Factors Predicting Type II Histology in Endometrial Biopsies Among Postmenopausal Minority Women at a Safety-Net Hospital.

Background: Rates of type II endometrial cancers (EC) are increasing in the United States, especially in minority women. The purpose of this project was to examine a primarily minority and low socioeconomic status patient population in a public hospital to identify risk factors associated with the finding of type II histology in endometrial biopsies (EMBs). Materials and Methods: A retrospective chart review was performed of patients who underwent an EMB between 2010 and 2016. Included patients were postmenopausal women older than 50 years with biopsy-proven EC. Basic demographic data were analyzed, along with indication for EMB and ultrasound findings. Statistics were completed using analysis of variance and logistic regression with significance set at p < 0.05. Results: Four hundred sixty-one EMB results were reviewed. Around 17.4% (n = 80) resulted in a diagnosis of EC, with 45% (n = 36) being type II histology. Average age was 62.5 (standard deviation [SD] = 7.63), and the majority (64%) were Hispanic. Type II malignancies were diagnosed in 17% of Caucasians, 41% of Hispanics, and 61% of blacks/Haitians (p = 0.03). Factors associated with type II tumors in univariable models included older age (odds ratio [OR] 1.10 [confidence interval; CI 1.03-1.18], p = 0.007), black/Haitian (vs. Caucasian) race (OR 8.75 [CI 0.86-88.70], p = 0.066), obesity (OR 0.39 [0.15-0.98], p = 0.044), and number of years since menopause (OR 1.06 [CI 1.01-1.12], p = 0.027), although none remained independently predictive in the multivariable analysis. Conclusion: This minority population of postmenopausal women with EC had a greater prevalence of type II histologies. Understanding this pattern may be helpful in expediting the workup for abnormal symptoms in these women and prompt a higher level of suspicion for EC.

Vaginal Dysplasia and HIV: An African American and Caribbean American Cohort Study.

BACKGROUND: Vaginal cancer is a rare disease with poor clinical outcomes and limited therapeutic options. In the United States (US), minority women and older women are disproportionately diagnosed with late-stage vaginal cancer. Sociodemographic characteristics, risk behaviors, and cooccurring conditions are linked to vaginal intraepithelial neoplasia (VaIN). The diagnosis of VaIN is more prevalent among older women and women living with HIV (WLWH). The Caribbean basin has one of the highest rates of anogenital cancers in the Western Hemisphere. In the US, vaginal infections are more prevalent among Caribbean women, and these infections contribute to higher rates of Human Papilloma Virus (HPV). Given the high rate of anogenital cancers in the Caribbean and the high rates of HPV among Caribbean women in the US, we sought to describe the occurrence of VaIN in a cohort of Black non-Hispanic WLWH. The cohort was followed by an interdisciplinary team of providers with the University of Miami, Miller School of Medicine. RESULTS: Caribbean Americans were living with HIV longer and more were uninsured; more African Americans endorsed cigarette and illicit substance use. Caribbean Americans trended towards the highest grades of VaIN (VaIN 2+) at baseline, but more African Americans progressed to VaIN 2+ in subsequent biopsies. CONCLUSION: In this cohort of Caribbean American and African American women living with HIV diagnosed with VaIN, Caribbean Americans had the highest grade of VaIN at baseline, but more African Americans progressed to more advanced stages of the disease.

Gunshot wound to the gravid uterus with non-lethal fetal injury.

We report a case of an abdominal gunshot wound in a third trimester pregnant woman. The fetus sustained a superficial skin injury, with survival of both mother and fetus. Conservative management was conducted successfully. Other management options are discussed.