Incidence of endometrial carcinoma in patients with endometrial intraepithelial neoplasia versus atypical endometrial polyp.

ObjectiveOur study's primary aim was to compare the incidence of endometrial carcinoma in patients with a presurgical diagnosis of endometrial intraepithelial neoplasia confined to the endometrium (EIN-E) versus endometrial intraepithelial neoplasia confined to a polyp (EIN-P). Our secondary aim was to examine the difference in pathological features, prognostic risk groups and sentinel lymph node involvement between the two groups. METHODS: We conducted a retrospective cohort study between January 2014 and December 2020 in a tertiary university-affiliated medical center. The study considered the characteristics of women who underwent hysterectomy with sentinel lymph node dissection for endometrial intraepithelial neoplasia (EIN). We compared EIN-E diagnosed by endometrial sampling via dilatation curettage or hysteroscopic curettage vs EIN-P. A multivariate logistic regression analysis was used to assess risk factors for endometrial cancer. RESULTS: Eighty-eight women were included in the study, of those, 50 were women with EIN-P (EIN-P group) and 38 were women with EIN following an endometrial biopsy (EIN-E group).The median age was 57.5 years (range; 52-68) in the EIN-P group as compared with 63 years (range; 53-71) in the EIN-E group (p=0.47). Eighty-nine percent of the women in the EIN-E group presented with abnormal uterine bleeding whereas 46% of the women in the EIN-P group were asymptomatic (p=0.001). Pathology results following hysterectomy revealed concurrent endometrial carcinoma in 26% of women in the EIN-P group compared with 47% of women in the EIN-E group (p=0.038). Multivariate analysis showed that endometrial cancer was significantly less common in the EIN-P group (overall response (OR)=0.3 95% confidence interval (CI)=0.1-0.9, p=0.03). Eighty-four percent of cancers were grade one in the EIN-P group compared with 50% in the EIN-E group (p=0.048). CONCLUSIONS: Concurrent endometrial cancer is less frequent with EIN-P than with EIN-E. The high incidence of endometrial carcinoma in both groups supports the current advice to perform hysterectomy for post-menopausal women. Our data does not support performing sentinel lymph node dissection for EIN-P that was completely resected. The benefit of sentinel lymph node dissection for women with pre-operative EIN-E is yet to be determined.

Illness Perception, Perceived Social Support and Quality of Life in Patients with Pemphigus Vulgaris: What Should Dermatologists Know?

Data regarding the impact of psychological factors in patients with pemphigus is sparse. This study evaluated the correlation of demographic, clinical, and psychological parameters with quality of life in 58 patients with pemphigus. Illness perception showed a realistic view, with the highest scores for cyclical course (3.35 ± 0.09) and treatment control (3.08 ± 0.06). Mean scores for perceived social support were relatively high from family and significant others (5.89 ± 0.18 and 5.66 ± 0.23, accordingly), and relatively low from friends (4.55 ± 0.24). There were no correlations be-tween demographic, clinical parameters, perceived social support, and Dermatology Life Quality Index. Beliefs in cyclical course, emotional influence, psychological cause, and treatment control correlated significantly with quality of life. Stronger beliefs in self-control, chronicity, and accidental cause predicted higher quality of life, while stronger beliefs in cyclical course, psychological cause, and risk factors predicted lower quality of life. In order to enhance QoL, dermatologists should deliver the message to the patients that pemphigus is a chronic disease rather than cyclical and unexpected, and stress the patients' role in controlling it.