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1.
Genes Chromosomes Cancer ; 62(1): 27-38, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35822448

RESUMO

Uterine leiomyomas, or fibroids, are very common smooth muscle tumors that arise from the myometrium. They can be divided into distinct molecular subtypes. We have previously shown that 3'RNA-sequencing is highly effective in classifying archival formalin-fixed paraffin-embedded (FFPE) leiomyomas according to the underlying mutation. In this study, we performed 3'RNA-sequencing with 111 FFPE leiomyomas previously classified as negative for driver alterations in mediator complex subunit 12 (MED12), high mobility group AT-hook 2 (HMGA2), and fumarate hydratase (FH) by Sanger sequencing and immunohistochemistry. This revealed 43 tumors that displayed expression features typically seen in HMGA2-positive tumors, including overexpression of PLAG1. We explored 12 such leiomyomas by whole-genome sequencing to identify their underlying genomic drivers and to evaluate the feasibility of detecting chromosomal driver alterations from FFPE material. Four tumors with significant HMGA2 overexpression at the protein-level served as controls. We identified chromosomal rearrangements targeting either HMGA2, HMGA1, or PLAG1 in all 16 tumors, demonstrating that it is possible to detect chromosomal driver alterations in archival leiomyoma specimens as old as 18 years. Furthermore, two tumors displayed biallelic loss of DEPDC5 and one tumor harbored a COL4A5-COL4A6 deletion. These observations suggest that instead of only HMGA2-positive leiomyomas, a distinct leiomyoma subtype is characterized by rearrangements targeting either HMGA2, HMGA1, or PLAG1. The results indicate that the frequency of HMGA2-positive leiomyomas may be higher than estimated in previous studies where immunohistochemistry has been used. This study also demonstrates the feasibility of detecting chromosomal driver alterations from archival FFPE material.


Assuntos
Leiomioma , Neoplasias Uterinas , Feminino , Humanos , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Proteína HMGA1a/genética , Leiomioma/genética , Leiomioma/patologia , Proteína HMGA2/genética , Proteína HMGA2/metabolismo , Fumarato Hidratase/genética , Aberrações Cromossômicas , Mutação , Fatores de Transcrição/genética , RNA , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo
2.
Turk J Med Sci ; 52(3): 762-769, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36326312

RESUMO

BACKGROUND: In this single-center study, we aimed to analyze texture features of primary uterine lesions on 18F-FDG PET/CT to predict lymph node metastases. METHODS: Totally, 157 (mean age: 62 ± 10.2 years) patients were included in the analysis. Histopathological examination results were considered as the standard reference for nodal involvement. On 18F-FDG PET/CT images, only the primary tumor was segmented. SUVmax, SUVmean, SUVpeak, MTV, and TLG of primary uterine lesions were calculated for analyses. For texture analysis first, second, and higher-order texture features were calculated. RESULTS: Mean diameter of primary uterine lesions was calculated as 35± 18.1 mm. Lymph node metastases were detected in 19% of patients in histopathological examination of surgical materials. While 26 patients had pelvic lymph node metastases, 19 patients had additional paraaortic lymph node metastases. On radiomics analysis for 20 features, a significant difference was found between patients with and without lymph node metastasis. With using data mining methods GLZLM ZLNU, EntropyGLCM, Entropyhisto, GLRLM LRHGE, GLZLM HGZE, GLZLM SZHGE, GLRLM HGRE, GLRLM SRHGE were found significant radiomics features to predict lymph node metastasis with a diagnostic accuracy of 0.8. DISCUSSION: The radiomics analysis of intratumoral heterogeneity is a promising method for improving triage of the patients for lymph node dissection in endometrial carcinoma.


Assuntos
Neoplasias do Endométrio , Neoplasias Uterinas , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Tomografia por Emissão de Pósitrons/métodos , Neoplasias do Endométrio/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias Uterinas/patologia , Estudos Retrospectivos
3.
BMC Womens Health ; 22(1): 435, 2022 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335369

RESUMO

BACKGROUND: To assess the efficacy of dysdrogesterone in the treatment of chronic endometritis (CE) treated with antibiotic in premenopausal women with endometrial polyps (EPs). METHODS: Routine detection of endometrium was simultaneously conducted to determine whether there was CE by syndecan-1 (CD138), while women underwent hysteroscopic polypectomy in our hospital. Antibiotic was given for the treatment of CE. A total of 235 premenopausal women with CE who underwent hysteroscopic polypectomy were enrolled in the retrospective observational study. In the control group, single antibiotic was given for the treatment of CE form January 2016 to December 2018, and in the treatment group additional dydrogesterone was used from January 2019 to November 2020. Comparison of cure rates of CE with different treatment regimens was performed. RESULTS: The cure rates of CE in dydrogesterone and antibiotic combination group and the single antibiotic group were 85.2% and 74.3%, respectively, with overall cure rate of 80.0% (188/235). The combination group showed better effects regarding the cure rate of CE (P < .05). Multivariate analysis confirmed that the cure rate of CE was not affected by age, body mass index, number of EPs, the status of estrogen receptor and the status of progesterone receptor. Conversely, dydrogesterone and endometrial scratching were beneficial factors for cure rate increase with antibiotic treatment. CONCLUSION: Combination of dydrogesterone and antibiotic was more effective for cure rate of CE than antibiotic alone in premenopausal women after hysteroscopic polypectomy. Endometrial scratching also contributed to the cure rate increase with antibiotic treatment.


Assuntos
Endometrite , Pólipos , Neoplasias Uterinas , Gravidez , Feminino , Humanos , Endometrite/diagnóstico , Didrogesterona/uso terapêutico , Histeroscopia , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Pólipos/tratamento farmacológico , Pólipos/cirurgia , Endométrio/cirurgia , Endométrio/patologia , Neoplasias Uterinas/patologia , Doença Crônica
4.
Sci Rep ; 12(1): 19612, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36385486

RESUMO

Uterine sarcomas have very poor prognoses and are sometimes difficult to distinguish from uterine leiomyomas on preoperative examinations. Herein, we investigated whether deep neural network (DNN) models can improve the accuracy of preoperative MRI-based diagnosis in patients with uterine sarcomas. Fifteen sequences of MRI for patients (uterine sarcoma group: n = 63; uterine leiomyoma: n = 200) were used to train the models. Six radiologists (three specialists, three practitioners) interpreted the same images for validation. The most important individual sequences for diagnosis were axial T2-weighted imaging (T2WI), sagittal T2WI, and diffusion-weighted imaging. These sequences also represented the most accurate combination (accuracy: 91.3%), achieving diagnostic ability comparable to that of specialists (accuracy: 88.3%) and superior to that of practitioners (accuracy: 80.1%). Moreover, radiologists' diagnostic accuracy improved when provided with DNN results (specialists: 89.6%; practitioners: 92.3%). Our DNN models are valuable to improve diagnostic accuracy, especially in filling the gap of clinical skills between interpreters. This method can be a universal model for the use of deep learning in the diagnostic imaging of rare tumors.


Assuntos
Aprendizado Profundo , Leiomioma , Neoplasias Pélvicas , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Uterinas , Feminino , Humanos , Diagnóstico Diferencial , Sensibilidade e Especificidade , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Leiomioma/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Neoplasias de Tecidos Moles/diagnóstico
5.
Taiwan J Obstet Gynecol ; 61(6): 935-940, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36427995

RESUMO

Uterine smooth muscle tumor of uncertain malignant potential is a subtype of uterine smooth muscle neoplasms. It is characterized by distinct pathologic findings with morphologic features intermediate between those of benign leiomyoma and malignant leiomyosarcoma. Clinically, STUMP is rare and its clinical picture is comparable to that of leiomyoma, with diagnosis typically being made postoperatively. Most patients with STUMP are uneventful after tumor resection. However, a small portion of patients may experience recurrence that may even lead to mortality. Given the uncommon occurrence of STUMP and the low frequency of malignant potential, currently there is still no standard guideline in treating patients with this disease and this can be challenging for physicians. Moreover, because cases are rarely available for study, investigating this tumor is difficult. Thus, matters such as the pathologic diagnostic criteria, strategy of clinical management, identification of prognostic factors, and the pathogenesis of this disease remain to be clarified. We collected and analyzed recently published case series studies of STUMP to obtain up-to-date clinical information. The current status of research in various basic and clinical aspects of this tumor was also reviewed.


Assuntos
Leiomioma , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Feminino , Humanos , Tumor de Músculo Liso/diagnóstico , Tumor de Músculo Liso/cirurgia , Neoplasias Uterinas/patologia , Leiomioma/cirurgia , Leiomioma/patologia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Leiomiossarcoma/patologia , Útero/patologia
6.
Surg Oncol ; 45: 101879, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332557

RESUMO

Intravenous leiomyomatosis (IVL) is characterized by the presence of vascular extension and invasion of benign smooth muscle lesions in a worm-like manner from uterine fibroids into the systemic vasculature system. Surgery with complete tumour resection remains the main treatment approach, however both treated and untreated of this disease is associated with high morbidity and mortality. The aim of this systematic review is to highlight the systemic manifestations and surgical management of IVL.


Assuntos
Leiomiomatose , Neoplasias Uterinas , Humanos , Feminino , Leiomiomatose/cirurgia , Leiomiomatose/patologia , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia
7.
Medicina (Kaunas) ; 58(11)2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36422166

RESUMO

Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive management of symptomatic submucosal fibroids, with high efficacy and safety. Several techniques have been introduced over time and will be covered in depth in this manuscript. Advances in optics, fluid management, electrosurgery, smaller diameter scopes, and tissue removal systems, along with improved training have contributed to improving the safety and efficiency of hysteroscopic myomectomy.


Assuntos
Infertilidade , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Gravidez , Humanos , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia , Histeroscopia/métodos , Leiomioma/cirurgia
8.
Eur J Obstet Gynecol Reprod Biol ; 279: 118-121, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332539

RESUMO

OBJECTIVE: To evaluate the relative rates of malignancy in women with single and multiple polyps presenting to a UK Cancer Centre with postmenopausal bleeding (PMB). STUDY DESIGN: A retrospective review of patients treated at Royal Derby Hospital (RDH) for PMB who underwent outpatient hysteroscopy based on ultrasonographic suspicion of endometrial polyps between May 2014 to December 2019. The main outcome measure was the rates of precancerous and malignant histology for single or multiple polyps. The secondary outcomes assessed the influence of risk factors on the rates of malignancy within the single and multiple polyps groups. RESULTS: The study population was 851 women of which 533 were in the single polyp group and 318 in the multiple polyps group. The multiple polyps group (mean age 65.2 years) was older compared to the single polyp group (mean age 62.1 years), P = 0.0001. Elevated rates of cancer was driven most significantly by endometrioid cancer in the multiple polyps compared to single polyp group, with rates of 50/314 (16 %) and 28/512 (5.5 %) respectively, P=< 0.00001. For rarer histologies there was no significant difference between the proportion of serous, carcinosarcomas and clear cell cancers between those with single compared to multiple polyps (P > 0.05). Significantly more endometrial hyperplasia with atypia (AEH) was found in the multiple polyps compared to single polyp group, with rates of 18/314 (5.7 %) and 15/512 (2.9 %) respectively, P = 0.046. CONCLUSION: Our study found increased rates of endometrioid cancer and its precursor, AEH within the multiple polyps compared to the single polyps groups. Future risk predicting algorithms should consider incorporating single and multiple polyps as part of their risk model.


Assuntos
Neoplasias do Endométrio , Pólipos , Lesões Pré-Cancerosas , Neoplasias Uterinas , Gravidez , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Pós-Menopausa , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Pólipos/patologia , Neoplasias Uterinas/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Histeroscopia/efeitos adversos , Hemorragia Uterina/etiologia , Hemorragia Uterina/complicações , Neoplasias do Endométrio/patologia , Estudos Retrospectivos
9.
Rom J Morphol Embryol ; 63(2): 323-334, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36374138

RESUMO

Endometrial polyps (EPs) are a frequent gynecological condition. EPs often arise in the common womanly patients and are appraised to be about 25%. Advancing age, hyperestrogenism, hypertension, and Tamoxifen use are acknowledged as ordinary risk elements for the development of EP. The etiopathogenesis of EP is not accurately elucidated, but certain considerations such as diabetes mellitus, hormonal factors or arterial hypertension are considered to perform a significant contribution. The diagnosis of EPs is essentially by imaging. Transvaginal ultrasound is the primary investigation in EPs. Hysteroscopic resection is now the "gold standard" to treat to treat this disease. Hysterectomy is the definitive treatment for EPs, but it requires a judicious indication and an adequate counseling of the patient. Currently, a certain histological pattern is found in different sequences in EPs. Even if the vast majority EPs are benign, they may reach hyperplastic, with malignant alteration. The purpose of this pictorial review is the integrated approach to this type of abnormal endometrial proliferation from the perspective of natural history, diagnosis, management, morphological aspects, risk of malignancy, recurrence and last but not least, clinical outcome.


Assuntos
Neoplasias do Endométrio , Hipertensão , Pólipos , Neoplasias Uterinas , Humanos , Gravidez , Feminino , Histeroscopia/métodos , Pólipos/patologia , Neoplasias Uterinas/patologia , Histerectomia , Hipertensão/patologia , Neoplasias do Endométrio/patologia , Endométrio/patologia
10.
Placenta ; 130: 17-24, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36370491

RESUMO

INTRODUCTION: Gestational trophoblastic disease (GTD) encompasses a range of trophoblastic disorders from hydatidiform mole (HM), to malignant gestational trophoblastic neoplasia (GTN). The exact molecular mechanisms of GTN remain unknown. Dysregulation and dysfunction of programmed cell death 4 (PDCD4)have been observed in many cancers. The roles of PDCD4 in GTD have not been previously reported. METHODS: A total of 161 cases of formalin-fixed, paraffin-embedded trophoblast blocks, and 36 cases of fresh trophoblast tissues were collected, including normal first trimester placentas, HM, and invasive HM. Choriocarcinoma cells JAR and JEG-3 were employed. The expressions of PDCD4 and small ubiquitin-like modifier 2/3 (SUMO2/3) were examined by immunohistochemistry, quantitative reverse transcription PCR and Western blotting in trophoblastic tissues and cells. The relationship between SUMOylation and PDCD4 was investigated. The effects of PDCD4 on proliferation, invasion, and migration of choriocarcinoma cells were evaluated by Cell Counting Kit-8 and transwell assays post siRNA transfection. Extracellular Matrix & Adhesion Profiler PCR Array was used to screen the downstream molecules of PDCD4. RESULTS: PDCD4 was significantly repressed in HM tissues. Loss of PDCD4 expression was demonstrated in 90% invasive HMs. Choriocarcinoma cells also displayed with suppressed PDCD4 expression. The varied expression of PDCD4 was paralleled by SUMO2/3. Inhibition of SUMOylation reduced the expression of PDCD4. Silencing of PDCD4promoted proliferation/migration/invasion, upregulatedMMP3/MMP8/ITGB2, and downregulated TIMP1/TIMP2 in choriocarcinoma cells. DISCUSSION: Our results suggest that reduced SUMOylation is one reason for suppressed PDCD4 in GTD. Loss of PDCD4 likely determines the malignant phenotype of GTN by dysregulating some members of the MMPs/TIMPs/integrins complex.


Assuntos
Coriocarcinoma , Doença Trofoblástica Gestacional , Mola Hidatiforme , Neoplasias Uterinas , Humanos , Gravidez , Feminino , Regulação para Baixo , Linhagem Celular Tumoral , Doença Trofoblástica Gestacional/patologia , Mola Hidatiforme/patologia , Coriocarcinoma/patologia , Neoplasias Uterinas/patologia , Proteínas de Ligação a RNA/genética , Proteínas de Ligação a RNA/metabolismo , Proteínas Reguladoras de Apoptose/genética , Proteínas Reguladoras de Apoptose/metabolismo
11.
Placenta ; 130: 46-52, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36379183

RESUMO

INTRODUCTION: Choriocarcinoma is a highly invasive gynaecologic malignancy. Molecular mechanism of metastasis in choriocarcinoma is poorly understood. Migration and invasion inhibitory protein (MIIP) regulates cell migration and invasion. Therefore, we aimed to elucidate the function of MIIP in choriocarcinoma. METHODS: Choriocarcinoma cell lines, JAR and JEG-3, were transfected with lentivirus carrying the MIIP-interfering RNA (to downregulate MIIP expression) or left untransfected (negative control). Cell migration and invasion were studied using transwell migration assays and scratch assays. In vivo tumour burden was studied using tumour xenograft models in specific-pathogen-free nude mice and live imaging. We elucidated possible molecular signalling pathways using western blotting. RESULTS: In transwell migration and scratch assays MIIP-downregulated JAR and JEG-3 cells migrated and invaded faster compared to their respective negative control cells. Migration and invasion by the MIIP-upregulated SWAN cells was slower than that by negative control SWAN cells. Live imaging revealed that bioluminescence values were higher in MIIP-downregulated tumours than in the negative control tumours. Mice with MIIP-downregulated tumours had higher serum human chorionic gonadotropin (HCG) levels than those with negative control tumours. The MIIP expression was negatively correlated with that of histone deacetylase (HDAC6) and positively correlated with that of acetylated α-tubulin. DISCUSSION: Thus, MIIP-by inhibiting cellular motility in choriocarcinoma-acts as a tumour suppressor gene. This highlights a potential therapeutic target for refractory choriocarcinoma. Additionally, HDAC6 and acetylated α-tubulin may be involved in the regulatory effects of MIIP on the biobehaviour of choriocarcinoma cells.


Assuntos
Coriocarcinoma , Neoplasias Uterinas , Gravidez , Feminino , Humanos , Camundongos , Animais , Linhagem Celular Tumoral , Camundongos Nus , Tubulina (Proteína) , Coriocarcinoma/patologia , Movimento Celular/genética , Proliferação de Células/genética , Neoplasias Uterinas/patologia
13.
Curr Oncol ; 29(10): 7607-7623, 2022 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-36290878

RESUMO

Uterine carcinosarcoma (UCS) is a highly aggressive gynecologic malignancy. Recurrent or persistent/progressive disease is usually fatal. We aimed to investigate the management and prognosis of these patients. Clinical records of UCS patients from June 1987 to April 2020 were retrospectively reviewed. The stage was re-assigned with the FIGO 2009 staging system. Univariate and multivariate analyses were used to identify the independent predictors of survival after recurrence (SAR) and cancer-specific survival (CSS). Of the 168 patients, 98 experienced treatment failure. The median time to treatment failure (TTF) was 8.1 months (range: 0.0-89.1). The median follow-up time of censored patients was 32.0 months (range: 16.8-170.7). The 5-year SAR rates of those with recurrent or persistent/progressive disease were 7.6%. On multivariate analysis, salvage therapy mainly using radiotherapy (HR 0.27, 95% CI: 0.10-0.71) or chemotherapy (HR 0.41, 95% CI: 0.24-0.72) or chemoradiotherapy (CRT) (HR 0.33, 95% CI: 0.15-0.75) were associated with improved SAR, whereas disseminated recurrence was associated with significantly worse SAR (HR 3.94, 95% CI: 1.67-9.31, p = 0.002). Salvage therapy using radiotherapy or chemotherapy or CRT significantly improved SAR. Surgery significantly improved CSS but not SAR, adjusting for confounding factors.


Assuntos
Carcinossarcoma , Neoplasias Uterinas , Humanos , Feminino , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia , Prognóstico
14.
Int J Med Sci ; 19(12): 1779-1786, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36313223

RESUMO

Background: Uterine leiomyoma is the most common benign tumor in women of reproductive age, and it can cause infertility. The growth of uterine leiomyoma is mediated by various steroids and growth factors. The purpose of this study was to evaluate the expression of various growth factors in uterine leiomyoma. Additionally, comparing the effects of existing medication and specific growth factor inhibitors on leiomyoma and the normal myometrium, we aimed to see the potential of transforming growth factor-beta (TGF-ß) inhibitors and vascular endothelial growth factor (VEGF) inhibitors as therapeutic drugs for uterine leiomyoma. Methods: This in vitro study included uterine leiomyoma samples from 12 patients who underwent hysterectomy by laparoscopy or laparotomy at Seoul St. Mary's Hospital between May 2016 and March 2018. Normal myometrium and uterine leiomyoma tissue were obtained from each patient and the expression of growth factors was compared using immunohistochemical staining. After the primary culture of normal myometrial and leiomyoma cells, cell viability was evaluated following treatment with 100 nM ulipristal acetate (UPA) and mifepristone for 48 h. Western blot analysis was performed to determine the protein expression of each growth factor. Cell viability was determined following treatment with a 10-µM TGF-ß inhibitor (LY364947) and a 5-µM VEGF inhibitor (axitinib) for 24 h in cultured normal myometrium and leiomyoma cells. Results: Immunohistochemical staining revealed the significantly higher intensity of TGF-ß and VEGF in the leiomyoma tissue than in the normal myometrium (P < 0.05). Mifepristone treatment decreased VEGF expression by 62% in the leiomyoma cells (P < 0.05). According to the cell counting kit-8 (CCK-8) assay, cell viability was decreased after UPA, mifepristone, TGF-ß1 inhibitor, and VEGF inhibitor treatments in the normal myometrium and leiomyoma tissue. The effects of the TGF-ß1 inhibitor significantly differed between normal myometrium and leiomyoma tissue, with a greater decrease in cell survival in the leiomyoma tissue (P < 0.05). Post-hoc analysis showed that the TGF-ß1 and VEGF inhibitors had a greater inhibitory effect on leiomyoma tissue compared with that of UPA. Conclusion: TGF-ß and VEGF inhibitors significantly decreased the viability of uterine leiomyoma cells, showing stronger effects than the conventional drug, UPA. TGF-ß1 inhibitors affect both leiomyoma tissue and the normal uterus; thus, targeted local treatment rather than systemic treatment should be considered.


Assuntos
Leiomioma , Neoplasias Uterinas , Humanos , Feminino , Fator A de Crescimento do Endotélio Vascular , Fator de Crescimento Transformador beta1 , Fator de Crescimento Transformador beta/metabolismo , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia , Mifepristona/uso terapêutico , Leiomioma/tratamento farmacológico , Leiomioma/patologia , Peptídeos e Proteínas de Sinalização Intercelular , Fatores de Crescimento Transformadores/uso terapêutico
15.
Int J Gynecol Pathol ; 41(6): 622-627, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36302191

RESUMO

Ovarian microcystic stromal tumors (MST) are a rare subtype of sex-cord stromal tumors. We are presenting a case of a MST arising in a patient with familial adenomatous polyposis (FAP) and concurrent colonic adenocarcinoma. During the patient's workup of an ampullary adenoma associated with her FAP, she was found to have an enlarged uterus with a thickened endometrium and an incidental pelvic mass on the fundus of the uterus. Subsequent imaging identified heterogenous bulky ovaries. This patient underwent surgical resection including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic sentinel lymph node biopsy during her planned total proctocolectomy and transduodenal ampullectomy. Extensive histologic and immunohistochemical investigations were completed and the final pathology report revealed a unique compilation of International Federation of Gynecology and Obstetrics Stage II, grade 1 endometrioid endometrial adenocarcinoma, bilateral ovarian MST, a sperate pedunculated mass favoring a diagnosis of uterine tumor resembling ovarian sex cord tumor (UTROSCT), 2 distinct adenocarcinomas of the colon (T2N0 and T1N0) and a tubular adenoma of the ampulla. The pathology showed the endometroid adenocarcinoma was ß-catenin negative while the MST and UTROSCT both showed nuclear positivity with ß-catenin. To our knowledge this is the first reported case of a UTROSCT with concurrent endometrial adenocarcinoma presenting with bilateral ovarian MST's and adenomatous polyposis coli gene positive FAP colon adenocarcinoma.


Assuntos
Adenocarcinoma , Adenoma , Polipose Adenomatosa do Colo , Neoplasias do Colo , Neoplasias Ovarianas , Tumores do Estroma Gonadal e dos Cordões Sexuais , Neoplasias Uterinas , Feminino , Humanos , Adenocarcinoma/genética , beta Catenina , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologia , Polipose Adenomatosa do Colo/complicações , Polipose Adenomatosa do Colo/cirurgia , Polipose Adenomatosa do Colo/genética , Neoplasias Uterinas/patologia , Neoplasias Ovarianas/patologia , Adenoma/cirurgia
16.
Int J Gynecol Pathol ; 41(6): 573-577, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36302188

RESUMO

Leiomyo-adenomatoid tumour (LMAT) is a rare benign neoplasm and very few cases of LMAT of the uterus are documented in the literature. Uterine LMATs are usually detected incidentally during the histopathologic evaluation of routine myomectomy or hysterectomy specimens for leiomyomata. Thorough evaluation of the morphological features and a concise immunohistochemical panel allows for accurate classification of this benign neoplasm.


Assuntos
Tumor Adenomatoide , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Tumor Adenomatoide/diagnóstico , Tumor Adenomatoide/cirurgia , Tumor Adenomatoide/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/patologia , Leiomioma/diagnóstico , Leiomioma/patologia , Útero/patologia
17.
Medicine (Baltimore) ; 101(41): e31061, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36254025

RESUMO

RATIONALE: Uterine metastasis from breast cancer is extremely rare. Asymptomatic patients with cervical metastases from breast cancer are rarer and more likely to be missed. We present an asymptomatic patient with breast cancer metastasized to the uterus and share opinions on diagnosing and treating for this kind of cases. PATIENT CONCERNS: We present the case of a 64-year-old woman who was diagnosed with both breast cancer and uterine fibroids after examination. She had no symptoms of gynecological disease during breast cancer treatment. A positron emission tomography/computed tomography (PET/CT) scan was performed during reexamination, revealing multiple metastases of the bone throughout the body and an abnormal hypermetabolic mass in the uterus. It was later confirmed as uterine metastasis by pathology. DIAGNOSIS: A diagnosis of metastatic breast invasive lobular carcinoma was established after a uterine curettage. INTERVENTIONS AND OUTCOMES: Treatment of the uterine metastasis included systemic chemotherapy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO), postoperative radiotherapy, and postoperative chemotherapy. The patient eventually refused further treatment for personal reasons and died at home. LESSONS: Breast cancer metastases to the uterus are very rare and further research is needed for their diagnosis and treatment. During reexamination of breast cancer patients, clinicians must be alert to metastasis to gynecologic organs. This is particularly important in hormone receptor-positive patients with asymptomatic distant metastasis.


Assuntos
Neoplasias da Mama , Carcinoma Lobular , Leiomioma , Neoplasias Uterinas , Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Uterinas/patologia , Útero/patologia
18.
Medicine (Baltimore) ; 101(39): e30665, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36181050

RESUMO

RATIONALE: Lipoleiomyoma is a rare neoplasm of the uterus. It is considered a variant of uterine myomas. Its reported incidence varies from 0.03% to 0.2%. Lipoleiomyoma consists of variable proportions of mature lipocytes and smooth muscle cells. These tumors generally occur in asymptomatic obese perimenopausal or postmenopausal women. About 90.7% of lipoleiomyomas arise from the uterine corpus, with only 6.5% arising from the cervix. When it occurs in the cervix, it is difficult to diagnose and treat it. We report an uncommon case of pelviscopic resection of uterine cervical lipoleiomyoma showing continuous growth after menopause. PATIENT CONCERNS: A 55-year-old postmenopausal woman was diagnosed with 40 mm-sized uterine myoma 4 years ago. The size of the mass increased to 58 mm in the last year. DIAGNOSES: An ultrasound scan revealed a 58 × 34-mm-sized round hyperechogenic and barely vascularity mass that appeared to have originated on the left side of the uterine cervix. Final pathologic findings showed lipoleiomyoma. INTERVENTIONS: After admission to the hospital, we performed pelviscopic removal of uterine lipoleiomyoma and both tubes. Microscopic examination revealed a significant amount of fat cells between muscle cells. OUTCOMES: Surgeries were successful. The patient had been followed up regularly for three years after surgery. She did not experience any complications. She remained disease-free. LESSONS: Although lipoleiomyomas mainly occur in postmenopausal women, they can also occur in the uterine cervix. They can increase in size after menopause. They can be removed laparoscopically. If a hyperechoic mass occurred in the uterus after menopause that keeps growing without symptoms, a differential diagnosis of lipoleiomyomas must be performed.


Assuntos
Leiomioma , Lipoma , Neoplasias do Colo do Útero , Neoplasias Uterinas , Colo do Útero/patologia , Feminino , Humanos , Leiomioma/patologia , Lipoma/cirurgia , Pessoa de Meia-Idade , Pós-Menopausa , Neoplasias do Colo do Útero/patologia , Neoplasias Uterinas/patologia
19.
BMC Cancer ; 22(1): 1050, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36207687

RESUMO

BACKGROUND: Uterine sarcomas are rare and aggressive gynaecologic malignancies, characterized by a relatively high recurrence rate and poor prognosis. The aim of this study was to investigate the clinicopathological features and explore the prognostic factors of these malignancies. METHODS: This was a single-institution, retrospective study. We reviewed the medical records of 155 patients with pathologically confirmed uterine sarcomas including uterine leiomyosarcoma (ULMS), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma (UUS) and adenosarcoma (AS) between 2006 and 2022. A total of 112 patients who underwent surgery between January 2006 and April 2019 were included in the survival analysis. The current study recorded the clinicopathological, treatment and outcome data to determine clinical characteristics and survival. RESULTS: The most common histopathological type was ULMS (63/155, 40.64%), followed by LG-ESS (56/155, 36.13%) and HG-ESS (16/155, 10.32%). The mean age at diagnosis of all patients was 49.27±48.50 years and 32.90% (51/155) of patients were postmenopausal. Fifteen patients underwent fast-frozen sectioning, 63(54.78%) were diagnosed with malignancy, 29(25.22%) were highly suspected of malignancy that needed further clarification and 23(14.84%) were diagnosed with benign disease. A total of 124(80%) patients underwent total hysterectomy (TH) and salpingo-oophorectomy. Multivariate analyses showed that histological type and tumour size were independent prognostic factors both for overall survival (OS) (p<0.001 and P=0.017, respectively) and progression-free survival (PFS) (p<0.001 and P=0.018, respectively). Tumour stage was only significantly associated with PFS (P=0.002). Elevated preoperative NLR, PLR and postmenopausal status were significantly correlated with shorter PFS and OS in univariate analysis, but no statistically significant difference was found in multivariate analysis. CONCLUSIONS: In patients with uterine sarcoma, in comparison to LMS and LG-ESS, UUS and HG-ESS tend to present as more aggressive tumour with poorer outcomes. Furthermore, larger tumour (>7.5 cm) were an important predictor of shorter PFS and OS.


Assuntos
Neoplasias do Endométrio , Tumores do Estroma Endometrial , Leiomiossarcoma , Neoplasias Pélvicas , Sarcoma do Estroma Endometrial , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Uterinas , Neoplasias do Endométrio/patologia , Feminino , Humanos , Leiomiossarcoma/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/cirurgia , Sarcoma do Estroma Endometrial/diagnóstico , Sarcoma do Estroma Endometrial/cirurgia , Neoplasias Uterinas/patologia
20.
Biomed Pharmacother ; 156: 113909, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36279721

RESUMO

Currently, there is a limited number of treatment options available for patients with symptomatic leiomyomas, and surgical removal is by far the most frequent procedure. Previous studies found that GnRH agonists and antagonists acting through GnRH receptors led to cell death and decreased extracellular synthesis in cultured leiomyoma cells. In this study, we encapsulated the GnRH antagonist ganirelix in PLGA microspheres contained in an alginate scaffold that also supports a leiomyoma ex vivo tissue explant. Microspheres maintained ganirelix concentration stably during six days of culture, inducing significant cell death in 50-55% of tumor cells. Although no changes were observed in the expression of extracellular matrix genes, a decreased expression of the Nuclear Factor of Activated T cells 5, a transcription factor involved in osmotic stress and tumor size. Interestingly, all tumors analyzed experienced apoptosis independently of the original driver mutation. These data indicate that local therapy of ganirelix would induce tumor reduction in a wide range of uterine leiomyomas.


Assuntos
Leiomioma , Neoplasias Uterinas , Humanos , Feminino , Preparações de Ação Retardada , Leiomioma/metabolismo , Hormônio Liberador de Gonadotropina/farmacologia , Antagonistas de Hormônios/farmacologia , Antagonistas de Hormônios/uso terapêutico , Neoplasias Uterinas/patologia
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