Treatment outcomes of patients with stage II pure endometrioid-type endometrial cancer: a Taiwanese Gynecologic Oncology Group (TGOG-2006) retrospective cohort study

Hung-Chun Fu,Jen-Ruei Chen,Min-Yu Chen,Keng-Fu Hsu,Wen-Fang Cheng,An Jen Chiang,Yu-Min Ke,Yu-Chieh Chen,Yin-Yi Chang,Chia-Yen Huang,Chieh-Yi Kang,Yuan-Yee Kan,Sheng-Mou Hsiao,Ming-Shyen Yen 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.5

Objective: Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. Methods: The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. Results: Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p<0.001), recurrent urinary tract infections (p=0.013), and leg lymphedema (p=0.038). Age over 50-year (HR=9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR=7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR=5.13; 95% CI, 1.38–19.1) and DSS (HR=5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p=0.046), but no impact on survival. Conclusion: Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.

복막세척액 세포검사에서 난소의 점액성, 장액성 및 자궁내막양 선암종의 감별진단

이시내,박인애,Lee, Shi-Nae,Park, In-Ae 대한세포병리학회 2000 대한세포병리학회지 Vol.11 No.2

This study presents the cytologic features of peritoneal washings, with particular emphasis on the cytologic discrimination among serous, mucinous, and endometrioid adenocarcinoma of the ovary. We selected histologically confirmed 27 cases of peritoneal washing : 8 cases of serous cystadenocarcinomas, 5 cases of mucinous cystadenocarcinomas, and 14 cases of endometrioid adenocarcinomas. The most frequent cytologic pattern of three tumors was clusters. Ball pattern was found in serous cystadenocarcinoma(36%) and acinar pattern in endometrioid adenocarcinoma(36%). Mucinous adenocarcinoma showed mucoid background(100%) and endometrioid adenocarcinoma revealed inflammatory background(43%). The cytoplasmic vacuoles were noted in 80%, 13%, and 43% of mucinous, serous, and endometriold adenocarcinoma, respectively. The endometrioid adenocarcinoma showed prominent nucleoli(64%). In conclusion, the cytologic findings of mucinous cystadenocarcinoma were different from that of serous and endometrioid carcinomas, such as mucoid background, abundant cyytoplasm with vacuolated cytoplasm, and peripherally located cytoplasm. Although endometriold carcinoma showed acinar pattern and prominent nucleoli, the differential diagnosis between serous cystadenocarcinoma and endometrioid adenocarcinoma in peritoneal washing cytology was was always possible.

Incidence and Clinical Outcomes of Non-endometrioid Carcinoma of Endometrium: Siriraj Hospital Experience

Jaishuen, Atthapon,Kunakornporamat, Kate,Viriyapak, Boonlert,Benjapibal, Mongkol,Chaopotong, Pattama,Petsuksiri, Janjira,Therasakvichya, Suwanit Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.6

Background: To study the incidence of non-endometrioid carcinoma of endometrium and compare the clinical characteristics and treatment outcomes with endometrioid carcinoma patients. Materials and Methods: This study included 236 patients with endometrial carcinoma at Siriraj Hospital whom were diagnosed and treated from 2003 through 2006. The clinical characteristics, pathological features, treatment and clinical outcomes were collected from the medical records. The 5-year survival was calculated according to 2009 FIGO staging. Results: Non-endometrioid carcinoma of endometrium accounted for 10.2% of all endometrial carcinomas (24/236 patients). The 5-year survival rate was significantly lower in the non-endometrioid group compared to the endometrioid group (77.3% vs 96%, p<0.001) and clinical data pointed to greater malignancy. Conclusions: Non-endometrioid carcinoma of endometrium is relative rare but is more aggressive, has more distant metastasis at diagnosis with a worse survival rate than endometrioid carcinoma. Only patients in stage IA with no residual disease on a hysterectomy specimen may not need adjuvant treatment.

Endometrioid Adenocarcinoma Arising from Endometriosis of the Uterine Cervix: A Case Report

박한뫼,이상수,엄대운,강길현,이상욱,손우석 대한의학회 2009 Journal of Korean medical science Vol.24 No.4

Endometrioid adenocarcinoma arising from endometriosis of the uterine cervix is rare in premenopausal woman. We describe here a patient with this condition and review the clinical and pathological features of these tumors. A 48-yr-old woman complaining of severe dysmenorrhea was referred for investigation of a pelvic mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological examination revealed an endometrioid adenocarcinoma directly adjacent to the endometriosis at the uterine cervix, with a transition observed between endometriosis and endometrioid adenocarcinoma. The patient was diagnosed as having endometrioid adenocarcinoma arising from endometriosis of the uterine cervix and underwent postoperative chemotherapy. Gynecologists and pathologists should be aware of the difficulties associated with a delay in diagnosis of endometrioid adenocarcinoma arising from endometriosis when the tumor presents as a benign looking endometrioma.

Myoferlin Expression and Its Correlation with FIGO Histologic Grading in Early-Stage Endometrioid Carcinoma

김민혜,송대현,고경혁,이정희,김동출,양정욱,이향임,안효정,이종실 대한병리학회 2018 Journal of Pathology and Translational Medicine Vol.52 No.2

Background: For endometrioid carcinoma patients, International Federation of Gynecologists and Obstetricians (FIGO) histologic grading is very important for identifying the appropriate treatment method. However, the interobserver discrepancy with this three-tiered grading system is a serious potential problem. In this study, we used immunohistochemistry to analyze the relationship between FIGO histologic grading score and myoferlin expression. Methods: We studied the endometrioid carcinoma tissues of 60 patients from Gyeongsang National University Hospital between January 2002 and December 2009. Immunohistochemical analysis of myoferlin was performed on tissue microarray blocks from surgical specimens. Results: Myoferlin expression was observed in 58 of 60 patients. Moderate and strong myoferlin expression was observed in low-grade endometrioid carcinoma, while there was a tendency toward loss of myoferlin expression in high-grade endometrioid carcinoma (p < .001). Conclusions: Our study revealed that myoferlin loss is significantly correlated with high FIGO grade of endometrioid carcinoma.

Endometrioid Adenocarcinoma in Urethrovaginal Septum: A Diagnostic Pitfall

임명철,이승미,이정윤,최혁재,이선,허주엽,박상윤 대한의학회 2009 Journal of Korean medical science Vol.24 No.1

Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.

Minimal Deviation Endometrioid Adenocarcinoma of the Uterine Cervix - A Case Report -

권계원,진수지,김희경,고은석,김규래,남계헌 대한병리학회 2008 Journal of Pathology and Translational Medicine Vol.42 No.4

We describe here a case of minimal deviation endometrioid adenocarcinoma (MDEA) of the uterine cervix that was initially suspected according to the abnormal cytologic findings in a 39-year-old woman. The Papanicolaou (pap) smear showed many neoplastic glandular cells in monolayered sheets, rosettes, and clusters with palisading and feathering borders. The tumor cells had oval, hyperchromatic nuclei, with chromatin clumping and small nucleoli. Histologic examination disclosed endometrial-type glands with a bland, isolated, mainly rounded appearance and these glands were widely scattered deep into the cervical stroma with only scant stromal reaction. An association of MDEA with tubo-endometrioid metaplasia or cervical endometriosis has been suggested by identifying the tubo-endometrioid glands in the vicinity of the MDEA.

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

Vakkas Korkmaz,Mehmet Mutlu Meydanli,Ibrahim Yalçın,Mustafa Erkan Sarı,Hanifi Sahin,Eda Kocaman,Ali Haberal,Polat Dursun,Tayfun Güngör,Ali Ayhan 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.6

Objective: To compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus. Methods: A total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity. Results: Systematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR−], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR−, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR−, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively. Conclusion: The ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.

The Potential Roles of MELF-Pattern, Microvessel Density, and VEGF Expression in Survival of Patients with Endometrioid Endometrial Carcinoma: A Morphometrical and Immunohistochemical Analysis of 100 Cases

Dmitry Aleksandrovich Zinovkin,Md Zahidul Islam Pranjol,Daniil Rudolfovich Petrenyov,Eldar Arkadievich Nadyrov,Oleg Gennadievich Savchenko 대한병리학회 2017 Journal of Pathology and Translational Medicine Vol.51 No.5

Background: In this study, we hypothesized that microcystic, elongated, fragmented (MELF)-pattern, vascular endothelial growth factor (VEGF) expression by cancer cells and microvessel density of cancer stroma may be associated with progression of endometrioid adenocarcinoma. Methods: The study used data from the Belarus Cancer Registry and archival histological material of 100 patients with retrospectively known good (survival) and poor (disease progression and death) outcomes. All cases were immunohistochemically stained for CD34 and VEGF. Two independent samples were compared for the characteristics of signs, and obtained results were analyzed by receiver operating characteristic analysis, Mann-Whitney U test, χ2 test (Yates correction), and Mantel-Cox test. Multivariate Cox hazard analysis and Spearman correlation test were used. A p-value of less than .05 was considered statistically significant. Results: The observed survival rate of patients with endometrioid adenocarcinoma was significantly lower (p = .002) in MELF-pattern positive patients when compared with MELF-pattern negative patients. The overall survival rate of patients whose tumors had more than 114 vessels/mm2 of tissue was significantly low (p < .001). Interestingly, a similar observation was found in patients with increased vessel area, evidenced by VEGF expression in the glandular tumor component. Conclusions: Our study suggests, for the first time, that these criteria may be used as risk factors of endometrioid adenocarcinoma progression during 5 years after radical surgical treatment. However, a large independent cohort of samples should be considered in the future to validate our findings.

Microscopic lesions of fallopian tubes in endometrioid carcinoma of the endometrium: How effective are the macroscopic tubal sampling techniques?

Ibrahim Kulac,Alp Usubutun 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.2

Objective: Extrauterine involvement of endometrial carcinoma has a significant effect on the patients’ prognosis and treatment decision. In classical method, macroscopic section is taken from the fallopian tube sparing the fimbrial ends. Fimbrial end of fallopian tube may be involved by tumors and precursor lesions. This study aims to determine the importance of sampling of fimbrial ends of fallopian tube in endometrioid endometrial carcinoma specimens. Methods: We reevaluated the fallopian tubes of 200 cases of endometrioid endometrial carcinoma cases that have no macroscopic tubal lesion. A hundred cases were sampled with classical method, and the other 100 were sampled with a new method that includes the fimbrial ends. Statistical difference was examined by Fisher’s exact test. Results: No microscopic tubal lesion lesion was detected in cases that were sampled with the classical method. In contrast, there were 4 cases with tubal lesions in patients sampled with the new technique; 3 of them were located in the fimbrial end. Of the 3, there was one microscopic invasive carcinoma and two proliferative endometrial glandular lesions. Endometriosis was detected in two of the 4 cases with tubal lesions. Conclusion: Including the fimbrial end of fallopian tube to macroscopic sampling could detect more tubal lesions, which might provide additional prognostic and pathogenetic information of endometrioid endometrial carcinoma.