Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis.

BACKGROUND: There are various surgical approaches of hysterectomy for benign indications. This study aimed to compare vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) with respect to their complications and operative outcomes. METHODS: We selected randomised controlled trials that compared VH with LH for benign gynaecological indications. We included studies published after January 2000 in the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library). The primary outcome was comparison of the complication rate. The secondary outcomes were comparisons of operating time, blood loss, intraoperative conversion, postoperative pain, length of hospital stay and duration of recuperation. We used Review Manager 5.3 software to perform the meta-analysis. RESULTS: Eighteen studies of 1618 patients met the inclusion criteria. The meta-analysis showed no differences in overall complications, intraoperative conversion, postoperative pain on the day of surgery and at 48 h, length of hospital stay and recuperation time between VH and LH. VH was associated with a shorter operating time and lower postoperative pain at 24 h than LH. CONCLUSIONS: When both surgical approaches are feasible, VH should remain the surgery of choice for benign hysterectomy.

Internal jugular vein thrombosis with OHSS.

Ovarian hyperstimulation syndrome (OHSS) includes ovarian enlargement and ascites. It is usually mild but can be, rarely, fatal. Deep vein thrombosis (DVT) is among the potentially fatal complications of OHSS. During pregnancy, DVT is more common in the lower extremities than in the upper part of the body, but OHSS-related DVT occurs more frequently in the upper part. Internal jugular vein thrombosis is considered rare, and duplex ultrasound is the appropriate examination for its diagnosis. We present a rare case of internal jugular vein thrombosis following OHSS. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:450-452, 2017.

Comparison of survival and adverse events between women with stage IB1 and stage IB2 cervical cancer treated by laparoscopic radical vaginal hysterectomy.

PURPOSE: The goal of this study was to evaluate the operative feasibility and survival for patients with stage IB2 cervical cancer who undergo laparoscopic radical vaginal hysterectomy (LRVH) compared with those with stage IB1 cervical cancer. METHODS: We identified 90 patients who were eligible to participate in the study through retrospective analysis of medical records from March 2003 to June 2010. Patients with stage IB1 cervical cancer were divided into two groups by a cutoff value of 2 cm for tumor size. Data regarding surgicopathologic risk factors, surgical outcomes, and survival rates were compared among three groups (two with stage IB1 and one with stage IB2). RESULTS: The tumor size was ≤2 cm in 27 patients, 2-4 cm in 30, and >4 cm in 33. The number of intermediate and high-risk factors was significantly lower in patients with stage IB1 cervical cancer (≤2 cm) than in those with stage IB2. Surgical outcomes (mean operating time, estimated blood loss, number of harvested lymph nodes, and sites of metastatic lymph nodes) did not show any significant difference among the three groups. The rates of intraoperative complications also did not differ among the three groups (P = 0.833). The estimated 5-year recurrence-free and overall survival rates were not significantly different among the three groups (P = 0.253 and 0.525, respectively). CONCLUSIONS: LRVH for stage IB2 cervical cancer can be performed with similar safety and survival rates compared to stage IB1 cervical cancer. Overall, LRVH is feasible for the treatment of stage IB2 cervical cancer.

Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2-IIA cervical cancer?

OBJECTIVES: To determine if laparoscopic radical hysterectomy (LRH) can be substituted for radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA cervical cancer. METHODS: We retrospectively reviewed the medical records of cervical cancer patients who underwent LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) from March 2003 to December 2011. RESULTS: Of 118 enrolled patients, six were in FIGO stage IA2, 66 were in IB1, 41 were in IB2, one was in IIA1, and four were in IIA2. The median operating time, perioperative hemoglobin change, the number of harvested pelvic and para-aortic lymph nodes were 270 min (range, 120-495), 1.7 g/dL (range, 0.1-5), 26 (range, 9-55), and 7 (range, 1-39), respectively. There was no unplanned conversion to laparotomy. Intra- and postoperative complications occurred in 16 (13.5%) and 8 (6.7%) patients, respectively. In a median follow-up of 31 months (range, 1-89), 5-year recurrence-free and overall survival rates were 90% and 89%, respectively. Univariate analysis showed that cervical stromal invasion (P=0.023) and lymph node metastasis (P=0.018) affected survival rate. Cox-proportional hazards regression analysis showed that lymph node metastasis was the only independent factor for poor prognosis (hazard ratio=7.0, P=0.022). CONCLUSIONS: LRH with LPL and/or LPAL in women with stage IA2-IIA cervical cancer is safe and feasible in terms of survival and morbidity. Our data suggest the need for larger prospective trials which could support this approach as a new standard of care for stage IA2-IIA cervical cancer.

Laparoscopic lymphadenectomy for isolated lymph node recurrence in gynecologic malignancies.

STUDY OBJECTIVE: To assess the feasibility and efficacy of laparoscopic lymphadenectomy in patients with isolated lymph node recurrences (ILNR) who underwent initial surgery because of gynecologic malignancy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Six patients with ILNR (1 cervical, 4 ovarian, and 1 peritoneal) diagnosed between March 2003 and July 2010. INTERVENTION: Laparoscopic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: Median (range) patient age was 59.5 (24-70) years, and body mass index was 21.7 (21.0-24.6). There was no unplanned conversion to laparotomy. Operating time was 337.5 (200-400) minutes, hemoglobin change was 0.9 (0.4-2.6) g/dL, and hospital stay was 8.5 (5-19) days. The number of harvested lymph nodes was 20 (5-27), and of positive lymph nodes was 4 (1-24). One patient had common iliac vein laceration, with complete hemostasis achieved using intracorporeal suture. Postoperative lymphedema occurred in 1 patient, and was managed conservatively. All patients received adjuvant chemotherapy after laparoscopic lymphadenectomy. CONCLUSION: Laparoscopic lymphadenectomy in patients with ILNR is feasible and might be an alternative therapeutic strategy.

Laparoscopic management of large ovarian tumors: clinical tips for overcoming common concerns.

AIM: This study was performed to assess the feasibility and efficacy of laparoscopic management for patients with large ovarian tumors. MATERIAL AND METHODS: A retrospective analysis was performed of the medical records of 52 women who underwent laparoscopic surgery for large ovarian tumors whose maximum diameter was ≥15cm and a low possibility of malignancy. RESULTS: The median age of patients was 35years (range 18-84), median body mass index was 22.4kg/m(2) (range 12.4-31.5) and 18 patients had previous operative history. The median tumor diameter was 17cm (range 15-40). There were no conversions to laparotomy and perioperative complications. The median operating time, estimated blood loss, and hospital stay were 80min (range 25-225), 100mL (range 50-500) and 3days (range 2-14), respectively. The operative procedures performed were salpingo-oophorectomy (n=26), ovarian cystectomy (n=16), laparoscopically assisted vaginal hysterectomy with unilateral or bilateral salpingo-oophorectomy (n=9), and laparoscopically assisted staging surgery (n=1). The histopathological results were mucinous cystadenoma (n=25), mature cystic teratoma (n=9), serous cystadenoma (n=6), endometrioma (n=5), mucinous borderline tumor (n=4), follicular cyst (n=2), and clear cell carcinoma (n=1). CONCLUSION: Laparoscopic management of large ovarian tumors is feasible and efficient with appropriate patient selection and experience of surgeons.

Laparoscopic lymphadenectomy for gynecologic malignancies: evaluation of the surgical approach and outcomes over a seven-year experience.

PURPOSE: The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic lymphadenectomy in patients with gynecologic malignancies and improve upon the existing published data regarding laparoscopic lymphadenectomy. METHODS: We conducted a retrospective chart review of 225 patients with various gynecologic malignancies who had undergone laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) at Kangbuk Samsung Hospital between November 2003 and October 2010. RESULTS: One hundred and seventy-two patients underwent both LPL and LPAL, 47 patients underwent LPL alone, and six patients underwent a repeat laparoscopic lymphadenectomy. The median age and body mass index of the patients were 49.4 years (range 23-79 years) and 24.2 kg/m(2) (range 17.5-37.2 kg/m(2)). The median numbers of harvested pelvic and para-aortic lymph nodes were 25.9 (range 3-63) and 10.6 (range 1-34), respectively. The median operating times for the LPL and LPAL were 72.3 min (range 40-120 min) and 40 min (range 20-70 min), respectively. There were seven cases of major vessel injuries, two lymphocytes, two lymphedemas, and two chylous ascites. There was no unplanned conversion to laparotomy. CONCLUSIONS: Laparoscopic lymphadenectomy can be considered a technically feasible and safe procedure and has become the alternative modality in the field of gynecologic oncology surgery. And our results could reinforce the existing published data regarding laparoscopic lymphadenectomy.

Laparoscopic incidental appendectomy during laparoscopic surgery for ovarian endometrioma.

OBJECTIVE: We sought to investigate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic surgery for endometrioma. STUDY DESIGN: We conducted a retrospective study of 356 patients undergoing laparoscopic surgery for endometrioma with appendectomy (appendectomy group, n = 172) or not (nonappendectomy group, n = 184). Primary outcome measures were operating time, hemoglobin change, hospital stay, return of bowel activity, and any complications. The secondary outcome was appendiceal histopathology. RESULTS: There were no statistical differences between groups in operating time, postoperative changes in hemoglobin concentration, hospital stay, return of bowel activity, or complication rate. Of the 172 resected appendices, 52 had histopathologically confirmed abnormal findings including appendiceal endometriosis in 16. CONCLUSION: Incidental appendectomy at the time of laparoscopic surgery for endometrioma does not increase operative morbidity, and it has considerable diagnostic and preventive value. However, a large prospective randomized study is needed in the future to confirm this conclusion.

Is laparoscopic surgery safe in women over 70 years old with benign gynecological disease?

AIM: To evaluate the feasibility, efficacy, and safety of laparoscopic surgery for benign gynecological disease in women over 70 years old. MATERIALS AND METHODS: Fifty-four women over 70 years old underwent surgery for benign gynecological disease from January 2003 to December 2009. Each woman was matched with two subjects of 30-50 years old in the younger group; the matching with patients undergoing a similar surgical technique was retrospective from December 2009. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, hemoglobin change, postoperative complications, hospital stay, and return of bowel activity. The χ² -test and t-test were used to compare the results of the elderly group and the younger group. RESULTS: There were no significant differences between the elderly group (over 70 years old) and a matched younger group (aged 30-50 years old) in body mass index, number of previous abdominal surgeries, operating time, hospital stay, and postoperative complications. CONCLUSION: Laparoscopic surgery in elderly women for benign gynecological disease is feasible, efficient, and safe. However, a large prospective randomized study is needed to confirm the conclusion.

Laparoscopic surgical management and clinical characteristics of ovarian fibromas.

OBJECTIVE: This study aims to analyze the clinical characteristics and diagnostic features of ovarian fibromas and to evaluate the efficacy and safety of laparoscopic surgery for ovarian fibromas. METHODS: We reviewed the records of 47 consecutive women who underwent laparoscopic or laparotomic surgeries and whose final histopathological diagnoses were ovarian fibroma, cellular fibroma, or fibrothecoma from January 1999 to August 2010. RESULTS: During the study period, 49 tumors were removed from 47 women including 27 ovarian fibromas, 19 fibrothecomas, and 3 cellular fibromas. The preoperative diagnoses were ovarian fibroma in 25 women (53.2%) and uterine myoma in 16 women (34.0%). A high serum CA 125 level (>35U/mL) was observed in 15 women, and serum CA 125 level was significantly higher in women with ascites (P=<0.001). The tumors were removed surgically in all women, using the laparotomic approach in 16 women (34.0%) and the laparoscopic approach in 31 women (66.0%). The laparoscopic surgery had the advantages of shorter hospital stay and faster return of bowel activities compared to laparotomy. CONCLUSIONS: Ovarian fibromas are often misdiagnosed as uterine myomas, and sometimes mistaken for a malignant tumor of the ovary preoperatively. Laparoscopic surgery can be an effective and safe surgical approach for managing ovarian fibromas.

Efficacy of nerve-sparing radical hysterectomy vs. conventional radical hysterectomy in early-stage cervical cancer: A systematic review and meta-analysis.

The aim of the present study was to compare the oncological outcome of nerve-sparing radical hysterectomy (NSRH) and conventional radical hysterectomy (CRH) for early-stage cervical cancer using a meta-analysis. A systematic review and meta-analysis was conducted, including 4 randomized controlled trials (RCT), 8 case-control and 11 comparative cohort studies comparing the morbidity, pelvic dysfunctions and oncological outcome between the two surgical methods. A total of 23 studies were included in this meta-analysis. The studies reported data of patients affected by cervical cancer; were written in English; included ≥20 patients; and reported data of patients with a comparison of clinical outcomes between NSRH and CRH. Data were extracted and risk of bias was assessed by four independent reviewers. A total of 1,796 patients were included: 884 patients (49.2%) undergoing NSRH and 912 (50.8%) undergoing CRH. The meta-analyses were conducted using Review Manager version 5.3 software, which is designed for conducting Cochrane reviews. As regards perioperative parameters, NSRH was found to be associated with a lower intraoperative blood loss and a shorter length of hospital stay in comparison with CRH. Patients undergoing NSRH experienced lower incidence of urinary, colorectal and sexual dysfunction compared with patients undergoing CRH. However, the resected parametrial width was favorable in patients with CRH, suggesting that NSRH was inferior to CRH in terms of radicality. The 5-year disease-free and overall survival rates were similar between the two groups. In this systematic review and meta-analysis, the collected data to date demonstrated that the nerve-sparing approach guarantees minimized surgical-related pelvic dysfunction, with similar oncological outcomes as CRH. However, further RCTs should be conducted to confirm the superiority and safety of NSRH.

Recurrence of Ovarian Endometrioma in Adolescents after Conservative, Laparoscopic Cyst Enucleation.

STUDY OBJECTIVE: To evaluate the cumulative recurrence rate of endometriomas after a laparoscopic endometriotic cyst enucleation in adolescents and to find the factors associated with recurrence. DESIGN: A multicenter retrospective cohort study. SETTING: Three university hospitals. PARTICIPANTS: One hundred five patients surgically treated with laparoscopic enucleation of endometriotic cysts younger than 20 years of age were selected. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Endometrioma recurrence was considered when transvaginal or transrectal sonography indicated a cystic mass with a diameter of 20 mm or greater. Recurrence rate of endometrioma and median time to recurrence were evaluated. RESULTS: In total, 105 patients were followed for 47.3 (±44.3) months (range, 3-161 months). Seventeen patients (16.2%) experienced recurrence after the first-line surgery and 8 patients (7%) underwent a second surgery. The median time to recurrence was 53.0 (±8.5) months (range, 8-111 months). Using Kaplan-Meier method, the cumulative recurrence rates of endometrioma per patient at 24, 36, 60, and 96 months after the first-line surgery were 6.4%, 10%, 19.9% and 30.9%, respectively. Surgical characteristics, such as the diameter of the cyst, revised American Society for Reproductive Medicine stage, unilateral or bilateral involvement, and coexistence of deep endometriosis were not associated with recurrence in this age group. CONCLUSION: Although the short-term recurrence rate in adolescents after first-line surgery is relatively low, the recurrence rate appears to be higher according to the follow-up duration. Long-term and continuous follow-up is needed for patients who have undergone surgical treatment for endometriosis in the adolescent period.

Epithelioid Trophoblastic Tumor in a Postmenopausal Woman: A Case Report.

Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic neoplasm composed of intermediate trophoblasts. Most cases of ETT are reported in women of reproductive age following a prior gestation within 2 weeks to 30 years. ETT is extremely rare in postmenopausal women. It is commonly misdiagnosed as a poorly differentiated carcinoma or another type of gestational trophoblastic tumor. We report a case of ETT in a 56-year-old woman that developed 23 years after the patient's last pregnancy.

Prognostic significance of positive lymph node number in early cervical cancer.

The aim of the present study was to investigate whether the number of metastatic lymph nodes (LNs) is an independent prognostic factor for early cervical cancer. The medical records of 163 stage IB-IIA cervical cancer patients, treated with radical hysterectomy with accompanying pelvic and/or para-aortic lymphadenectomy between 1999 and 2007, were retrospectively reviewed. All prognostic factors identified as being significant in the univariate analysis were included in the multivariate analysis using the Cox proportional hazards model. Of the 156 patients included in our analysis, 27 had LN metastasis, of whom 14 patients had 1 positive node and 13 patients had ≥2 positive nodes. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 92.9 and 87.2%, respectively. In terms of OS, tumour stage (P=0.002) and the number of positive LNs (P=0.021) were identified as significant prognostic factors. In terms of PFS, tumour stage (P=0.049) was identified as a significant prognostic factor. In conclusion, the number of LN metastases is an independent risk factor for poorer survival outcomes in patients with cervical cancer.

Superficial Angiomyxoma of the Vulva in a Postmenopausal Woman: A Case Report and Review of Literature.

Superficial angiomyxomas (SAMs) are rare benign cutaneous tumors that involve the subcutaneous layer. They are commonly located in the trunk, lower limbs and head or neck of women of reproductive age. SAMs in the vulva of postmenopausal women are especially rare case. Herein, we report a vulvar SAM in a postmenopausal 60-year-old woman. The patient presented with a palpable cutaneous mass in the right labium majora that had appeared 3 months earlier. The mass was slow growing and approximately 5 cm in size and resembled a soft tissue malignancy. It appeared as a well-defined multilocular cystic mass in magnetic resonance images. The preoperative diagnosis was a benign cystic lesion such as an epidermoid cyst. Grossly, the completely excised mass was 6 × 5 cm in size and well circumscribed with a multilocular outer surface, a yellowish-gray gelatinous cut surface, and a smooth rubbery inner surface. Histologic review revealed that the mass contained small to moderate amount of cellular angiomyxoid nodules and bland-looking spindle-shaped to ovoid cells without atypia. Neutrophil infiltration, which is a diagnostic feature of SAMs, was observed. Immunohistochemistry showed expression of CD34, but not of estrogen receptors, progesterone receptors, or desmin in the SAM. The patient has been followed up for 12 months without recurrence.

Postmenopausal Meigs' Syndrome in Elevated CA-125: A Case Report.

Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated cancer antigen 125 (CA-125) in Meigs' syndrome is an unusual clinical condition reported in few cases. We report here on a 61-year-old woman who presented with dyspnea; in imaging assessment, a heterogeneous pelvic mass measuring 12 × 11 cm with ascitic fluid was reported. Pleural effusion was detected on Chest X-ray. Aspiration of pleural fluid showed no evidence of malignancy. CA-125 level was 347 IU/mL. The patient underwent laparotomy during which a mass measuring 12 × 11 cm was detected in her left adnexa. Histology showed ovarian thecoma. The mass was resected, and, after that, the symptoms disappeared and CA-125 level reached 19 IU/mL. The patient had experienced no problem after 12 months of follow up. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA-125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.

Pure primary ovarian squamous cell carcinoma: A case report and review of the literature.

Pure primary ovarian squamous cell carcinoma (SCC) is a rare lesion that usually arises from the malignant transformation of an existing ovarian dermoid cyst. The de novo occurrence of an ovarian SCC in the absence of a prior ovarian dermoid cyst, Brenner tumor or endometriosis is extremely rare. At present, no effective therapy exists for treating pure primary ovarian SCC. The present case study describes a patient that presented with progressive coughing, who was diagnosed with an International Federation of Gynecology and Obstetrics stage IV pure primary ovarian SCC with lung metastases. The patient received postoperative chemotherapy, however, the patient succumbed to the disease. The current study also presents a review of the literature.

Uterine Lipoleiomyoma in Peri or Postmenopausal Women.

Lipoleiomyoma is an uncommon neoplasm of the uterus, composed of smooth muscles intermixed with mature adipocytes. These tumors are considered a benign variant of uterine leiomyomas. Herein, we report six cases of lipoleiomyoma experienced in our institution from January 2005 to March 2015. The patients ranged in age from 45 to 70 years; the etiology may be related to estrogen deficiency occurring after menopausal transition. Except for one lipoleiomyoma in the broad ligament, all others were found in the uterine corpus. The presenting symptoms were nonspecific, and most cases were incidentally diagnosed during surgery for other reasons. We performed preoperative imaging studies, including abdominal and pelvic computed tomography and magnetic resonance imaging. Preoperatively, four patients were diagnosed as having a pelvic mass and one patient was diagnosed as having a right ovarian mature teratoma. In one case, we found a gynecologic malignancy (cervical cancer 1A1). Histologically, there was no gross or microscopic contiguity between the lipoleiomyoma and the malignancy. Lipoleiomyomas seem to have a benign clinical course. In our study, there were no recurrences of or deaths attributed to the lipoleiomyomas during a mean follow-up period of 16.17 ± 23.80 months.

Biomonitoring of Lead, Cadmium, Total Mercury, and Methylmercury Levels in Maternal Blood and in Umbilical Cord Blood at Birth in South Korea.

With rising concerns of heavy metal exposure in pregnancy and early childhood, this study was conducted to assess the relationship between the lead, cadmium, mercury, and methylmercury blood levels in pregnancy and neonatal period. The study population included 104 mothers and their children pairs who completed both baseline maternal blood sampling at the second trimester and umbilical cord blood sampling at birth. The geometric mean maternal blood levels of lead, cadmium, total mercury, and methylmercury at the second trimester were 1.02 ± 1.39 µg/dL, 0.61 ± 1.51 µg/L, 2.97 ± 1.45 µg/L, and 2.39 ± 1.45 µg/L, respectively, and in the newborns, these levels at birth were 0.71 ± 1.42 µg/dL, 0.01 ± 5.31 µg/L, 4.44 ± 1.49 µg/L, and 3.67 ± 1.51 µg/L, respectively. The mean ratios of lead, cadmium, total mercury, and methylmercury levels in the newborns to those in the mothers were 0.72, 0.04, 1.76, and 1.81, respectively. The levels of most heavy metals in pregnant women and infants were higher in this study than in studies from industrialized western countries. The placenta appears to protect fetuses from cadmium; however, total mercury and methylmercury were able to cross the placenta and accumulate in fetuses.

Antiproliferative and apoptotic effect of epigallocatechin-3-gallate on Ishikawa cells is accompanied by sex steroid receptor downregulation.

Endometrial cancer is a significant malignancy in developed countries. Unopposed estrogen stimulation is considered as an important risk factor for endometrial cancer. Epigallocathechin-3-gallate (EGCG), biological active component of green tea, inhibits cancer cell proliferation. However, it is unknown whether EGCG has anticancer effects on endometrial cancer and what the molecular mechanism(s) are. We investigated the anticancer effects of EGCG on a human endometrial adenocarcinoma cell line (Ishikawa cells) with or without 17ß-estradiol (E2) treatment. Cell proliferation assay was performed using 3-(4,5-dimethylthiaxol-2-yi)-2,5-diphenyltetraxolium bromide (MTT). The cell cycle was determined by flow cytometry and real-time analysis of cyclin and cdk genes. The apoptosis was measured by Annexin V-PI staining and real-time analysis of bcl-2, Bax and caspase genes. The MAPK signal, Akt and caspase-3 were determined by immunoblotting. Decreased estrogen and progesterone receptor expression was observed in EGCG-treated Ishikawa cells, and decreased MAPK signals and phospho-Akt were observed as well. EGCG caused the arrest of cells in the G0/G1 phase of the cell cycle. This compound interfered with Akt activation and MAPK signals, and increased apoptosis signals leading to a controlled caspases, Bcl-2, Bax genes and protein expression. Taken together, EGCG inhibits cell proliferation and induces apoptosis through Akt and MAPK signals. These findings suggest that EGCG may exert growth-inhibitory and apoptosis-inducing effects on endometrial cancer cells, accompanied by decreased estrogen and progesterone receptor. EGCG may have future clinical implications with respect to the development of novel approaches as an adjuvant therapy in endometrial cancer.