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Uterine Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Claudia von Arx, Hani Gabra, Christina Fotopoulou
In the case of a carcinoma involving only an endometrial polyp: Prognosis is in general more favorable. Such carcinomas have an excellent prognosis, especially when they are of endometrioid histology and carry a low risk of lymph node metastasis; thus, extensive staging (e.g., lymph node dissection [LND]) is generally not performed. Caution should be exercised here, however, in cases of polypectomy specimens or outpatient biopsies without endometrial curettings, as this may underestimate the true extent of disease in other areas of the uterus. The coincidence of EC in a polyp does not imply that endometrial polyps are premalignant. Their association is due to the fact that endometrial polyps, carcinoma, and cancer precursors (endometrial intraepithelial neoplasia) arise at higher risk in the setting of persistent estrogen exposure (anovulatory cycles or obesity).22
Endometrial cancer: epidemiology, pathology and natural history
Published in A. R. Genazzani, Hormone Replacement Therapy and Cancer, 2020
Over the last decade, the application of molecular genetic methods coupled with morphometric analysis (particularly the study of point mutations, X chromosome inactivation and microsatellite instability) has revealed that the precancerous lesions of the endometrium are monoclonal neoplasms that derive from a polyclonal normal endometrium by mutations which confer small increases in growth advantage26. Although genetically abnormal, these lesions may exhibit a benign growth pattern. Accumulation of sufficient genetic damage allows malignant transformation, a stage in which hormonal support is no longer required for survival. Morphometric analysis has suggested that the architecture of these lesions (glandular crowding) may be as important a diagnostic feature as lesion cytology. As a simplified alternative to the WHO classification system, a group of gynecologic pathologists has proposed the introduction of the Endometrial Intraepithelial Neoplasia (EIN) nomenclature27. According to these authors, the diagnostic features of EIN are glandular crowding with reduction of the stroma (less than 55%), and nuclear atypia. Endometrial lesions which do not meet these diagnostic criteria should be classified as ‘endometrial hyperplasia’.
Uterine Corpus Cancer
Published in Dongyou Liu, Tumors and Cancers, 2017
Histologically, endometrial carcinoma often displays back-to-back endometrial-type glands of varying differentiation or atypia, occasional villoglandular pattern, desmoplastic stroma, foamy cells (due to tumor necrosis), adjacent endometrium with endometrial intraepithelial neoplasia (EIN) or atypical hyperplasia, vascular invasion (with chronic inflammation around lymphatics), trophoblastic differentiation with hCG+ cells, and common squamous metaplasia.
Severe hyperandrogenemia in postmenopausal woman as a presentation of ovarian hyperthecosis. Case report and mini review of the literature
Published in Gynecological Endocrinology, 2017
Adam Czyzyk, Justyna Latacz, Dorota Filipowicz, Agnieszka Podfigurna, Rafal Moszynski, Piotr Jasinski, Stefan Sajdak, Michal Gaca, Andrea R Genazzani, Blazej Meczekalski
Some authors [8,10,12,14,15] raised an issue of ‘unaffected’ ovaries of normal postmenopausal size detected in preoperative imaging. On the other hand, taking into consideration smaller size of postmenopausal ovaries between 2.5 and 3.5 cm³ and average ovarian volume in OH patients of at least 6 cm³ [16], this assessment can be easily underestimated [9,12]. Another issue is reported non-suppressed level of gonadotropins after normalization of T in ovariectomized patients, which is also typical for OH [7,12]. Beksac et al. [1] described two patients diagnosed with stromal OH, one 59-year-old with typically clinical manifestation of hirsutism, acne, alopecia, insulin resistance and second 55-year-old with no clinically symptoms besides postmenopausal bleeding. Both were obese and hypertensive. Similarly to Madiedo et al. [8] endometrial intraepithelial neoplasia was detected in the second women. Also cases of coexisting endometrial adenocarcinoma in the course of OH has been described [13].
Clinical indications referrals – what is the risk of premalignant and malignant female genital tract disease in women referred to a dedicated nurse-led colposcopy service? A retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Florence E. Barton, Rachel E. Lyon, Kay Ellis, Alan M. Gillespie, Madeleine C. Macdonald, Julia E. Palmer
Thirty-seven women (1%) were diagnosed with pre-malignant disease of the cervix or endometrium. One 52 year old woman referred with an abnormal cervix, and irregular bleeding, had endometrial intraepithelial neoplasia (EIN) detected on endometrial biopsy with no malignancy detected at subsequent hysterectomy. Of the remaining 36 women, four had actually been seen due to cytological abnormality and were diagnosed with high-grade cervical intraepithelial neoplasia (CIN). Of the remaining 32 women, 17 (53%) had high-grade CIN and 15 (47%) had low-grade CIN.
Fallopian tube cancer– challenging to diagnose but not as infrequent as originally thought
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Jasmin Hundal, Nerea Lopetegui-Lia, William Rabitaille
Patient is a 50-year-old woman with tobacco use disorder who presented with abnormal uterine bleeding. Since her menarche, she had had regular menstrual cycles. 15 days into her menstrual cycle, she noticed vaginal bleeding, requiring approximately 3 pads daily. Given that it persisted after a few weeks, she sought medical attention. Vaginal bleeding was associated with fatigue, bloating, nausea, loss of urinary control and hot flashes. Her obstetric history included one normal pregnancy and an uncomplicated vaginal delivery. The only relevant family history was breast cancer in her paternal grandmother. Her most recent Pap smear was negative for intraepithelial lesion or malignancy and Human Papilloma Virus (HPV) high risk was negative. Her laboratory testing and physical examination were grossly unremarkable. An endometrial biopsy was performed with no evidence of endometrial intraepithelial neoplasia (EIN). Subsequent gynecologic ultrasound demonstrated multiple uterine fibroids and a double layer endometrium measuring 4.5 mm. More importantly, the left ovary was seen with a complex cyst with mildly echogenic fluid and a solid excrescence. Increased flow was noted in the septum and the excrescence. These findings were suspicious for malignancy. For staging purposes, a computed tomography (CT) of chest, abdomen and pelvis was obtained. Multiple enlarged retroperitoneal lymph nodes and some enlarged lymph nodes along the iliac chain on the right side were visualized. The patient subsequently underwent a diagnostic laparoscopy, which required conversion to exploratory laparotomy, supracervical hysterectomy, bilateral salpingo-oophorectomy, right ureteral lysis, right para-aortic and right pelvic lymph node debulking and omentectomy. The surgical debulking was suboptimal due to unresectable right periaortic lymphadenopathy. Peritoneal washings were negative for malignant cells.