RESUMO
OBJECTIVE: To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. DESIGN: Prospective cohort study. SETTING: Thirteen NHS Trusts in England, Wales and Northern Ireland. POPULATION: A total of 202 506 postmenopausal women recruited between 2001 and 2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. METHODS: Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. MAIN OUTCOME MEASURES: Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. RESULTS: Hysterectomy with conservation of one or both adnexa was reported in 41 912 (20.7%; 41 912/202 506) women. Median follow up was 11.1 years (interquartile range 9.96-12.04), totalling >2.17 million woman-years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 0.98, 95% CI 0.85-1.13, P = 0.765). CONCLUSIONS: This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. These data are important both for clinical counselling and for refining risk prediction models. TWEETABLE ABSTRACT: Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.
Assuntos
Carcinoma Epitelial do Ovário/mortalidade , Neoplasias das Tubas Uterinas/mortalidade , Histerectomia/estatística & dados numéricos , Neoplasias Ovarianas/mortalidade , Idoso , Carcinoma Epitelial do Ovário/cirurgia , Estudos de Coortes , Inglaterra , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Irlanda do Norte , Neoplasias Ovarianas/cirurgia , Estudos Prospectivos , Fatores de Risco , Medicina Estatal , Inquéritos e Questionários , País de GalesRESUMO
BACKGROUND: Oestrogens play a crucial role in breast carcinogenesis. Earlier studies have analysed the serum levels of endogenous hormones measured by conventional assays. In this study, we analysed the capacity of serum from breast cancer cases and controls to transactivate the oestrogen receptor alpha (ER-alpha) and beta (ER-beta). METHODS: We used a receptor oestrogen-responsive element (ERE) -- the green fluorescent protein (GFP)-reporter test system in Saccharomyces cerevisiae. Oestrogen receptor-alpha or ER-beta bioactivity was determined in serum from 182 randomly chosen postmenopausal women with breast cancer and from 188 age-matched controls. RESULTS: High serum ER-alpha and ER-beta bioactivity were independently associated with the presence of breast cancer. Women whose levels of serum ER-alpha and ER-beta bioactivity were in the highest quintile among controls had a 7.57-(95% confidence interval (CI): 2.46-23.32; P=0.0004) and a 10.14 (95% CI: 3.19-32.23; P<0.0001)-fold risk for general and oestrogen receptor-positive breast cancer, respectively. CONCLUSION: The use of serum ER-alpha and ER-beta bioactivity assays as clinical tools in the management of breast cancer warrants further research. Future studies will dictate whether surrogate markers of ER-alpha and ER-beta bioactivity will provide a means to monitor the efficacy of anti-endocrine, adjuvant and chemopreventive strategies.
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Neoplasias da Mama/sangue , Receptor alfa de Estrogênio/sangue , Receptor beta de Estrogênio/sangue , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Estudos de Casos e Controles , Estradiol/sangue , Receptor alfa de Estrogênio/genética , Receptor beta de Estrogênio/genética , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/sangue , Valor Preditivo dos Testes , Elementos de Resposta , Fatores de Risco , Ativação TranscricionalRESUMO
Low-moderate risk alleles that are relatively common in the population may explain a significant proportion of the excess familial risk of ovarian cancer (OC) not attributed to highly penetrant genes. In this study, we evaluated the risks of OC associated with common germline variants in five oncogenes (BRAF, ERBB2, KRAS, NMI and PIK3CA) known to be involved in OC development. Thirty-four tagging SNPs in these genes were genotyped in approximately 1800 invasive OC cases and 3000 controls from population-based studies in Denmark, the United Kingdom and the United States. We found no evidence of disease association for SNPs in BRAF, KRAS, ERBB2 and PIK3CA when OC was considered as a single disease phenotype; but after stratification by histological subtype, we found borderline evidence of association for SNPs in KRAS and BRAF with mucinous OC and in ERBB2 and PIK3CA with endometrioid OC. For NMI, we identified a SNP (rs11683487) that was associated with a decreased risk of OC (unadjusted P(dominant)=0.004). We then genotyped rs11683487 in another 1097 cases and 1792 controls from an additional three case-control studies from the United States. The combined odds ratio was 0.89 (95% confidence interval (CI): 0.80-0.99) and remained statistically significant (P(dominant)=0.032). We also identified two haplotypes in ERBB2 associated with an increased OC risk (P(global)=0.034) and a haplotype in BRAF that had a protective effect (P(global)=0.005). In conclusion, these data provide borderline evidence of association for common allelic variation in the NMI with risk of epithelial OC.
Assuntos
Predisposição Genética para Doença , Oncogenes , Neoplasias Ovarianas/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Classe I de Fosfatidilinositol 3-Quinases , Feminino , Genes erbB-2 , Genótipo , Haplótipos , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/genética , Pessoa de Meia-Idade , Fosfatidilinositol 3-Quinases/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras) , Proteínas ras/genéticaRESUMO
OBJECTIVES: This study aims to establish three-dimensional (3D) cell culture models of human ovarian and endometrial cancers and to compare biological and morphological characteristics of these models with those of two-dimensional (2D) models of the same cell lines and the primary tumours. METHODS: 3D models of ovarian and endometrial cancer cell cultures were established using a Rotary Cell Culture System. Immunohistochemical profiling and differential proteomics were used to characterize biological characteristics of multicellular spheroids (MCS) formed from these cultures. These were compared to characteristics of the same cells established in 2D and of the primary tumours from which the cell lines were derived. RESULTS: MCSs from 3D cell cultures appeared histologically similar to the primary tumours. Immunohistochemical profiling of multiple markers, including CA125, BCL2 and p53, showed that patterns of protein expression in MCSs resemble those of the primary tumours. Proteomic profiling identified several differentially expressed protein markers between 2D and 3D cultures. These included prohibitin, which was down-regulated in 3D cultures suggesting cells proliferate less compared to 2D cultures; and VDAC1 and annexin 4, which were up-regulated in 3D cultures suggesting greater levels of apoptosis in 3D compared to 2D models. CONCLUSION: Establishing 3D models of cancer cell lines is likely to be of value for studying the molecular and biological mechanisms of ovarian/endometrial tumour progression and for testing novel molecular targets for cancer therapy.
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Neoplasias do Endométrio/patologia , Modelos Biológicos , Neoplasias Ovarianas/patologia , Esferoides Celulares/metabolismo , Esferoides Celulares/patologia , Biomarcadores Tumorais/metabolismo , Antígeno Ca-125/metabolismo , Técnicas de Cultura de Células , Linhagem Celular Tumoral , Proliferação de Células , Células Clonais/química , Células Clonais/metabolismo , Células Clonais/patologia , Eletroforese em Gel Bidimensional , Células Epiteliais/citologia , Células Epiteliais/metabolismo , Feminino , Humanos , Queratina-7/metabolismo , Antígeno Ki-67/metabolismo , Invasividade Neoplásica , Proteoma/análise , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Receptores Citoplasmáticos e Nucleares/metabolismo , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Esferoides Celulares/química , Proteína Supressora de Tumor p53/metabolismoRESUMO
A risk of malignancy index (RMI), based on menopausal status, ultrasound (US) findings, and serum CA125, has previously been described and validated in the primary evaluation of women with adnexal masses and is widely used in selective referral of women from local cancer units to specialized cancer centers. Additional imaging modalities could be useful for further characterization of adnexal masses in this group of women. A prospective cohort study was conducted of 196 women with an adnexal mass referred to a teaching hospital for diagnosis and management. Follow-up data was obtained for 180 women; 119 women had benign and 61 women malignant adnexal masses. The sensitivity and specificity of specialist US, magnetic resonance imaging (MRI), radioimmunoscintigraphy (RS), and the RMI were determined. We identified a subgroup of women with RMI values of 25-1000 where the value of further specialist imaging was evaluated. Sensitivity and specificity for specialist US were 100% and 57%, for MRI 92% and 86%, and for RS 76% and 87%, respectively. Analysis of 123 patients managed sequentially, using RMI cutoff values of > or =25 and <1000 and then US and MRI provided a sensitivity of 94% and a specificity of 90%. Using this RMI cutoff followed by specialist US and MRI, as opposed to the traditional RMI cutoff value of 250, can increase the proportion of patients with cancer appropriately referred in to a cancer center, with no change in the proportion of patients with benign disease being managed in a local unit.
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Doenças dos Genitais Femininos/diagnóstico , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico , Anexos Uterinos/diagnóstico por imagem , Anexos Uterinos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/patologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico por imagem , Neoplasias de Anexos e de Apêndices Cutâneos/patologia , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , UltrassonografiaRESUMO
OBJECTIVE: Retrospective studies have reported that 95% of women with ovarian cancer have symptoms prior to diagnosis and that women with these symptoms are at an increased risk of ovarian cancer. Failure to recognise these symptoms may result in a delay in referral and diagnosis. We assess the feasibility of screening for ovarian cancer using symptoms as selection criteria. DESIGN: A randomised controlled trial. SETTING: General practices in East London. POPULATION: Three hundred and ninety GPs. METHODS: GPs were randomised by practice, and those in the study group were given rapid access to ultrasound and CA125 test for women, >45 years, suffering from symptoms that may be caused by ovarian cancer. MAIN OUTCOME MEASURES: Symptoms leading to referral, ultrasound and CA125 results and ovarian cancer diagnosis. RESULTS: Seventy nine practices containing 197 GPs were randomised to the study arm. Three hundred and seventeen women were referred, of which 315 were eligible. Women reported the following symptoms: abdominal 87%, gastrointestinal 41% and constitutional 29%. Twenty-three women had abnormal findings on ultrasound: 20 were managed conservatively and 3 surgically. Histology revealed a mucinous cystadenoma, a Brenner tumour and a serous cystadenoma. Incidental findings included endometrial pathology in 13 women and bladder pathology in 2. Ninety five percent of CA125 results were <35 units/ml. CONCLUSIONS: This pilot study confirms the feasibility of screening for ovarian cancer using symptoms as selection criteria. Specificity was high and patient compliance good. Initial concerns about referral volumes and additional investigations and referrals generated were not confirmed. No ovarian cancers were detected in this pilot study, and this may be due to the size of the cohort.
Assuntos
Antígeno Ca-125/sangue , Programas de Rastreamento/métodos , Neoplasias Ovarianas/diagnóstico , Seleção de Pacientes , Adulto , Idoso , Medicina de Família e Comunidade , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Projetos Piloto , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , UltrassonografiaRESUMO
OBJECTIVE: To date, most mtDNA mutations in cancer have been identified in the control region (D-loop) containing the major promoters. However, almost all studies used one sample per tumor and there is no clear evidence whether metastatic deposits harbor different mtDNA variants. To establish whether different mtDNA variants can be found in the same cancer but at different sites, we analyzed a series of unilateral and bilateral primary epithelial ovarian cancers as well as paired metastatic tumor deposits. METHODS: We sequenced the D-loop region in 52 different tumor samples of 35 ovarian cancer cases, as well as matched normal tissues. Seventeen of those 35 cases had bilateral ovarian cancer, with a sample from each tumor analyzed. RESULTS: Eighty-six polymorphisms (4 new in ovarian cancer) were detected, and 9 different somatic mtDNA mutations were found in 26% (9 of 35) of ovarian cancer cases; all were homoplasmic in nature. Six of the mutations were novel in ovarian cancer. In 24% (4 of 17) of cases with bilateral ovarian tumors, different mtDNA variants were found between paired tumors, suggesting the presence of different clonal populations of cancer cells. Metastatic tumor deposits showed identical mtDNA variants to those found in at least one of the ovarian tumors in cases with bilateral ovarian cancer. CONCLUSION: Our data demonstrate that multiple tumor samples from the same patient may harbor different mtDNA variants.
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DNA Mitocondrial/genética , DNA de Neoplasias/genética , Mutação , Neoplasias Ovarianas/genética , Sequência de Bases , Feminino , Humanos , Polimorfismo GenéticoRESUMO
Genetic analysis of solid tumours using DNA or cDNA expression microarrays may enable individualized treatment based on the profiles of genetic changes that are identified from each patient. This could result in better response to adjuvant chemotherapy and, consequently, improved clinical outcome. So far, most research studies that have tested the efficacy of such an approach have sampled only single areas of neoplastic tissue from tumours; this assumes that the genetic profile within solid tumours is homogeneous throughout. The aim of this study was to evaluate the extent of genetic intra-tumour heterogeneity (ITH) within a series of epithelial ovarian cancers. Several different regions (five to eight regions) of tumour tissue from 16 grade 3, serous epithelial ovarian cancers were analysed for genetic alterations using a combination of microsatellite analysis and single nucleotide polymorphism (SNP) analysis, in order to establish the extent of ITH. Maximum parsimony tree analysis was applied to the genetic data from each tumour to evaluate the clonal relationship between different regions within tumours. Extensive ITH was identified within all ovarian cancers using both microsatellite and SNP analysis. Evolutionary analysis of microsatellite data suggested that the origin of all tumours was monoclonal, but that subsequent clonal divergence created mixed populations of genetically distinct cells within the tumour. SNP analysis suggested that ITH was not restricted to random genetic changes, but affected genes that have an important functional role in ovarian cancer development. The frequent occurrence of ITH within epithelial ovarian cancers may have implications for the interpretation of genetic data generated from emerging technologies such as DNA and mRNA expression microarrays, and their use in the clinical management of patients with ovarian cancer. The basis of genetic ITH and the possible implications for molecular approaches to clinical diagnosis of ovarian cancers may apply to other tumour types.
Assuntos
Adenocarcinoma Papilar/genética , Regulação Neoplásica da Expressão Gênica , Heterogeneidade Genética , Neoplasias Ovarianas/genética , Polimorfismo de Nucleotídeo Único , Adenocarcinoma Papilar/diagnóstico , Alelos , Progressão da Doença , Feminino , Genótipo , Humanos , Instabilidade de Microssatélites , Repetições de Microssatélites , Estadiamento de Neoplasias , Neoplasias Ovarianas/diagnósticoAssuntos
Programas de Rastreamento/métodos , Neoplasias Ovarianas/diagnóstico , Adulto , Idoso , Proteína BRCA1/genética , Proteína BRCA2/genética , Antígeno Ca-125/análise , Saúde da Família , Feminino , Predisposição Genética para Doença/genética , Humanos , Pessoa de Meia-Idade , Mutação/genética , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/genética , Sensibilidade e Especificidade , Ultrassonografia , Vagina/diagnóstico por imagemRESUMO
OBJECTIVES: Although invasion of the bladder or rectum is rare in cervical carcinoma, endoscopic assessment of both organs is part of the standard FIGO clinical staging system, with associated increase in cost and risk of complications. Our objective was to evaluate whether MRI could be used to select patients who did not require invasive staging of the bladder or rectum. METHODS: Two observers, blinded to the results of cystoscopy and endoscopic examination of the rectum, retrospectively reviewed the MR images of 112 patients with cervical carcinoma. A 5-point invasion score was used to determine bladder and rectal invasion (1 = no invasion, 5 = definite invasion). A confidence score of 3 or above was used to identify patients with possible bladder or rectal involvement. The results of cystoscopy and endoscopic examination of the rectum were recorded and correlated with the MR findings. RESULTS: MRI was negative for both bladder and rectal invasion in 94/112 patients. Cystoscopy and endoscopic examination of the rectum were confirmed to be normal in all 94 cases. MRI identified 12 patients with possible rectal invasion, 2 confirmed at endoscopy. MRI identified 14 patients with possible bladder invasion, one confirmed at cystoscopy. Using a low threshold cut-off score of >3 to predict invasion resulted in a 100% negative predictive value (NPV) in detection of bladder and rectal invasion. CONCLUSION: The absence of bladder or rectal invasion can be diagnosed with sufficient confidence using an MRI scoring system to safely obviate the need for invasive cystoscopic or endoscopic staging in the majority of patients with cervical cancer. This could potentially lead to a reduction in staging costs and morbidity.
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Imageamento por Ressonância Magnética/métodos , Neoplasias Retais/secundário , Neoplasias da Bexiga Urinária/secundário , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Retais/diagnóstico , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias do Colo do Útero/diagnósticoRESUMO
AIMS: To evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in characterizing adnexal masses, and to determine which patients may benefit from MRI. METHODS: We prospectively studied 72 women (mean age 53 years, range 19 to 86 years) with clinically suspected adnexal masses. A single experienced sonographer performed transabdominal and transvaginal greyscale spectral and colour Doppler examinations. MRI was carried out on a 1.5T system using T1, T2 and fat-suppressed T1-weighted sequences before and after intravenous injection of gadolinium. The adnexal masses were categorized as benign or malignant without knowledge of clinical details, according to the imaging features which were compared with the surgical and pathological findings. RESULTS: For characterizing lesions as malignant, the sensitivity, specificity and accuracy of MRI were 96.6%, 83.7% and 88.9%, respectively, and of US were 100%, 39.5% and 63.9%, respectively. MRI was more specific (p<0.05) than US. Both MRI and US correctly diagnosed 17 (24%) cases with benign and 28 (39%) cases with malignant masses. MRI correctly diagnosed 19 (26%) cases with benign lesion(s), which on US were thought to be malignant. The age, menopausal status and CA-125 levels in these women made benign disease likely, but US features were suggestive of malignancy (large masses and solid-cystic lesions with nodules). CONCLUSION: MRI is more specific and accurate than US and Doppler assessment for characterizing adnexal masses. Women who clinically have a relatively low risk of malignancy but who have complex sonographic features may benefit from MRI.
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Doenças dos Anexos/diagnóstico , Imageamento por Ressonância Magnética , Ultrassonografia Doppler em Cores , Doenças dos Anexos/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
Studies, to date, have suggested that there are distinct molecular differences between microsatellite stable (RER(-)) and unstable (RER(+)) solid tumors, such as colorectal carcinoma. We investigated a range of molecular events including mutation frequency of K-ras, microsatellite instability within the coding region of TGF-beta RII, BAX, and IGF-IIR, loss of expression of p53, hMLH1, hMSH2, hMSH6, and PTEN, and methylation of hMLH1, hMSH2, and PTEN within a large population-based series of sporadic endometrial carcinomas to establish whether there are distinct differences between replication error repair (RER(+)) and RER(-) cases. RER(+) endometrial carcinomas tended to be diploid with normal p53 expression, compared with RER(-) cases. Mutations in TGF-beta RII, IGF-IIR, and BAX were rare, but there was a strong association between mutation and RER(+) status. Methylation and loss of hMLH1 expression were significantly more common in RER(+) cases, as was methylation of PTEN. K-ras mutations were equally frequent in RER(+) and RER(-) cases. Despite the absence of distinct clinicopathological differences between RER(+) and RER(-) cases in this series of sporadic endometrial carcinomas, our results confirm that there are molecular differences between RER(+) and RER(-) cases, but the molecular events occurring in RER(+) endometrial carcinomas differ from those seen in RER(+) colorectal carcinomas.
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Carcinoma/genética , Neoplasias do Endométrio/genética , Genes ras , Repetições de Microssatélites/genética , Proteínas Adaptadoras de Transdução de Sinal , Pareamento Incorreto de Bases , Carcinoma/patologia , Proteínas de Transporte , Metilação de DNA , Análise Mutacional de DNA , Reparo do DNA , Neoplasias do Endométrio/patologia , Feminino , Humanos , Imuno-Histoquímica , Proteína 1 Homóloga a MutL , Proteínas de Neoplasias , Proteínas NuclearesRESUMO
BACKGROUND: There is a strong correlation between disease mortality and the depth of myometrial invasion in stage I endometrial cancer (EC). Current assessment of the depth of invasion relies on light microscopy. Tumor cells can evade detection by light microscopy if they are vastly outnumbered by myometrial cells. Immunohistochemical (IHC) techniques against pancytokeratins (PCKs) have a great potential in the detection of such isolated cells. OBJECTIVES: To investigate the application of IHC techniques in the identification of isolated infiltrating tumor cells within myometrium and assess its significance in clinically stage I EC. METHODS: A single representative tissue block containing the deepest myometrial invasion by the tumor was selected for 90 patients with stage I EC. Sections from each block were immunostained in accordance with established streptavidin-biotin peroxidase method using a mouse monoclonal antikeratin clone AE1/AE3. Myometrium was re-examined to identify deeper myometrial invasion that had escaped detection on hematoxylin and eosin (H&E) section. The clinical records were reviewed, and following data were collected: age, race, parity, presentation, associated medical disorders (obesity, diabetes, and hypertension), use of tamoxifen or hormone replacement therapy, menopausal state, recurrence, and survival. RESULTS: Of 90 cases, deeper myometrial invasion was detected on IHC sections in seven cases (7.7%). In five of these seven cases, isolated tumor cells surrounded by inflammatory cells were noted 0.2-1.2 mm deeper within the myometrium than that detected by H&E staining. In the remaining two cases, the deeper extension seen was the result of examining serial levels through the tumor block; in these cases, deeper infiltration should have been apparent on H&E sections. Follow-up data was available in 72 of the 90 cases. A trend was noted between the presence of isolated tumor cells deeper within myometrium on IHC and tumor recurrence (P = 0.056). The 2-year recurrence-free survival was 40% for the group with IHC evidence of deeper invasion compared with 89% for the group without (P = 0.005). Similarly, analysis of cause-specific and overall survival revealed significant differences between the two groups (P = 0.038 and P = 0.026, respectively). CONCLUSIONS: In this study, we have shown that it is possible to identify deeper level of myometrial invasion by tumor cells using an IHC technique. IHC-detected deeper invasion is an uncommon event and may be a feature of more aggressive tumors with greater potential for recurrence and lower survival.
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Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Imuno-Histoquímica/métodos , Queratinas/imunologia , Miométrio/patologia , Carcinoma Endometrioide/mortalidade , Neoplasias do Endométrio/mortalidade , Feminino , Humanos , Invasividade Neoplásica , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Análise de SobrevidaRESUMO
Currently in the UK cervical cancer has a peak incidence in women aged 35-39. Fertility-conserving surgical treatment by radical trachelectomy is established in the management of early disease. This study aimed at establishing the value of cytology in follow-up after trachelectomy. The cytological features of isthmic-vaginal smears post-trachelectomy for cervical cancer are presented together with a discussion of relevant clinical issues. One hundred and ninety seven smears from 32 women were reviewed. Two of the 32 patients developed pelvic recurrences. In both cases recurrence was detected cytologically long before development of a clinical or radiological abnormality. There is, however, a potential for overcall due to the presence of endometrial cells. These were present in large numbers and varying configurations in 58% of smears and led to a false positive report of malignancy in 2% of smears. The rate of referral for a cytologist opinion was significantly higher in smears containing endometrial cells (26%) than those without (13%). While all smears contained squamous cells, 41% contained squamous cells only and it is proposed that such smears should be reported as unsatisfactory in the first 2 years after surgery and negative thereafter, although the absence of glandular cells should be recorded. When an abnormality is reported, smear review and multidisciplinary discussion may avoid unnecessary investigations.
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Neoplasias do Endométrio/diagnóstico , Fertilidade , Recidiva Local de Neoplasia/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal , Neoplasias do Endométrio/patologia , Endométrio/patologia , Reações Falso-Positivas , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia , Humanos , Recidiva Local de Neoplasia/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVES: To describe our experience of laparoscopic extraperitoneal paraaortic lymphadenectomy and to study the feasibility, safety and applications of this technique in managing cervical, ovarian and endometrial carcinomas. METHODS: Our study included 32 women with cervical, ovarian or endometrial cancers undergoing laparoscopic extraperitoneal paraaortic lymphadenectomy between December 1997 and May 2002. The operating time, nodal yield, hospital stay and complications were recorded prospectively. The impact on the overall management was assessed by comparing the preoperative therapeutic plan with that following surgicopathological staging. RESULTS: The median nodal yield was 12 nodes, median-operating time was 80 min and the median hospital stay was 2 days. The median follow-up was 15.25 months. Lymphadenectomy was successful in all but one woman who had a peritoneal tear causing CO(2) gas leakage. Complications included one case each of pulmonary embolism, umbilical hernia, lymphocoele, pelvic collection and left-thigh cellulitis. In all women, the need for adjuvant chemotherapy or extended field radiotherapy (EFRT) was based on nodal histology. The primary plan of management was changed in 22.6% women. In the endometrial and cervical cancer group, 8.3% women deferred and 20.8% additionally received EFRT. All women with ovarian cancer (stage I) were completely staged and avoided chemotherapy. CONCLUSIONS: Laparoscopic extraperitoneal paraaortic lymphadenectomy is feasible with minimal complications, acceptable nodal yield and short hospital stay. It accurately identifies those cervical and endometrial cancers requiring extended field irradiation as part of their adjuvant therapy. It can be effectively applied in staging early ovarian cancers to determine the need for adjuvant chemotherapy.
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Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta , Feminino , Neoplasias dos Genitais Femininos/patologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo/efeitos adversos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos ProspectivosRESUMO
INTRODUCTION: Lymphovascular Invasion (LVSI) of tumour cells is marked as an important step in the process of tumour metastases and is an important prognostic factor in Endometrial Cancer (EC). Currently, the standard method for assessing LVSI is light microscopic examination of H&E stained sections. Tumour cells within lymphovascular spaces can evade detection on H&E staining if they are present in very small numbers or surrounded by a greater number of circulating cells. Dual immunostaining for epithelial and endothelial cell markers cell markers has been shown to increase detection rate of LVSI significantly. OBJECTIVES: To investigate the clinical significance of LVSI as detected by H&E (LVSI-H&E) and immunohistochemically (LVSI-IHC) in clinically stage I endometrioid EC patients. Methods. Single representative section of 90 patients with stage I endometriod EC were immunostained in accordance with established streptavidin-biotin peroxidase method using a mouse monoclonal pancytokeratin (PCK), clone AE1/AE3 and CD31 endothelial cell marker. The H&E sections and their corresponding immunostained sections were re-examined to identify LVSI. Clinical records were available on 72 patients. The following data were collected: age, race, parity, presentation, associated medical disorders (obesity, diabetes and hypertension), use of Tamoxifen or HRT, menopausal state, recurrence and survival. RESULTS: Overall, LVSI was present in 45 (50%) cases and absent in 45 (50%) cases on IHC, as compared with 17 (19%) and 73 (81%) cases, respectively, on H&E. Statistical analysis revealed significant association between LVSI-H&E and depth of myometrial invasion (P < 0.0001). The median follow-up period was 161 months (range 5-207 months). During the follow-up period, six of 14 cases with evidence of LVSI-H&E presented with recurrence as opposed to six of 58 patients with no evidence (OR = 6.26, 95%: CI = 1.3-30.6). There was a significant association between tumour recurrence rate and LVSI-H&E (P = 0.01). The 5-year recurrence-free survival was 54% for the group with H&E evidence of LVSI (95%: CI = 44-64%) compared with 89% for the group without (95%: CI = 82-97%). There was a significant difference in the recurrence-free survival between the two groups (Chi-square = 6.96, P = 0.008). In contrast, LVSI-IHC was found to be significantly associated only with high-grade tumours (P = 0.01) and survival analysis revealed no statistically significant association with recurrence or survival. CONCLUSIONS: LVSI-H&E in stage I EC remains an important predictive factor of recurrent disease and reduced disease-free interval. Immunohistochemically detected LVSI is a common event, associated with tumour grade and appears to be of no statistically significant clinical value.
Assuntos
Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Vasos Linfáticos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/metabolismo , Neoplasias do Endométrio/metabolismo , Amarelo de Eosina-(YS) , Feminino , Hematoxilina , Humanos , Imuno-Histoquímica , Queratinas/metabolismo , Vasos Linfáticos/metabolismo , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
BACKGROUND: Lymphovascular space invasion (LVSI) is an important step in the complex process of tumour metastasis. Various methods have been used in the past to improve the histological detection of LVSI. AIMS: To develop a sensitive immunohistochemical method for the detection of LVSI. METHODS: Paraffin wax blocks from 108 patients who had undergone hysterectomy for stage I endometrial cancer were retrieved. Dual immunostaining for pancytokeratin and the CD31 endothelial cell marker was carried out on 4 micro m sections cut from these bocks and compared with conventional haematoxylin and eosin staining. RESULTS: The detection rate for LVSI increased threefold compared with conventional haematoxylin and eosin staining in the test group. CONCLUSION: This finding suggests that LVSI is a much more common phenomenon than previously thought and questions current understanding of tumour metastasis.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias do Endométrio/imunologia , Queratinas/análise , Sistema Linfático/patologia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Amarelo de Eosina-(YS) , Feminino , Hematoxilina , Humanos , Imuno-Histoquímica/métodos , Invasividade Neoplásica , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Coloração e RotulagemRESUMO
Human papillomavirus (HPV) is thought to cause some vulval squamous cell carcinomas (VSCC) by degrading p53 product. Evidence on whether HPV-negative VSCC results from p53 mutation is conflicting. We performed immunohistochemistry for p53 product on 52 cases of lone vulval intraepithelial neoplasia (VIN), 21 cases of VIN with concurrent VSCC and 67 cases of VSCC. We had previously performed HPV detection and loss of heterozygosity (LOH) analyses on these samples. Abnormal p53 immunoreactivity (p53-positive) rates in HPV-positive VSCC and HPV-negative VSCC were 22% (12/54) and 31% (4/13), respectively (P<0.74). p53 immunoreactivity was associated with LOH at the p53 locus (P<0.004), but neither technique differentiated between HPV-positive and HPV-negative VSCC. p53 immunoreactivity was associated with overall LOH rates (p53-positive VSCC vs p53-negative VSCC mean fractional regional allelic loss 0.41 vs 0.24, respectively, P<0.027). LOH at 3p25 was more frequent in p53-positive VSCC cf p53-negative VSCC (70 vs 21%, respectively, P<0.007). There was a trend in p53 disruption associated with invasive disease; HPV-positive VSCC demonstrated more disruption than VIN associated with VSCC, which had more disruption than lone VIN III (22 vs 10 vs 0%, respectively, P<0.005). In all, three out of 73 cases of VIN were p53-positive. All three were associated with concurrent or previous VSCC. Meta-analysis of previous studies revealed significantly more p53 disruption in HPV-negative VSCC cf HPV-positive VSCC (58 vs 33%, respectively; P<0.0001). p53 immunoreactivity/mutation in VIN only appeared in association with VSCC. These data suggest that HPV-independent vulval carcinogenesis does not exclusively require disruption of p53, p53 disruption may work synergistically with LOH at specific loci and p53-positive VIN should be checked carefully for the presence of occult invasion.
Assuntos
Carcinoma in Situ/metabolismo , Carcinoma de Células Escamosas/metabolismo , Papillomaviridae/patogenicidade , Proteína Supressora de Tumor p53/metabolismo , Neoplasias Vulvares/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/patologia , Carcinoma in Situ/virologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , DNA de Neoplasias/genética , DNA Viral/genética , Feminino , Humanos , Técnicas Imunoenzimáticas , Perda de Heterozigosidade , Repetições de Microssatélites , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/metabolismo , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/metabolismo , Infecções Tumorais por Vírus/patologia , Infecções Tumorais por Vírus/virologia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/virologiaRESUMO
BACKGROUND/AIMS: Loss of heterozygosity (LOH) on chromosome 13q has been reported to occur frequently in human ovarian cancer, and indications have been found that chromosome 13 may also play a specific role in the inherited form of ovarian cancer. The aim of this study was to define regions on chromosome 13 that may harbour additional tumour suppressor genes involved in the tumorigenesis of BRCA1 related ovarian and fallopian tube cancer. MATERIALS/METHODS: DNA extracted from paraffin wax blocks of 36 BRCA1 associated ovarian and fallopian tube carcinomas was analysed by LOH polymerase chain reaction using seven highly polymorphic microsatellite markers spanning chromosome 13q. RESULTS: High LOH frequencies were found on loci 13q11, 13q14, 13q21, 13q22-31, 13q32, and 13q32-4, suggesting the presence of putative tumour suppressor genes on the long arm of chromosome 13 that may play a role in the pathogenesis of BRCA1 related ovarian and fallopian tube cancer. LOH patterns appeared to be independent of the type of BRCA1 mutation, stage, and grade. Although in some cases there were indications for loss of larger parts of chromosome 13, in most cases losses were fairly randomly distributed over chromosome 13 with retained parts in between lost parts. Microsatellite instability was found in six cases. CONCLUSION: Several loci on chromosome 13q show high frequencies of LOH in BRCA1 related ovarian and fallopian tube cancer, and may therefore harbour putative tumour suppressor genes involved in the carcinogenesis of this particular type of hereditary cancer.