Endometrioid Adenocarcinoma Arising in Endometriosis Foci Six Years After Estrogenic Replacement Therapy: A Case Report (original) (raw)

Adenocarcinoma of the Endometrium — The Art of Its Diagnosis

Gynecologic Cancers - Basic Sciences, Clinical and Therapeutic Perspectives, 2016

The diagnostic process begins at the first meeting with the patient, where we must relate the symptoms and signs associated with endometrial disease. Communication skills are fundamental for excellence in medical care. Even with the development and improvement of new technologies in recent decades, be it endoscopy, ultrasound, computed tomography or magnetic resonance imaging, the communication is also essential. We must have skills to recognize and elucidate a wide variety of signs and symptoms when we take a history and do a physical examination of the patient, where abnormal uterine bleeding is the first main sign that can lead to an early diagnosis of endometrial cancer. The endometrium, as every target organ of steroid hormones, shows involutional changes during ovarian failure. In peri-menopause, however, tissue hyperactivity stages occur with some frequency, showing a marked endometrial sensitivity to hormonal fluctuations, whether on an absolute or relative level. Irregular blood loss occurs in many women during this period, and although being most times of functional origin, it requires investigation. It is noteworthy that the most frequent cause of abnormal bleeding of organic origin in menopause is endometrial. Endometrial pathologies appear with advancing age. Therefore an appropriate workup should diagnose or rule out disease at this site. Thus, preventive measures should be adopted, such as screening and early diagnosis, and the best treatment for the patient should be established.

The Significance of Tumor Involved Adenomyosis in Otherwise Low-stage Endometrioid Adenocarcinoma

International Journal of Gynecological Pathology, 2010

Depth of myometrial invasion by endometrioid adenocarcinoma (EMAC) is one of the most important predictive factors of disease recurrence. It is unclear whether myoinvasion arising in carcinomatous involvement of adenomyosis (AM) changes prognosis. The purpose of this study was to evaluate the significance and frequency of the tumor involved AM in otherwise low-stage cancers. Eighty-two hysterectomies with EMAC with less than 50% myoinvasion (T1a, FIGO IA), AM, and at least 2 years of follow-up information were reviewed. The tumors were divided into 4 histologic groups: group 1, no involvement of AM by EMAC (n ¼ 38); group 2, tumor involved AM surrounded by endometrial stroma (n ¼ 31); group 3, tumor involved AM with incomplete peripheral endometrial stroma (n ¼ 10); and group 4, tumor involved AM with invasion into adjacent smooth muscle (n ¼ 3). Tumor involved AM was in the inner half of the myometrium in 35 cases and in the outer half of the myometrium in 9 cases. The only adverse outcome was vaginal recurrence, which was noted in 2 of 82 patients; both the patients were from the control group. None of the patients with deep-seated tumor involved AM had tumor recurrence. In otherwise low-stage tumors, our data support the concept that tumor involvement of the deeply located AM does not affect prognosis. Myometrial-based foci of well-differentiated EMAC, completely or partially surrounded by endometrial stroma, most likely represents tumor colonized AM. Determining invasion out of these foci is subjective, and although limited by rarity in this study, carries no adverse outcome. Therefore, staging should be based on the myoinvasion noted at the native endomyometrial junction.

Endometrioid adenocarcinoma of the ovary and endometriosis

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2007

Objective: We present a retrospective analysis of 22 cases of endometrioid ovarian carcinoma, reviewed to identify endometriosis and its malignant transformation. Study design: Twenty-two patients with endometrioid ovarian cancer were included in the review. Their clinical and histological data were retrospectively reviewed. The origin of the tumours was considered endometriosis-related when the presence of malignant changes in endometriosis glands leading to endometrioid carcinoma were found. Results: Endometriosis was detected in three cases (3/22 = 14%). One of them presented a clearly benign to malignant transformation area. In another patient, the transition zone was abrupt and present in both ovaries. In the third, a pre-menopausal woman, ovarian endometriosis with only focal endometrioid carcinoma was observed. The three of them had a clear-cell carcinoma component. The presence of a clear-cell component was significantly greater in patients with endometriosis than in patients without endometriosis Each patient had a different clinical presentation: increase in abdominal perimeter, post-menopausal vaginal haemorrhage and hypermenorrhea. Preoperative CA 125 levels were avalaible in 15 of the patients (15/22 = 68%). Endometriosis was found in two of these 15 patients, both with the highest CA 125 measured levels, exceeding 1700 U/ml. In the remaining of the patients, CA 125 value did not exceed 35 U/ml. Conclusion: Although this association is not very frequent, patients with ovarian endometriosis and a high CA 125 serum level should be managed with special care, regardless of their pre-menopausal or post-menopausal status. #

A profile of endometrioid adenocarcinoma of uterus in a tertiary centre

IP innovative publication pvt. ltd, 2019

Aims: To evaluate the clinicopathological features and relationship of tumor grade, myometrial invasion and lymph node metastasis. Settings and Design: Retrospective analysis. Materials and Methods: The medical records of patients with endometrioid adenocarcinoma of the endometrium treated between January 2013 and January 2016 were reviewed retrospectively. Statistical Analysis Used: The continuous variables were reported using mean +/- SD and the categorical variables were reported using number and percentages. The pre and post operative grades were compared using Wilcoxon Sign Rank Test. All the analyses were done using SPSS version 18.0. Results: A total number of 40 patients were included in the analysis. The mean age was 58.65 years (range- 39 to71). While 29 (72.5%) were post menopausal, 28 (70%) patients presented with PMB. metastases was detected in 12.5% patients. Conclusions: Complete surgical staging is the precise way of determining stage and requirement of adjuvant treatment as it defines prognosis and survival. Studies including large number of patients with complete surgical staging done is required to define the surgical management of patients with endometrial carcinoma.

Morphological, imaging and surgical aspects in endometrial endometrioid adenocarcinoma

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2016

Endometrioid endometrial adenocarcinomas (EECs) are frequent genital tumors for which the clinical, imaging and histopathological integrated analysis is the basis of differential diagnosis and therapeutic attitude. This research represents a tertiary multicenter study including 58 cases examined histopathologically and immunohistochemically, surgically treated, on a five years period. The main characteristics of the patients in the study group are represented by the average age of 66 years, associated with obesity, hypertension, diabetes, history of infertility, early menopause, nulliparity or long-time oral contraception. The most important clinical sign was the menopausal or postmenopausal vaginal bleeding. The golden standard in the diagnosis of endometrial carcinoma is the dilation and curettage of the uterine cavity, followed by histopathological assessment. The association between transvaginal ultrasonography (TVUS) and endometrial biopsy increases to 100% the diagnostic sensi...

Endometrial adenocarcinoma - presenting pathology is a poor guide to surgical management

The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2000

We aimed to evaluate the correlation between the histological grade of endometrial cancer diagnosed on endometrial biopsy or curettage, with the definitive grade and stage of lesion as determined by surgery and histopathological examination and to make recommendations about the suitability of conservative surgery based on preoperative determination of the grade of endometrial adenocarcinoma.

Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection

Journal of Minimally Invasive Gynecology, 2007

A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, presented with menorrhagia. She had been treated with oral contraceptives for 3 years. Office endometrial biopsy indicated well-differentiated villoglandular adenocarcinoma of the endometrium. The patient refused hysterectomy and would consent only to hysteroscopic resection. She remains alive and well, with no clinical evidence of recurrence 5 years after resection. We propose that skillful resectoscopic surgery, under specific circumstance, may be an appropriate alternative treatment to hysterectomy for some early uterine malignancies.