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1.
Yonsei Med J ; 61(4): 317-322, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32233174

RESUMO

PURPOSE: To evaluate factors associated with endometrial pathology during tamoxifen use in premenopausal breast cancer (BC) patients. MATERIALS AND METHODS: We reviewed the medical records of premenopausal BC patients treated with tamoxifen who underwent endometrial biopsy with or without hysteroscopy. Clinical characteristics were compared between women with endometrial pathology (endometrial hyperplasia or cancer) and those with normal histology or endometrial polyps. RESULTS: Among 284 endometrial biopsies, endometrial hyperplasia was diagnosed in 7 patients (2.5%), endometrial cancer was diagnosed in 5 patients (1.8%), normal histology was noted in 146 patients (51.4%), and endometrial polyp was present in 114 patients (40.1%). When comparing women with endometrial cancer (n=5) to women with normal histology, abnormal uterine bleeding was more common (p=0.007), and endometrial thickness was greater (p=0.007) in women with endometrial cancer. Chemotherapy for BC was also more common in patients with endometrial cancer (p=0.037). When comparing women with endometrial polyps and those with endometrial hyperplasia or cancer, the presence of abnormal uterine bleeding was more common in patients with endometrial hyperplasia or cancer (p<0.001); however, tamoxifen duration and endometrial thickness did not differ significantly between the two groups. CONCLUSION: In premenopausal BC patients treated with tamoxifen, abnormal uterine bleeding, increased endometrial thickness, and chemotherapy for BC were associated with the occurrence of endometrial cancer. These findings may provide useful information for gynecologic surveillance and counseling during tamoxifen treatment in premenopausal BC patients.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Hiperplasia Endometrial/induzido quimicamente , Neoplasias do Endométrio/induzido quimicamente , Endométrio/efeitos dos fármacos , Pólipos/induzido quimicamente , Pré-Menopausa , Tamoxifeno/efeitos adversos , Adulto , Antineoplásicos Hormonais/uso terapêutico , Biópsia , Hiperplasia Endometrial/diagnóstico por imagem , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Pólipos/patologia , Fatores de Risco , Tamoxifeno/uso terapêutico , Fatores de Tempo , Doenças Uterinas , Neoplasias Uterinas/induzido quimicamente , Neoplasias Uterinas/patologia
2.
Clin Nucl Med ; 44(12): 961-963, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689277

RESUMO

A 57-year-old woman with a history of uterine endometrial carcinoma underwent PET/CT examinations for initial staging and posttreatment survey. Multiple patchy accumulations were noted in the muscles, particularly in both thighs. These accumulations resolved spontaneously 6 months after the follow-up examination. However, 3.5 years after the surgery, the multiple patchy accumulations reappeared in the muscle of the upper and lower extremities showing an increase in signal intensity from previous examination. A biopsy of the right thigh revealed epithelioid cell granuloma without necrosis. We therefore consider that this case might be "idiopathic" granulomatous myositis.


Assuntos
Fluordesoxiglucose F18 , Granuloma/complicações , Miosite/complicações , Miosite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Miosite/patologia , Estadiamento de Neoplasias
3.
Curr Med Sci ; 39(5): 816-819, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612401

RESUMO

Sometimes endometrial polyps, submucosal myomas, and endometrial cancer show similar findings under ultrasonography. The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional (3D) power Doppler ultrasonography angiography (PDA) between endometrial cancer and uterine parenchyma lumps. The data of the blood flow indices in 3D-PDA including the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps (endometrial polyps and submucosal myomas) were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis (VOCAL) software. The results showed that all the blood flow parameters (VI, FI, VFI) were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps (P<0.001). The area under the curve of ROC of VI, FI, and VFI was 0.98, 0.84, and 0.97, respectively. Thus, the best predictor of endometrial carcinoma was VI with a sensitivity of 97.0% and a specificity of 91.0%. The optimal cutoff value of VI was 4.06%. Our data demonstrated that all of the blood flow signal parameters (including VI, FI, and VFI) in 3D power Doppler ultrasonography had significant antidiastole values between endometrial cancer and uterine parenchyma lumps to assist clinicians in properly diagnosing patients.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Mioma/diagnóstico por imagem , Pólipos/diagnóstico por imagem , Adulto , Angiografia/estatística & dados numéricos , Área Sob a Curva , Velocidade do Fluxo Sanguíneo , Carcinoma/irrigação sanguínea , Carcinoma/patologia , Diagnóstico Diferencial , Neoplasias do Endométrio/irrigação sanguínea , Neoplasias do Endométrio/patologia , Endométrio/irrigação sanguínea , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Mioma/irrigação sanguínea , Mioma/patologia , Pólipos/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Software , Ultrassonografia Doppler/estatística & dados numéricos
4.
Nucl Med Commun ; 40(11): 1099-1104, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31568194

RESUMO

OBJECTIVE: Surgical staging is the most confidential method for prognosis prediction. However, in which stage the surgery is needed and the treatment management of these patients is controversial. Presentation of new determinant factors with imaging methods for prediction of poor prognosis can provide better disease management. The aim of our study was to demonstrate the ability of metabolic tumor volume and total lesion glycolysis as a prognostic factor to predict the disease-free survival time, necessity of adjuvant radiotherapy-chemotherapy, and the association of these parameters with the clinicopathological features. METHODS: Forty-four endometrial cancer diagnosed patients whose PET/CT scans were performed for treatment planning were included in our study. Metabolic parameters (SUVmax, metabolic tumor volume, total lesion glycolysis) of the primary tumor were calculated. Abdominal hysterectomy was performed for all patients. Histopathologic findings were noted. Patients were followed for 31.4 ± 14.8 months. RESULTS: Metabolic tumor volume and total lesion glycolysis were significant prognostic factors for disease-free survival, whereas SUVmax did not effect disease-free survival. According to regression analysis, only metabolic tumor volume was found significant for radiotherapy planning (cutoff metabolic tumor volume; 26.30 ml). There was significant association between metabolic tumor volume, total lesion glycolysis and early-stage, myometrial invasion, and lymph node positivity. We observed only weak association between SUVmax and myometrial invasion. ROC curve calculated metabolic tumor volume and total lesion glycolysis cutoff values as 19.6 ml and 90 g for early-stage, 14.3 ml and 173.4 g for myometrial invasion, and 29.7 ml and 283.1 g for lymph node positivity, respectively. CONCLUSION: Metabolic tumor volume and total lesion glycolysis may be used as prognostic factors for endometrial cancer. The association between SUVmax and clinical findings, disease-free survival, histopathological features are weak. Further studies are needed for demonstrating the prognostic value of metabolic volumetric parameters.


Assuntos
Neoplasias do Endométrio/metabolismo , Neoplasias do Endométrio/patologia , Fluordesoxiglucose F18 , Glicólise , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Carga Tumoral , Transporte Biológico , Neoplasias do Endométrio/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18/metabolismo , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
5.
Cancer Imaging ; 19(1): 63, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514752

RESUMO

BACKGROUND: Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that features different prognoses for its high- and low-grade subtypes. We investigated the diagnostic accuracy of magnetic resonance (MR) imaging in diagnosing and differentiating between high- and low-grade ESS. METHODS: We retrospectively reviewed the preoperative pelvic MR images of consecutive patients who received histologically confirmed diagnoses of high-grade ESS (n = 11) and low-grade ESS (n = 9) and T2-hyperintense leiomyoma (n = 16). Two radiologists independently evaluated imaging features in T1-, T2-, and diffusion-weighted and contrast-enhanced MR images. Statistical analysis included Mann-Whitney tests and Fisher's exact test, with sensitivity, specificity and diagnostic accuracy of imaging features. RESULTS: High-grade ESS was associated with significantly more extensive necrosis and hemorrhage and distinct feather-like enhancement compared with low-grade ESS (P < .05 for all). The feather-like enhancement pattern yielded a diagnostic accuracy of 95%, sensitivity of 91%, and specificity of 100% in differentiating high-grade from low-grade ESS. This imaging characteristic was significantly superior to the necrosis (80%, P = .033) or hemorrhage (75%, P = .007). Both high- and low-grade ESS demonstrated T2 hypointense bands, marginal nodules, intratumoral nodules, and worm-like intra-myometrial nodules, and their tumor apparent diffusion coefficient (ADC) values were significantly lower than those of T2-hyperintense leiomyomas (P < .001). CONCLUSIONS: Diffusion-weighted MR imaging is useful in diagnosing ESS against T2-hyperintense leiomyomas, and contrast enhancement aids in further differentiating between high- and low-grade ESS.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias do Endométrio/diagnóstico por imagem , Tumores do Estroma Endometrial/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/normas , Neoplasias do Endométrio/patologia , Tumores do Estroma Endometrial/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade
6.
Semin Ultrasound CT MR ; 40(4): 287-294, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31375169

RESUMO

Endometrial carcinoma is the most common female pelvic malignancy in the United States. Although endometrial cancer is staged according to the International Federation of Gynecology and Obstetrics surgical system, early and accurate diagnostic assessment of disease status of gynecologic malignancies is important for optimal treatment planning and outcome prediction. Preoperative imaging may assist in evaluation of local extent and detection of distant metastatic disease guiding the optimal course of treatment. Several imaging techniques such as transvaginal ultrasound, computed tomography, and magnetic resonance imaging have been used as tools for preoperative staging of endometrial cancer. Positron emission tomography/computed tomography and more recently, positron emission tomography/magnetic resonance imaging have also been used in the management of endometrial cancer. Cross-sectional imaging, especially MRI, may detect gross myometrial invasion or extension of tumor to the cervical stroma which can alter management. Imaging studies can also evaluate the presence of lymph nodal involvement, and detect local and distant metastatic disease at diagnosis. Additionally, imaging also plays a role in the monitoring of treatment and surveillance of the patients for detection of early recurrent disease. In this article, we will review the imaging and staging of endometrial cancer.


Assuntos
Diagnóstico por Imagem/métodos , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Imagem Multimodal , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia
7.
Semin Ultrasound CT MR ; 40(4): 295-301, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31375170

RESUMO

Uterine carcinosarcoma (UCS) is a rare and aggressive variant of endometrial cancer, distinguished by its containment of both epithelial and sarcomatous elements. This article reviews the epidemiology, pathologic classification and staging of UCS, along with the typical findings seen on different imaging modalities. Prognosis and therapies will also be discussed.


Assuntos
Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/patologia , Diagnóstico por Imagem/métodos , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia , Neoplasias Uterinas
8.
Semin Ultrasound CT MR ; 40(4): 358-363, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31375175

RESUMO

The coexistence of endometrial adenocarcinoma and adenomyosis in the same uterus is a common phenomenon. In many of such affected patients foci of adenomyosis could also be colonized by adenocarcinoma. The various permutations arising from these scenarios pose preoperative imaging and postoperative pathologic staging challenges. This article aims to raise awareness of these staging issues and lists some of the relevant practical approaches. Adenomyosis reduces the accuracy of magnetic resonance imaging in assessing the depth of invasion as it reduces the contrast between the endometrial cancer adenomyosis-involved myometrium. The article also offers an alternate argument for staging cancers where myoinvasion is found deep in the myometrium, arising from cancer-positive adenomyotic foci when the surface tumor is either limited to the endometrium or to the inner half of myometrium.


Assuntos
Adenomiose/diagnóstico por imagem , Adenomiose/patologia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Imagem por Ressonância Magnética/métodos , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Estadiamento de Neoplasias
9.
Radiología (Madr., Ed. impr.) ; 61(4): 315-323, jul.-ago. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185309

RESUMO

Antecedentes y objetivos: El tratamiento estándar para el cáncer de endometrio (CE) es la histerectomía simple con salpingo-ooforectomía bilateral. Las pacientes dentro del grupo de alto riesgo son las que se benefician de la linfadenectomía lumboaórtica. En dicho grupo se encuentran las que presentan grado y subtipo histológico de mal pronóstico y profundidad de invasión miometrial superior al 50% (M2). Este último parámetro puede ser brindado por el estudio intraoperatorio por congelación (EIC) y la resonancia magnética (RM), contribuyendo a decidir quiénes se beneficiarán de la linfadenectomía. El objetivo es establecer el rédito diagnóstico de la RM y EIC para determinar la presencia de M2 en pacientes con CE. Materiales y métodos: Estudio de tipo test diagnóstico, corte transversal. Se incluyeron pacientes de sexo femenino con diagnóstico histopatológico de CE, a las que se realizó RM inicial o basal y fueron intervenidas quirúrgicamente en nuestra institución entre el 1 de enero de 2010 y el 31 de diciembre de 2017. Se estudiaron las RM y los informes de EIC y se compararon con los datos del informe de anatomía patológica. Se efectuó un análisis estadístico de sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de ambas pruebas diagnósticas. También se calculó la tasa de precisión diagnóstica de cada método discriminado, el porcentaje de subestimación y sobrestimación. Finalmente, se calculó el valor predictivo de la RM para determinar la presencia de M2 ajustándolo por las variables histológicas de mal pronóstico conocidas. Resultados: Para la determinación de M2, la RM presentó una sensibilidad del 63%, una especificidad del 87%, un VPP del 73% y un VPN del 81%. La tasa de precisión diagnóstica fue del 78,8%, un 13,12% por subestimación y un 8,13% por sobrestimación de M2. Por su parte, el EIC presentó una sensibilidad del 69%, una especificidad del 86,7%, un VPP del 69% y un VPN del 86%. La tasa de precisión diagnóstica fue del 81,5%, un 9,24% por subestimación y 9,24% por sobrestimación de M2. El grado de concordancia entre ambos métodos es moderada (valor de kappa de 0,54, p < 0,00001). Conclusiones: En nuestra experiencia, la RM y el EIC presentan un adecuado rédito diagnóstico, pero a favor del EIC, para determinar M2. La contribución de la RM al determinar la presencia y el sitio de invasión miometrial profunda, así como de los factores que puedan resultar confundidores, sumado al aporte de la EIC, se traduce en que ambos métodos ayudan a disminuir el número innecesario de linfadenectomías, con la morbimortalidad y los costos en salud asociados


Background and objectives: The standard treatment for endometrial cancer is simple hysterectomy with bilateral salpingo-oophorectomy. Patients with high risk also benefit from lumbo-aortic lymphadenectomy. High risk patients include those with grades and histologic subtypes associated with poor prognosis and depth of myometrial invasion greater than 50% (M2). To determine which patients would benefit from lumbo-aortic lymphadenectomy, the depth of myometrial invasion can be assessed by intraoperative frozen section or by magnetic resonance imaging (MRI). We aimed to determine the diagnostic yield of intraoperative frozen section and MRI for detecting the presence of M2 in patients with endometrial cancer. Materials and methods: This cross-sectional study included women with a histologically confirmed diagnosis of endometrial cancer who underwent baseline MRI and surgical intervention in our institution between 1 January 2010 and 31 December 2017. We reviewed the MRI studies and the intraoperative frozen section reports and compared them with the information in the histopathology report. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the two tests. We also calculated the diagnostic accuracy of each method and the percentages of underestimation and overestimation. Finally, we calculated the predictive value of MRI for the presence of M2, adjusting it for the histologic variables known to be associated with poor prognosis. Results: To detect M2, MRI had 63% sensitivity, 87% specificity, 73% PPV, and 81% NPV; the diagnostic accuracy was 78.8%, with 13.12% underestimation and 8.13% overestimation of M2. Intraoperative frozen section had 69% sensitivity, 86.7% specificity, 69% PPV, and 86% NPV; the diagnostic accuracy was 81.5%, with 9.24% underestimation and 9.24% overestimation of M2. The degree of concordance between the two methods was moderate (k=0.54, p < 0.00001). Conclusions: In our experience, MRI and intraoperative frozen section have adequate diagnostic yields for determining M2, though intraoperative frozen section is slightly better. The contribution of MRI in determining the presence and the site of deep myometrial invasion, as well as the factors that can confound the diagnosis, when added to the contribution of intraoperative frozen section, means that both methods help reduce the number of unnecessary lymph node dissections and the morbidity, mortality, and health costs associated with this practice


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias do Endométrio/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Excisão de Linfonodo/métodos , Histerectomia/métodos , Neoplasias do Endométrio/patologia , Espectroscopia de Ressonância Magnética/métodos , Período Intraoperatório , Biópsia/métodos
10.
Taiwan J Obstet Gynecol ; 58(4): 497-500, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307740

RESUMO

OBJECTIVES: The feasibility of vaginoscopic hysteroscopy combined with office endometrial biopsy after ultrasonography for management of post-menopausal vaginal bleeding (PMB). MATERIALS AND METHODS: A prospective observational study of with PMB whom attending the Outpatient Clinic of Kang Ning Hospital during a four months period (1st Feb to 31st May 2018) was included. Vaginoscopic hysteroscopy was performed with endometrial biopsy after the initial clinical pelvic examination and transvaginal ultrasound examination. RESULTS: A total of 45 consecutive women with PMB was included. The hysteroscopy and endometrial biopsy were successful in 44 out of 45 (98%), a complete view in 82%, adequate tissue was in 91%, only one case was failed both procedures due to pain. The correlation between hysteroscopy and endometrial biopsy by was 100%. The mean operation time was 229 ± 68 s. The most common histological findings was atrophic endometrium 18 (42%). Five endometrial polyps and 2 submucosal leiomyomas were found. One rare case of endometrial carcinosarcoma (2%) was detected. Patients reported less pain for hysteroscopy than endometrial biopsy with rated VAS pain score was 3.5 ± 2.2, with 5 more score in 18%, and for endometrial biopsy 4.2 ± 2 and 33% respectively (p < 0.001). Six cases (13%) experienced vasovagal attacks immediately after the procedure. There is no other complication. CONCLUSION: The Vaginoscopic hysteroscopy combined endometrial biopsy is safe and feasible for assessment of endometrial pathology with postmenopausal bleeding.


Assuntos
Neoplasias do Endométrio/cirurgia , Endossonografia/métodos , Histeroscopia/métodos , Pós-Menopausa , Hemorragia Uterina/diagnóstico por imagem , Hemorragia Uterina/cirurgia , Idoso , Biópsia por Agulha , Estudos de Coortes , Neoplasias do Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Exame Ginecológico/métodos , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Taiwan , Resultado do Tratamento , Ultrassonografia Doppler/métodos
11.
Am J Case Rep ; 20: 961-964, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31273185

RESUMO

BACKGROUND Glassy cell carcinoma of the endometrium is an extremely rare variant of adenosquamous carcinoma, and it has a poor prognosis. In postmenopausal women it typically presents as unprovoked, painless uterine bleeding. Tissue sampling is necessary to establish the diagnosis. CASE REPORT A 58-year-old postmenopausal woman on no hormone replacement therapy experienced 2 months of intermittent uterine bleeding. An office transvaginal ultrasound discovered a 1.7-cm intracavitary leiomyoma, but because the endometrial stripe was not visualized, an endometrial biopsy was performed. She was found to have a Stage 1 A endometrial poorly-differentiated adenosquamous carcinoma, glassy cell carcinoma tumor of 1.5 cm in greatest dimension. She underwent a robotic total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymph node mapping, and bilateral pelvic lymphadenectomy. CONCLUSIONS Glassy cell carcinoma of the endometrium can present as an intracavitary leiomyoma in postmenopausal women.


Assuntos
Carcinoma Adenoescamoso/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Ultrassonografia , Carcinoma Adenoescamoso/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Leiomioma/cirurgia , Excisão de Linfonodo , Pessoa de Meia-Idade
12.
BMC Cancer ; 19(1): 547, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174495

RESUMO

BACKGROUND: Obesity is an important cause of multiple cancer types, amongst which endometrial cancer (EC). The relation between obesity and cancer is complicated and involves alterations in insulin metabolism, response to inflammation and alterations in estradiol metabolism. Visceral obesity is assumed to play the most important role in the first two mechanisms, but its role in estradiol metabolism is unclear. Therefore, this retrospective study explores the relationship of body mass index (BMI), visceral fat volume (VAV) and subcutaneous fat volume (SAV) and serum levels of sex steroids and lipids in patients with endometrial cancer. METHODS: Thirty-nine postmenopausal EC patients with available BMI, blood serum and Computed Tomography (CT) scans were included. Serum was analyzed for estradiol, dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, cholesterol, triglycerides and high (HDL), low (LDL) and non-high density (NHDL) lipoprotein. VAV and SAV were quantified on abdominal CT scan images. Findings were interpreted using pearson correlation coefficient and linear regression with commonality analysis. RESULTS: Serum estradiol is moderately correlated with BMI (r = 0.62) and VAV (r = 0.58) and strongly correlated with SAV (r = 0.74) (p < 0.001 for all). SAV contributes more to estradiol levels than VAV (10.3% for SAV, 1.4% for VAV, 35.9% for SAV and VAV, p = 0.01). Other sex steroids and lipids have weak and moderate correlations with VAV or SAV. CONCLUSIONS: This study shows that serum estradiol is correlated with BMI and other fat-distribution measures in postmenopausal endometrial cancer patients. Subcutaneous fat tissue contributes more to the estradiol levels indicating that subcutaneous fat might be relevant in endometrial cancer carcinogenesis.


Assuntos
Tecido Adiposo/patologia , Adiposidade , Neoplasias do Endométrio/sangue , Neoplasias do Endométrio/patologia , Hormônios Esteroides Gonadais/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Índice de Massa Corporal , Comorbidade , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/etiologia , Feminino , Humanos , Lipídeos/sangue , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Obesidade/complicações , Obesidade/metabolismo , Tamanho do Órgão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
Diagn Pathol ; 14(1): 54, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174566

RESUMO

BACKGROUND: Endometrial mesonephric-like adenocarcinomas exhibit classical histologic features of mesonephric carcinoma; however, it remains unclear whether these tumors represent mesonephric (Wolffian) carcinoma or endometrioid (Müllerian) carcinomas that closely mimic mesonephric carcinoma. CASE PRESENTATION: A 32-year-old Japanese primigravida presented with atypical vaginal bleeding. An endometrial biopsy suggested low-grade endometrioid carcinoma, and she was administered medroxyprogesterone acetate. Her tumor recurred 6 years later, and she underwent hysterectomy, salpingo-oophorectomy, and omentectomy, at which point she was diagnosed with mesonephric-like adenocarcinoma of the uterine endometrium. Retrospective pathological review of the initial biopsy confirmed coexisting low-grade endometrioid carcinoma and mesonephric-like adenocarcinoma of the uterine endometrium. On immunohistochemistry, the endometrioid carcinoma component was diffuse positive for estrogen and progesterone receptors but negative for thyroid transcription factor 1. However, the mesonephric-like adenocarcinoma component exhibited a mixture of estrogen receptor- and thyroid transcription factor 1-positive cells within the same glands. CONCLUSIONS: We encountered a patient with coexisting endometrial mesonephric-like adenocarcinoma and low-grade endometrioid carcinoma, which was treated using medroxyprogesterone acetate therapy, resulting in recurrence of mesonephric-like adenocarcinoma alone. These clinicopathological findings support the prevailing notions that mesonephric-like adenocarcinoma is a Müllerian adenocarcinoma exhibiting mesonephric differentiation.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Antineoplásicos Hormonais/uso terapêutico , Biomarcadores Tumorais/metabolismo , Carcinoma Endometrioide/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Acetato de Medroxiprogesterona/uso terapêutico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma Endometrioide/tratamento farmacológico , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Diferenciação Celular , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Endométrio/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética , Ductos Paramesonéfricos/patologia , Ductos Paramesonéfricos/cirurgia , Estudos Retrospectivos , Ductos Mesonéfricos/patologia
14.
Clin Nucl Med ; 44(7): 574-575, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31107747

RESUMO

For early-stage endometrial cancer patients who wish to preserve fertility, progestin treatment is effective. However, repeated endometrial curettage to evaluate treatment response may cause infertility. The clinical courses of 3 patients who were treated with fertility-sparing progestin treatment and underwent serial F-FES PET before and after treatment are presented. The SUVmean decreased greatly in patients with pathologically complete response (44.2%, 46.2%), whereas there was only a small change (22.5%) in the patient with pathologically stable disease who finally underwent hysterectomy. F-FES PET can be a noninvasive method to evaluate response to fertility-sparing progestin treatment.


Assuntos
Hiperplasia Endometrial/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Estradiol/análogos & derivados , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Adulto , Hiperplasia Endometrial/tratamento farmacológico , Neoplasias do Endométrio/tratamento farmacológico , Feminino , Humanos , Tomografia por Emissão de Pósitrons/normas , Progestinas/uso terapêutico
15.
Medicine (Baltimore) ; 98(22): e15707, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145284

RESUMO

INTRODUCTION: Magnetic resonance (MR) relaxometry provides a noninvasive predictive tool to discriminate between benign ovarian endometrioma (OE) and endometriosis-associated ovarian cancer (EAOC). Transverse relaxation rate R2 value was determined using a single-voxel, multi-echo MR sequence (HISTO) by a 3T-MR system. R2 with cutoff value of 12.1 s was established to discriminate between benign and malignant tumors. PATIENT CONCERNS: We present a case of a 39-year-old woman who was initially thought to be malignant transformation of endometriosis by diagnostic MR imaging of the vascularized solid components. DIAGNOSIS: A R2 value of 42.62 s on MR relaxometry demonstrated that this case is non-malignant. INTERVENTIONS: To confirm the diagnose, left salpingo-oophorectomy by laparoscopic surgery was performed. OUTCOMES: Histopathological results revealed seromucinous borderline tumor (SMBT). Our experience suggests that preoperative MR relaxometry may be useful for discriminating "borderline (SMBT)" from "malignancy (EAOC)." Furthermore, immunohistochemical studies of this case demonstrated ovarian SMBT cells were positive for estrogen receptor, progesterone receptor, and hepatocyte nuclear factor-1beta. A similar expression pattern was also observed in patients with benign OE. LESSONS: In many respects, SMBT characteristics differ from those of EAOC but resemble those of benign OE. MR relaxometry unveils a new clinical approach as an adjunctive modality for discriminating SMBT from EAOC.


Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Endometriose/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/estatística & dados numéricos , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Endometriose/complicações , Feminino , Humanos , Espectroscopia de Ressonância Magnética/métodos , Neoplasias Císticas, Mucinosas e Serosas/etiologia , Neoplasias Ovarianas/etiologia , Ovário/diagnóstico por imagem , Ovário/patologia , Valores de Referência , Salpingo-Ooforectomia
16.
A A Pract ; 13(5): 169-172, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31045587

RESUMO

Percutaneous cryoablation of pulmonary tumors at the posterior lung base is challenging due to diaphragmatic motion and the requirement for prone positioning. High-frequency jet ventilation allows oxygenation and ventilation with minimal diaphragmatic movement. In this case report, we describe the use of high-frequency jet ventilation in the prone position to facilitate the cryoablation of a peridiaphragmatic pulmonary neoplasm.


Assuntos
Criocirurgia/métodos , Neoplasias do Endométrio/terapia , Ventilação em Jatos de Alta Frequência/métodos , Neoplasias Pulmonares/terapia , Idoso , Neoplasias do Endométrio/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Decúbito Ventral , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Acta Oncol ; 58(8): 1127-1134, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31017032

RESUMO

Introduction: Adjuvant whole-pelvic radiation therapy (WPRT) improves locoregional control for high-intermediate stages I-III endometrial cancer patients. Intensity modulated radiation therapy (IMRT) tends to replace the standard 3D conformal radiation therapy (3DCRT) technique used in trials. Material and methods: Consecutive patients with stages I-IIIc endometrial cancer treated between 2008 and 2014 in our department with post-operative 3DCRT or IMRT WPRT were studied retrospectively. Patients with cervical involvement underwent additional low-dose rate vaginal brachytherapy. The impact of the WPRT technique on local control, tolerance, disease-free survival (DFS) and overall survival (OS) was assessed. Clinicians evaluated routinely acute radiation toxicity each week during radiation therapy and late toxicity during standard follow-up consultations. Results: Median follow-up was 50 months (range: 6-158). Among the 83 patients included, 47 were treated with 3DCRT and 36 with IMRT. There was no difference in patient characteristics between groups. The 5-year locoregional control and DFS rates were 94.5% and 68%, respectively. No significant difference was found between the 3DCRT and IMRT groups in terms of survival, with 5-year OS rates of 74.6% and 78%, respectively. In multivariate analysis, age over 68, stage > T1 and grade 3 were independently associated with shorter DFS and OS. Seven patients (8.4%) had grades 3-4 acute gastrointestinal (GI) toxicity with five patients (10.6%) and two (5.4%) in the 3DCRT and IMRT groups, respectively (p = .69). One case (1.2%) of late grade 3 GI toxicity was observed treated in 3DCRT. Conclusions: IMRT seems to be a safe technique for the treatment of endometrial cancer with a trend towards decreased acute GI toxicities. Results of the phase 3 RTOG 1203 trial are needed to confirm these results.


Assuntos
Neoplasias do Endométrio/terapia , Recidiva Local de Neoplasia/epidemiologia , Lesões por Radiação/epidemiologia , Radioterapia Conformacional/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/mortalidade , Feminino , Seguimentos , Humanos , Histerectomia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Prognóstico , Lesões por Radiação/etiologia , Planejamento da Radioterapia Assistida por Computador , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X
18.
Ginekol Pol ; 90(3): 128-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30950001

RESUMO

OBJECTIVES: To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer. MATERIAL AND METHODS: This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion. RESULTS: In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684-0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812-0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001). CONCLUSIONS: The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.


Assuntos
Neoplasias do Endométrio , Secções Congeladas/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Miométrio , Idoso , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Pessoa de Meia-Idade , Miométrio/diagnóstico por imagem , Miométrio/patologia , Cuidados Pré-Operatórios/métodos , Curva ROC , Estudos Retrospectivos
19.
Brachytherapy ; 18(4): 437-444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31005602

RESUMO

PURPOSE: Many patients with endometrial cancer cannot undergo surgery and instead receive definitive radiation therapy (RT). We investigate the correlation between MRI response to RT and clinical outcomes. METHODS AND MATERIALS: Women with inoperable, clinical Stage I endometrial cancer were treated with definitive brachytherapy (BT) with/without pelvic RT (PRT). Patients underwent MRI with functional diffusion-weighted imaging before and after RT. A radiologist retrospectively classified cases as complete, partial, or indeterminate response (CR, PR, or IR, respectively) vs. disease progression. Local control was clinicopathologically defined. RESULTS: From 2007 to 2017, 50 women underwent definitive RT. Thirty-five (70%) received BT alone (median dose 37.5 Gy). For combined therapy, the median PRT and BT doses were 45 and 25 Gy, respectively. Median gross tumor volume and high-risk clinical target volume were 7.1 cc and 90.0 cc, respectively. Median followup among living patients was 20 months. All patients underwent post-RT MRI with T1/T2 sequencing at a median of 3.2 months after RT; 40 patients (80%) underwent functional diffusion-weighted imaging sequences. On initial post-RT MRI, CR was documented in 42 patients (84%), IR in 1 patient (2%), and PR in seven patients (14%). At median followup of 16.3 months, no CR patients had uterine failure. Among eight patients with initial PR/IR, all were found to be clinicopathologically no evidence of disease at the uterus on further evaluation. CONCLUSIONS: Definitive RT with BT or BT + PRT is associated with high response rates on MRI. Overall, initial CR predicted for excellent outcome with no infield failure.


Assuntos
Braquiterapia , Imagem de Difusão por Ressonância Magnética , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/radioterapia , Recidiva Local de Neoplasia/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Resultado do Tratamento
20.
Clin Nucl Med ; 44(7): e425-e427, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30985410

RESUMO

Primary endometrial hepatoid adenocarcinoma is a rare tumor. We present a case of a 64-year-old woman with vaginal bleeding for 2 months and a markedly elevated serum α-fetoprotein of 3931 ng/mL. Hysteroscopic segmental curettage revealed endometrial adenocarcinoma. A pelvic MRI was performed for local tumor invasion, which showed only endometrial mass. An abdominal enhanced CT showed no liver lesion, which excluded primary hepatic carcinoma. Staging F-FDG PET/CT demonstrated a hypermetabolic mass in the endometrium. A total hysterectomy with bilateral salpingo-oophorectomy and regional lymphadenectomy were performed. Postoperatively, the mass was diagnosed as primary endometrial hepatoid adenocarcinoma.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adenocarcinoma/patologia , Neoplasias do Endométrio/patologia , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos
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