Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos / MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases

Introducción. El adenocarcinoma endometrioide del endometrio (AEE) es un tumor generalmente de buen pronóstico. Recientemente se ha descrito el patrón MELF (del inglés microcystic, elongated, and fragmented) de infiltración miometrial que se asocia a invasión linfovascular y a metástasis ganglionares. Se revisan 70 casos de AEE para establecer la presencia de MELF y correlacionar su presencia con otros factores pronósticos. Material y métodos. Se han revisado las histerectomías practicadas por AEE en un periodo de 5 años en busca del patrón MELF de infiltración miometrial. Su presencia se ha correlacionado con otras variables como el grado histológico, el nivel de infiltración miometrial, las metástasis ganglionares pélvicas y/o paraaórticas, los implantes peritoneales y la evolución. Resultados. En 17 (24%) casos se observó el patrón MELF. Aunque era más frecuente en tumores de bajo grado, estaba presente en 4 casos de grado3. En 9 (53%) casos la infiltración miometrial era profunda. Cinco casos mostraron metástasis ganglionares pélvicas y 3 aórticas. Una de las pacientes falleció, otra mostró recidiva vulvar y otra, metástasis pulmonares. Conclusión. El patrón MELF puede encontrarse en adenocarcinomas de alto grado y se correlaciona con otros hallazgos morfológicos de mal pronóstico como la infiltración miometrial profunda y la afectación de ganglios linfáticos pélvicos. Su presencia no parece influir en la evolución (AU)

Introduction. Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. Material and methods. Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. Results. In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. Conclusion. MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival (AU)

[MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases]. / Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos.

INTRODUCTION: Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. MATERIAL AND METHODS: Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. RESULTS: In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. CONCLUSION: MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival.