Presentation of endometrial carcinoma in young women

Background: Endometrial carcinoma is a disease of older postmenopausal women, and is relatively uncommon in patients younger than 40 years. Endometrial carcinomas in this age group may be familial, associated with Lynch syndrome, or sporadic. Patient usually has increased exposure to estrogen. In 2%–14% of cases, it occurs in young patients (less than 40 years of age) who are eager to preserve their fertility. Its treatment includes hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy and in some cases, radiation therapy. Prevention of fertility is major challenge encountered in such cases. Aim: To present a case of young woman with endometrial carcinoma and through it to review the literature of its presentation and management in such groups. Case: We report a case of endometrial cancer in a 35-year-old woman with previous 3 cesarean treated for abnormal uterine bleeding and cared for in our department. Conclusion: Most endometrial carcinomas presenting in this young age are associated with estrogen excess. Pathologically they are usually low-grade endometrioid carcinomas with lower stage and are associated with favorable clinical outcomes. With this case the authors emphasize the need of endometrial reckoning in young females with abnormal bleeding before starting any medical treatment. Also highlighting the management options in such cases where fertility preservation holds challenge.

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Endometrial Carcinoma in Women Aged 40 Years and Younger

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0654-ra ◽

2014 ◽

Vol 138 (3) ◽

pp. 335-342 ◽

Cited By ~ 32

Author(s):

Karuna Garg ◽

Robert A. Soslow

Keyword(s):

Lynch Syndrome ◽

Endometrial Carcinoma ◽

Current Knowledge ◽

Young Patients ◽

Data Sources ◽

Low Grade ◽

Age Group ◽

Clinical Behavior ◽

Ovarian Conservation ◽

Endometrial Carcinomas

Context.—Endometrial carcinoma is a disease of older postmenopausal women, and is relatively uncommon in patients younger than 40 years. Endometrial carcinomas in this age group may be familial, associated with Lynch syndrome, or sporadic. Objectives.—To present our current knowledge of endometrial carcinomas in women younger than 40 years. Data Sources.—The review is based on previously published articles on this topic. Conclusions.—Most endometrial carcinomas that occur in this age group are associated with estrogen excess. They are usually low-grade endometrioid carcinomas that present at low stages and are associated with favorable clinical outcomes. Tumors associated with mismatch repair abnormalities and Lynch syndrome appear to be distinct, with worse prognostic factors and, possibly, clinical behavior. Conservative hormonal therapy and ovarian conservation are reasonable considerations in the management of these young patients, but carry the risk of tumor progression, recurrence, and an occult synchronous or metachronous ovarian carcinoma.

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Myoinvasive Pattern as a Prognostic Marker in Low-Grade, Early-Stage Endometrioid Endometrial Carcinoma

Cancers ◽

10.3390/cancers11121845 ◽

2019 ◽

Vol 11 (12) ◽

pp. 1845 ◽

Cited By ~ 2

Author(s):

Ignacio Ruz-Caracuel ◽

Jorge L Ramón-Patino ◽

Álvaro López-Janeiro ◽

Laura Yébenes ◽

Alberto Berjón ◽

...

Keyword(s):

Prognostic Factor ◽

Microsatellite Instability ◽

Endometrial Carcinoma ◽

Early Stage ◽

Disease Free Survival ◽

Figo Stage ◽

Low Grade ◽

Gynecology And Obstetrics ◽

Endometrioid Endometrial Carcinoma ◽

Endometrial Carcinomas

Low-grade and early Federation for Gynecology and Obstetrics (FIGO) stage endometrioid endometrial carcinomas (EEC) have an excellent prognosis. However, approximately 10% of patients develop recurrence, which cannot be correctly predicted at diagnosis. We evaluated myoinvasive patterns as a prognostic factor of relapse in low-grade, early-stage EEC. Two-hundred and fifty-eight cases were selected according to the following inclusion criteria: (i) endometrioid endometrial carcinomas, (ii) grade 1 or 2 with (iii) FIGO stage I or II, and (iv) clinical follow-up. Slides were reviewed to annotate the myoinvasive pattern present in each case (infiltrative glands, microcystic, elongated and fragmented –MELF-, broad front, adenomyosis-like and adenoma malignum). Microsatellite instability was studied by immunoexpression of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6). There were 29 recurrences (11.2%) among the 258 cases analysed. A predominant broad front myoinvasive pattern was significantly associated with tumour relapse (p = 0.003). The presence of a pattern of infiltrative glands (p = 0.001) and microsatellite instability (p = 0.004) were associated with lower disease-free survival, without having an impact on overall survival. Our observations suggest the potential value of the pattern of myoinvasion as a prognostic factor in low-grade, early-stage endometrioid endometrial carcinoma.

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Evaluation of Serum Human Epididymis Secretory Protein 4 (HE4) in Benign Endometrial Disease and Endometrial Cancer

QJM ◽

10.1093/qjmed/hcaa056.028 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S S Mohamed ◽

M A Abdelhafeez ◽

H F Mohamed ◽

F M Abukra

Keyword(s):

Endometrial Cancer ◽

Abnormal Uterine Bleeding ◽

Secretory Protein ◽

Pelvic Lymphadenectomy ◽

Younger Women ◽

Human Epididymis ◽

Significant Difference ◽

Abnormal Bleeding ◽

The Difference ◽

Endometrial Pathology

Abstract Objective The incidence of endometrial cancer is constantly growing. More aggressive types of endometrial cancer as well as the incidence in younger women are being observed. More than 80% of cases are diagnosed in early stages due to early symptoms like abnormal bleeding. Aim of our study to evaluate the ability of serum HE4 concentration to differentiate between benign endometrial disease and endometrial cancer and ass’s correlation it with prognosis of EC. Material and methods Serum HE4 level was measured in 85 patients with abnormal uterine bleeding. Based on histology after curettage the study group was divided into the benign and malignant endometrial pathology groups. Statistical analysis was performed using Mann-Whitney test Results The difference of serum HE4 level between benign endometrial pathology and cancer was significant (p = 0.000) and the cut-off for identification of patients with endometrial cancer was 62 pmol/l. There was a significant difference between Stage (I – II) endometrial cancer, and Stage (III – IV) p = 0.01, Patients who needed lymphadenectomy had significantly higher HE4 level than those who had no indications for this procedure (p = 0,001). Conclusion HE4 is a useful biomarker in diagnosing endometrial cancer. HE4 is associated with high grade endometrial cancer. It can also serve as an useful preoperative counseling tool to identify patients, who may require pelvic lymphadenectomy.

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Differences in endometrial carcinoma presentations and characteristics in pre- and postmenopausal women

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh181107055a ◽

2019 ◽

Vol 147 (11-12) ◽

pp. 692-698

Author(s):

Sasa Andrijasevic ◽

Jelena Dotlic ◽

Nebojsa Arsenovic ◽

Milan Terzic

Keyword(s):

Endometrial Carcinoma ◽

Endometrial Thickness ◽

Preoperative Evaluation ◽

Menopausal Status ◽

Uterine Cavity ◽

Premenopausal Women ◽

Free Fluid ◽

Histopathological Findings ◽

Abnormal Bleeding ◽

Endometrial Carcinomas

Introduction/Objective. As of recently, an increasing number of premenopausal women is being diagnosed with endometrial carcinomas. The objective of our study was to determine if routinely collected clinical and imaging parameters, implying on tumor characteristics, are different in pre- and postmenopausal endometrial carcinoma patients, enabling their appropriate preoperative evaluation. Methods. The study included all patients (n = 209) operated on due to endometrial carcinoma over a period of three years. The diagnosis was based on histopathological findings of exploratory curettage. Medical history was taken for all the patients and they were divided regarding menopausal status. On preoperative ultrasound scan, the endometrial echo pattern was established. The existence of myomas, adnexal masses, free fluid in the abdomen or uterine cavity was noted. Magnetic resonance imaging detected the presence of pelvic metastases and tumor spreading into the uterine cavity, myometrium, cervix, and lymph nodes. Postoperatively, histopathological findings, the tumor stage and grade were established. Results. The majority of women were postmenopausal and secundiparous. Significantly more patients were obese, especially the postmenopausal ones (p = 0.001). Most tumors were endometrioid adenocarcinomas regardless of menopausal status. Irregular/abnormal bleeding (p = 0.037), presence of ascites (p = 0.010), obesity (p = 0.046), and lower parity (p = 0.016) correlated with postmenopausal status. Large exophytic endometrial carcinomas were predominant in younger patients (p = 0.026). Endometrial carcinomas were significantly more often diagnosed in the II FIGO stage in premenopausal patients. There were no other significant differences (endometrial thickness, uterine homogeneity, echogenicity, tumor infiltration and spreading, histopathological type and grade) between pre- and postmenopausal endometrial carcinoma patients. Conclusions. Few differences between pre- and postmenopausal endometrial carcinoma patients existed and the most prominent ones were obesity, parity, irregular/abnormal bleeding, and tumor growth into the cavity.

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Synchronous Primary Ovarian and Endometrial Carcinomas in a Young PatientCase report and literature review

Revista de Chimie ◽

10.37358/rc.19.12.7758 ◽

2020 ◽

Vol 70 (12) ◽

pp. 4360-4365

Keyword(s):

Malignant Tumors ◽

Histopathological Examination ◽

Young Patients ◽

Lower Abdominal Pain ◽

Rare Condition ◽

Abnormal Uterine Bleeding ◽

Serum Levels ◽

Cystic Tumors ◽

Endometrioid Ovarian Carcinoma ◽

Endometrial Carcinomas

Synchronous primary ovarian and endometrial carcinomas is a rare condition encountured in clinical practice, especially in young patients with history of endometriosis. The most frequent histopatological subtype is endometrioid carcinoma. We present a case of a 36-years old patient admitted in the Emergency Department for lower abdominal pain and abnormal uterine bleeding. The clinical and ultrasound examination diagnosed bilateral ovarian cystic tumors, a normal uterine structure and no abdominal fluid colection. Serum levels of ROMA score was performed with normal value. The International Ovarian Tumor Analysis (IOTA) criteria used for ovarian tumors scoring diagnosed a 55% probability for malignant tumors. Laparotomy was performed with prelevation of peritoneal fluid for citology. After right anexectomy was performed, the intraoperative histopathological examination diagnosed endometrioid ovarian carcinoma. Left anexectomy and total hysterectomy with omentectomy and multiple peritoneal biopsy was further performed. The final histopathological examination confirmed endometroid carcinoma in both ovaries and endometrial tissue. Keywords: synchronous genital carcinomas, endometrioid subtype, endometriosis

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Subsequent endometrial carcinoma with adjuvant tamoxifen treatment in Japanese breast cancer patients

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200107000-00003 ◽

2001 ◽

Vol 11 (4) ◽

pp. 272-276 ◽

Cited By ~ 1

Author(s):

N. Nishimura ◽

T. Hachisuga ◽

T. Saito ◽

T. Kawarabayashi

Keyword(s):

Breast Cancer ◽

Endometrial Carcinoma ◽

Cancer Patients ◽

Myometrial Invasion ◽

Tamoxifen Treatment ◽

Adjuvant Tamoxifen ◽

Serous Carcinoma ◽

Breast Cancer Patients ◽

Two Stage ◽

Endometrial Carcinomas

Abstract.Nishimura N, Hachisuga T, Saito T, Kawarabayashi T. Subsequent endometrial carcinoma with adjuvant tamoxifen treatment in Japanese breast cancer patients.This study aimed to detail the clinicopathologic features of endometrial carcinomas that developed in Japanese patients receiving adjuvant tamoxifen treatment for breast cancer patients. Ten endometrial carcinomas in tamoxifen-treated breast cancer patients were collected from two medical centers. The endometrial carcinomas included two stage Ia, four stage Ib, two stage Ic and two stage IIIc. Three tumors were Grade 1, six were Grade 2, and one was Grade 3. The tumor was limited to the endometrium in two cases. Myometrial invasion was limited to the inner half of the myometrium in five cases and involved the outer half in three. A mild degree of lymphovascular space invasion was identified in five cases. Deep cervical invasion was recognized in one case. The cell types comprised nine endometrioid adenocarcinomas and one serous carcinoma. Five of eight postmenopausal endometrial carcinomas were associated with polypoid endometrial lesions composed of cystically dilated atrophic and proliferative glands widely separated by fibrotic stroma. Two patients with retroperitoneal lymph node metastases died of endometrial cancer. One patient developed a contralateral breast cancer during tamoxifen treatment. No patient died of breast cancer. We did not demonstrate a higher frequency of either high-grade tumors or unfavorable histologic subtypes in tamoxifen-treated Japanese breast cancer patients.

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Clinicopathological review of epithelial ovarian tumors in young females and reproductive and survival outcome: Ten years expierence from a tertiary center

10.1055/s-0039-1685302 ◽

2016 ◽

Author(s):

Kusum Lata ◽

Nutan Agarwal ◽

Neerja Bhatla ◽

Alka Kriplani

Keyword(s):

Age Groups ◽

Young Patients ◽

Stage Iv ◽

Progression Free Survival ◽

Survival Outcome ◽

Ovarian Tumors ◽

Tertiary Referral Hospital ◽

Young Females ◽

Presenting Symptoms ◽

Tertiary Center

Objective: To find out the prevalence of epithelial ovarian tumors in young females and correlation with reproductive and survival outcome. Design: Retrospective study. Setting: Tertiary referral hospital. Methods: A retrospective analysis of females from 9-35 year of age group treated for ovarian tumors between January 2003 to July 2013 was performed. Variables studied included age, presenting symptoms, imaging, tumor markers, surgical findings, type of surgery, histopathology reports and follow-up. Main Outcome Measures: Histopathological variant, FIGO stage, reproductive and survival outcome. Results: A total of 155 patients were found to have ovarian tumors. Mean age at time of diagnosis was 24.9 ± 1.8 years (range 9-35). Clinical presentation in majority of the cases was abdominal pain in 68 (43.8%), ascites in 13 (8.3%) mass in abdomen in 25 (16%), followed by irregular menstrual cycles in 15 (9.6%), infertility in 18 (11.6%) 12 (7.7%) were found to be incidental on ultrasound examination while 4 women were found to have virilising symptoms. There were 76 (49.1%) cases of epithelial ovarian tumors, 6 (0.03%) of borderline tumors and 30 (19.3%) were of malignant ovarian tumors while 40 (25.8%) were benign. Stage IA (N = 80), Stage I 8 (n = 2), Stage III (N = 6) and Stage IV (N = 12). Females were further subdivided into three age groups 9-15 years, 15-25 years and 25 to 35 years for determining outcome of epitheliail tumors. Reproductive and survival outcome were studied in each stage. Conclusions: Limited data exists about the histological type distribution, surgical treatment and overall survival of epithelial ovarian tumors in women aged below 35 years. Young patients have higher overall progression-free survival and a better clinical outcome than older patients. Any women presenting with pain and nonspecific symptoms should be investigated and evaluated properly.

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Evaluating the effectiveness of Let’s Talk Period’s educational outreach for high school students

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.11513 ◽

2018 ◽

Author(s):

Lubnaa Hossenbaccus

Keyword(s):

High School ◽

High School Students ◽

Young Female ◽

Von Willebrand Disease ◽

Educational Outreach ◽

School Students ◽

Young Females ◽

Abnormal Bleeding ◽

Von Willebrand ◽

Health Teachers

Von Willebrand Disease, the most common bleeding disorder, is inherited equally by men and women, though bleeding symptoms are usually more evident in females due to their menstrual cycles and childbirth. The goal of developing a youth outreach project was to empower young female high school students with knowledge and resources about abnormal bleeding. The 75-minute presentation was given to five Grade 9 Girls’ Health classes across the Limestone District School Board, and led by a Hemophilia Nurse, supported by a Clinical Research Assistant and a 2nd year undergraduate student, who interacted with students and documented the presentation with photographs. Queen’s REB approved the project, and parental and student permission was obtained for photographs. Using Kahoot, an interactive online quiz program, students participated in short pre- and post-presentation quizzes to evaluate their knowledge and learning. Questions including "True/False: Iron deficiency is normal and expected among young females," were posed within the set of 9 questions on topics of anemia, menstruation, and abnormal bleeding. 84 students participated, aged 14 and 15, and 58 had evaluable quiz results. The results showed an average pre-presentation score of 77%, ranging from 72-83%, with a post-presentation quiz average of 92%, ranging from 83-95%. It was determined that students’ post-presentation scores were significantly higher (p<0.001) than those before the presentation, providing evidence for an increase in student understanding. Testing efficacy of these presentations can help determine their level of utility as a resource for health teachers to implement in their classrooms.

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