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.

CLINICOPATHOLOGICAL SIGNIFICANCE OF PLAP,NSE AND WT1 DETECTION IN OVARIAN DYSGERMINOMA

Objective: To evaluate the expression of placental alkaline phosphatase (PLAP), neuron-specific enolase (NSE), prolactin (PRL) and Wilms?tumor gene (WT1) protein in ovarian dysgerminoma and its Clinico- pathological significance. Methods: Clinicopathological data were retrospectively reviewed in a total of 31 patients with pure dysgerminoma who were treated at College Clinical Medicin, Chongqing Medical University from January 1983 to October 2002. Immunohistological staining for PLAP, NSE, PRL and WT1 was performed in all 31 tumor tissues. Results: The age of the patients ranged from 12 to 42 years old (average 25 yrs). According to the clinical staging, eighteen patients (58.1%) had stage I disease, 5 (16.1%) had stage II, 6(19.4%) had stage III, and 2 (6.4%) had stage IV disease. Of the 31 cases, the positive expression rates of PLAP, NSE, PRL and WT1 were 100% (31/31), 70.9%(22/31), 3.2%(1/31) and 12.9(4/31) respectively. There was a significant relation between NSE expression and clinical stages (P<0.05) and 5 years survival rate (P<0.05). The positive expression rate of WT1 was significantly related to histological types (P<0.05). Conclusion: Dysgerminomas in earlier stages (stage I/II) are associated with a favorable prognosis. NSE positive expression is closely related with advanced tumor stage (stage III/IV). PLAP and NSE can be considered as important markers of dysgerminoma tissues, and the tumor tissues are the main resources of serum PLAP and NSE. WT1 expression correlates with poorer differentiation of dysgerminoma. The importance of PRL in dygerminoma was not certified in this study, and remains to be defined.