Endometriosis-associated endometrioid adenocarcinoma of the fallopian tube synchronized with endometrial adenocarcinoma:A case report

BACKGROUND Endometriosis is a common gynecological disorder that affects women of reproductive age.It is characterized by a cancer-like invasion of the extra-uterine endometrium and exhibits a strong association with ovarian clear cell cancer and endometrioid cancer.Endometriosis-associated fallopian tube endometrioid adenocarcinoma synchronized with endometrial adenocarcinoma was rarely reported.CASE SUMMARY A 49-year-old woman was referred to our hospital complaining about abnormal vaginal bleeding for three years following unsatisfactory medication.Intraop-erative frozen sections unexpectedly unveiled an endometrioid cancer of the left fallopian tube with superficial invasion surrounded by diffuse endometriosis synchronized with endometrioid endometrial cancer.CONCLUSION It was difficult to make a differential diagnosis when confronted with incidental findings of fallopian tube cancer lesions synchronized with endometrial cancer.The key differential diagnosis of primary endometriosis-associated endometrioid adenocarcinoma of the fallopian tube from endometrial adenocarcinoma invol-vement relies on the pathological identification of malignant transformation in fallopian tube endometriosis disease.

Correlation between PTEN Expression and PI3K/Akt Signal Pathway in Endometrial Carcinoma

In order to investigate the role of the PTEN expression in carcinogenesis and development of endometrial carcinoma and clarify whether and how PTEN and PI3K/Akt pathway relate to endometrial carcinoma, the expression of PTEN and phospho-Akt was detected by semiquantitative reverse transcription-polymerase chain reaction （RT-PCR） methods and Western-blot from 24 cases of endometrial carcinoma, 10 cases of endometrial atypical hyperplasia, 10 cases of endometrial hyperplasia, and 10 cases of normal endometriurn. SP immunohistochemical methods were used to measure levels of PTEN protein expression in following 5 study groups： 31 cases of endometrium in proliferative phase, 30 cases of endometrium in secretory phase, 71 cases of endometrial hyperplasia, 25 cases of atypical hyperplasia and 73 cases of endometrial carcinoma. Immunostaining score of PTEN was 3.39±0.15 in proliferative phase, 1.90±0.21 in secretory phase, 3.34±0.29 in endometrial hyperplasia, 0.62±0.11 in atypical hyperplasia, and 0.74±0.19 in endometrial carcinoma, respectively. PTEN mRNA relative value in normal endometrium, endometrial hyperplasia, endometrial atypical hyperplasia, and endometrial carcinoma was 2.45±0.51, 2.32±0.32, 0.46±0.11, and 0.35±0.13 respectively. The expression levels of PTEN mRNA and protein in patients with endometrial carcinoma and atypical hyperplasia were significantly lower than in those of proliferative phase and with endometrial hyperplasia. The level of PTEN expression in patients with endometrial carcinoma was significantly related to tissue type （P〈0.005）, differentiation （P〈0.05） and clinical stage （P〈0.05）, but not to depth of myometrium invasion （P〉0.05）. Western blot analysis revealed that Phospho-Akt level in PTEN negative cases was significantly higher, and there was a negative correlation between PTEN and phospho-Akt （r=-0.8973, P〈0.0001）. It was suggested that loss of PTEN expression was an early event in endometrial tumorigenesis. The phosphorylation of Akt induced by the loss of PTEN took part in the tumorigenesis and development of endometrial carcinoma.

OVARIAN METASTASIS IN PATIENT WITH ENDOMETRIAL CARCINOMA

Objective： To study the clinical pathological characteristics of ovarian metastasis of endometrial carcinoma and the factors affecting prognosis. Methods： Retrospective analysis was made to the clinical pathological outcome of endometrial carcinoma patients receiving surgical treatment in our hospital from January 1990 to December 2002. Results： Among the 191 cases of endometrial carcinoma patients, 17 cases （8.9%） had ovarian metastasis and young patients were more likely to have ovarian metastasis. The multiple factor analysis showed that the independent risk factors of ovarian metastasis in endometrial carcinoma included the depth of myometrial invasion, lymph node metastasis and pathological types. Conclusion： Ovarian metastasis in patients with endometrial carcinoma is associated with poor prognosis, the depth of myometrial invasion, lymph node metastasis and histologic types are independent risk factors affecting the prognosis. For young patients at early stage of the disease, it should be prudent as to whether to retain the ovary.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

Correlation between single nucleotide polymorphisms of 17β-HSD-1 and endometrial adenocarcinoma

Objective: To investigate the correlation between 17-beta-hydroxysteroid dehydrogenase type1(17β-HSD-1) gene polymorphisms and risk of endometrial adenocarcino-ma.Methods: Forty-one patients with endometrial adenocarcinoma were selected as experimen-tal group and twenty-seven healthy women were selected as control group.The three common single nucleotide polymorphism of 17β-HSD-1 gene at sites + 1004,+ 1322 and + 1954 were detected by allele-specific PCR(ASA-PCR).The allele frequencies were analyzed by SPSS13.0 software between endometrial cancer cases and controls.Results: We observed no significant difference in various frequency distribution between experimental group and control group.P1004= 0.994,P1322 = 0.974,and P1954 = 0.981.Conclusion: We found that three common SNPs with the 17β-HSD-1 gene were not associated with endometrial adenocarcinoma.We suggest that more research for 17β-HSD needs to explore.

Synchronous primary cancers of the endometrium and ovary： review of 43 cases

Objective： To investigate the clinical and pathological characteristics, treatment methods, and prognosis of synchronous primary cancer of the endometrium and ovary. Methods： The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed. The survival was calculated by Kaplan-Meier method and compared using the log-rank test. Results： The median age of the patients at diagnosis was 49 years （range, 28-73 years）. The most common symptoms were abnormal vaginal bleeding （69.8%） and abdominal or pelvic pain （44.2%）. Pelvic masses were found in 39.5% of the patients and enlarged corpus in 27.9% at physic examination, while pelvic masses were found in 67.4% of the 43 patients （29 cases） and thickening or abnormal endometrium in 23.3% （10 cases） during ultrasound examination. Of 25 patients examined by CT/MRI, pelvic masses were found in 13 cases and enlarged uterus in 11 cases. All 15 patients who underwent endometrial biopsies were proven to have endometrioid carcinomas. Serum CA125 level was found to be elevated in 22 of the 34 examined cases （64.7%） with median value 500 U/mL （range, 39-3439 U/mL）. FIGO stages of endometrial carcinomas： IA 18 cases, IB 20 cases, IC 2 cases, and ⅡA 3 cases; Stages of ovarian carcinomas： IA 19 case, IB 4 cases, IC 7 cases, Ⅱ 4 cases, and ⅢC 9 cases. Twenty-four patients （55.8%） were in stage I both endometrial and ovarian carcinomas. Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy, meanwhile, 12 patients had pelvic lymph nodes dissection. Thirty-eight of the 43 patients （88.4%） had a pathologically proven endometrial adenocarcinomas. The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components （30/43, 69.8%）. Postoperatively, 26 patients （60.5%） received adjuvant chemotherapy alone, 12 had chemotherapy plus radiotherapy, only one patients had radiation alone and the remaining 4 cases received no adjuvant treatment. The 3-year and 5-year survival rates of the group were 87.4% and 71.1% respectively. The 3-year and 5-year survival rates of patients with endometrioid carcinoma at both endometrial and ovarian were higher than that of those with non-endometrioid or mixed histologic subtypes （93.8%, 82% vs 79.7%, 69%）. The 3-year and 5-year survival rates of patients with early stages disease were better than those of other patients （93.3%, 93.3% vs 69.7%, 36.7%）. Recurrence developed in 15 patients （34.9%）. It was showed by univariate analysis that lower CA125 level, early FIGO stage, and adjuvant chemotherapy plus radiotherapy significantly and positively affected the 5-year survival rate, while only early FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors. Conclusion： Synchronous primary cancers of the endometdum and ovary were different from either the primary endometrial or ovarian cancer, while usually it can be detected in early stage with a good prognosis. The impact of the CA125 level on prognosis needs to be further studied. Surgery treatment alone may be enough for early stage patients. Chemotherapy plus radiotherapy may be necessary for advanced patients.

Blockage of PI3K/PKB/P27^(kip1) signaling pathway can antagonize 17β-estradiol-induced Ishikawa proliferation and cell cycle progression

It is well-known that risk for endometrial adenocarcinoma increases in patients with high level ofestrogen that is unopposed by progestin. And activation of extracellular signal-regulated kinase （ERK） and phosphatidylinositol 3 kinase/protein kinase B （PI3K/PKB） pathway are responsible for hormone-dependent cell growth in endometrial carcinoma. PI3K produces phosphatidylinositol- 3-phosphates by phosphory-lating the D3 hydroxyl of phosphoinositides, leading to membrane translocation of PKB,

Accuracy of tumor grade by preoperative curettage and associated clinicopathologic factors in clinical stage Ⅰ endometriod adenocarcinoma

Background Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage Ⅰ endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage Ⅰ endometriod adenocarcinoma. Methods Clinical data of totally 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed. Results In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% （281/687） and an upgraded rate of 24.7% （170/687）. The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively. Conclusions Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage Ⅰ endometriod adenocarcinoma.

Application of ovarian transposition during hysterectomy

Objective To study the optimal position and method for ovarian transposition and its benefits and indications.Methods We performed ovarian transposition in 34 patients from August 1989 to December 2000. Twelve patients were diagnosed with stage Ⅰb to Ⅱa cervical cancer, 4 had stage Ⅰa endometrial carcinoma, 12 had stage Ⅲ to Ⅳ endometriosis, 4 had myoma of uterus, 1 had dysfunctional uterine bleeding, and 1 had an ovarian granulosa cell tumor. Surgery went as follows: the ovary was dissociated by clamp, the skin was incised and a tunnel was made, then the ovary was translocated to the subcutaneous site. In the cases of benign lesions, the ovarian vessel pedicel went in through the abdominal cavity, but in malignant tumors, it went out through the peritoneum. Results In both cases (benign lesions or malignant tumors), the short-term and long-term endocrine function of the translocated ovary remained normal. Furthermore, patients could supervise their translocated ovary themselves.Conclusions Subcutaneous ovary transposition might prevent not only implantation of gastrointestinal cancer but also the extension of pelvic carcinoma to the ovary. Because of the shallow transposition and the incision scar, it is easy for patients to supervise themselves. Moreover, the site of the ovary is easy to locate for ultrasound examinations. Thus, it can obtain the goal of early prevention for cancer. Subcutaneous ovarian transposition with skin incision is the optimal selection and suitable for all patients with various gynecologic diseases in which ovary removal is not necessary.