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1.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 756-762, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752459

RESUMO

Objective: To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. Methods: A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Results: Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of ß-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ(2)=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ(2)=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57(KIP2) immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ(2)=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01). Conclusions: The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57(K)IP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.


Assuntos
Mola Hidatiforme/diagnóstico , Hemorragia Uterina/etiologia , Neoplasias Uterinas/diagnóstico , China/epidemiologia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Idade Gestacional , Humanos , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/patologia , Mola Hidatiforme/cirurgia , Incidência , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Hemorragia Uterina/epidemiologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Curetagem a Vácuo
2.
Pan Afr Med J ; 33: 211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693718

RESUMO

Introduction: Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB). Methods: This cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist. Results: Mean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively. Conclusion: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.


Assuntos
Histeroscopia/métodos , Solução Salina/administração & dosagem , Doenças Uterinas/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
5.
Bull Cancer ; 106(9): 747-758, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31182221

RESUMO

INTRODUCTION: Delays for consultation of more than six months exist for uterine cancer. Delays in diagnosis of more than five years exist for vulvar cancer. The peak incidence of these neoplasms appear after the age of 65 years. Patient's symptoms are characteristically swelling, vaginal bleeding or itching. This study aims to understand what is happening during this period for women over 65 years old. It also tries to identify triggers during the help-seeking period. METHODS: Qualitative studies using semi-structured interviews with dual analyses (semio-pragmatic and psychodynamic) have been conducted on a population of older (65+) gynaecologic cancer patients, recruited from a French oncology centre. RESULTS: Twelve patients were interviewed. Patients' courses of action were determined by the characteristics of their symptoms, their feelings and their emotions. Representations, subjective beliefs and past experiences were employed to make sense of their symptoms. The patient's friend and family circle had an important role in incentivizing the patient to seek consultation. Multiple factors affected the path towards consulting the doctor. The initial medical contact included several challenges. The patient would consult a doctor earlier if he had more information about his illness and if his relationship with the doctor was better. CONCLUSION: Our findings are similar to those of other cancers. The peculiarity for this population appears to be the different representations of age-related changes in the reproductive system, and the taboo associated with this issue when facing friends and family.


Assuntos
Diagnóstico Tardio/psicologia , Comportamento de Busca de Ajuda , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias Uterinas/diagnóstico , Neoplasias Vaginais/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cultura , Mecanismos de Defesa , Família , Feminino , Amigos , Humanos , Pesquisa Qualitativa , Avaliação de Sintomas/psicologia , Tabu , Fatores de Tempo , Neoplasias Uterinas/psicologia , Neoplasias Vaginais/psicologia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/psicologia
6.
J Ayub Med Coll Abbottabad ; 31(2): 192-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094115

RESUMO

BACKGROUND: Abnormal uterine bleeding is a common problem encountered by the gynaecologists, leiomyoma being one of the most common causes. An accurate knowledge of the different variants and secondary changes occurring in leiomyoma is essential as some of these may mimic malignancy clinically, radiologically and histologically. Some important examples being atypical, cellular and mitotically active leiomyoma. Similarly, hydropic and myxoid change can be misdiagnosed as malignancy. While dealing with these variants and changes, leiomyosarcoma although a rare tumour has to be excluded because of the difference in management. Hence a comprehensive knowledge of all the variants is mandatory to avoid misdiagnosis. METHODS: This study was carried out at the Pathology Department of Ayub Medical College Abbottabad where 964 cases of leiomyoma of the female genital tract were studied. These cases were received during the period January 2013 to December 2017. RESULTS: The most common variant of leiomyoma was cellular leiomyoma while hyaline degeneration was the most common secondary change identified. CONCLUSIONS: Accurate knowledge of these variants and degenerative changes in leiomyomas are mandatory to prevent misdiagnosis and over treatment along with undue stress to the patient. Secondly it is important to identify variants which require follow-up.


Assuntos
Leiomioma , Neoplasias Uterinas , Estudos de Coortes , Erros de Diagnóstico , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
7.
Pathology ; 51(4): 369-374, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31040050

RESUMO

Neuroendocrine (NE) tumours are uncommon in the gynecological tract. In addition to their histological features, what defines NE carcinoma is the expression of markers such as chromogranin, synaptophysin and neural cell adhesion molecule (CD56) by immunohistochemistry (IHC). Although limited data have demonstrated that some high-grade uterine tumours may focally express these markers, the incidence of such labelling in endometrial carcinomas in general is not well known. The goal of this study was to characterise the expression of NE markers in a cohort of endometrial carcinomas. We searched our institutional surgical pathology database for hysterectomy specimens containing endometrial carcinomas. Cases demonstrating classic morphological features of NE carcinomas were excluded. IHC for synaptophysin, chromogranin and CD56 was performed in whole-tissue sections of formalin-fixed, paraffin-embedded (FFPE) tumours. Thyroid transcription factor 1 (TTF-1) was also included, given its positivity in a subset of small cell carcinomas. Marker expression was graded based on percentage of positive tumour cells (0, not detected; 1, 1-25%; 2, 25-50%; 3, >50%). Chi-square was used for statistical analysis and significance was set at p<0.05. In total, 71 carcinomas of endometrioid (EMCA; 26 cases), serous (20), clear cell (12), undifferentiated (2) and dedifferentiated (1) histologies were obtained, as well as 10 carcinosarcomas. The majority expressed one or more NE markers (47/71; 66%), with most positive cases showing focal (1+) staining of a single marker. Significantly more tumours stained positive for CD56 than synaptophysin (58% vs 7%, p<0.01). Clear cell carcinomas were the least likely to express any NE marker (4/12; 33%), whereas serous carcinomas (80%) and carcinosarcomas (100%) were the most likely. CD56 labelling was seen in 9/10 carcinosarcomas, in both epithelial (7/9) and mesenchymal (5/9) elements. A slightly greater proportion of non-endometrioid histological types stained positive for TTF-1 compared with endometrioid type (31% vs 12%, p=0.06). Immunohistochemical expression of NE markers is relatively common in endometrial carcinomas that lack classic NE histology. The most frequent pattern encountered in our study was focal (1-25%) labelling of a single marker. Synaptophysin appeared reliably negative, while CD56 was commonly present in non-NE histology. Clear cell carcinomas tend to be consistently negative, whereas carcinosarcomas and serous carcinomas frequently express at least one marker. Awareness of these data may help to avoid misdiagnosis of a neuroendocrine carcinoma in limited samples.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Neuroendócrino/metabolismo , Proteínas de Ligação a DNA/metabolismo , Neoplasias do Endométrio/metabolismo , Fatores de Transcrição/metabolismo , Neoplasias Uterinas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno CD56/metabolismo , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/patologia , Cromograninas/metabolismo , Estudos de Coortes , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/patologia , Endométrio/metabolismo , Endométrio/patologia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Sinaptofisina/metabolismo , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
9.
Surg Pathol Clin ; 12(2): 363-396, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097109

RESUMO

The spectrum of mesenchymal neoplasia in the uterus has expanded in recent years. First, the identification of prevalent, recurrent molecular alterations has led to a more biologically and clinically congruent classification of endometrial stromal tumors. Likewise, the diagnostic criteria of several rare and miscellaneous tumor types have been refined in recent case series (Perivascular Epithelioid Cell tumor, inflammatory myofibroblastic tumor). Pure mesenchymal tumors are still broadly classified based on morphology according to the tumor cell phenotype. Smooth muscle tumors predominate in frequency, followed by tumors of endometrial stromal derivation; the latter are covered in depth in this article with an emphasis on defining molecular alterations and their morphologic and clinical correlates. The remaining entities comprise a miscellaneous group in which cell derivation does not have a normal counterpart in the uterus (eg, rhabdomyosarcoma) or is obscure (eg, undifferentiated uterine sarcoma). This article discusses their clinical relevance, recent insights into their molecular biology, and the most important differential diagnoses. Regarding the latter, immunohistochemistry and (increasingly) molecular diagnostics play a role in the diagnostic workup. We conclude with a few considerations on intraoperative consultation and macroscopic examination, as well as pathologic staging and grading of uterine sarcomas as per the most recent American Joint Cancer Commission and the Fédération Internationale de Gynécologie et d'Obstétrique staging systems.


Assuntos
Neoplasias Uterinas/diagnóstico , Adenossarcoma/diagnóstico , Adenossarcoma/genética , Adenossarcoma/patologia , Biomarcadores Tumorais/metabolismo , Diagnóstico Diferencial , Feminino , Predisposição Genética para Doença , Humanos , Mutação , Estadiamento de Neoplasias , Sarcoma do Estroma Endometrial/diagnóstico , Sarcoma do Estroma Endometrial/genética , Sarcoma do Estroma Endometrial/patologia , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
10.
Surg Pathol Clin ; 12(2): 397-455, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097110

RESUMO

Smooth muscle tumors are the most common mesenchymal tumors of the female genital tract. However, awareness of tumor variants and unconventional growth patterns is critical for appropriate classification and patient management. For example, recognition of fumarate hydratase-deficient leiomyomas allows pathologists to alert providers to the potential for hereditary leiomyomatosis and renal cell carcinoma. Furthermore, myxoid and epithelioid smooth muscle tumors have different thresholds for malignancy than spindled tumors and should be classified by criteria specific to these variants. This article provides an overview of smooth muscle tumors of each major organ of the gynecologic tract and discusses diagnostic challenges.


Assuntos
Neoplasias dos Genitais Femininos/patologia , Tumor de Músculo Liso/patologia , Diagnóstico Diferencial , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Humanos , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Prognóstico , Tumor de Músculo Liso/diagnóstico , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
11.
Medicine (Baltimore) ; 98(21): e15741, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124955

RESUMO

RATIONALE: The purpose of this case report was to raise awareness regarding endometriosis on the surface of the uterus mimicking malignant tumor and thus manage it accurately. PATIENT CONCERNS: A 40-year-old Asian woman with a 2-year history of lower abdomen pain was admitted to our department with elevated serum cancer antigen (CA) 125 level, weight loss, and pelvic mass from 20 days previously. Magnetic resonance imaging revealed a high volume of effusion in the pelvic cavity, an irregular occupying lesion on the surface of the fundus of the uterus, and multiple nodules. DIAGNOSES: Postoperative pathology confirmed the diagnosis of endometriosis. INTERVENTIONS: Diagnostic laparoscopy revealed large crunchy tissue and soft nodules on the surface of the posterior wall of the uterus and approximately 2000 mL of bloody ascites. The result of the frozen-section analysis of the tissue on the surface of the uterus indicated endometriosis. The surgical procedure was converted to laparotomy due to bleeding after biopsy. OUTCOMES: The patient's recovery was uneventful. Three months after the operation, the patient had a good general state without periodic pain, and the CA125 level returned to normal. LESSONS: A large mass occurring in the pelvic cavity could be indicative of endometriosis, especially if accompanied by a history of period pain. Preoperative positron emission tomography may increase the accuracy of the diagnosis.


Assuntos
Endometriose/diagnóstico , Endometriose/patologia , Adulto , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Dor Pélvica/etiologia , Neoplasias Uterinas/diagnóstico , Perda de Peso
12.
Presse Med ; 48(4): 440-446, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31036388

RESUMO

The most common indication for selective uterine artery angiography is embolisation of symptomatic uterine fibroids (leiomyomas or leiomyomata). It is a safe and effective treatment with worldwide acceptance and may be considered a first-line therapy for women who are finished with childbearing and interested in a minimally invasive uterine-sparing therapy, with only few relative and absolute contraindications remaining. Women interested in pregnancy may be offered embolisation, but only after careful counselling and consideration of other possibilities and patient's reasonable expectations, needs and preferences.


Assuntos
Leiomioma/terapia , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Cateterismo , Contraindicações de Procedimentos , Feminino , Humanos , Leiomioma/diagnóstico , Embolização da Artéria Uterina/efeitos adversos , Embolização da Artéria Uterina/métodos , Neoplasias Uterinas/diagnóstico
13.
Arch Esp Urol ; 72(4): 435-438, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31070141

RESUMO

OBJECTIVE: Persistent Müllerian Duct Syndrome (PMDS), one of the causes of male pseudohermaphroditism, is a rare syndrome characterized by the presence of internal female genitalia (uterus, fallopian, tubes, cervix and upper vagina) in otherwise phenotypically and normally virilized men. METHODS: We present the 4th documented case of uterine malignancy in a 45-year-old man with PMDS presenting with lower abdominal protuberance and hematuria. RESULTS: Although testicular malignancies are common in undescended testis associated with PMDS, very few cases of müllerian duct malignancies have been reported. CONCLUSIONS: Persistent mullerian duct syndrome can be associated with aggressive non-testicular malignancies, especially uterine cancer, in normally virilized males.


Assuntos
Transtorno 46,XY do Desenvolvimento Sexual , Transtornos do Desenvolvimento Sexual , Neoplasias Uterinas , Transtorno 46,XY do Desenvolvimento Sexual/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico
14.
Chirurgia (Bucur) ; 114(2): 243-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060657

RESUMO

Introduction: Neuroendocrine tumors of the gastro-entero-pancreatic system have a variety of components, clinical manifestations and prognostic indices according to their anatomical site. Therefore, their diagnostic and management strategies differ a great deal. Prognosis concerning NETs can be poor due to the degree of differentiation, early metastasizing and the high degree of invasiveness. Material and Methods: For the present study, the patient files were evaluated and the parameters of interest were followed. Results: Over the course of 6 years there were 37 patients diagnosed with and treated for NETs, regardless of primary tumor site. There were 9 patients with NETs of the primite mid- and hindgut thusly: 5 cases with colorectal NETs and 4 cases of small bowel NETs. 6 patients benefited from radical surgical treatment, 2 cases with palliative procedures and only one patient with tumor biopsy. The tumors were evaluated according to the 2010 WHO classification based on the number of mitoses and the Ki67 proliferation index. Adjuvant treatment was adapted according to staging and histopathological parameters. Conclusions: Despite recent progress in managing NETs, there are still many controversial aspects regarding the management of these cases, mainly about timing the right sequence of therapy.


Assuntos
Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/terapia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/terapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Neoplasias do Sistema Digestório/tratamento farmacológico , Neoplasias do Sistema Digestório/cirurgia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/cirurgia , Prognóstico , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapia , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia
15.
Int J Gynecol Pathol ; 38(3): 205-215, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30958427

RESUMO

Uterine carcinosarcomas are rare aggressive biphasic neoplasms. Because of its rarity, limited data are available on potential prognostic parameters. While several studies support that carcinomatous components predict outcomes, others do not. In this study, we evaluated the clinical and histopathologic features of 196 uterine carcinosarcomas to identify potential prognostic factors. Patients' ages ranged from 34 to 95 yr (median, 68 yr). Seventy-three (38%) patients experienced tumor recurrence during follow-up. Tumors ≥5 cm, outer half myometrial invasion, lymphovascular invasion, lymph node metastasis, advanced stage (International Federation of Gynecology and Obstetrics stages III-IV), sarcomatous component on recurrence, sarcoma dominance, and positive cytology were significantly associated with shorter disease-free interval (P<0.05). In addition, serous histology and rhabdomyoblastic differentiation was significantly associated with worse 3-yr overall survival. Our data supports that both carcinomatous and sarcomatous components play a role in tumor progression and survival of uterine carcinosarcoma patients, suggesting their equal importance in guiding management decisions.


Assuntos
Carcinossarcoma/patologia , Sarcoma/patologia , Neoplasias Uterinas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/diagnóstico , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Pessoa de Meia-Idade , Miométrio/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Útero/patologia
16.
Fertil Steril ; 111(4): 629-640, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30929720

RESUMO

Endometrial polyps, adenomyosis, and leiomyomas are commonly encountered abnormalities frequently found in both fertile women and those with infertility. The clinician is frequently challenged to determine which of these entities, when found, is likely to impair fertility, and which are "innocent bystanders" unrelated to the problem at hand. Although removing an endometrial polyp may be seen as a relatively benign and safe intervention, myomectomy, and in particular adenomyomectomy, can be substantive surgical procedures, associated with their own potential for disrupting fertility. One of the mechanisms thought to be involved when these entities are contributing to infertility is an adverse impact on endometrial receptivity. Indeed polyps, adenomyosis, and leiomyomas have all been associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development. This review is designed to examine the relationship of these common entities to endometrial receptivity and to identify evidence gaps that should be considered when strategizing research initiatives. It is apparent that we have the tools necessary to fill these gaps, but it will be necessary to approach the issue in a strategic and coordinated fashion. It is likely that we will have to recognize the limitations of imaging alone and look to the evidence-based addition of molecular analysis to provide the individualized phenotyping of disease necessary for patient-specific treatment decisions.


Assuntos
Adenomiose/fisiopatologia , Implantação do Embrião/fisiologia , Endométrio/fisiologia , Leiomioma/fisiopatologia , Pólipos/fisiopatologia , Doenças Uterinas/fisiopatologia , Neoplasias Uterinas/fisiopatologia , Adenomiose/complicações , Adenomiose/diagnóstico , Adenomiose/terapia , Endométrio/patologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Infertilidade Feminina/terapia , Leiomioma/complicações , Leiomioma/diagnóstico , Leiomioma/terapia , Pólipos/complicações , Pólipos/diagnóstico , Pólipos/terapia , Gravidez , Doenças Uterinas/complicações , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia
17.
Malays J Pathol ; 41(1): 15-24, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31025633

RESUMO

INTRODUCTION: In the event of encountering hydropic villi in products of conception specimens, pathologists will have to distinguish complete and partial hydatidiform mole (CHM & PHM) from hydropic abortion (HA). The histological diagnostic criteria are subjective and demonstrate considerable inter-observer variability. MATERIALS AND METHODS: This study evaluated the inter-observer variability in diagnosis of CHM, PHM and HA according to defined histologic criteria. Ninety abortus conception specimens were reviewed. Representative haematoxylin and eosin-stained slides were assigned independently to two pathologists who were asked to make a diagnosis of CHM, PHM or HA, and provide a report of the identified diagnostic histological criteria. Kappa value was calculated for the inter-observer agreement. RESULTS: There was a total of 36.7% disagreement between two pathologists (K = 0.403, Strength of Agreement = moderate), of which 24.4% and 12.2%, were differentiating PHM from CHM and PHM from HA, respectively. Among defined diagnostic histological criteria, the highest rate of agreement was observed in the identification of cistern formation and hydropic changes (K = 0.746 and 0.686 respectively, Strength of Agreement = substantial). CONCLUSION: There was moderate to substantial agreement rate between two pathologists in identification of two essential histologic criteria for diagnosis of molar pregnancies i.e. "hydropic change" and "trophoblastic proliferation".


Assuntos
Mola Hidatiforme/diagnóstico , Mola Hidatiforme/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/patologia , Diagnóstico Diferencial , Feminino , Humanos , Variações Dependentes do Observador , Gravidez
18.
Eur J Obstet Gynecol Reprod Biol ; 236: 143-147, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30925450

RESUMO

OBJECTIVE: Since there are no approved reliable biomarkers for detecting preoperatively uterine sarcoma, lactate dehydrogenase (LDH) isoenzymes are usually required. We first evaluated the role of LDH isoenzymes in detecting uterine sarcoma risk, and then we tried to introduce a model to easily interpret the biochemical results. METHODS: We retrospectively retrieved records of patients who underwent surgical treatment for uterine masses from 2004 to 2016, and we compared data of 2211 patients with a definitive surgical diagnosis of uterine fibroids and 43 with uterine sarcomas. Quantitative relationships between serum LDH isoenzymes levels, as different single markers or in multiple assays, and the final diagnosis were investigated. RESULTS: LDH isoenzymes levels significantly differed between patients with benign uterine masses or sarcomas. LDH3 isoenzyme exhibited better predictive performances than the other four isoforms. Combining LDH3 with LDH1 isoenzymes into an inverse algebraic relationship, named Uterine mass Magna Graecia (U.M.G.) risk index, the accuracy of markers in discriminating between benign and suspicious malignant uterine masses was significantly enhanced, sensitivity at 100% and specificity at 99.6%, with nine false positive over 2211 benignant cases and no false negative over 43 sarcomas. CONCLUSIONS: This retrospective analysis suggests to consider U.M.G. risk index as an inexpensive and accurate prognostic index that, once validated in a prospective study, may help clinicians in discriminating between benignant and suspicious malignant uterine masses.


Assuntos
Biomarcadores Tumorais/sangue , Isoenzimas/sangue , L-Lactato Desidrogenase/sangue , Leiomioma/diagnóstico , Sarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Feminino , Humanos , Leiomioma/sangue , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sarcoma/sangue , Neoplasias Uterinas/sangue
19.
Clin Imaging ; 56: 28-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30851496

RESUMO

OBJECTIVES: Lymphadenectomy is not recommended for low risk stage I endometrial carcinoma (EC) patients. This study was to investigate the predictive value of apparent diffusion coefficient (ADC) values in predicting patients with low risk EC, and to identify an optimum ADC measurement for preoperative assessment. MATERIALS AND METHODS: Eighty-one patients with stage I EC who underwent diffusion-weighted imaging (DWI) at 1.5T were included and divided into low group and intermediate-high risk group based on the ESMO-ESGO-ESTRO classification. Clinical indexes, conventional MRI parameters, minimum ADC values (minADC), mean ADC values (meanADC) and relative ADC values (rADC) were compared between those two groups. rADC was calculated using the equation ADC (cancer)/ADC (reference) with the obturator internus muscle as reference. The optimal ADC measurement and cut-off ADC value for low risk EC were calculated using the receiver operating characteristic (ROC) curve. RESULTS: The low risk group had significantly higher meanADC, minADC, and rADC values than did the intermediate-high risk group (1.095 vs. 0.902 × 10-3 mm2/s, 0.755 vs. 0.657 × 10-3 mm2/s, 0.754 vs. 0.603, respectively). In assessments of low risk EC patients, the area under the curve (AUC) values for meanADC, minADC, and rADC were 0.840 (95%CI, 0.749,0.931), 0.681 (95% CI: 0.561,0.800), and 0.876(95% CI: 0.798,0.954), respectively. The optimal cut-off rADC value for prediction was 0.669, the maximum Youden index, sensitivity, specificity, and accuracy values were 0.683, 81.8%, 86.5%, and 84.0%, respectively. CONCLUSIONS: rADC is superior to minADC and meanADC for predicting patients with low risk EC, and could potentially aid to the surgical management of these patients in avoiding unnecessary lymphadenectomy.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias do Endométrio/patologia , Endométrio/patologia , Neoplasias Uterinas/patologia , Idoso , Área Sob a Curva , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/cirurgia , Endométrio/diagnóstico por imagem , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
20.
Int J Mol Sci ; 20(5)2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845657

RESUMO

Uterine leiomyomas (LMs), currently the most common gynecological complaint around the world, are a serious medical, social and economic problem. Accurate diagnosis is the necessary prerequisite of the diagnostic-therapeutic process. Statistically, mistakes may occur more often in case of disease entities with high prevalence rates. Histopathology, based on increasingly advanced immunohistochemistry methods, is routinely used in the diagnosis of neoplastic diseases. Markers of the highest sensitivity and specificity profiles are used in the process. As far as LMs are concerned, the crux of the matter is to identify patients with seemingly benign lesions which turn out to be suspicious (e.g., atypical LM) or malignant (e.g., leiomyosarcoma (LMS)), which is not uncommon. In this study, we present the current state of knowledge about the use of immunohistochemical markers in the differential diagnosis of LM, atypical LM, smooth muscle tumors of uncertain malignant potential (STUMP), and LMS, as well as their clinical predictive value.


Assuntos
Biomarcadores Tumorais/metabolismo , Leiomioma/diagnóstico , Leiomiossarcoma/diagnóstico , Miométrio/patologia , Neoplasias Uterinas/diagnóstico , Biomarcadores , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Leiomioma/metabolismo , Leiomiossarcoma/metabolismo , Miométrio/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Neoplasias Uterinas/metabolismo
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