
a histologically confirmed diagnosis of endometrial carcinoma that was
first diagnosed and reported to The Israel Cancer Registry between 1
women from the same dialing areas selected by random digit dialing. A
variety of demographic and clinical parameters were compared between
cases and controls. A multivariate logistic model, controlling for age,
was used to assess the independent effects of factors found to be
significantly associated with endometrial cancer on univariate analysis.
RESULTS: About 7 women with endometrial carcinoma (5.5%) and 10 healthy
controls (3.9%) reported that they had used any fertility drug (crude
odds ratio (OR) 1.4; 95% confidence interval (CI) 0.47-4.2). Use of
fertility drugs did not meet the criteria for entry into the logistic
model. The following parameters were found to be independently
associated with endometrial cancer controlling for age,
European-American background OR=2.2, (95% CI 1.3-3.7, P=0.004);
nulliparity OR=2.7 (95% CI 1.1-6.5, P=0.03); history of infertility
OR=1.8 (95% CI 1.0-3.3, P=0.05); BMI> or =27 OR=2.3 (95% CI 1.4-3.9,
P=0.001). The use of oral contraceptives and IUD were found to be
protective, OR=0.29 and 0.37, respectively, (95% CI 0.14-0.61, P=0.001
and 0.19-0.70, P=0.003, respectively). CONCLUSIONS: We found no evidence
that the use of ovulation induction agents, including clomiphene
citrate, are associated with a higher risk of endometrial carcinoma. The
association between infertility drugs and endometrial carcinoma should
be examined in other, larger studies.
21
UI - 11549315
AU - Noonan FC; Mutch DG; Ann Mallon M; Goodfellow PJ
TI -
Characterization of the homeodomain gene EMX2: sequence conservation,
expression analysis, and a search for mutations in endometrial cancers.
SO - Genomics 2001 Aug;76(1-3):37-44
AD - Department of Surgery, Washington University School of Medicine, 660 S.
Euclid Avenue, St. Louis, Missouri, 63110, USA.
Previous loss-of-heterozygosity studies in endometrial carcinoma mapped
a putative tumor suppressor gene to 10q25.3-26.1. An analysis of genomic
sequences for the deletion interval showed several expressed sequence
tags and the homeodomain gene EMX2, a homologue of Drosophila
melanogaster empty spiracles. Expression studies showed that EMX2
transcripts are abundant in the adult uterus and that message levels
seem to be inversely correlated with endometrial proliferation. EMX2 RNA
was more abundant in quiescent postmenopausal endometrium than in
premenopausal endometrium. We found decreased EMX2 expression in a
subset of primary endometrial tumors, and four of six endometrial cancer
cell lines investigated failed to express EMX2. The predicted protein
showed extensive amino acid conservation with EMX2 sequences from
several vertebrates. There was also considerable evolutionary
conservation in the 3' untranslated region. To examine the potential
function of EMX2 in endometrial tumorigenesis, we investigated 20
primary tumors and 6 endometrial cancer cell lines for mutations. Two
primary tumors had mutations. Inactivation or reduced expression of EMX2
in cancers, coupled with increased expression in the quiescent
endometrium, indicate that this homeodomain gene is involved in
maintenance of the differentiated state.
22
UI - 11574518
AU - Kokawa K; Shikone T; Otani T; Nishiyama R; Ishii Y; Yagi S; Yamoto M
TI -
Apoptosis and the expression of Bax and Bcl-2 in hyperplasia and
adenocarcinoma of the uterine endometrium.
SO - Hum Reprod 2001 Oct;16(10):2211-8
AD - Department of Obstetrics and Gynecology, Wakayama Medical University,
811-1 Kimidera, Wakayama 641-0012, Japan. katsu@wakayama-med.ac.jp
BACKGROUND: Apoptosis plays a crucial role in carcinogenesis in various
tumours. This study was designed to investigate the occurrence of
apoptosis and the expression of Bcl-2 and Bax proteins in endometrial
tumours of corpus uteri. METHODS: Endometrial tissues were obtained from
20 patients with endometrioid adenocarcinoma, 16 patients with
endometrial hyperplasia, and 4 patients with myoma uteri (which were
used as controls). The occurrence of apoptosis was examined by using
molecular biochemical techniques. The expression of Bcl-2 and Bax
proteins was also investigated using immunohistochemical staining with
appropriate antibodies. RESULTS: The labelling of DNA in situ indicated
that apoptotic cells were sporadically seen in postmenopausal
endometrium (5.2 +/- 2.1, n = 4) and endometrial hyperplasia without
atypia (2.6 +/- 0.5, n = 9). In contrast, labelled cells were detected
in atypical endometrial hyperplasia (15.9 +/- 2.2, n = 7), and their
numbers increased intensely in adenocarcinoma (29.3 +/- 3.7, n = 20).
Autoradiographic analysis revealed DNA laddering in many cases of
carcinoma. Bcl-2 was highly immunopositive in hyperplasia without atypia
(36.2 +/- 6.5%, n = 9), but was decreased in the atypical endometrial
hyperplasia (16.3 +/- 4.8%, n = 7). Large fractions of the carcinoma
(6.3 +/- 1.8%, n = 20) and normal endometrium (2.8 +/- 1.4%, n = 4) were
immunonegative or slightly immunopositive to Bcl-2. In contrast, Bax
immunoreactivity was more frequent and stronger in adenocarcinoma (43.6
+/- 4.1%, n = 20) than that in normal endometrium (17.6 +/- 6.7%, n = 4)
and hyperplasia (7.2 +/- 2.2%, n = 16). CONCLUSIONS: These results
suggest that cells in hyperplasia expressing Bcl-2 might have prolonged
survival ability. Neoplastic cells in adenocarcinoma might show
apoptosis in association with a decreased expression of Bcl-2 and an
increased expression of Bax. Therefore, the frequency of apoptosis and
the expression of Bcl-2 and Bax might be correlated with carcinogenesis
in the uterine endometrium of humans.
23
UI - 11574177
AU - Rozenberg S; Auvertin S; Ham H
TI -
A survey of physicians' attitude towards women with postmenopausal
bleeding.
SO - Maturitas 2001 Sep 28;39(3):189-93
AD - Department of Obstetrics and Gynaecology, CHU St Pierre, Free University
of Brussels (ULB), rue Haute 322, B-1000, Brussels, Belgium.
serge.rozenberg@skynet.be
OBJECTIVE: To study how gynaecologist manage postmenopausal bleeding in
women not using HRT. The impact on the physicians' attitude of risk
factors for endometrial cancer and of the endometrial thickness was
essentially accounted for. METHODS: Two different case-types were
defined by modifying the risk level of developing endometrial cancer.
Also the level of endometrial thickness, assessed by ultrasound, was
made to vary. In total four case-types were constructed. One case-type
was sent at random to each Belgian gynaecologist (n=970). RESULTS:
Response rate: 55%. The proportion of physicians who would not
investigate the patients' endometrium varied between 2% (high-risk
patient with abnormal ultrasound) and 34% (low risk patient, normal
ultrasound). Significant differences were observed in relation to the
level of risk factors for endometrial cancer and in relation to
endometrial thickness. No significant relationship was found between the
choice of the method of endometrial investigation and the risk situation
or the ultrasound result. CONCLUSIONS: The attitude of Belgian
gynaecologists towards postmenopausal bleeding is modified by the
presence of risk factors and by the level of endometrium thickness.
About one third of physicians would not further investigate the
endometrium of a patient with a low risk profile and a normal
endometrium as assessed by ultrasound.
24
UI - 11574186
AU - Foth D; Nawroth F; Schmidt T; Ortmann M; Romer T
TI -
Bilateral ovarian fibromas and endometrial adenocarcinoma in a
postmenopausal patient with growing uterine myomas.
SO - Maturitas 2001 Sep 28;39(3):259-64
AD - Department of Obstetrics and Gynecology, University of Cologne, Kerpener
Str. 34, 50931, Koln, Germany. dfoth@t-online.de
Bilateral ovarian fibromas are a rare condition. We report a case of
bilateral ovarian fibromas with endometrial adenocarcinoma in a
postmenopausal woman who clinically showed symptoms of an
estrogen-producing tumour. Clinical and histopathological problems in
the pre- and intraoperative diagnostics of fibromas are discussed.
25
UI - 11584939
AU - Sharma DN; Chander S; Gairola M; Kumar L; Parida DK; Pathy S
TI -
Medical disorders associated with endometrial carcinoma.
SO - J Assoc Physicians India 2001 Jun;49():630-3
AD - Department of Radiation Oncology, Institute Rotary Cancer Hospital, All
India Institute of Medical Sciences, New Delhi.
From January, 1990 to December, 1995, 113 cases of endometrial carcinoma
were registered. Of them, 24 patients (20%) had associated medical
disorders. A total of 37 medical disorders were found in these 24
patients. The distribution was as follows: diabetes mellitus in 15
patients, hypertension in 13 patients, coronary artery disease in two,
asthma in one, RBBB in one and hypothyroidism in five patients. Age of
the patients ranged from 48-76 years (Median 62 years). Fifteen patients
underwent surgery and rest nine were inoperable due to medical
illnesses. Eleven patients received radiotherapy and four received
chemotherapy. Of the two failures, one developed metastasis to lung and
another to bone. No local recurrence was observed. Median survival was
20 months. Late radia
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