Using a Panel of Immunohistochemical Stains to Determine Risk of Lymph Node Metastases in Women with Endometrioid Adenocarcinoma of the Endometrium

Objectives: The purpose of this study was to determine whether a correlation exists between a panel of immunohistochemical stains (consisting of estrogen receptor (ER), progesterone receptor (PR) and wild type p53 (p53)) and nodal status in women with endometrioid endometrial cancer. Methods: Three hundred forty-three women underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymph node dissection performed. All tumors were stained for ER, PR and p53. This panel was compared to the patient’s nodal status and other clinic-pathologic factors. All data was collected from the patients’ charts. Results: One hundred eight patients had grade 1 tumors (83.3% node negative), one hundred forty three had grade 2 (86.6% node negative), and seventy had grade 3 (74.3% node negative). One hundred thirty six patients (39.6%) had tumors that were positive for ER, PR and negative for p53. Twenty eight patients (8.1%) had tumors that were negative for ER, PR and positive for p53. One hundred seventy nine patients (52.1%) had tumors that had mixed staining. Only 6 (4.4%) patients with ER+, PR+, p53– tumors had positive node nodes (P = 0.005). None of the sixty patients with grade 1 tumors that stained ER+, PR+, p53– had positive nodes found. Conclusion: In women with grade 1 disease, no positive nodes were found if the tumors stained positively for ER and PR and negatively for p53. Further studies will look at staining in diagnostic biopsies specimens and their correlation with nodal status.

Factors Associated with Need for Drainage of Pleural Effusion after Diaphragm Surgery

Background: Diaphragm surgery is common with advanced ovarian malignancies. The purpose of this study is to determine associated factors with the need for drainage of pleural effusion after diaphragm surgery. Methods and Materials: A retrospective chart review was undertaken in all women undergoing debulking surgery for stage IIIc/IV ovarian cancer from 2007-2009. Results: One hundred and eight patients were found to be eligible for the study, but 73 were the primary focus of this paper due to having undergone debulking surgery, including diaphragmatic surgery, from 2007-2009. All 73 had ablation with the argon beam coagulator, 7 had a full thickness resection, and 7 had extensive peritoneal peel. Five patients had preoperative effusions. Only 7 patients required chest drainage postoperatively. Pre-operative ascites correlated closely with postoperative effusion (p-value = 0.031) but not with drainage (p-value = 0.068). The mean age of patients requiring drainage was significantly older (73 years) than that of patients who did not require drainage (60 years) (p-value = 0.002). Conclusion: Older patients undergoing diaphragm surgery are more likely to require chest tube or thoracentesis due to concurrent symptoms. Pre-operative ascites correlates closely with the development of postoperative effusion after diaphragm surgery.