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1.
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
2.
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
3.
Medicine (Baltimore) ; 98(41): e17565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593140

RESUMO

RATIONALE: Invasive moles occur in the fertile period, with about 95% occurring after previous mole removal and the remaining 5% occurring after several other pregnancies. PATIENT CONCERNS: A 27-year-old patient developed a rare invasive mole two months after a missed abortion. DIAGNOSES: A transvaginal ultrasound scan revealed a 3.6 × 2.9 × 2.4 cm sized lesion with cystic vascular areas within it, within the myometrium of the right fundal posterior region of the uterus. There was no metastasis to other organs. INTERVENTIONS: After administration of methotrexate, the level of beta-human chorionic gonadotropin (ß-hCG) was elevated and liver enzymes were also markedly elevated. She wanted to retain fertility for future pregnancies. After laparoscopic removal of the myometrial invasive mole, the incision site was sutured with a 3-0 V-Loc. OUTCOMES: One year later, a natural pregnancy occurred and a cesarean section was performed at 36 weeks. LESSONS: This is the first reported case of its type. Our case demonstrated that pelviscopic removal of an invasive mole is possible if there are no other metastases, and that future pregnancy and childbirth are still feasible in women of reproductive age.


Assuntos
Mola Hidatiforme Invasiva/cirurgia , Miométrio/cirurgia , Pelve/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Adulto , Gonadotropina Coriônica/análise , Feminino , Humanos , Mola Hidatiforme Invasiva/diagnóstico por imagem , Mola Hidatiforme Invasiva/patologia , Laparoscopia/métodos , Metotrexato/administração & dosagem , Miométrio/patologia , Gravidez , Resultado do Tratamento , Ultrassonografia/métodos , Neoplasias Uterinas/patologia
4.
Isr Med Assoc J ; 21(10): 653-657, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599505

RESUMO

BACKGROUND: Complete hydatidiform mole and a co-existing normal fetus (CHMCF) is associated with a high complication rate. A possible association with assisted conception might increase the prevalence of CHMCF. OBJECTIVES: To study the potential association between assisted conception and the risks of CHMCF. METHODS: Case series at a single university hospital from 2008 to 2018 are presented and contrasted with data from a comprehensive literature review (1998-2018). Cases were identified from the institutional database that matched the sonographic criteria for CHMCF. A literature review showed comparable cases. RESULTS: None of the three pregnancies presented in this article resulted in a viable fetus, all were aborted. One of the three patients needed chemotherapy due to gestational trophoblastic neoplasia (GTN). A literature search identified 248 reported cases in which 22 fetuses (9%) reached term, 88/248 (35%) progressed to GTN, and 25/120 (21%) were conceived following assisted conception. From 2008 until 2018 at our medical facility, there were 3144 twin pregnancies of which 1667 (53%) were conceived using assisted conception. In our cohort, there was no statistical trend for assisted conception as an etiological factor for CHMCF. CONCLUSIONS: No association between assisted conception and the risk for CHMCF was established at our hospital, although approximately one-quarter of all reported CHMCF pregnancies are attributed to assisted conception technology. However, these data are not always reported, making it difficult to draw definitive conclusions.


Assuntos
Mola Hidatiforme/patologia , Gravidez de Gêmeos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Neoplasias Uterinas/patologia , Aborto Eugênico , Aborto Induzido , Adulto , Feminino , Humanos , Mola Hidatiforme/terapia , Doença Iatrogênica , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Ultrassonografia Pré-Natal/métodos , Neoplasias Uterinas/terapia
5.
Adv Exp Med Biol ; 1167: 129-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31520353

RESUMO

Multiple large-scale epidemiological studies have identified obesity as an important risk factor for a variety of human cancers, particularly cancers of the uterus, gallbladder, kidney, liver, colon, and ovary, but there is much uncertainty regarding how obesity increases the cancer risks. Given that obesity has been consistently identified as a major risk factor for uterine tumors, the most common malignancies of the female reproductive system, we use uterine tumors as a pathological context to survey the relevant literature and propose a novel hypothesis: chronic downregulation of the cyclin-dependent kinase 8 (CDK8) module, composed of CDK8 (or its paralog CDK19), Cyclin C, MED12 (or MED12L), and MED13 (or MED13L), by elevated insulin or insulin-like growth factor signaling in obese women may increase the chances to dysregulate the activities of transcription factors regulated by the CDK8 module, thereby increasing the risk of uterine tumors. Although we focus on endometrial cancer and uterine leiomyomas (or fibroids), two major forms of uterine tumors, our model may offer additional insights into how obesity increases the risk of other types of cancers and diseases. To illustrate the power of model organisms for studying human diseases, here we place more emphasis on the findings obtained from Drosophila melanogaster.


Assuntos
Drosophila melanogaster , Obesidade/complicações , Neoplasias Uterinas/patologia , Animais , Quinase 8 Dependente de Ciclina/genética , Modelos Animais de Doenças , Proteínas de Drosophila/genética , Feminino , Humanos , Complexo Mediador/genética , Fatores de Risco
7.
Anticancer Res ; 39(8): 3981-3989, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366479

RESUMO

Uterine sarcomas are rare but very aggressive. Uterine myomas, on the other hand, are the most common benign tumors of the uterus. Currently there is no diagnostic technique available to distinguish them with certainty. This study aimed to summarize the published literature concerning protein-based biomarkers in the peripheral blood that can assist in this difficult differential diagnosis. In total, 48 articles, published between 1990 and 2017, were included. Most studies (n=37) concerned soft tissue sarcomas, while 11 discussed uterine sarcomas specifically. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), interleukins (IL), cancer antigen 125 (CA 125), lactate dehydrogenase, gangliosides (LDH) and growth differentiation factor 15 (GDF-15) are the most studied proteins in soft tissue sarcomas, including uterine sarcomas. Future research on improving sarcoma diagnosis should include these proteins.


Assuntos
Leiomioma/sangue , Neoplasias/sangue , Sarcoma/sangue , Neoplasias Uterinas/sangue , Biomarcadores Tumorais/sangue , Diferenciação Celular/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Leiomioma/patologia , Neoplasias Musculares/sangue , Neoplasias Musculares/patologia , Neoplasias/patologia , Sarcoma/patologia , Neoplasias Uterinas/patologia
8.
Georgian Med News ; (291): 117-121, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31418743

RESUMO

Hydatidiform mole represents the major cause of the molar pregnancy, which is a special cause of spontaneous abortions. We analysed phenotypic characteristics of epithelial hyperplasia and tumor microenvironment alterations in different types of hydatidiform moles. Standard immunohistochemistry was used for the detection of Ki67, Cyclin D1, p53, BCL2, E-cadherin, p63, Vimentin, CD34, CD3, CD4, CD8 and CD68. In addition, epithelial hyperplasia has been assessed in standard diagnostic haematoxylin and eosin stained tissue specimens. The results of our study indicated that both cytotrophoblast and sincitiptrophoblast layers are characterised with marked epithelial hyperplasia and high proliferation index in partial and complete moles, whilst apoptotic index is minimal. Early complete mole resembles the partial mole, rather than complete mole. Lymphocyte infiltration, marked by CD3, CD4 and CD8 is also higher in complete and partial moles, whilst macrophage infiltration is relatively lower. Macrophage infiltration marked by CD68 correlates with microvessel density marked by CD34. The evaluation of proliferation and apoptotic markers, as well as microenvironment, might serve as additional diagnostic markers in patients with hydatidiform moles and hydropic abortions.


Assuntos
Aborto Espontâneo/psicologia , Vilosidades Coriônicas/patologia , Mola Hidatiforme/patologia , Hiperplasia/patologia , Trofoblastos/patologia , Microambiente Tumoral , Neoplasias Uterinas/patologia , Feminino , Humanos , Gravidez
9.
Med. clín (Ed. impr.) ; 153(2): 83-87, jul. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183370

RESUMO

Antecedents: Perivascular epitheliod cell tumor (PEComa) is a rare mesenchymal tumor. They are rare in the field of gynecology, which makes them difficult to consider as a possible diagnostic. We aim to contribute with our experience to ease clinical practice to others gynecologists. Patients and methods: We contribute to literature with three gynecological cases; uterine, vaginal and retroperitoneal PEComas. Results: The uterine and vaginal PEComa, have required surgical treatment, and are free of disease at 9 and 5 months respectively. The retroperitoneal PEComa has recurred at 72 months of follow-up in form of retroperitoneal mass and pulmonary lymphangioleomyomatosis, continues treatment with sirolimus with good tolerance and partial response. Discussion: Given the scarcity of cases, the literature consists of case reports and mini-reviews. Some authors have categorized the PEComas based on prognostic factors, but there is no agreement regarding the follow-up and treatment. 18F-FDG-PET/CT can help characterize these lesions. The surgery is the standard. In recurrent or malignant cases, there is a lack of evidence regarding chemotherapy and radiotherapy. New therapies with inhibitory m-TOR open a hopeful therapeutic window


Antecedentes: El tumor de célula epitelioide perivascular (PEComa) es un tumor mesenquimal raro. Son entidades ginecológicas extrañas, lo que dificulta su consideración diagnóstica. Contribuimos con nuestra experiencia para facilitar la práctica clínica a otros ginecólogos. Pacientes y métodos: Aportamos 3 casos ginecológicos a la literatura: PEComas uterino, vaginal y retroperitoneal. Resultados: Los PEComas uterino y vaginal requirieron tratamiento quirúrgico y están libres de enfermedad a los 9 y 5 meses, respectivamente. El PEComa retroperitoneal recidivó a los 72 meses de seguimiento en forma de masa retroperitoneal y linfangioleiomiomatosis pulmonar, continuando tratamiento con sirolimus, con buena tolerancia y respuesta parcial. Discusión: Dada la escasez de casos, la literatura consiste en casos clínicos y mini revisiones. Algunos autores han categorizado los PEComas en base a factores pronósticos, pero no hay acuerdo respecto al seguimiento y tratamiento. La 18F-FDG-PET/TC puede ayudar a caracterizar estas lesiones. La cirugía es el tratamiento estándar. En casos de recurrencia o malignidad, hay falta de evidencia respecto a la quimioterapia y radioterapia. Nuevas terapias con inhibidores mTOR abren una ventana terapéutica esperanzadora


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias de Células Epitelioides Perivasculares/diagnóstico por imagem , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias de Células Epitelioides Perivasculares/patologia , Linfangioleiomiomatose/complicações , Linfangioleiomiomatose/tratamento farmacológico , Sirolimo/uso terapêutico , Neoplasias Uterinas/patologia , Útero/patologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia
10.
BMC Womens Health ; 19(1): 100, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331317

RESUMO

BACKGROUND: Uterine leiomyomas are often discovered during early pregnancy and in most cases will have no effect on pregnancy outcomes. However, in rare cases uterine leiomyomas may lead to obstetric complications. The aim of the study was to evaluate rate of uterine leiomyoma growth in the 3 trimesters of pregnancy. METHODS: We conducted a retrospective cohort study. Included were women who were diagnosed with uterine leiomyoma during pregnancy and had at least two sonographic measurements in different trimesters. Data regarding leiomyoma growth, recorded by ultrasound examination, during 1st 2nd and 3rd trimesters were collected from electronic patient records. RESULTS: Two-hundred forty-eight uterine leiomyomas were included in the study. Leiomyoma area increased substantially in size between the 1st and 2nd trimesters (54.5% ± 75.9%, p = .007) and to a lesser degree between the 2nd and 3rd trimesters (17.9% ± 59.7%, NS). Evaluation of the change in size throughout the pregnancy - between 1st and 3rd trimesters revealed a significant increase of 95.9% ± 191.3% (p < .001). There was no significant growth of the leiomyomas between the 2nd and 3rd trimesters. CONCLUSIONS: Uterine leiomyomas tend to grow substantially during the 1st trimester of pregnancy. This trend is attenuated later with minimal growth towards the end of gestation.


Assuntos
Leiomioma/patologia , Complicações Neoplásicas na Gravidez/patologia , Trimestres da Gravidez , Neoplasias Uterinas/patologia , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Pessoa de Meia-Idade , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Carga Tumoral , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Adulto Jovem
11.
Cancer Sci ; 110(9): 2894-2904, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31348579

RESUMO

Nivolumab is a human monoclonal antibody against the immune checkpoint receptor programmed death-1, inhibiting binding to programmed death-ligand 1 or 2 (PD-L1 or PD-L2). This phase 2 study evaluated the efficacy and safety of nivolumab in patients with advanced/recurrent uterine cervical cancer, uterine corpus cancer, or soft tissue sarcoma (STS). Patients received nivolumab 240 mg at 2-week intervals. Primary endpoint was objective response rate; secondary endpoints included overall survival, progression-free survival, and safety. PD-L1 expression and microsatellite-instability (MSI) status were analyzed as potential efficacy biomarkers. Objective response rate was 25%, 23%, and 0% in patients with cervical cancer (n = 20), corpus cancer (n = 22), and STS (n = 21), respectively. The lower 80% confidence intervals of objective response rates in patients with cervical or corpus cancer exceeded the threshold rate (5%); the primary endpoint was met in cervical and corpus cancer, but not in STS. Median progression-free survival was 5.6, 3.4, and 1.4 months, and 6-month overall survival was 84%, 73%, and 86% in cervical cancer, corpus cancer, and STS, respectively. The objective response rate was higher in patients with cervical cancer with PD-L1-positive (n = 5/15; 33%) versus PD-L1-negative (n = 0/5; 0%) tumors. The two patients with corpus cancer classified as MSI-high responded; the six patients classified as microsatellite stable did not respond. Overall, nivolumab showed acceptable toxicity in all cohorts, with evidence of clinical activity in uterine cervical or corpus cancer, but not in STS. PD-L1 expression in cervical cancer and MSI-high in corpus cancer may predict clinical activity of nivolumab in these cancers.


Assuntos
Antineoplásicos/administração & dosagem , Recidiva Local de Neoplasia/tratamento farmacológico , Nivolumabe/administração & dosagem , Sarcoma/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antígeno B7-H1/metabolismo , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Japão/epidemiologia , Instabilidade de Microssatélites , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Nivolumabe/efeitos adversos , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/metabolismo , Intervalo Livre de Progressão , Estudos Prospectivos , Sarcoma/genética , Sarcoma/mortalidade , Sarcoma/patologia , Análise de Sobrevida , Neoplasias Uterinas/genética , Neoplasias Uterinas/mortalidade , Neoplasias Uterinas/patologia , Útero/patologia
12.
Clin Nucl Med ; 44(10): 826-828, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306202

RESUMO

We reported the preoperative radio-guided localization of 4 peritoneal metastatic nodules in the case of a 45-year-old woman with uterine leiomyosarcoma. Three lines of chemotherapy were tried, but cardiotoxicity occurred. Within the context of so-called GOSTT (guided intraoperative scintigraphic tumor targeting), preoperative radio-guided localization of peritoneal metastases enabled their subsequent radio-guided excisional biopsy. SPECT/CT allowed for anatomical localization of the hot lesions and generated a 3-dimensional volume-rendering roadmap, facilitating a surgical approach.


Assuntos
Leiomiossarcoma/patologia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/secundário , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias Uterinas/patologia , Feminino , Humanos , Pessoa de Meia-Idade
13.
Arkh Patol ; 81(3): 5-11, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317925

RESUMO

OBJECTIVE: To investigate microsatellite instability in smooth muscle tumors of uncertain malignant potential and to compare the results with clinical and morphological data. SUBJECT AND METHODS: Histological and immunohistochemical studies were conducted in 26 patients aged 30-63 years (mean age, 37 years) with leiomyomatosis; which revealed intravenous leiomyomatosis in 20 cases, metastasizing leiomyoma in 2, disseminated peritoneal leiomyomatosis in 3, and smooth muscle tumor of uncertain malignant potential in 1 case. Microsatellite instability was studied by fragment analysis on a genetic analyzer using a test system of six markers: D10S1146, D10S218, D10S24, D10S1213, D3S1295, and D9S942. RESULTS: Microsatellite repeat changes characteristic of leiomyosarcomas (heterozygosity loss and/or microsatellite instability in at least one locus studied) were found in 6 patients; all were clinically and morphologically diagnosed as having intravenous leiomyomatosis. In 3 of these 6 cases, leiomyomatosis was accompanied by metastases to the lungs and spread to the peritoneum; heart damage was noted in 2 cases. The data analysis did not allow identification of any significant clinical and morphological criteria for this group. CONCLUSION: Leiomyomatosis is not a transitional form from benign leiomyoma to leiomyosarcoma, as evidenced by the difference in the status of molecular markers. Analysis of molecular genetic changes in DNA from tumor tissue samples cannot categorically clarify the nature of the disease by identifying the signs of genetic instability; however, there is a need for further accumulation of experience in studying tumors of this group and in identifying the possible association with disease prognosis.


Assuntos
Leiomiomatose , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Adulto , Feminino , Humanos , Leiomiomatose/patologia , Leiomiossarcoma/patologia , Pessoa de Meia-Idade , Prognóstico , Tumor de Músculo Liso/patologia , Neoplasias Uterinas/patologia
14.
Gynecol Oncol ; 154(3): 631-637, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31326137

RESUMO

Uterine smooth muscle tumors of unknown malignant potential [STUMP]s are neoplasms with pathological features that preclude an equivocal diagnosis of leiomyosarcoma, but that do not fulfill the criteria for leiomyoma or its variants, and raise concerns that the tumors may behave in a malign fashion. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard treatment if fertility is completed, whereas myomectomy alone can be taken into consideration in young patients who desire to preserve childbearing potential. A careful surveillance every 6 months for 5 years and then yearly is strongly warranted. Patients with STUMP can relapse as either STUMP or leiomyosarcoma in approximately 11-13% of the cases, and their 5-year overall survival ranges from 92 to 100%. The present paper reviews the clinicopathological features of uterine STUMPs with a particular focus on most commonly accepted histopathological criteria for the diagnosis and on biological behaviour of these controversial neoplasms.


Assuntos
Tumor de Músculo Liso/patologia , Neoplasias Uterinas/patologia , Feminino , Humanos , Leiomiossarcoma/patologia
16.
Gynecol Oncol ; 154(2): 328-332, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31221496

RESUMO

OBJECTIVE: To evaluate clinicopathologic factors and adjuvant treatment effects on recurrence free (RFS) and overall survival (OS) in early stage uterine clear cell carcinoma (UCCC). METHODS: Our retrospective review included central pathology confirmed stage I or II UCCC treated and/or followed between 2000 and 2016. Cases with pure or mixed histology with >50% UCCC were included. Data were analyzed using Kaplan-Meier method and Cox proportional hazards regressions. RESULTS: 112 women were identified. Median age was 65.5 years (range 34-94). Most patients had mixed UCCC (61%), while 39% had pure UCCC. The majority of patients had stage IA UCCC (66%) versus stage IB (15%) or stage II (18%) disease. Adjuvant treatment included chemotherapy + radiation (26%), brachytherapy (27%), whole pelvic radiation (15%), chemotherapy alone (8%), and observation (24%). Thirty-eight (34%) women had recurrent disease. Median RFS was 4.32 years (95% CI 2.77-5.78). On multivariate analysis, age ≥70 (HR 2.48, 95% 1.28-4.81) and positive LVSI (HR 2.19, 95% CI 1.15-4.18) were associated with shorter RFS. Median OS was 9.8 years (95% CI 7.46-15.93). On multivariate analyses, age ≥70 (HR 3.57, 95% CI 1.64-7.74) and positive LVSI (HR 2.46, 95% CI 1.12-5.37) were associated with shorter OS. In this retrospective descriptive uncontrolled patient series, adjuvant treatment type did not impact RFS or OS. CONCLUSIONS: OS approaches 10 years for early stage UCCC patients. Women ≥70 years have worse PFS and OS regardless of treatment modality, encouraging consideration of quality of life implications when electing for adjuvant therapy.


Assuntos
Adenocarcinoma de Células Claras/terapia , Neoplasias Uterinas/terapia , Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma de Células Claras/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias Uterinas/mortalidade , Neoplasias Uterinas/patologia , Conduta Expectante
17.
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
18.
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
19.
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
20.
Gynecol Oncol ; 154(1): 177-182, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056111

RESUMO

OBJECTIVES: To describe and compare treatments and outcomes of patients with malignant bowel obstructions (MBO) due to uterine or ovarian cancer. METHODS: Retrospective chart review from two institutions of women admitted 1/1/2005-12/31/2016 with a MBO from recurrent/progressive uterine or ovarian cancer. Data collected includes patient characteristics, cancer-directed treatments before and after MBO, MBO management strategies, and survival after MBO. RESULTS: Women with MBO from uterine cancer (n = 46) and ovarian cancer (n = 130) underwent similar inpatient interventions such as inpatient chemotherapy and surgery. Median overall survival (OS) after admission for MBO for all patients was 105 days and was shorter for uterine cancer patients (57 vs 131 days, p = 0.0013). Uterine and ovarian cancer patients who had surgery had similar survival (182 vs 210 days, p = 0.6), as did those discharged on hospice from their first admission for MBO (26 vs 38 days, p = 0.1). Uterine and ovarian cancer patients had similar rates of post-discharge chemotherapy (37% vs 50%, p = 0.12), but uterine cancer patients who had chemotherapy still had shorter survival (151 vs 225 days, p = 0.03). CONCLUSIONS: MBO has a relatively poor prognosis. Ovarian and uterine cancer patients whose interventions included surgery or hospice had similar outcomes. Among patients managed medically without hospice, uterine cancer patients experienced worse survival, even when candidates for subsequent chemotherapy. Patient counseling regarding goals of care at this difficult juncture can be informed by these findings and will be enhanced by patient-reported and qualitative data on the patient experience with MBO.


Assuntos
Obstrução Intestinal/etiologia , Neoplasias Ovarianas/complicações , Neoplasias Uterinas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/patologia , Obstrução Intestinal/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia
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