Digging into phenotype change in mismatch repair deficient endometrial carcinoma and treatment with immune checkpoint inhibition, a case report.

•False negative cases for mismatch repair determination by immunohistochemistry may occur.•The mismatch repair phenotype in endometrial carcinoma impacts on therapeutic decision making.•Retesting for mismatch repair at relapse of endometrial carcinoma should be considered.

Radical Surgery for Endometriosis: Analysis of Quality of Life and Surgical Procedure.

OBJECTIVE: The main aim of this study is to determine the improvement in quality of life in patients who have undergone radical surgery because of severe endometriosis. PATIENTS AND METHODS: This nonrandomized interventional study (quasi experimental) was carried out between January 2009 and September 2014. A total of 46 patients with diagnosis of severe endometriosis were included. Radical surgery, including hysterectomy, was performed. Acting as their own control group, the patients were asked to fill in a validated questionnaire of quality of life [Endometriosis Health Profile-5 (EHP-5)] and a visual analog scale of pain at the moment of the preoperative visit (one month prior to surgery) and six months after the surgery. RESULTS: Radical surgery for endometriosis was performed in 46 patients at our center over the period of six years. Among the patients, 73.9% of them had undergone previous surgery for endometriosis. In 82.6% of cases, a complete laparoscopic resection was carried out. Gastrointestinal tract resection was performed in 21.7%, and urinary tract resection was necessary in 8.7%. The mean age of the patients was 38.6 years. The rate of complications was 30.4%. Six months after the surgery, all items of the EHP-5 questionnaire had a lower score, which means an improvement in all aspects of quality of life related to endometriosis. The difference obtained between the scores before and after the surgery was statistically significant. The mean visual analog scale score before the surgery was 8.5, whereas it decreased to 1.4 after the surgery (P < 0.001). CONCLUSION: Performing a radical surgery is a difficult decision to make; however, it can provide optimal results in terms of improvement of quality of life and, therefore, should be considered when conservative therapy fails.

Endometriosis: alternative methods of medical treatment.

Endometriosis is an inflammatory estrogen-dependent disease defined by the presence of endometrial glands and stroma at extrauterine sites. The main purpose of endometriosis management is alleviating pain associated to the disease. This can be achieved surgically or medically, although in most women a combination of both treatments is required. Long-term medical treatment is usually needed in most women. Unfortunately, in most cases, pain symptoms recur between 6 months and 12 months once treatment is stopped. The authors conducted a literature search for English original articles, related to new medical treatments of endometriosis in humans, including articles published in PubMed, Medline, and the Cochrane Library. Keywords included "endometriosis" matched with "medical treatment", "new treatment", "GnRH antagonists", "Aromatase inhibitors", "selective progesterone receptor modulators", "anti-TNF α", and "anti-angiogenic factors". Hormonal treatments currently available are effective in the relief of pain associated to endometriosis. Among new hormonal drugs, association to aromatase inhibitors could be effective in the treatment of women who do not respond to conventional therapies. GnRH antagonists are expected to be as effective as GnRH agonists, but with easier administration (oral). There is a need to find effective treatments that do not block the ovarian function. For this purpose, antiangiogenic factors could be important components of endometriosis therapy in the future. Upcoming researches and controlled clinical trials should focus on these drugs.

Endometritis granulomatosa: hallazgo histológico en procesos de diferente etiología / Granulomatous endometritis: an histological finding in processes with distinct etiology

La endometritis granulomatosa es una inflamación crónica que se define histológicamente por la presencia de granulomas en un endometrio con un infiltrado linfoplasmocitario. Su hallazgo en una biopsia o pieza de endometrio, debe hacer pensar en tuberculosis (TBC) genital. Esta TBC era una infección rara en la mujer, las localizaciones endometriales, tubárica y ovárica casi siempre secundaria de otra localización. Más rara en mujeres posmenopáusicas, se cree debida a la escasez de los cultivos del endometrio atrófico. El diagnóstico definitivo de TBC genital es el cultivo del bacilo de Koch. La presunción se puede hacer si aparecen granulomas en la biopsia y Mantoux positivo. Su tratamiento es médico y con buen pronóstico. Presentamos 5 casos clínicos en posmenopáusicas, diagnosticados entre junio de 2001 y abril de 2003

Granulomatous endometritis is a chronic inflammation histologically characterized by the presence of granulomas in an endometrium with lymphoplasmacytic infiltrate. A finding of granulomatous endometritis in the biopsy or endometrial specimen should lead to suspicion of genital tuberculosis. This infection used to be rare in women. Tubal, endometrial and ovarian localizations are almost always secondary to a focus in another location. This entity is less frequent in postmenopausal women, probably because the atrophic endometrium provides a poor environment for growth of the tuberculosis bacillus. The definitive diagnosis of genital tuberculosis is culture of the Koch bacillus. A presumptive diagnosis can be made on the basis of granulomas in biopsy and a positive Mantoux test. Treatment is medical and the prognosis is good. We present five cases of genital tuberculosis in postmenopausal women, diagnosed between June 2001 and April 2003