Reproductive preservation for treatment of stage IA endometrial cancer in a young woman: hysteroscopic resection.

Uterine cancer is the most common type of gynecological neoplasm. Conventionally, the standard treatment for early-stage endometrial cancer is surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment. However, this leads to definitive sterilization in reproductive-age women. We report a rare case of a young woman with endometrioid endometrial adenocarcinoma successfully treated with reproductive preservation therapy in order to preserve her uterus. Pretreatment evaluation including tumor grade, depth of myometrial invasion, tumor size, and hormone-receptor status indicated a favorable prognosis. The patient was treated with hysteroscopic resection of the endometrial cancer, of the endometrium near lesion, and of the myometrium under lesion plus hormone therapy. Thirty months after operative hysteroscopy, the patient has given birth by cesarean section at 39 weeks of gestation to a male child of 3.2 kg and is now completely free of disease. We therefore conclude that there may be a role for effective treatment of endometrioid carcinomas with preservation of reproductive capacity, even if our preliminary result should be validated by a longer follow-up.

Diverse domains of THREAD/DIAP1 are required to inhibit apoptosis induced by REAPER and HID in Drosophila.

Significant amounts of apoptosis take place during Drosophila development. The proapoptotic genes reaper (rpr), grim, and head involution defective (hid) are required for virtually all embryonic apoptosis. The proteins encoded by these genes share a short region of homology at their amino termini. The Drosophila IAP homolog THREAD/DIAP1 (TH/DIAP1), encoded by the thread (th) gene, negatively regulates apoptosis during development. It has been proposed that RPR, GRIM, and HID induce apoptosis by binding and inactivating TH/DIAP1. The region of homology between the three proapoptotic proteins has been proposed to bind to the conserved BIR2 domain of TH/DIAP1. Here, we present an analysis of loss-of-function and gain-of-function alleles of th, which indicates that additional domains of TH/DIAP1 are necessary for its ability to inhibit death induced by RPR, GRIM, and HID. In addition, that analysis of loss-of-function mutations demonstrates that th is necessary to block apoptosis very early in embryonic development. This may reflect a requirement to block maternally provided RPR and HID, or it may indicate another function of the TH/DIAP1 protein.

Analysis of the prognostic factors of endometrial carcinoma. A retrospective study of 144 patients.

One hundred and fourty-four patients with endometrial carcinoma who had undergone surgery as primary treatment were retrospectively studied from January 1980 to September 1990 for the purpose of correlating the survival rate with known or presumed prognostic factors. The patients averaged 63.1 years of age (range 32-88 years); 106 were classified as having Stage I disease, 10 Stage II, 16 Stage III and 2 Stage IV. Histology confirmed pure adenocarcinomas in 77%, adenosquamous carcinoma in 3.5%, clear cell carcinomas in 2.5% and serous papillary in 17%. Surgical treatment consisted of extrafasial hysterectomy with pelvic lymphadenectomy up to the aortic bifurcation in 69 patients (48%), Wertheim's hysterectomy in 10 (7%), simple or vaginal hysterectomy in the remaining 65 patients (45%). Five-year survival rate in all the case series was 74.3% whereas for patients with Stage I carcinoma it was 79.9%. Different prognostic factors were correlated in a multivariate analysis with the outcome of the disease. Myometrial invasion presented a mortality ODDS RATIO (OR) of 3.18 (95% CI 1.25-8.06), for histologic grade OR 4.33 (95% CI 1.74-10.74) and for stage (2-3 vs 1) OR of 2.73 (95% CI 1.09-6.83) demonstrating a high significance, whereas pregnancy, excess body weight, age and histotype were not considered as relevant factors for prognosis. For age we found mortality OR 2.54 (95% CI 0.75-8.59) for women greater than 55y.

Outpatient hysteroscopy in the diagnosis of neoplastic and preneoplastic lesions of the endometrium.

The results of a study performed on a case series of 250 women treated in our out-patient department for abnormal uterine bleeding are reported. Half of these patients (125) were 45 years of age or over and therefore at risk of adenocarcinoma or endometrial hyperplasia while the other half were under 45 years of age. All the patients were submitted to hysteroscopic examination as out-patients (no important side-effects occurred), together with cytologic and/or histological examination of the endometrium. This procedure revealed no disease in 59 cases (23.6%) and the presence of one or more benign conditions in 188 patients (75.2%) (inflammation, polyposis, myomatosis, endocervical or uterine adenomiosis, endometrial hyperplasias, dysfunctional patterns, intrauterine foreign bodies). Endometrial adenocarcinoma was diagnosed in 3 patients (1.2%). The discovery of 3 cases (1.2%) of adenocarcinomas and 62 cases (24.8%) of endometrial hyperplasias (58 simple glandular hyperplasia, 3 cystic-glandular hyperplasias and 1 polypoid hyperplasia) emphasive the reliability of hysteroscopy in the diagnosis of endometrial neoplasias and their precursors.

Endometrial carcinoma. Clinical and pathological correlations with survival and surgical treatment.

From 1978 to 1985 a total of 151 patients were treated for endometrial carcinoma. Of these, 25 patients underwent extrafascial abdominal hysterectomy and pelvic lymphadenectomy, 25 were treated according to Wertheim procedure and pelvic lymphadenectomy and 32 underwent intrafascial abdominal hysterectomy; 62 women underwent vaginal surgery, 7 of whom according to Shauta. A correlation between the degree of myometrial invasion, histological grading, hystological type and stage of the tumor showed no statistically significant difference. The 5-year actuarial survival rate was found to be 76.5%. A comparison between survival and age of patients showed a significant difference in the survival (p less than .01) of the group less than 55 years as compared to the older age group. As far as the surgical treatment instituted is concerned, no statistical difference in survival was found between patients operated vaginally and those operated abdominally (p greater than .05). The site of recurrences were then analyzed in 22 patients, 50% were local recurrences, and the remaining distant metastases. Of these only one patient was cured and is still free of disease 5 years after recurrence. The criteria used to select patients for vaginal surgery are also indicated.

[Vesicular mole. Epidemiological considerations]. / La mola vescicolare. Considerazioni epidemiologiche.

A full and detailed review of trophoblast disease at Rome University's Obstetrics and Gynecology Clinic led to a re-examination of some of the classical epidemiological factors in this pathology: age, parity and blood group. The precise incidence of this condition is difficult to establish from hospital series alone. In spite of numerous clinical studies, its aetiology has not yet been fully clarified. The various environmental socio-economic, racial, genetic and other factors, which are sometimes quoted, are too heterogeneous and contradictory to provide significant results. Of evaluated risk parameters, only pregnancy at an advanced age appears to carry increased risk. For these reasons, and given the low incidence of trophoblast pathology, it is recommended that a register of the disease be instituted, at least at Regional level.