Malignant uterine neoplasms attended at a brazilian regional hospital: 16-years profile and time elapsed for diagnosis and treatment / Neoplasias malignas do útero atendidas em hospital regional brasileiro: Perfil em 16 Anos e tempo dispendido até diagnóstico e tratamento

Abstract Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed fromsymptoms to diagnoses or treatment in cancer stage and survival. Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnosticmethods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan- Meier method, with p-values < 0.05 for significance. Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% nonendometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas weremore frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis. Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Resumo Objetivo O presente estudo avaliou o perfil dos carcinomas endometriais e sarcomas uterinos atendidos em um centro brasileiro de câncer no período de 2001 a 2016, e avaliou o impacto do tempo decorrido entre os sintomas até o diagnóstico ou tratamento no estadiamento e sobrevida pelo câncer. Métodos Estudo observacional com 1.190 casos que analisou o ano do diagnóstico, faixa etária, estágio e tipo histológico do câncer. Um subgrupo de 185 mulheres com histologia endometrioide e atendidas no período de 2012 a 2017 foi selecionado para avaliar informações sobre sintomas iniciais, métodos de diagnóstico, sobrevida global e para analisar a relação entre o tempo decorrido a partir dos sintomas até o diagnóstico e tratamento no estadiamento e sobrevida. Foram realizadas análises estatísticas descritiva, de tendência linear e de sobrevida pelo método de Kaplan-Meier, com valores de p < 0,05 para significância. Resultados Os casos estudados de acordo com a histologia foram 1.068 (89,7%) carcinomas (77,2% endometrioides e 22,8% não endometrioides) e 122 (10,3%) sarcomas, com tendência crescente no período (p < 0,05). Histologias de carcinomas não endometrioides, G3 endometrioides e carcinossarcomas consistiram em 30% dos casos. Carcinomas não endometrioides e sarcomas forammais frequentemente diagnosticados em pacientes acima de 70 anos de idade e em estágio IV (p < 0,05). O subgrupo com185 mulheres com carcinoma endometrioide apresentou 92% de sangramento uterino anormal e 43% de diagnóstico após curetagem. O tempo médio decorrido entre os sintomas e o diagnóstico foi de 244 dias e entre os sintomas e o tratamento, 376 dias, todos sem associação com estadiamento (p = 0,976) e sobrevida (p = 0,160). Apenas 12% das pacientes iniciaram o tratamento em até 60 dias após o diagnóstico. Conclusão O número de casos de carcinomas e sarcomas uterinos aumentaram no período de 2001 a 2016. A histologia agressiva compreendeu 30% dos pacientes e, no caso dos carcinomas endometrioides, o tempo decorrido entre os sintomas e o diagnóstico ou tratamento foi longo, embora sem associação com estadiamento ou sobrevida.

Residual disease after operative hysteroscopy in patients with endometrioid endometrial cancer associated with polyps / Doença residual após histeroscopia cirúrgica em pacientes com câncer de endométrio endometrioide associado a pólipo endometrial

Abstract Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. Results In78cases (75%), thepolyphad EC, and in 40(38.5%), itwas restricted tothe polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Resumo Objetivo Avaliar a presença de doença residual no exame anatomopatológico definitivo de pacientes com câncer de endométrio endometrioide após polipectomia ou biópsia de pólipo histeroscópica. Métodos Analisamos 104 pacientes (92 casos do Hospital AC Camargo e 12 casos do Hospital do Servidor Público Estadual de São Paulo) com pólipos diagnosticados durante histeroscopia e cuja biópsia histeroscópica ou exame patológico final do útero acusaram câncer de endométrio endometrioide. As pacientes foram submetidas a cirurgia para câncer de endométrio de janeiro de 2002 a janeiro de 2017. Os dados clínicos e anatomopatológicos de cada paciente foram retirados dos prontuários médicos Resultados Em 78 casos (75%), o pólipo continha a neoplasia, e em 40 (38.5%), ela estava restrita ao tecido do pólipo, sem envolvimento endometrial adjacente. O estadio final foi IA em 96 casos (92.3%) e em 90 (86.5%) tratava-se de grau 1 ou 2. Em 18 casos (17.3%), não havia doença residual no espécime uterino, mas emapenas 9 deles a histeroscopia sugeriu doença restrita ao pólipo. Em 5 casos (4.8%), não havia doença aparente extrapólipo na histeroscopia, mas havia invasão miometrial, sugerindo extravasamento do tumor pela base do pólipo. Conclusão Pacientes com câncer de endométrio associado a pólipos podem ter o tumor completamente removido durante a histeroscopia, mas, com as variáveis avaliadas, é difícil predizer com segurança qual paciente ficará sem tumor residual.

Efficacy of endometrial cancer follow-up protocols: time to change?

Abstract Objective The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. Methods Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. Results Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serummarker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. Conclusion Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.

Células glandulares atípicas: abordagem ginecológica / Atypical glandular cells: gynecological approach

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)

Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)

Carcinoma endometrioide sincrónico de ovario y endometrio / Ovarian and endometrial synchronous endometrioid carcinoma

ANTECEDENTES: existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully. OBJETIVO: presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo. CASO CLÍNICO: paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I. El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial. CONCLUSIÓN: el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.

BACKGROUND: there is a demonstrated association between endometriosis and some epithelial ovarian carcinoma histologies. On the other hand, it has been observed that up to 30% of ovarian neoplasms present concomitantly with endometrial neoplasms. To consider synchronicity between these neoplasms, they must meet strict pathological criteria such as those described by scully. OBJECTIVE: to introduce a case of an ovarian and endometrial synchronous endometrioid carcinoma implanted on endometriosis sites, as well as its diagnosis and management. CLINICAL CASE: a 27-year-old patient who consulted because of an intermenstrual spotting. The ultrasound image showed an endometrial polyp. Furthermore, a 42 mm left adnexal trilobal tumor with a 17×15mm solid pole was described. She underwent a hysteroscopic polypectomy and laparoscopic ovarian cystectomy. Likewise, resection of a suspicious implant in the posterior vaginal fornix was done. The pathological result of the surgical pieces was: endometrial polyp with complex hyperplasia with atypia and focal points of grade I endometrioid adenocarcinoma; the left ovarian cystectomy: endometriotic cyst with focal points of endometrioid adenocarcinoma. The peritoneal lesion corresponded to a grade I endometrioid adenocarcinoma implant. The study of the pathological characteristics and the presence of the peritoneal implant suggest the diagnosis of endometrioid ovarian carcinoma originated in a synchronous endometriotic lesion with endometrial endometrioid carcinoma. CONCLUSION: differential diagnosis between the synchronicity or spread of ovarian and endometrial endometrioid cell line carcinomas, is a great challenge and it is essential for the correct management of these neoplasms

Carcinoma dediferenciado do endométrio: Uma revisão da literatura / Dedifferentiated endometrial carcinoma: A literature review

"O Carcinoma Dediferenciado do Endométrio (DDEC) é uma neoplasia constituída por dois componentes histológicos morfologicamente distintos (diferenciado e indiferenciado). O componente diferenciado corresponde a um carcinoma endometrioide de baixo grau (I ou II), enquanto o componente indiferenciado é caracterizado por células epiteliais homogêneas de tamanho médio, sem qualquer tipo de diferenciação ou padrão morfológico arquitetural. Esta neoplasia foi descrita inicialmente em 2006, mas somente em 2014 foi incluída na classificação dos tumores da Organização Mundial de Saúde (OMS). Por ser uma entidade relativamente nova e ainda desconhecida por parte de alguns patologistas, estimase que o DDEC seja subdiagnosticado. O componente indiferenciado pode ser confundido com área sólida de um carcinoma endometrioide grau III ou mesmo com outras entidades tais como tumores neuroendócrinos, sarcomas ou linfomas. O estudo imuno-histoquímico e molecular contribui para confirmação do diagnóstico. Este trabalho tem como objetivo revisar a literatura recente do DDEC para melhor caracterização dos seus aspectos clínicopatológicos, já que esta neoplasia tem um pior prognóstico quando comparado com os carcinomas endometrioides e serosos uterinos."(AU)

"Dedifferentiated Endometrial Carcinoma (DDEC) is a neoplasm consisting of two morphologically distinct histological components (differentiated and undifferentiated). The differentiated component corresponds to a low grade endometrioid carcinoma (I or II), while the undifferentiated component is characterized by homogeneous epithelial cells of medium size, without any kind of differentiation or architectural morphological pattern. This neoplasm was first described in 2006, but only in 2014 it was included in the World Health Organization (WHO) classification of tumors. Because it is a relatively new entity and still unknown to some pathologists, it is estimated that DDEC is underdiagnosed. The undifferentiated component can be confused with the solid area of a grade III endometrioid carcinoma or even with other entities such as neuroendocrine tumors, sarcomas or lymphomas, and immunohistochemical and molecular study contribute to confirmation of the diagnosis. This paper aims to review the recent literature of DDEC to better characterize its clinical and pathological aspects, since this neoplasia has a worse prognosis when compared to endometrioid and serous uterine carcinomas." (AU)

Primary broad ligament adenocarcinoma

Primary broad ligament carcinoma is a very rare occurrence with 28 reported cases worldwide, to date. The epidemiology, treatment strategy and prognosis are still uncertain because of the scarcity of cases. Currently, all broad ligament carcinomas are managed similar to epithelial ovarian cancer. We report the case of a 43-year-old female with a prolonged complaint of abdominal pain and intermittent urinary retention, requiring frequent catheterization. She was diagnosed with obstructive right hydroureteronephrosis. The abdominal Contrast Enhanced Computed Tomography (CECT) revealed a well-defined heterogeneous lesion of 2.1х3х3.2cm size in the right lateral and posterior wall of the cervix. An ultrasound (USG)-guided Fine Needle Aspiration Cytology (FNAC) of the mass was done and it was suspected to be malignant. The patient underwent total abdominal hysterectomy, right salpingo-oophorectomy, pelvic lymph-nodal sampling, and peritoneal washing. Histological examination depicted an endometrioid adenocarcinoma of the broad ligament. She received adjuvant chemotherapy, followed by hormonal therapy. It has been five years since her surgery, and she is now alive and disease free.

Rendimiento de la biopsia por aspirado en el diagnóstico del carcinoma de endometrio / Performance of aspirate biopsy in the diagnosis of endometrial carcinoma

OBJETIVO: Analizar la concordancia histológica pre y postoperatoria del cáncer de endometrio (CE) diagnosticado por cánula de biopsia tipo Cornier. MÉTODOS: Se incluyen 82 pacientes sometidas a biopsia ambulatoria a ciegas por aspirado con diagnóstico anatomo-patológico final de CE en la pieza de histerectomía. Se estudia la concordancia atendiendo al tipo y al grado histológico haciendo dos grupos para cada análisis: CE endometrioide/no endometrioide y Ce de bajo/alto grado. RESULTADOS: La sensibilidad de la biopsia para detectar malignidad fue del 100%. El grado de concordancia atendiendo al tipo histológico fue de 94% (96,7% para los tipo endometrioide y del 85% para los tipos no endometrioides). En cuanto al grado histológico la precisión en el diagnóstico fue del 90,2% (94,3% en los tumores de bajo grado y 82,7% en los de alto grado) con una tasa de subestimación del grado tumoral del 6%. CONCLUSIONES: La biopsia por aspiración con cánula tipo Cornier detecta adecuadamente el CE y la concordancia entre la biopsia preoperatoria y la pieza quirúrgica es alta, por lo que puede considerarse una técnica fiable en el diagnóstico del cáncer de endometrio y precisa en la valoración del grado y tipo histológicos. El grupo más discordante es el CE G3 de tipo endometrioide.

OBJECTIVE: Analyze pre and post operative histological concordance of endometrial cancer (EC) diagnosed by Cornier biopsy cannula. METHODS: 82 patients under going out patient biopsy aspirate blindly with EC in the hysterectomy specimen. We study the type and histological grade accuracy by two groups for each analysis: EC endometrioid/non-endometrioid and low/high grade. RESULTS: The sensitivity for detecting malignancy was 100%. The histological type agreement was 94% (96.7% for the endometrioid type and 85% for non-endometrioid type). The histological grade accuracy was 90.2% (94.3% in low-grade tumors and 82.7% in high grade) with a rate of under estimation of tumor grade of 6%. CONCLUSIONS: Cornier aspiration biopsy is safe in the diagnosis of EC. Grade and histological type accuracy between preoperative biopsy and surgical specimen is high. The most discordant is EC G3 endometrioid type.

Adjuvant radiotherapy in early stage endometrial cancer / Radioterapia adjuvante para câncer do endométrio estádio inicial

OBJECTIVE: To compare the rates of overall survival (OS), disease-free survival (DFS) and toxicity in different techniques of postoperative radiotherapy for stage IA endometrioid adenocarcionoma of endometrium, histological grades 1and 2. METHODS: A historical comparison between treatment regimens was performed, and 133 women with a minimum follow-up of 5 years were included. Teletherapy (TELE group), with 22 patients treated from 1988 to 1996, with a 10 MV linear accelerator, average dose 46.2 Gy. Low dose rate brachytherapy (LDRB group) was performed between 1992 and 1995, in 19 women, with an insertion of Cesium 137, at a 60 Gy dose. Fourteen women operated between 1990 and 1996 did not receive radiotherapy (NO RT group). High dose rate brachytherapy was performed in 78 patients (HDRB group), from 1996 to 2004, in five weekly 7 Gy insertions, prescribed at 0.5 cm from the vaginal cylinder. RESULTS: The 5-year disease-free survival was 94.6 percent for the HDRB group, 94.1 percent for the LDRB group, 100 percent for the TELE group and NO RT groups (p = 0.681). The 5-year overall survival was 86.6 percent for the HDRB group, 89.5 percent for the LDRB group and 90 percent for the TELE group and NO RT groups (p = 0.962). Grades 3-5 late toxicity was 5.3 percent in LDRB group and 27.3 percent for the TELE group (p < 0.001). CONCLUSION: Patients submitted to adjuvant teletherapy showed very high toxicity, which contraindicates that treatment for those patients. There may be a role for adjuvant HDRB, but randomized controlled trials are still needed to evaluate its benefit.

OBJETIVO: Comparar as taxas de sobrevida global (SG), sobrevida livre de doença (DFS) e de toxicidade em diferentes técnicas de radioterapia pós-operatória para adenocarcionoma endometrioide do endométrio estádio IA, graus histológicos 1 e 2. MéTODOS: Realizou-se uma comparação histórica entre regimes de tratamento, incluindo 133 mulheres com seguimento mínimo de cinco anos. Teleterapia (grupo TELE), com 22 pacientes, de 1988 a 1996, tratadas com acelerador linear 10 MV, dose média de 46,2 Gy. Braquiterapia de baixa taxa de dose (grupo LDRB), realizada entre 1992 e 1995, em 19 mulheres, com uma inserção de Césio 137, dose de 60 Gy. Quatorze mulheres operadas entre 1990 e 1996 não receberam radioterapia (grupo NO RT). Braquiterapia de alta taxa de dose foi realizada em 78 pacientes (grupo BATD), 1996-2004, cinco inserções semanais de 7 Gy, a 0,5 cm do cilindro vaginal. RESULTADOS: A DFS em cinco anos foi de 94,6 por cento para o grupo BATD, 94,1 por cento para o grupo LDRB, 100 por cento para os grupos TELE e RT (p = 0,681). A sobrevida global em cinco anos foi de 86,6 por cento para o grupo BATD, 89,5 por cento para o grupo LDRB e 90 por cento para os grupos TELE e NO RT (p = 0,962). A toxicidade tardia graus 3-5 foi de 5,3 por cento no grupo LDRB e 27,3 por cento para o grupo TELE (p < 0,001). CONCLUSãO: Pacientes submetidos à teleterapia adjuvante apresentaram toxicidade muito elevada, o que contraindica o tratamento para essas pacientes. Pode haver um papel para a BATD adjuvante, mas estudos controlados randomizados são necessários para avaliar seu benefício.

Neoplasia primaria sincrónica de endometrio y ovario: a propósito de un caso / Synchronous primary neoplasms of the endometrium and ovary: a case report

El desarrollo sincrónico de múltiples tumores en el tracto genital femenino es muy infrecuente, presentándose tan solo en el 1 al 2 por ciento de los cánceres ginecológicos. De estos, el 50 al 70 por ciento lo constituyen el grupo de neoplasias primarias sincrónicas de endometrio y ovario. El objetivo del artículo es exponer un caso diagnosticado histopatológicamente en el Departamento de Patología de la Universidad Industrial de Santander en material procedente de histerectomía abdominal ampliada, salpingooforectomía bilateral, linfadenectomía pélvica y apendicectomía, y hacer una revisión de la literatura de esta entidad, dada la infrecuencia de su diagnóstico y a la escasa información local al respecto.

Synchronous development of multiple tumors in the female genital tract is rare, occurring only in the 1 to 2 percent of gynecologic cancers. Of these, 50 to 70 percent consists of the group of synchronous primary neoplasms of the endometrium and ovary. The aim of this paper is to present a case diagnosed histopathologically at the Department of Pathology of the Universidad Industrial de Santander in a sample for histological study consists of material from enlarged abdominal hysterectomy, bilateral salpingoophorectomy, pelvic lymphadenectomy and appendectomy sent by the Hospital Universitario de Santander in 2010, and a review of the literature of this entity, given the rarity of its diagnosis and the lack of local information about it.

Tumor endometrioide borderline de ovário em adolescente: relato de caso / Borderline ovarian endometrioid tumor in adolescent: case report and review of the literature

Os tumores endometrioides malignos ovarianos são neoplasias epiteliais raras em pacientes jovens. Enquanto os carcinomas endometrioides ovarianos acometem mulheres na quinta e na sexta décadas de vida, os tumores borderline acometem mulheres em uma faixa etária mais ampla (de 22 a 77 anos). Descreveremos a seguir um caso raro de tumor endometrioide borderline ocorrendo em paciente de 16 anos. Desde que tumores do saco vitelino (TSV) e de Sertoli-Leydig (TCSL) podem mimetizar morfologicamente tumor endometrioide, o uso da imuno-histoquímica, além dos aspectos morfológicos, foi fundamental para estabelecer o diagnóstico diferencial entre essas condições.

Malignant endometrioid ovarian tumors are rare epithelial neoplasias among young patients. Whereas endometrioid ovarian carcinomas are more common among women in their fifth and sixth decades of life, borderline endometrioid tumors affect 22 to 77 year-old women. The present study reports a rare case of borderline endometrioid tumor in a 16 year-old patient. Since yolk sac and Sertoli-Leydig cell tumor may morphologically mimic endometrioid tumor, both the use of immunohistochemistry and morphological aspects were essential to establish the differential diagnosis.

Adenocarcinoma endometrial concomitante con tumor estromal benigno del endometrio / Endometrial carcinoma concomitant with endometrial stromal tumor benign

La asociación de tumor epitelial y estromal maligno es muy infrecuente, habiendo pocos casos reportados, más infrecuente aún es la asociación de tumor epitelial maligno y tumor estromal benigno. Se presenta el caso de mujer de 65 años con diagnóstico preoperatorio de carcinoma endometrial, que durante el procesamiento de la pieza quirúrgica se encontró además una lesión intramural nodular estromal benigna, sin continuidad entre ambas lesiones.

The association of epithelial and stromal malignant neoplasm is very rare, with few reported cases, rarer still is the prescence of malignant epithelial tumor and stromal benign tumor. We present the case of women aged 65 with preoperative diagnosis of endometrial carcinoma, which in the pathological examination was found an intramural benign endometrial stromal lesión, without continuity between both tumors.

Rol patogénico del gen supresor de tumores PTEN en cáncer ovárico asociado a endometriosis / Pathogenic role of PTEN tumor suppressor gene in ovarian cancer associated to endometriosis

Background: Endometrioid carcinoma and clear cell carcinoma of the ovary are associated to endometriosis. Somatic mutations of PTEN (10q23.3) are present in endometrial endometrioid carcinoma. Therefore, these mutations could be also present in ovarian tumors. Molecular studies show that solitary endometriotic cysts are monoclonal, have aneuploid DNA, have a loss of 9p,11q and 22q heterozygosity (LOH) and a higher cellular proliferation index of the epithelial component. Aim: To determine the cellular proliferation index using Ki 67, the immunohistochemical expression of PTEN and LOH in patients with ovarian endometriosis without atypia (EN), ovarian endometriosis with atypia (EA) and endometriosis with adjacent ovarian carcinoma (ET). Material and methods: Paraffin embedded samples of 37 endometrioid and clear cell carcinomas of the ovary (CC/CE), 15 solitary ovarian EN and 15 ovarian EA, were studied. Expression of Ki 67 and PTEN was measured by immunohistochemistry. LOH of 10q23.3 locus was measured by polymerase chain reaction. Results: Ki 67 was 5.5 and 2.3% in EA and EN, respectively (p <0.005). There was a histological correlation between EA and a higher cellular proliferation index. PTEN was negative in 5 of 15 EN, 9 of 15 EA and 30 of 37 CE/CC. There was a correlation between LOH and loss of PTEN protein in EN, EA and ET (60%). Conclusions: Negative expression on PTEN in EN; EA; ET and CE/CC is a manifestation of the inactivation of this gene. The mechanisms that cause this inactivation, must be elucidated.

Rol de la histeroscopia en el diagnóstico de la neoplasia endometrial / Hysteroscopy role in endometrial neoplasm diagnosis

Entre enero de 1995 y julio de 1999 se realizaron 2789 histeroscopias diagnósticas de oficina en la unidad de histeroscopia, Servicio de Ginecología y Obstetricia del Hospital San José. Los objetivos del presente estudio son determinar la efectividad de la evaluación histeroscópica ambulatoria en el diagnóstico de la neoplasia endometrial y conocer el perfil epidemiológico de esta población. Durante el periodo de estudio se realizaron 1221 biopsias dirigidas bajo visión directa de las cuales 30 fueron informadas como neoplasia endometrial, habiéndose sospechado histeroscópicamente en 25 de estos casos. Un 96,7 por ciento de las neoplasias correspondieron a carcinoma endometrioide siendo mayoritariamente GI (46,7 por ciento). Las pacientes presentaron en promedio una edad de 67,7 años y una paridad de 3 hijos. Un 93,3 por ciento son postmenopáusicas, 96,7 por ciento no usuarias de THR y en un 83,3 por ciento de los casos la indicación del procedimiento fue la metrorragia de la postmenopausia. No tuvimos casos de neoplasia con un grosor ecográfico endometrial menor a 6 mm, siendo el promedio 18,5 mm. Hubo asociación significativa entre la presencia de neoplasia endometrial y la predicción de ésta a través del examen histeroscópico (p=0,001). La sensibilidad fue de 83,3 por ciento y la especificidad de 99,2 por ciento. Concluimos que el perfil epidemiológico de nuestras pacientes portadoras de neoplasia endometrial es concordante a lo publicado en la literatura y que la histeroscopia tiene una elevada sensibilidad y especificidad diagnóstica para la neoplasia endometrial

Carcinoma de endometrio: cuadro clínico - patológico / Endometrial carcinoma: clinico-patological picture

Con la finalidad de identificar el cuadro clínico patológico y determinar el estado clínico, se analizó retrospectivamente información de 38 pacientes con carcinoma de endometrio admitidas al Hospital Belén, Trujillo, Perú, desde 1966 a 1996. La edad promedio en la serie total fue 53.1ñ 11,4 años (rango, 22 a 83 años). La edad media de presentación de la menarquía fue 13,4 ñ 1,6 años y de la menopausia (n=25) 48,2 ñ 3,6 años. Once pacientes fueron nulíparas (28,9 por ciento), cinco (13,2 por ciento) presentaron ovario poliquístico, cuatro (10,5 por ciento) tuvieron historia previa de hipertensión arterial, dos (5,3 por ciento) diabetes mellitus y dos (5,3 por ciento) historia personal de otro cáncer primario. El tiempo promedio de enfermedad fue 7,9 meses. Los síntomas más comunes fueron sangrado genital (89,5 por ciento) y dolor pélvico (52,6 por ciento). El signo más frecuente fue útero aumentado de tamaño (44,7 por ciento). El rendimiento diagnóstico de la biopsia de endometrio (n=15) y de la dilatación más curetaje (n=7) fue 80 por ciento y 85,7 por ciento, respectivamente. En 12 de 13 pacientes en estadio I, el Papanicolaou fue negativo. De acuerdo a la FIGO, 73,7 por ciento de las pacientes estuvo en estadio clínico I, 15,8 por ciento en estadio III, 7,9 por ciento en estadio IV y 2,6 por ciento en estadio II. El adenocarcinoma fue el tipo histológico más frecuente (75,7 por ciento), seguido del adenoacantoma (8,1 por ciento). En el estadio I, 18 casos fueron carcinoma bien diferente y hubo 10 casos entre moderada y pobremente diferenciados. El diagnóstico precoz y el estadiaje adecuado son pasos previos muy importantes al tratamiento definitivo del cáncer endometrial. Palabras claves: Carcinoma endometrial. Cuadro clínico-patológico, estadiaje, diagnóstico.

Carcinoma endometrial: Hospital Oncológico "Padre Machado" Estudio retrospectivo 1985-1995 / Endometrial carcinoma: Hospital Oncology \"Padre Machado\" retrospective study 1985-1995

Fueron evaluadas un total de 194 pacientes vistas en 10 años en el HOPM con diagnóstico de adenocarcinoma endometrial en forma retrospectiva. Se estableció el diagnóstico más frecuente en la postmenopausia. Aunque evidenciamos una importante incidencia de nuliparidad, pudimos apreciar un promedio de 4 gestas en la población estudiada, factores de riesgo ya conocidos para esta patología como hipertensión, obesidad y diabetes fueron apreciados de manera significativa. En nuestro grupo de estudio, solo 2 pacientes de las estudiadas recibieron terapia de reemplazo estrogénico previa al diagnóstico. Llama la atención la gran frecuencia de multiparidad en este estudio. La variedad histológica más frecuente fue el bien diferenciado. La mayoría de los casos eran estadios I o II. Casi 60 por ciento de las pacientes recibieron radioterapia en alguna forma. La quimioterapia se utilizó solo en el 5 por ciento de las pacientes. El carcinoma endometrial en el HOPM tiene un comportamiento asociado a patrones epidemiológicos de dependencia hormonal. No se pudo establecer relación entre terapia de reemplazo estrógenico y este cáncer en las pacientes evaluadas. El manejo oncológico médico adyuvante se requiere con frecuencia en las pacientes tratadas con este diagnóstico en la institución

Sertoliform variant of endometrioid carcinoma of the ovary

Although endometrioid carcinoma constitutes the second most common type of primary ovarian adenocarcinoma, the sertoliform variant is rarely encountered. We describe a case of this rare ovarian carcinoma which mimics a Sertoli cell tumour in its pathological appearance

Carcinoma de endometrio. Revisión de casos 1969-1993 / Carcinoma of endometrium

El carcinoma de endometrio es un tumor maligno originado a expensas del epitelio endometrial, el que resultaría ser consecuencia de un hiperestronismo relativo o absoluto. Según algunos autores, pasaría por una gama de lesiones preliminares como las hiperplasias adenomatosas. En nuestro trabajo, revisamos 62 casos diagnosticados microscópicamente en el Servicio de Anatomía Patológica del Hospital Daniel A. Carrión en sus 24 años de funcionamiento. El 75 por ciento refirió ginecorragia de más de un mes de evolución: el 68 por ciento de casos corresponde a mujeres puérperas, nulíparas o con baja paridad. Al examen físico, en la mitad de los casos se reporta útero aumentado de tamaño, y en 30 por ciento como de caracteres normales. El diagnóstico clínico presuntivo al que arriba el ginecólogo, es de hemorragia uterina disfuncional en 32 por ciento y de cáncer en 33 por ciento, en este ultimo caso probablemente por contar con un diagóstico anatomo-patológico previo por legrado biópsico. Al examen microscópico, encontramos que más del 80 por ciento de nuestros casos corresponden a adenocarcinoma, sólo 6 son de tipo adenoescamoso. El tipo de adenocarcinoma predominante fue el de aspecto histológico endometrioide, en 32 por ciento de los cuales se encontró diferenciacióm celular. Los carcinomas bien diferenciados fueron los más frecuentes. En 64 por ciento del total no hubo infiltración alguna, llegando el tumor solo al miometrio. Se encontró escasas lesiones precursoras.