RESUMO
OBJECTIVE: Polycystic ovarian syndrome is associated with diverse pregnancy related complications and endometrial cancer. However, research on the relationship between pregnancy complications and endometrial cancer in women with polycystic ovarian syndrome is scarce. We aimed to examine the association between gestational diabetes mellitus, pregnancy induced hypertension, and preterm birth and the risk of endometrial cancer in women with polycystic ovarian syndrome. METHODS: We analyzed data from the National Health Information Database established by the Korean National Health Insurance Service between January 2002 and December 2019. We included women with gestational diabetes mellitus, pregnancy induced hypertension, preterm birth, and endometrial cancer from among the polycystic ovarian syndrome population. All conditions were diagnosed according to the Korean Informative Classification of Diseases, 10th revision codes. Age, area of residence, income, body mass index, waist circumference, total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides, fasting blood sugar, and creatinine levels were included as covariates in the multiple logistic regression analysis. RESULTS: Of 467 221 women with polycystic ovarian syndrome included, 5099 had endometrial cancer. Age, residence, income, body mass index, waist circumference, total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides, fasting blood sugar, and creatinine levels differed significantly between the endometrial cancer and non-endometrial cancer groups (p≤0.001-0.032). Among the polycystic ovarian syndrome population, the odds ratios (ORs) of endometrial cancer were 1.50, 1.43, and 1.23 in women with a history of gestational diabetes mellitus, pregnancy induced hypertension, and preterm birth, respectively, compared with those without a history of these conditions (OR 1.50, 95% confidence interval (CI) 1.32 to 1.69, p<0.001; 1.43, 1.04 to 1.97, p=0.027; and 1.23, 1.05 to 1.45, p=0.011, respectively). CONCLUSION: Our results suggest that a history of pregnancy complications (gestational diabetes mellitus, pregnancy induced hypertension, and preterm birth) increases the risk of endometrial cancer in women with polycystic ovarian syndrome.
Assuntos
Diabetes Gestacional , Neoplasias do Endométrio , Hipertensão Induzida pela Gravidez , Síndrome do Ovário Policístico , Complicações na Gravidez , Nascimento Prematuro , Gravidez , Feminino , Recém-Nascido , Humanos , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/diagnóstico , Diabetes Gestacional/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Glicemia , Creatinina , Triglicerídeos , Neoplasias do Endométrio/etiologia , Neoplasias do Endométrio/complicações , Lipoproteínas HDL , Lipoproteínas LDL , Programas Nacionais de Saúde , Colesterol , República da Coreia/epidemiologiaRESUMO
RATIONALE: The incidence of uterine malformations is low (4%-7%). Currently, the National Comprehensive Cancer Network clinical practice guidelines in oncology recommend minimally invasive surgery for early endometrial cancer. Minimally invasive surgery for the treatment of uterine didelphys with endometrial cancer is rare due to the large size of the uterus. To date, only 2 such patients have been reported to have undergone laparoscopy. Whether such patients can be treated with minimally invasive surgery needs to be further explored. PATIENT CONCERNS: A 40-year-old woman with uterine didelphys was hospitalized for menorrhagia in the past 2âmonths. DIAGNOSIS: Endometrial adenocarcinoma was found in both the uterus and cervix using fractional dilation and curettage. INTERVENTIONS: The patient underwent laparoscopic surgery. Postoperative adjuvant radiotherapy and chemotherapy were administered. OUTCOMES: There was no sign of recurrence during routine follow-up. LESSONS: The use of a uterine manipulator to lift either side of the uterus could help to expose the narrow ipsilateral para-uterine field. It is difficult to remove the uterus entirely through the vagina, making it necessary to select appropriate cases wherein screening is performed to check if the vagina is loose, and the uterus is of appropriate size. Minimally invasive surgery may be feasible for suitable patients.
Assuntos
Neoplasias do Endométrio , Anormalidades Urogenitais , Neoplasias Uterinas , Adulto , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Anormalidades Urogenitais/complicações , Neoplasias Uterinas/patologia , Útero/anormalidades , Útero/patologiaRESUMO
Endometrial biopsy can be used to diagnose endometrial hyperplasia, endometrial cancer, and uterine infections. This cost-effective procedure has minimal side effects, and complications are rare. The purpose of this clinical bulletin is to provide clinicians with guidance about endometrial biopsy including the procedure's advantages and disadvantages, indications and contraindications, and side effects. In addition, step-by-step instructions for performing endometrial biopsy, the equipment required, selection of sampling devices, and care before and after the procedure are discussed.
Assuntos
Biópsia/métodos , Hiperplasia Endometrial/diagnóstico , Neoplasias do Endométrio/diagnóstico , Endométrio/cirurgia , Ginecologia/métodos , Hemorragia Uterina , Biópsia/efeitos adversos , Contraindicações de Procedimentos , Hiperplasia Endometrial/complicações , Neoplasias do Endométrio/complicações , Endometrite/diagnóstico , Endométrio/patologia , Feminino , Humanos , Tocologia , Enfermeiros Obstétricos , Gravidez , Complicações na Gravidez , Sociedades Médicas , Estados Unidos , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiologiaRESUMO
BACKGROUND Paraneoplastic hypercalcemia is a well-described complication associated with a variety of malignancies. However, its incidence in gynecological malignancies is low. CASE REPORT A 53-year-old woman presented with progressive abdominal distention and irregular vaginal bleeding of several weeks' duration. A contrast CT abdomen and pelvis was significant for a mass in the lower uterine/cervical region, multiple peritoneal and omental masses, enlarged pelvic and paraaortic lymph nodes, and large-volume ascites. A pelvic exam revealed a fungating vaginal mass, with biopsy showing a high-grade tumor with immunohistochemical staining positive for vimentin, CD10, and cyclin D1, consistent with endometrial stromal sarcoma. During her hospitalization, the patient became increasingly lethargic. Workup showed severe hypercalcemia and evidence of acute kidney injury. The patient did not have evidence of bony metastatic disease on imaging studies. Further laboratory evaluation revealed an elevated PTHrP of 301 pg/mL (nl 14-27), a depressed PTH level of 3 pg/mL (nl 15-65), and a depressed 25-OH vitamin D level of 16 ng/mL (nl 30-100), consistent with humoral hypercalcemia of malignancy. The patient was treated with pamidronate, calcitonin, and intravenous fluids. She eventually required temporary hemodialysis and denosumab for refractory hypercalcemia, which improved her electrolyte abnormalities and clinical status. CONCLUSIONS Uterine malignancies of various histologies are increasingly recognized as a cause of humoral hypercalcemia. They are an important differential diagnosis in a woman with hypercalcemia and abnormal vaginal bleeding or abdominal symptoms.
Assuntos
Biomarcadores Tumorais/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Síndromes Endócrinas Paraneoplásicas/complicações , Síndromes Endócrinas Paraneoplásicas/diagnóstico , Proteína Relacionada ao Hormônio Paratireóideo/sangue , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Quimioterapia Adjuvante/métodos , Diagnóstico Diferencial , Neoplasias do Endométrio/complicações , Evolução Fatal , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/terapia , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Síndromes Endócrinas Paraneoplásicas/sangue , Síndromes Endócrinas Paraneoplásicas/terapia , Hormônio Paratireóideo/sangue , Proteína Relacionada ao Hormônio Paratireóideo/metabolismo , Radioterapia Adjuvante/métodos , Fatores de Risco , Sarcoma do Estroma Endometrial/complicações , Fatores de Tempo , Neoplasias Uterinas/sangue , Neoplasias Uterinas/terapia , Vitamina D/sangue , Vitaminas/sangueRESUMO
BACKGROUND: The surgical management of morbidly (BMI >40) and super obese (BMI >50) women with endometrial cancer is challenging. The aim of this study was to describe the short and long term outcomes of apronectomy combined with laparotomy for endometrial cancer staging and tumour debulking. METHODS: A retrospective case note review of morbidly obese patients undergoing combined apronectomy and laparotomy for suspected endometrial cancer between 2007 and 2009 was performed. Short term (operating time, estimated blood loss, complication rates, duration of hospital stay) and long term outcomes (weight profile over 24-month follow up period) were evaluated. RESULTS: Twenty-one patients were identified with a median age of 58 years and a median BMI of 49 (range 37-64). Apronectomy combined with laparotomy took 192 min on average to complete, with a mean estimated blood loss of 497 ml. There were no intra-operative complications. Postoperative complications included anaemia (14% required a blood transfusion), urinary tract infection (5%) and wound complications (wound infection in 29% and partial wound dehiscence in 5%). The median post-operative stay was 9 days. At twenty-four months, one-third of patients were heavier (mean 5 kg, range 2-8 kg) but almost two-thirds of patients were considerably lighter than they had been pre-operatively (mean 13 kg lighter, range 9-17 kg). CONCLUSIONS: Apronectomy combined with laparotomy was safe and well tolerated in this group of patients. Sustained weight loss by two-thirds of the patients over the two-year follow up period may reflect lifestyle changes instigated by individual patients following surgery. Combined apronectomy and laparotomy may provide an alternative to standard surgery for this challenging group of patients.
Assuntos
Parede Abdominal/cirurgia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/cirurgia , Laparotomia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Parede Abdominal/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Obesidade Mórbida/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To determine whether the prescribing practice of physicians with regard to estrogen replacement therapy (ERT) in symptomatic women with previous endometrial cancer is consistent with the available evidence. METHODS: A descriptive survey was conducted among physicians in Germany, using a questionnaire containing two hypothetical cases of endometrial cancer patients ('low-risk' and 'high-risk' disease) and menopausal symptoms. Physicians were asked about their prescribing practice concerning moderate to severe menopausal symptoms. RESULTS: Four hundred and twenty questionnaires were sent out, with an overall response rate of 39.8%; 45.6% in the 'low-risk' case and 75.4% in the 'high-risk' case (p < 0.0001) stated that ERT is contraindicated. Only 12.9% were willing to prescribe ERT; 81.9% preferred to prescribe non-estrogenic alternatives (44.8% phytoestrogens, 29.0% selective serotonin reuptake inhibitors). CONCLUSION: Despite the evidence that ERT does not increase the risk of recurrence of endometrial cancer, many physicians are reluctant to prescribe ERT in women suffering from moderate to severe menopausal symptoms.
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Atitude do Pessoal de Saúde , Neoplasias do Endométrio/complicações , Terapia de Reposição de Estrogênios , Menopausa , Padrões de Prática Médica/estatística & dados numéricos , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Contraindicações , Neoplasias do Endométrio/patologia , Feminino , Alemanha , Fogachos/tratamento farmacológico , Humanos , Libido , Fitoestrógenos/uso terapêutico , Medição de Risco , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Inquéritos e QuestionáriosRESUMO
BACKGROUND: To evaluate the safety and toxicity of weekly low-dose paclitaxel plus carboplatin therapy in gynecological cancer patients with venous thrombosis (VT). MATERIALS AND METHODS: Ovarian or endometrial cancer patients with VT who were scheduled to receive neoadjuvant or adjuvant chemotherapy were eligible. Each 21-day cycle of treatment consisted of carboplatin (AUC 2.0) and paclitaxel (80 mg/m2) on days 1, 8 and 15. At the end of chemotherapy, each patient's VT was checked by ultrasonography. RESULTS: Twenty-five gynecological cancer patients who received warfarin therapy with a target international normalized ratio (INR) of 1.5-2.5 were enrolled in this study. Neutropenia and peripheral neuropathy (grades 3 or 4) occurred in 26% and 4% of the patients, respectively. Chemotherapy did not cause any changes of the INR in any patient. After chemotherapy, the VT showed resolution in 19 patients (76%) and no patient developed fresh thrombosis. CONCLUSION: Weekly low-dose paclitaxel plus carboplatin therapy is a reasonable treatment option for gynecological cancer patients with VT.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/tratamento farmacológico , Trombose Venosa/complicações , Adulto , Idoso , Carboplatina/administração & dosagem , Quimioterapia Adjuvante , Relação Dose-Resposta a Droga , Esquema de Medicação , Neoplasias do Endométrio/sangue , Neoplasias do Endométrio/patologia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/patologia , Paclitaxel/administração & dosagem , Trombose Venosa/tratamento farmacológico , Varfarina/uso terapêuticoAssuntos
Antígenos de Neoplasias/imunologia , Autoanticorpos/análise , Proteínas de Ligação ao Cálcio/imunologia , Neoplasias do Endométrio/imunologia , Proteínas do Olho , Lipoproteínas , Proteínas do Tecido Nervoso , Síndromes Paraneoplásicas/imunologia , Doenças Retinianas/imunologia , Adjuvantes Imunológicos/uso terapêutico , Aminoácidos/uso terapêutico , Anticorpos Antineoplásicos/análise , Biomarcadores Tumorais/análise , Carboidratos/uso terapêutico , Terapia Combinada , Combinação de Medicamentos , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/terapia , Feminino , Glucocorticoides/uso terapêutico , Hipocalcina , Humanos , Substâncias Húmicas/uso terapêutico , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/terapia , Recoverina , Doenças Retinianas/etiologia , Doenças Retinianas/terapia , Linfócitos T/imunologia , Ácidos Urônicos/uso terapêuticoRESUMO
En el presente articulo revisamos la etiopatogenia y presentacion clinica de la endometriosis haciendo hincapie en las localizaciones atopicas, reforzando lo anterior hacemos la presentacion de 3 casos diagnosticados y tratados en el servicio de obstetricia y ginecologia del hospital San Gabriel en el periodo comprendido entre el primero de enero al 31 de julio de 1994, en pacientes de consulta externa cuyas manifestaciones clinicas estuvieron relacionadas con la via de obtencion del producto de la concepcion.