Detection of endometrial cancer by determination of matrix metalloproteinases in the uterine cavity

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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Sarcoidosis and Sarcoid Reactions in Endometrial Cancer Cases Masquerading Advanced Stage Malignancy

Current Women s Health Reviews ◽

10.2174/1573404817666210208163237 ◽

2021 ◽

Vol 17 ◽

Author(s):

Serkan Akis ◽

Canan Kabaca ◽

Esra Keles ◽

Handan Cetiner ◽

Hatice Akay

Keyword(s):

Endometrial Cancer ◽

Lymph Nodes ◽

Inflammatory Diseases ◽

Uterine Cavity ◽

Standardized Uptake Value ◽

Granulomatous Inflammation ◽

Pathological Examination ◽

Pet Ct ◽

Granulomatous Lesions ◽

Granulomatous Lymphadenitis

Background: Sarcoidosis is usually diagnosed by ruling out other granulomatous inflammatory diseases. Rarely, it may be suspected with a pathological examination after surgical intervention for another disease. The sarcoid reaction is noninfectious granulomatous lymphadenitis which can occur at nodes draining a neoplasm. We demonstrated granulomatous lesions masquerading metastasis by Positron Emission Tomography/Computed Tomography (PET/CT) in endometrial cancer. We presented two cases of endometrial cancer with sarcoidosis and sarcoid-like reactions because of their challenging clinical and radiological findings. Cases: In case 1, there was diffuse granulomatous inflammation (no metastasis) in lymph nodes (n=92) and giant cells containing calcifications (Schaumann bodies). In case 2, PET/CT revealed hypermetabolism with malignancy suspicion in the pelvic lymph nodes (maximum standardized uptake value= 13) and pathological evaluation reported a 4.5 cm tumor within the uterine cavity without any nodal metastasis. Results: PET/CT has no role in the evaluation of differential diagnosis between granulomatous lymphadenitis and metastatic disease. Conclusions: Granulomatous lesions might mimic the metastasis of coexisting malignant diseases.

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Advisability of using early generation Cephalosporines for prevention and treatment of postpartum infection

Journal of obstetrics and women s diseases ◽

10.17816/jowd66371-74 ◽

2017 ◽

Vol 66 (3) ◽

pp. 71-74

Author(s):

Nikolay A. Korobkov

Keyword(s):

Antibacterial Effect ◽

Penetration Rate ◽

Venous Blood ◽

Uterine Cavity ◽

Surgical Site Infections ◽

Lime Treatment ◽

Early Generation ◽

E Coli ◽

Highperformance Liquid Chromatography

Introduction: the following research investigates an availability of a long-lime treatment of postpartum infection by using of Cephalozolin (the Cephalosporine of generation I). Matherials and Methods. Lochia samples were obtained from the uterine cavities of 21 puerperal women who did not receive drug after delivery and were cultured for the identification and the determination of the susceptibilities of the clinical isolates to Cephalozolin. The concentrations of Cephalozolin in the supernatants were measured by highperformance liquid chromatography. Results. We determined the sensivity of the most clinically important bacteria to Cephazoline and its penetration rate to the uterine cavity. We found out the following bacteria which are sensible to Cephazoline – S. agalactiae, E. coli, K. pneumoniae, E. aerogenes. A low rate of Cephazoline ≤ 0,78 mg/ml was inhibited the growth of mentioned above bacteria. Cephazoline is also active as for S. aureus – MIC90 and was equal 3.13 mg/ml. In 3 hours after the injection of 1.0 gr of Cephazoline there was a maximum concentration in a venous blood – 1.63 mg/ml. The concentration of Cephazoline in lochia was rising gradually and it maximum in the uterus cavity in 5 hours was 1.26 mg/ml, and then its slowly went down. Conclusions. The mention above results let us suggest that Cephazoline is penetrates actively to lochia and its still has a good antibacterial effect. Cephazoline is still a treatment of choice as for prevention and a treatment of postpartum surgical site infections by a sensitive microorganism.

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Is lymph node dissection mandatory among early stage endometrial cancer patients? A retrospective study

BMC Women s Health ◽

10.1186/s12905-020-01128-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Guangmin Zhang ◽

Hongyou Chen ◽

Yanying Liu ◽

Liyan Niu ◽

Liming Jin ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Node Dissection ◽

Vaginal Hysterectomy ◽

Uterine Cavity ◽

Pathological Examination ◽

Node Dissection ◽

Node Metastasis ◽

Laparoscopic Assisted Vaginal Hysterectomy

Abstract Background Whether routine lymph node dissection for early endometrial cancer is beneficial to survival is still controversial. However, surgeons usually perform lymph node dissection on all patients with early endometrial cancer. This study aimed to prove that the risk of lymph node metastasis, as defined by our standard, is very low in such patients and may change the current surgical practice. Methods 36 consecutive patients who had staged surgery for endometrial cancer were collected. All eligible patients meet the following very low risk criteria for lymph node metastasis, including: (1) preoperative diagnosis of endometrial cancer (preoperative pathological diagnosis), (2) tumors confined to the uterine cavity and not beyond the uterine body, (3) PET-MRI lymph node metastasis test is negative. PET-MRI and pathological examination were used to assess the extent and size of the tumor, the degree of muscular invasion, and lymph node metastasis. Results The median age at diagnosis was 52 years (range 35–72 years). The median tumor size on PET-MRI was 2.82 cm (range 0.66–6.37 cm). Six patients underwent robotic surgery, 20 underwent laparoscopic surgery, 8 underwent Laparoscopic-assisted vaginal hysterectomy, and 2 underwent vaginal hysterectomy. 23% (63.9%) patients had high-grade (i.e. 2 and 3) tumors. Among the 36 patients who underwent lymph node sampling, the median number of lymph nodes retrieved was 32 (range 9–57 nodules). No patient (0%) was diagnosed with lymph node metastasis. According to the policy of each institution, 8 patients (22.2%) received adjuvant therapy, and half of them also received chemotherapy (4 patients; 50%). Conclusions None of the patients who met the criteria had a pathological assessment of lymph node metastasis. Omitting lymph node dissection may be reasonable for patients who meet our criteria.

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