National Cancer Institute®
Last Modified: February 1, 2002
UI - 11731188
AU - Maia H; Maltez A; Athayde C; Coutinho EM
TI - Proliferation profile of endometrial polyps in post-menopausal women.
SO - Maturitas 2001 Dec 14;40(3):273-81
AD - Endoscopy Unit, CEPARH, Rua Caetano Moura, 35, Salvador 40210-341, Bahia, Brazil. email@example.com
OBJECTIVE: To determine whether or not the presence of c-erbB2 over-expression in endometrial polyps affects the percentage of cells positive for Ki-67 proliferation marker. METHODS: Thirty-five patients with endometrial polyps were submitted to polypectomy by hysteroscopy. Ki-67 and c-erbB2 over-expression were investigated in the polyps by immunohistochemistry. RESULTS: The presence of c-erbB2 over-expression by immunohistochemistry was observed in 80% of endometrial polyps and was associated with higher proliferation rates as determined by the number of positive Ki-67 cell nuclei. In c-erbB2-negative polyps, the proliferation rates were low. CONCLUSION: Ki-67 and c-erbB2 over-expression are frequent in endometrial polyps in post-menopausal women.
UI - 11791283
AU - Brandner P; Neis KJ
TI - Diagnosis of endometrial cancer and its precursors.
SO - Contrib Gynecol Obstet 2000;20():27-40
AD - St. Theresia Caritas Hospital, Gynecological Clinic, School of Midwifery, Saarbrucken, Germany. firstname.lastname@example.org
Whereas cervical carcinoma is reliably detectable by the noninvasive methods of cytological/cervical smear and HPV typing even in the early stages, endometrial carcinoma thus far eludes effective check-up. Neither ultrasound nor invasive procedures such as Pipelle de Cornier, abrasio fracta or hysteroscopy, succeeded in making the majority of endometrial carcinomas detectable at an early stage in systematic screenings. Several factors contribute to this fact: first, only a fraction of these carcinomas develops through early stages of atypical hyperplasia, whereas the majority develops de novo. As the most suitable screening method in general, ultrasound fails in pre- and perimenopausal women, who account for 30% of new endometrial carcinoma cases. Moreover, patient compliance with preventive examinations is especially low in the high risk population of senior women. And, finally, there are issues regarding the clinical consequences of improved diagnosis, since endometrial carcinomas may become clinically significant in only 1 of every 4-6 patients, whereas the majority of these malignomas remains clinically inapparent. Hence, atypical uterine bleeding will continue to be the main symptom prompting hysteroscopic and histological clarification (H&H) and ensuing detection of endometrial carcinomas and their early stages.
UI - 11791287
AU - Tercanli S; Kochli OR; Hoesli I; Feichter G; Schaub A; Holzgreve W
TI - Differentiation and management of endometrium abnormalities and leiomyomas by hydrosonography.
SO - Contrib Gynecol Obstet 2000;20():69-80
AD - Department of Ultrasound, University Hospital Basel, Switzerland. email@example.com
Transvaginal sonography is an established method for numerous clinical indications in the assessment of endometrium pathology. The investigation of the endometrium consists of the measurement of the thickness, the visualization of the echogenity and echotexture and of the demonstration of focal masses. However, evaluation of the uterine cavity by transvaginal sonography is limited and an abnormal ultrasound of the endometrium may reflect benign or malignant conditions. Furthermore, small structures can be missed or overlooked. If indicated, hydrosonography offers various advantages compared to dilatation and curettage and hysteroscopy in terms of costs, availability and risks. Additional informations obtained after hydrosonography may influence the management before consideration of curettage or hysteroscopy.
UI - 11584479
AU - Wu HH; Schuetz MJ 3rd; Cramer H
TI - Significance of benign endometrial cells in Pap smears from postmenopausal women.
SO - J Reprod Med 2001 Sep;46(9):795-8
AD - Department of Pathology, Ball Memorial Hospital, 2401 University Avenue, Muncie, IN 47303, USA. firstname.lastname@example.org
OBJECTIVE: To assess the significance of benign exfoliated endometrial epithelial or stromal cells on cervicovaginal Pap smears obtained from postmenopausal women not receiving exogenous hormones. STUDY DESIGN: A computerized search of the cytology database at two institutions was performed for a five-year period, and all cervical cytology cases from postmenopausal patients diagnosed with benign endometrial cells were identified. Those cases with histologic follow-up within 12 months of the original cytologic evaluation were selected for analysis, and their cytology and surgical pathology slides were reviewed. RESULTS: A total of 227 postmenopausal women with benign endometrial cells were identified. Of the 61 patients with histologic follow-up, 25 (41%) had significant endometrial diseases, including hyperplasia without atypia (11), atypical endometrial hyperplasia (5), well-differentiated adenocarcinoma (8) and high grade serous carcinoma (1). Benign diagnoses, including atrophy (15), weakly proliferative endometrium (9) and proliferative endometrium (6), were noted in 30 patients (49%). Endometrial polyp was identified in three patients (5%). There were three cases of nondiagnostic histologic specimens that lacked endometrial tissue (5%). Two of nine women (22%) with proven carcinoma were asymptomatic. CONCLUSION: The diagnosis of endometrial cells, cytologically benign, in a postmenopausal woman not receiving hormone on Pap smears is associated with a significant number of cases of endometrial hyperplasia, atypical hyperplasia and carcinoma.
UI - 11584486
AU - Dunn TS; Stamm CA; Delorit M; Goldberg G
TI - Clinical pathway for evaluating women with abnormal uterine bleeding.
SO - J Reprod Med 2001 Sep;46(9):831-4
AD - Departments of Obstetrics and Gynecology, Denver Health Medical Center, University of Colorado Health Science Center, 777 Bannock Street, M/C 0660, Denver, CO 80204, USA. email@example.com
OBJECTIVE: To devise a clinical pathway for evaluating women with abnormal uterine bleeding. STUDY DESIGN: One thousand women with the complaint of abnormal uterine bleeding were enrolled. All would have undergone endometrial biopsy based on older recommendations. The patients followed a clinical pathway to determine if an endometrial biopsy was necessary. The pathway divided women into the categories of premenopausal, postmenopausal, low risk and high risk. If one risk factor was present, the patient underwent endometrial biopsy. If there were no risk factors, the patient continued down the pathway with medical therapy. RESULTS: Five hundred seventy endometrial biopsies were performed. Five cases of endometrial cancer and three of complex atypical hyperplasia, both in the postmenopausal, high-risk group, were discovered. Subsequent reviews revealed that no cases of endometrial cancer were missed or developed in the two years following the initial complaint. CONCLUSION: Utilization of a clinical pathway reduced the number of endometrial biopsies by 50%. The introduction of clinical pathways at our institution was done successfully in the evaluation of abnormal uterine bleeding.
UI - 11788613
AU - Hale GE; Hughes CL; Cline JM
TI - Endometrial cancer: hormonal factors, the perimenopausal "window of risk," and isoflavones.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):3-15
AD - Center for Women's Health, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
UI - 11784412
AU - McCann SE; Marshall JR; Brasure JR; Graham S; Freudenheim JL
TI - Analysis of patterns of food intake in nutritional epidemiology: food classification in principal components analysis and the subsequent impact on estimates for endometrial cancer.
SO - Public Health Nutr 2001 Oct;4(5):989-97
AD - Department of Social and Preventive Medicine, State University of New York at Buffalo, NY 14214, USA. firstname.lastname@example.org.
OBJECTIVE: To assess the effect of different methods of classifying food use on principal components analysis (PCA)-derived dietary patterns, and the subsequent impact on estimation of cancer risk associated with the different patterns. METHODS: Dietary data were obtained from 232 endometrial cancer cases and 639 controls (Western New York Diet Study) using a 190-item semi-quantitative food-frequency questionnaire. Dietary patterns were generated using PCA and three methods of classifying food use: 168 single foods and beverages; 56 detailed food groups, foods and beverages; and 36 less-detailed groups and single food items. RESULTS: Classification method affected neither the number nor character of the patterns identified. However, total variance explained in food use increased as the detail included in the PCA decreased (approximately 8%, 168 items to approximately 17%, 36 items). Conversely, reduced detail in PCA tended to attenuate the odds ratio (OR) associated with the healthy patterns (OR 0.55, 95% confidence interval (CI) 0.35-0.84 and OR 0.77, 95% CI 0.49-1.20, 168 and 36 items, respectively) but not the high-fat patterns (OR 0.95, 95% CI 0.57-1.58 and OR 0.85, 0.51-1.40, 168 and 36 items, respectively). CONCLUSIONS: Greater detail in food-use information may be desirable in determination of dietary patterns for more precise estimates of disease risk.
UI - 11774741
AU - Yokoyama Y; Wan X; Shinohara A; Takahashi Y; Tamaya T
TI - Hammerhead ribozymes to modulate telomerase activity of endometrial carcinoma cells.
SO - Hum Cell 2001 Sep;14(3):223-31
AD - Department of Obstetrics and Gynecology, Gifu University. email@example.com
Telomerase is an excellent target molecule for cancer therapy, though any effective agents have never been developed in human subjects. We designed a variety of hammerhead ribozymes against human telomerase RNA (hTR) and hTERT mRNA and studied their possibility as a tool for cancer therapy. To search promising target site of hTR, the catalytic actiuity of 3 kinds of hammerhead ribozymes was studied in cell-free system. They showed equivalent catalytic activity, but only 36-ribozyme, which was designed to cleave the template region of hTR, revealed telomerase inhibitory activity in an endometrial carcinoma cell line. Among hTERT-mRNA-targeted ribozymes, the ribozyme to cleave 13 nucleotides downstream from the 5'-end of hTERT mRNA (13-ribozyme) exhibited the strongest telomerase-inhibitory activity, and the ribozyme to cleave 59 nucleotides upstream from the poly(A) tail showed clear activity. Stable transfection studies confirmed that the 36-ribozyme as well as the 13-ribozyme suppressed telomerase. These observations suggest that the template region of hTR and 5'end of hTERT mRNA are promising target sites for ribozymes to reduce telomerase activity.
UI - 11782363
AU - Arnold JT; Lessey BA; Seppala M; Kaufman DG
TI - Effect of normal endometrial stroma on growth and differentiation in Ishikawa endometrial adenocarcinoma cells.
SO - Cancer Res 2002 Jan 1;62(1):79-88
AD - Department of Laboratory Pathology and Medicine, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, North Carolina 27599, USA. firstname.lastname@example.org
Endometrial cancer is characterized by alterations in the stromal cells and the supporting extracellular matrix in addition to the intrinsic alterations of the malignant epithelial cells. We have developed a cell culture model that demonstrates the role of stromal cells in the regulation of proliferation, hormone responsiveness, and differentiation of an endometrial adenocarcinoma cell line (Ishikawa). Conditioned medium (CM) was collected from normal primary human endometrial stromal cells grown on plastic or within the basement membrane extract, Matrigel. The CM produced by stromal cells cultured in contact with Matrigel markedly inhibited Ishikawa cell proliferation compared with CM from stromal cells cultured on plastic. Ishikawa cell proliferation varied with steroid hormone treatment in the presence of CM from stromal cells embedded in Matrigel. When the Ishikawa cells were placed in coculture in contact with stromal cells in Matrigel, production of a differentiated epithelial secretory product, glycodelin, was induced. Gene expression of stromal cell hormone receptors, growth factors, and integrins was analyzed by reverse transcription-PCR in the presence of Matrigel to determine the potential factors involved in stromal regulatory function. These combined studies imply that the phenotype of the Ishikawa cells can be induced to differentiate to more closely resemble normal endometrial epithelium by reintroduction of stromal factors and appropriate extracellular matrix. Additionally, the study shows that basement membrane proteins influence the regulatory function of stromal cells as they mediate epithelial cell growth.
UI - 11587008
AU - Goldstein RB; Bree RL; Benson CB; Benacerraf BR; Bloss JD; Carlos R;
TI - Fleischer AC; Goldstein SR; Hunt RB; Kurman RJ; Kurtz AB; Laing FC; Parsons AK; Smith-Bindman R; Walker J Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement.
SO - J Ultrasound Med 2001 Oct;20(10):1025-36
AD - Department of Radiology, University of California, San Francisco, 94143-0628, USA.
OBJECTIVES: A panel of 14 physicians practicing medicine in the United States with expertise in radiology, obstetrics and gynecology, gynecologic oncology, hysteroscopy, epidemiology, and pathology was convened by the Society of Radiologists in Ultrasound to discuss the role of sonography in women with postmenopausal bleeding. Broad objectives of this conference were (1) to advance understanding of the utility of different diagnostic techniques for evaluating the endometrium in women with postmenopausal bleeding; (2) to formulate useful and practical guidelines for evaluation of women with postmenopausal bleeding, specifically as it relates to the use of sonography; and (3) to offer suggestions for future research projects. SETTING: October 24 and 25, 2000, Washington, DC, preceding the annual Society of Radiologists in Ultrasound Advances in Sonography conference. PROCEDURE: Specific questions to the panel included the following: (1) What are the relative effectiveness and cost-effectiveness of using transvaginal sonography versus office (nondirected) endometrial biopsy as the initial examination for a woman with postmenopausal bleeding? (2) What are the sonographic standards for evaluating a woman with postmenopausal bleeding? (3) What are the abnormal sonographic findings in a woman with postmenopausal bleeding? (4) When should saline infusion sonohysterography or hysteroscopy be used in the evaluation of postmenopausal bleeding? (5) Should the diagnostic approach be modified for patients taking hormone replacement medications, tamoxifen, or other selective estrogen receptor modulators? CONCLUSIONS: Consensus recommendations were used to create an algorithm for evaluating women with postmenopausal bleeding. All panelists agreed that because postmenopausal bleeding is the most common presenting symptom of endometrial cancer, when postmenopausal bleeding occurs, clinical evaluation is indicated. The panelists also agreed that either transvaginal sonography or endometrial biopsy could be used safely and effectively as the first diagnostic step. Whether sonography or endometrial biopsy is used initially depends on the physician's assessment of patient risk, the nature of the physician's practice, the availability of high-quality sonography, and patient preference. Similar sensitivities for detecting endometrial carcinoma are reported for transvaginal sonography when an endometrial thickness of greater than 5 mm is considered abnormal and for endometrial biopsy when "sufficient" tissue is obtained. Currently, with respect to mortality, morbidity, and quality-of-life end points, there are insufficient data to comment as to which approach is more effective. The conference concluded by identifying several important unanswered questions and suggestions that could be addressed by future research projects.
UI - 11587009
AU - Doubilet PM
TI - Society of Radiologists in Ultrasound Consensus Conference statement on postmenopausal bleeding.
SO - J Ultrasound Med 2001 Oct;20(10):1037-42
AD - Brigham and Women's Hospital, Boston, Massachusetts, USA.
UI - 11714111
AU - Newcomer LM; Newcomb PA; Trentham-Dietz A; Storer BE
TI - Hormonal risk factors for endometrial cancer: modification by cigarette smoking (United States).
SO - Cancer Causes Control 2001 Nov;12(9):829-35
AD - Cancer Prevention Research Program, Fred Hutchinson Research Center, Seattle, WA 98109-1024, USA.
OBJECTIVES: To evaluate whether smoking modifies the risk of endometrial cancer associated with body mass index (BMI), postmenopausal hormone use, and other hormonal factors. METHODS: Using multivariate adjusted models we examined interview data from a population-based case-control study of Wisconsin women (n = 740 cases, n = 2,372 controls). RESULTS: The relative risk for endometrial cancer associated with current smoking was 0.8 (95% CI: 0.6-1.0) compared to never smokers. No clear dose-response relationship was evident for pack-years smoked. When examined according to smoking status the risk associated with the highest quartile of BMI seemed to be greater among non-smokers (OR = 3.6, 95% CI: 2.4-5.3) than among current smokers (OR = 2.8, 95% CI: 1.4-5.6). Among postmenopausal women the risk associated with current use of postmenopausal hormones appeared to be greater among non-smokers (OR = 3.3, 95% CI: 2.3-4.9) than among current smokers (OR = 2.7. 95% CI: 1.3-5.5). Risk for long-term use (10 or more years) compared with never users was 8.3 (95% CI: 4.6-15.1) among never smokers and 2.5 (95% CI: 0.8-7.9) among current smokers. The risk associated with non-insulin-dependent diabetes was greater among non-smokers (OR = 2.5, 95% CI: 1.7-3.6) than current smokers (OR = 1.1, 95% CI: 0.4-3.1). There was no modifying effect of smoking on the risk associated with parity. CONCLUSION: These results suggest that smoking moderates the risk associated with endometrial cancer among women at greatest risk, specifically women who are obese or who use postmenopausal hormones.
UI - 11779615
AU - Lowe MP; Bender D; Sood AK; Davis W; Syrop CH; Sorosky JI
TI - Two successful pregnancies after conservative treatment of endometrial cancer and assisted reproduction.
SO - Fertil Steril 2002 Jan;77(1):188-9
AD - Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
OBJECTIVE: To report successful pregnancies after conservative management of FIGO grade I adenocarcinoma of the endometrium. DESIGN: Retrospective chart review. SETTING: University-based assisted reproduction and oncology units. PATIENT(S): One patient who had two separate pregnancies. Intervention(s): High-dose progestin (megestrol acetate) therapy for adenocarcinoma, followed by assisted reproduction with donor oocyte. MAIN OUTCOME MEASURE(S): Histologic evaluation of endometrium after megestrol acetate and at completion of childbearing, and successful pregnancies and deliveries. RESULT(S): The patient had complete resolution of adenocarcinoma with progestin therapy and successful delivery of two pregnancies after assisted reproduction. CONCLUSION(S): Conservative management of International Federation of Gynecology and Obstetrics grade I adenocarcinoma of the endometrium allows preservation of childbearing.
UI - 11778238
AU - Chao H; Sun J; Lu S
TI - [Methylation and expression of the p16 gene in endometrial carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2000 May;22(3):228-31
AD - Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
OBJECTIVE: To analyse the relationship between methylation status of the 5' CpG island and mRNA expression of the p16 gene in endometrial carcinoma. METHODS: Methylation status of p16 gene was determined by methylation-sensitive restriction enzymes, PCR and p16 mRNA expression was evaluated by RT-PCR in a series of 8 specimens with normal endometrium(NE), 6 with simple and complex hyperplasia(SCH), 6 with atypical hyperplasia (AH) and 38 with endometrial carcinoma(EC). RESULTS: Eight specimens of NE displayed no methylation and showed normal expression of the p16 mRNA. In 1 of the 6 AH and 13 of the 38(34.21%) EC, there was methylation of p16 exon 1; 5 of the 6 SCH showed overexpression of p16 mRNA, 4 of the 6 AH and 27 of the 38 (71.05%) EC exhibited decrease or loss of p16 mRNA expression. CONCLUSION: Hypermethylation of p16 gene is an early event of endometrial carcinogenesis and is associated with the progression of endometrial carcinoma. Hypermethylation is highly correlated with inhibition of p16 gene transcription.
UI - 11550800
AU - Semczuk A; Skomra D; Cybulski M; Jakowicki JA
TI - Immunohistochemical analysis of MIB-1 proliferative activity in human endometrial cancer. Correlation with clinicopathological parameters, patient outcome, retinoblastoma immunoreactivity and K-ras codon 12 point mutations.
SO - Histochem J 2001 Apr;33(4):193-200
AD - IInd Department of Gynecological Surgery, Lublin University School of Medicine, Poland.
To test the prognostic utility of MIB-1 in human endometrial neoplasias, the proliferative activities of fifty-two endometrial carcinomas obtained from Polish women were assessed. We also investigated the relationship between the MIB-1 Proliferative Index and the well-known clinicopathological features of cancer (clinical stage, histological type, histological grade, depth of myometrial invasion), patient's age, overall survival, retinoblastoma immunostaining and K-ras codon 12 point mutations. The mean MIB-1 Proliferation Index was 43.8%, with a median of 36.0%. Due to the great intratumour heterogeneity of the immunoreaction, the Index ranged from 0% to 98%. A significant relationship was noted between MIB-1 expression and histological grading (p = 0.0004) and myometrial invasion of cancer (p = 0.01). Multivariate Cox regression demonstrated that the clinical stage was the only independent prognostic factor during follow-up (p = 0.025). There was a tendency towards a poorer outcome for women with a Proliferative Index of > 31% than for patients whose Index was < or = 31%; the difference, however, did not reach significance (p = 0.25; log-rank test). Interestingly, uterine cancers lacking retinoblastoma protein expression had a mean MIB-1 Proliferation Index that was nearly twice as high as in those neoplasias that stained positively for retinoblastoma (70.33% and 42.14%, respectively; p = 0.09; Mann-Whitney-U test). There were no significant differences between K-ras codon 12 point mutation-positive and -negative endometrial carcinomas regarding the proliferative activity of the cancer (mean Indexes 47.6% and 43.8%, respectively; p = 0.66, Mann-Whitney-U test). Our data support the view that MIB-1 proliferative activity was significantly increased with a decrease of the histological grading and with the myometrial invasion of human endometrial cancer.
UI - 11603220
AU - Peiro G; Diebold J; Baretton GB; Kimmig R; Lohrs U
TI - Cellular apoptosis susceptibility gene expression in endometrial carcinoma: correlation with Bcl-2, Bax, and caspase-3 expression and outcome.
SO - Int J Gynecol Pathol 2001 Oct;20(4):359-67
AD - Institute of Pathology, Klinikum Grosshadern, Ludwig-Maximilians University Munich, Munchen, Germany.
Deregulation of proliferation and apoptosis is known to contribute to neoplastic transformation and growth. Using specific antibodies for the cellular apoptosis susceptibility (CAS) gene, caspase-3, Bcl-2, and Bax, we examined the protein expression in 89 endometrial carcinomas and in 56 samples of nonneoplastic adjacent endometrium for comparison. Immunostaining results were scored with regard to approximate percentage of positive tumor cells (< 10%, 10% to 50%, > 50%) and relative immunostaining intensity (1+, 2+, 3+). In nonneoplastic endometrium, CAS protein was expressed in 70.6%, Bax in 64%, caspase-3 in 52%, and Bcl-2 in 87%. In neoplastic tissue, CAS was present in 93% of the tumors, Bax in 88%, caspase-3 in 77%, and Bcl-2 in 51%. Bcl-2:Bax ratio was > 1 in 9 cases (10%). In cases of atrophy (n = 24) and simple (n = 10) and complex (n = 22) hyperplasia in the adjacent endometrium, lower levels of expression compared with carcinoma were observed for CAS (p = 0.003), caspase-3 (p = 0.034), and Bax (p = 0.04) and higher levels for Bcl-2, although for this protein the results were not statistically significant (p = 0.32). There was no association between immunoscores and FIGO stage. High caspase-3 levels were seen in endometrioid tumor type (p = 0.017). CAS expression was higher in grade 3 tumors (p = 0.002) and older patients (p = 0.013). All tumors of younger patients (< 50 years) were Bcl-2 negative (p = 0.037). Caspase-3 correlated positively with CAS (p = 0.008), Bax (p = 0.04), and low Bcl-2:Bax ratio (p = 0.043), and inversely (as a trend) with Bcl-2 (p = 0.056). Survival analysis (Kaplan-Meier and Cox regression) established a strong association between prognosis and stage, grade, and histologic type (all p < or = 0.0036). In addition, shorter survival was observed for patients whose tumors contained > 50% of positive cells for caspase-3 (p = 0.024) or for CAS (p = 0.04). Age, Bcl-2, Bax, and Bcl-2:Bax ratio did not provide prognostic information. Our results suggest a role of CAS, Bcl-2, Bax, and caspase-3, which are apparently involved in the progressive deregulation of proliferation and apoptosis leading from simple and complex hyperplasia to carcinoma. In addition, CAS and caspase-3 protein levels may be useful markers in predicting the outcome of the patients.
UI - 11603221
AU - Watanabe Y; Nakajima H; Nozaki K; Ueda H; Obata K; Hoshiai H; Noda K
TI - Clinicopathologic and immunohistochemical features and microsatellite status of endometrial cancer of the uterine isthmus.
SO - Int J Gynecol Pathol 2001 Oct;20(4):368-73
AD - Department of Obstetrics and Gynecology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan. email@example.com
To clarify the clinicopathologic, molecular, and immunohistochemical characteristics of uterine isthmic endometrial cancer (UIE), we examined 13 cases of UIE and compared them with 33 cases of endometrial cancer of the uterine corpus (UCE) with respect to clinicopathologic factors, the expression of p53, the estrogen receptor (ER) and the progesterone receptor (PR) status, DNA ploidy, and microsatellite instability (MSI). Five (38.4%) of the UIE patients had stage I, two (15.4%) had stage II, and six (46.2%) had stage III disease (FIGO 1988). Myometrial invasion was confirmed in 92.3% of the UIE patients, and these patients had a higher (p < 0.05) frequency of > 50% myometrial invasion (46.2%) than the patients with UCE (15.2%). Moreover, the UIE patients had a higher frequency of positive peritoneal cytology (p < 0.05) and pelvic lymph node metastases (p < 0.05). No UIE tumors exhibited MSI, and the tumors in these patients had a higher expression of p53 (p < 0.01), a lower expression of ER (p < 0.05) and PR (p < 0.05), and a higher frequency of DNA aneuploidy (p < 0.01) than the UCE tumors. These findings suggest that the UIE is clearly different from UCE in the clinicopathologic, immunohistochemical features, and microsatellite status.
UI - 11603226
AU - Levine PH; Abou-Nassar S; Mittal K
TI - Extrauterine low-grade endometrial stromal sarcoma with florid endometrioid glandular differentiation.
SO - Int J Gynecol Pathol 2001 Oct;20(4):395-8
AD - Department of Pathology, New York University Medical Center, Bellevue Hospital, New York, NY, USA.
Endometrial stromal sarcoma of the uterus (ESS) is a rare lesion that can cause diagnostic difficulty especially when it presents with unusual histologic features such as diffuse endometrioid glandular differentiation. Only three such cases have been reported, all primary in the uterus. We report the first case of an extrauterine low-grade ESS with extensive glandular differentiation that appeared to arise in endometriosis.
UI - 11759963
AU - Sinawat S; Chiyabutra T; Kleabkaew P
TI - Detection of endometrial cancer in asymptomatic postmenopausal breast cancer patient treated with tamoxifen: a case report.
SO - J Med Assoc Thai 2001 Jul;84(7):1033-6
AD - Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Thailand.
Breast cancer is among the commonest malignancies in women and tamoxifen has been widely used for more than two decades for treatment of breast cancer. It has been known that long term use of tamoxifen significantly increases the risk of endometrial cancer but there is no generally accepted recommendation regarding the surveillance of endometrial pathologies in breast cancer patients taking tamoxifen. Although the incidence of endometrial cancer associated with tamoxifen use is not high, the risk is true and these patients could be helped by screening methods such as transvaginal ultrasonogrphy. We report here a case of endometrial cancer detected by transvaginal 2D scan in an asymptomatic postmenopausal woman taking tamoxifen.
UI - 11795358
AU - Goldstein SR
TI - The effect of SERMs on the endometrium.
SO - Ann N Y Acad Sci 2001 Dec;949():237-42
AD - Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA. Steven.Goldstein@Med.Nyu.Edu
Tamoxifen, the first clinically available SERM, was developed in 1966 and approved by the FDA (United States Food and Drug Administration) in 1978. It is the most prescribed antineoplastic drug in the world, with approximately 10 million women-use-years of experience. Tamoxifen has proved efficacious in all settings of breast cancer. However, in the mid-to-late 1980s, a series of letters to the editor and case reports announced an association between tamoxifen therapy in women with breast cancer and the development of endometrial carcinoma. Subsequently, in 1998, the observation of a significant 49% reduction in invasive breast cancer relative to placebo in a cohort of women at increased risk for the disease resulted in the early stopping of the National Surgical Adjuvant Breast and Bowel Project's (NSABP) P-1: Breast Cancer Prevention Trial (BCPT). Importantly, this was the first time that information became available about the effects of tamoxifen in healthy women, that is, women who did not already have breast cancer. In this healthy population, the relative risk of developing endometrial carcinoma in the tamoxifen arm was 2.54, although when stratified by age, in women over 50, the risk grew to 4.01. Thus, the risk appears to be confined to women over 50 because, in contrast, in women under 50 there was no statistically significant increase in the risk of endometrial carcinoma.
UI - 11814503
AU - Horowitz NS; Peters WA 3rd; Smith MR; Drescher CW; Atwood M; Mate TP
TI - Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma.
SO - Obstet Gynecol 2002 Feb;99(2):235-40
AD - The Swedish Medical Center, Seattle, Washington, USA. firstname.lastname@example.org
OBJECTIVE: To evaluate the efficacy of high dose rate vaginal brachytherapy in the treatment of International Federation of Gynecology and Obstetrics stage IB, IC, and II endometrial carcinoma after surgical staging and complete lymphadenectomy. METHODS: All patients with stage IB, IC, or II adenocarcinoma or adenosquamous carcinoma of the endometrium who received postoperative high dose rate vaginal brachytherapy at our institution between June 1, 1989, and June 1, 1999, were eligible. High dose rate vaginal brachytherapy was delivered in three fractions of 700 cGy. Retrospective chart review was performed. Kaplan-Meier estimates were calculated for disease-free and overall survival. RESULTS: One hundred sixty-four women were identified. Fifty-six percent had stage IB disease, 30% had stage IC disease, and 14% had stage II disease. Approximately one third of patients had high-grade lesions and nearly 40% had deep myometrial invasion. Median follow-up was 65 months (range 6-142 months). To date, 14 patients have had recurrence; 2 at the vaginal apex, 9 at distant sites, 1 at the pelvic sidewall, 1 simultaneously in the pelvis and at a distant site, and 1 at an unknown site. Both patients with vaginal apex recurrences had salvage therapy and are now free of disease. The overall 5-year survival and disease-free survival rates were 87% and 90%, respectively. There were no Radiation Therapy Oncology Group grade 3 or 4 toxicities. High dose rate vaginal brachytherapy was approximately $1,000 less expensive than external-beam whole-pelvic radiation. CONCLUSIONS: Adjuvant high dose rate vaginal brachytherapy in thoroughly staged patients with intermediate-risk endometrial carcinoma provides excellent overall and disease-free survival with less toxicity and at less cost compared with whole-pelvic radiation.
UI - 11843398
AU - Gornall RJ; Standfield N; deSouza NM; Aachi VR; McIndoe GA
TI - Resection of recurrent bulky gynaecological side wall malignancy with iliac vessel reconstruction.
SO - BJOG 2001 Dec;108(12):1305-8
AD - Institute of Obstetrics and Gynaecology, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
UI - 11695807
AU - Ampil FL; Caldito G; Unger J; Connor P; Pelser R
TI - Can intermediate-risk node-negative patients with stage I corpus cancer do without posthysterectomy radiotherapy? Review of a 13-year experience.
SO - Eur J Gynaecol Oncol 2001;22(4):269-72
AD - Department of Radiology, Louisiana State University Health Sciences Center Shreveport 71130, USA.
A retrospective comparative study of 41 patients with stage I corpus cancer, negative surgical staging, and adverse pathological features either treated or untreated by posthysterectomy radiotherapy (PHR) during a 13-year period was undertaken. The patients were matched for age, intermediate-risk classification, number of sampled nodes and the presence of coexisting illness. After complete follow-up, there was no significant difference in outcome between the patient groups. Unless it can be shown definitely that PHR is beneficial, its use in intermediate-risk node-negative stage I corpus cancer patients must be seriously questioned.
UI - 11604195
AU - Nasu K; Kai K; Fujisawa K; Takai N; Nishida Y; Miyakawa I
TI - Expression of cathepsin L in normal endometrium and endometrial cancer.
SO - Eur J Obstet Gynecol Reprod Biol 2001 Nov;99(1):102-5
AD - Department of Obstetrics and Gynecology, Oita Medical University, Hasama-machi, Oita 879-5593, Japan. email@example.com
OBJECTIVE: To evaluate the expression of cathepsin L in normal endometrium and endometrial adenocarcinoma. STUDY DESIGN: Tissue from eight cases of G1 and eight of G2 endometrioid adenocarcinoma, and 15 normal endometrial specimens were examined by immunohistochemistry. RESULTS: In the normal endometrium, cathepsin L was expressed in a few cell layers of the apical part of the glandular epithelium throughout the menstrual cycle. In the carcinomas, there was an inverse correlation between the grade of tumor and the cathepsin L expression. CONCLUSION: Cathepsin L expression may cease during endometrial carcinogenesis and its expression may be less important in tumor progression than it is in tumors of other tissues.
UI - 11836298
AU - Li XH; Li H; Xiao ZJ; Piao YS
TI - Divergent effects of retinoic acids on the expression of ERalpha and 17beta-hydroxysteroid dehydrogenase type 2 in endometrial carcinoma cells (RL 95-2).
SO - J Clin Endocrinol Metab 2002 Feb;87(2):640-9
AD - State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100080, China.
The effects of E2 are dependent on ERs and local E2 concentration in target cells. Modulation of intracellular E2 concentration involves the action of 17beta-hydroxysteroid dehydrogenase (17HSD) type 2, the enzyme converting E2 to estrone. In the present study, the influence of RAs on the growth of endometrial cancer cell line RL 95-2 as well as the expression of ERs and 17HSD type 2 have been investigated. It was found that RAs repress the growth of RL 95-2 cells, which express all subtypes of RXR and RAR, as examined by RT-PCR. Also, quantitative RT-PCR analysis showed that both ERalpha and ERbeta are present in RL 95-2 cells, and Western blot assay further revealed that ERalpha expression was decreased by all trans-RA treatment. In contrast, RAs induced 17HSD type 2 mRNA expression in a dose- and time-dependent fashion. This stimulatory effect was also detected at the level of in vivo oxidative 17HSD activity in cultured cells. On the other hand, the abundance of 17HSD type 2 mRNA was not altered by RAs in cultured normal epithelial cells isolated from human early- and late-secretory endometrium. The data indicate that RAs have an inhibitory effect on the growth of RL 95-2 cells and a cross-talk with the estrogen pathway in estrogen-responsive endometrial cancer cells.
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