Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature

Objective: This study aimed to systematically review the existing literature on malignant transformation of postmenopausal endometriosis to provide information about patient characteristics, hormonal replacement therapy (HRT) use, and outcomes over a period of 52 years (1969–2021). Methods: According to PRISMA guidelines, we searched for (endometriosis OR endometriotic) AND (cancer OR malignancy OR malignant transformation) AND (menopause OR menopausal OR postmenopause OR postmenopausal) in Pubmed (all fields) (accessed on 12 February 2021) and Scopus (Title/Abstract/Keywords) (accessed on 12 February 2021) databases. The only filter used was the English language. Relevant articles were obtained in full-text format and screened for additional references. Eligibility/inclusion criteria: studies including full case description of malignant transformation of endometriosis-related lesions in postmenopause. Results: 75 studies, including 90 cases, were retrieved. The mean age was 55.8 ± 8.5 years. Overall, about 65% of women had a positive personal history of endometriosis/adenomyosis, and 64% of women underwent previous hysterectomy ± bilateral salpingo-oophorectomy. Forty-nine of 74 women used HRT (66.2%). Among the women who used HRT, estrogen-only treatment was taken by approximately 75%. Duration of HRT was longer than five years in 63.3% of cases. About 70% of subjects had histology of endometrioid adenocarcinoma or clear cell carcinoma. Follow-up outcome, available for 61 women, showed a survival rate of 78.7%, recurrence of 9.8%, death of 11.5%. The duration of follow-up had a median of 12 months (interquartile range, 6.75–25 months). Interestingly, over the years of case publication there was a significant inverse correlation with previous history of endometriosis (r = −0.28, p = 0.007), HRT use (r = −0.31, p = 0.006), and previous definitive surgery (r = −0.42, p < 0.001). Conclusions: In the malignant transformation of postmenopausal endometriosis, there are some recurrent clinical conditions: previous endometriosis, major definitive surgery before menopause, and estrogen-only HRT for a relatively long time. However, these clinical conditions have shown a drastic decrease over time. This could likely be the consequence of different attitudes and management of gynecologists linked to up-to-date scientific evidence about the use of major surgery in gynecological pathologies. Malignant transformation of postmenopausal endometriosis is a clinical challenge to be explored further.

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Occurrence of seromucinous borderline tumours in the peritoneal lesions after bilateral salpingo-oophorectomy

BMJ Case Reports ◽

10.1136/bcr-2020-234692 ◽

2020 ◽

Vol 13 (12) ◽

pp. e234692

Author(s):

Taihei Yamada ◽

Satoko Eguchi ◽

Ikuko Yokoo ◽

Takahide Arimoto

Keyword(s):

Malignant Transformation ◽

Surgical Management ◽

Previous History ◽

Cancer Antigen ◽

History Of

A 65-year-old woman with a previous history of bilateral salpingo-oophorectomy had peritoneal cysts, increasing in size over 15 years and an increasing cancer antigen 19–9 (CA 19–9) level. The size of the cysts eventually reached 86 mm and 70 mm. As malignant transformation of endometriosis was suspected, we performed peritoneal cystectomy and hysterectomy. Histopathology revealed seromucinous borderline tumours (SMBTs) derived from endometriosis. One month after surgery, her CA 19-9 level had decreased. It is rare for SMBT to occur after bilateral salpingo-oophorectomy; surgical management is the best treatment at present.

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Parenchymal mucinous cystadenoma of the kidney: a case report and literature review

African Journal of Urology ◽

10.1186/s12301-021-00203-4 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Mahmoudreza Kalantari ◽

Shakiba Kalantari ◽

Mahdi Mottaghi ◽

Atena Aghaee ◽

Salman Soltani ◽

...

Keyword(s):

Renal Cyst ◽

Left Kidney ◽

Previous History ◽

Mucinous Cystadenoma ◽

Single Layer ◽

Renal Cysts ◽

Cystic Mass ◽

Flank Pain ◽

History Of

Abstract Background Mucinous cystadenoma (MC) of the kidney is exceedingly rare. We found 22 similar cases in the literature. These masses are underdiagnosed due to radiologic similarities with simple renal cysts. Case presentation A 66-year-old man with a previous history of hypertension and anxiety was referred to our tertiary clinic with left flank pain. Ultrasound revealed a 60 mm-sized, complex cystic mass with irregular septa in the lower pole of the left kidney (different from last year's sonographic findings of a simple benign cyst with delicate septa). CT scan showed the same results plus calcification. Due to suspected renal cell carcinoma, a radical nephrectomy was performed. Postoperative histopathologic examination revealed a cyst lined by a single layer of columnar mucin-producing cells with small foci of pseudo-stratification, consistent with the MC’s diagnosis. The first follow-up visit showed normal blood pressure without medication and no flank pain and anxiety after a month. Conclusion It is quite challenging to distinguish the primary MC of the kidney from a simple renal cyst based on clinical and imaging findings. The radiologic features of these entities overlap significantly. Thus, complex renal cyst and renal cysts with mural nodules should be followed closely to detect malignancy earlier.

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An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Journal of Personalized Medicine ◽

10.3390/jpm11030178 ◽

2021 ◽

Vol 11 (3) ◽

pp. 178

Author(s):

Noah R. Delapaz ◽

William K. Hor ◽

Michael Gilbert ◽

Andrew D. La ◽

Feiran Liang ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Previous History ◽

Current Treatment ◽

Careful Consideration ◽

P Value ◽

Post Traumatic Stress ◽

Increased Risk ◽

History Of ◽

Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

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A murine model of deep vein thrombosis Characterization and validation in transgenic mice

Thrombosis and Haemostasis ◽

10.1160/th05-03-0170 ◽

2005 ◽

Vol 94 (09) ◽

pp. 498-503 ◽

Cited By ~ 25

Author(s):

Linda Szema ◽

Chao-Ying Chen ◽

Jeffrey P. Schwab ◽

Gregory Schmeling ◽

Brian C. Cooley

Keyword(s):

Deep Vein Thrombosis ◽

Murine Model ◽

Femoral Vein ◽

Previous History ◽

Bed Rest ◽

Major Surgery ◽

Vein Thrombosis ◽

Transgenic Lines ◽

History Of ◽

Deep Vein

SummaryDeep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (>5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies. A transient direct-current electrical injury was induced in the common femoral vein of adult C57Bl/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p<0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121±0.018 mm3 vs. 0.052±0.008 mm3, respectively; p<0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.

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Malignant transformation of endometriosis on vaginal cuff after hysterectomy: a case report

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.13 ◽

2021 ◽

Vol 6 (2) ◽

pp. 161-165

Author(s):

Orkun Ilgen ◽

◽

Sefa Kurt ◽

Deniz Gokcay ◽

Emine Cagnur Ulukus

Keyword(s):

Case Report ◽

Malignant Transformation ◽

Hormone Replacement ◽

Endometrioid Adenocarcinoma ◽

Malignant Tissue ◽

Previous Surgery ◽

Vaginal Cuff ◽

Examination Result ◽

History Of ◽

Abnormal Vaginal Bleeding

Objective. Endometriotic tissue implants rarely transform to malignant tissue, especially in a patient with a hysterectomy and bilaterally salpingo-oophorectomy. However, several cases with cancer arising from endometriosis after hysterectomy were reported in the literature. Hormone replacement therapy only with estrogen is a crucial risk factor for malignant transformation of persistent endometriotic tissue. Case Report. The present case demonstrates an endometrioid adenocarcinoma arising from persistent endometriosis tissue in a patient who was performed hysterectomy with bilateral salpingectomy 3 years ago. The histopathologic specimens of the previous surgery did not include any malignant tissue. After 3 years, she applied to the hospital with abnormal vaginal bleeding, and her histopathologic examination result found an ulcerated mass at the upper one-third of the vagina that is compatible with endometrioid adenocarcinoma. Conclusion. It is crucial to keep in mind the endometriosis history of the patient, to be able to diagnose cancer arising from endometriosis while evaluating the patient with a hysterectomy.

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Clinical Implications of Carcinoma In Situ in Sinonasal Inverted Papilloma

Otolaryngology ◽

10.1177/0194599819883298 ◽

2019 ◽

Vol 161 (6) ◽

pp. 1036-1042 ◽

Cited By ~ 3

Author(s):

Ivy W. Maina ◽

Charles C. L. Tong ◽

Esther Baranov ◽

Neil N. Patel ◽

Vasiliki Triantafillou ◽

...

Keyword(s):

Malignant Transformation ◽

Recurrence Rate ◽

Carcinoma In Situ ◽

Inverted Papilloma ◽

Sinonasal Inverted Papilloma ◽

Definitive Surgery ◽

Severe Degree ◽

Multiple Recurrences

Objective Sinonasal inverted papilloma (IP) is a typically benign sinonasal tumor with a tendency to recur and the potential for malignant transformation. Varying degrees of dysplasia may be present, of which carcinoma in situ (CIS) is most advanced. We hereby describe the biological and clinical behavior of IP with CIS (IPwCIS). Study Design Retrospective cohort. Setting Tertiary academic referral center. Subjects and Methods Patients who underwent surgical resection for IP between 2002 and 2017. Pertinent clinical data were obtained, and all IPwCIS cases were histologically confirmed. Results In total, 37 of 215 cases (17.2%) were identified with IPwCIS. Mean age was 57 years and 86.5% of patients were male. Median follow-up was 82 months, and the recurrence rate was 27%. The maxillary sinus was the most common primary site (37.8%) and 14 tumors (37.8%) demonstrated multifocal attachment, which was associated with recurrence (odds ratio [OR], 9.7; 95% confidence interval [CI], 1.4-112.8; P = .028). IPwCIS was also associated with multiple recurrences (OR, 2.71; 95% CI, 1.246-5.814; P = .021). Most patients were treated with surgery alone (89.1%) and 4 patients received adjuvant radiotherapy (8.1%). Only 1 patient (2.7%) demonstrated malignant transformation after definitive surgery. Conclusions IPwCIS represents the most severe degree of dysplasia prior to malignant transformation and is associated with higher recurrence rate and multifocal involvement but low rate of conversion to invasive carcinoma. The need for adjuvant therapy remains controversial, and further research into the etiology of the disease is warranted.

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Intracranial Hemorrhage Secondary to a Delayed Cerebral Pseudoaneurysm Rupture 18 Years after Cranial Trauma

Case Reports in Neurology ◽

10.1159/000503812 ◽

2019 ◽

Vol 11 (3) ◽

pp. 325-329

Author(s):

Mikel Terceño ◽

Sebastià Remollo ◽

Yolanda Silva ◽

Saima Bashir ◽

Carlos Castaño ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Previous History ◽

Complete Recovery ◽

Good Clinical Outcome ◽

Intracranial Hematoma ◽

Cranial Trauma ◽

History Of ◽

Etiological Study

We report the case of a 38-year-old male with a previous history of severe cranial trauma and subsequent large subdural and subarachnoid hemorrhage on whom an emergent hematoma evacuation was performed with a good outcome and follow-up. Despite a good clinical evolution, the patient experienced a further intracranial hematoma 18 years after the trauma, with severe aphasia and mild right hemiparesis. After complete etiological study, two cranial pseudoaneurysms were observed in the cerebral angiography. Endovascular treatment was successfully completed, achieving full embolization without complications. No rebleeding was detected during follow-up. The patient had a good clinical outcome at 3 months and achieved complete recovery. Cranial pseudoaneurysm rupture is a rare cause of intracerebral hemorrhage, especially if the trauma occurs years before the bleeding.

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Suicidal Intent in Self-Injury

The British Journal of Psychiatry ◽

10.1192/bjp.130.4.377 ◽

1977 ◽

Vol 130 (4) ◽

pp. 377-385 ◽

Cited By ~ 120

Author(s):

David W. Pierce

Keyword(s):

Psychiatric Treatment ◽

Previous History ◽

Isolation Method ◽

Suicidal Intent ◽

Self Injury ◽

Suicide Prediction ◽

Long Term Follow Up ◽

History Of

SummaryThe difficulties in measuring suicidal intent in cases of self-injury are discussed, and a scale is described to measure this intent. This scale has been used in 500 cases of self-injury. It is practical and reliable. Results show that the scores derived from it are closely related to the similar Beck Scale; they are also related to age, sex, social isolation, method of self-injury, previous history of self-injury or of psychiatric treatment, physical health at the time of self-injury and alcohol abuse. These results are discussed with particular reference to suicide prediction and the future validation of the scale by long-term follow-up.

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Essential Thrombocythemia: Analysis of Risk Factors for Thrombotic Events in a Series of 306 Patients.

Blood ◽

10.1182/blood.v106.11.4937.4937 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4937-4937

Author(s):

Franca Radaelli ◽

Stefania Bramanti ◽

Mariangela Colombi ◽

Alessandra Iurlo ◽

Alberto Zanella

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Essential Thrombocythemia ◽

Thrombotic Event ◽

Previous History ◽

Significant Difference ◽

Platelet Number ◽

History Of

Abstract Essential thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by peripheral thrombocytosis and abnormal proliferation of megakariocytes in the bone marrow. Even thought thrombosis is frequently associated to ET, the risk factors of this clinical complication are still controversial. The aim of this retrospective, single institution study was to investigate clinical and laboratory characteristics associated with the occurrence of thrombotic events, with the purpose of identifying subgroups of patients who could benefit from antiaggregant and/or cytostatic treatment. 306 consecutive ET patients (109 men and 197 females, median age 58 yr) diagnosed between January 1979 and December 2002 were included in the study. At the time of analysis, 196 patients were still alive with a median follow up of 96 months. The following variables were investigated for the association with thrombotic complications: age, platelet count, previous history of thrombotic events, time from diagnosis, treatment with antiaggregant/cytostatic drugs, and cardiovascular risk factors such as arterial hypertension, obesity, hypercolesterolemia, diabetes, cigarette smoking. At the time of last follow up, 46 patients (15%) experienced at least one thrombotic event. The occurrence of thrombotic events was observed in 26/64 (40.6%) patients with previous history of thrombosis and in 20/242 (8.3%) patients with no previous history of thrombosis (p<0.0001 Fisher’s exact test, odd ratio 7.6). A significant difference between the two groups of patients was also confirmed when Kaplan Meier estimates of thrombosis-free survival were compared by log-rank test (p<0.0001). By logistic regression, platelet number at diagnosis did not associate with occurrence of thrombosis in the whole patient population. When patients without previous history of thrombosis were stratified according to the number of cardiovascular risk factors (none vs one vs more than one), a significant correlation with occurrence of thrombotic events was observed (Mantel-Haenszel Chi-square 5.47, p<0.05). This study confirms that history of thrombosis is strongly related with risk of further thrombotic events in patients with ET, whereas platelet number at diagnosis does not seem to represent a prognostic factor. In patients with no previous history of thrombosis, the presence of other cardiovascular risk factors has to be taken into account when establishing the therapeutic approach.

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Pleural Effusions Associated with Use of Dasatinib in Chronic Myeloid Leukemia May Have an Auto-Immune Pathogenesis.

Blood ◽

10.1182/blood.v110.11.2945.2945 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2945-2945 ◽

Cited By ~ 1

Author(s):

Sinthiya Punnialingam ◽

Hugues de Lavallade ◽

Dragana Milojkovic ◽

Bua Marco ◽

Jamshid S. Khorashad ◽

...

Keyword(s):

Multivariate Analysis ◽

Autoimmune Disease ◽

Skin Rash ◽

Previous History ◽

Fluid Retention ◽

Pleural Effusions ◽

Imatinib Resistance ◽

Immune Pathogenesis ◽

History Of

Abstract Pleural effusions (PE) are a relatively common side effect of dasatinib (an oral multi-targeted kinase inhibitor) and have been reported in 20–30% of CML patients. The underlying mechanism is unclear but may be related to inhibition of the PDGFR gene. We report a series of 43 patients, who received dasatinib while in first chronic phase, after imatinib resistance (n=31) or intolerance (n=12). Twenty two patients had previously received interferon. Patients were treated with dasatinib 70 mg twice daily. The median follow-up was 149 days (range 21–730). Of the 43 patients, 14 developed PE at a median of 150 days (range 21–698) after starting dasatinib. The dasatinib was interrupted in all cases and not resumed until the PE had resolved completely, which occurred in all cases. Diuretics were administered in some cases. The median duration of discontinuation was 14 days (range 7–65). In 8 of the 14 patients the drug was re-started at reduced dose following the first episode of PE. PE recurred in 4 patients (3 patients had two and 1 patient 5 episodes). The dose was further reduced in these cases and eventually abandoned in 2 patients. We performed univariate and multivariate analysis to identify prognostic factors for the development of PE. Significant variables were: prior skin rash on imatinib therapy, [21% non PE vs 57% PE (p=0.035)], skin rash on dasatinib [(before the development of PE vs any time during the follow up) 4% non PE vs 47% PE (p=0.002)], and previous history of autoimmune disease, [non PE 7% vs 50% PE (p=0.006)]. The documented autoimmune diseases were: hyperthyroidism (n=1), hypothyroidism (n=3), systemic lupus erythematosus (n=1), Sweets syndrome (n=1) and auto-immune hepatitis (n=1). We did not find correlation between the previous history of autoimmune disorders and having been treated with interferon. The dose of dasatinib prior to the onset of PE was compared with the dose in patients who did not develop PE at 6 months; patients still receiving 70 mg twice a day were more likely to develop PE than those for whom the dose had been reduced, with a relative risk (RR) for the development of PE of 4.7 (95CI 1.2–18.4, p=0.02). The only variables that were predictive in the multivariate analysis were a history of autoimmune disease and the dose of dasatinib [RR 13 (95CI 1.6–103) and RR 7.4 (95CI 1.2–44.3) respectively]. Interestingly the presence of generalised fluid retention was not found to be significant (p=0.54) nor the previous therapy with interferon (p=1.0). Our results are in agreement with recent reports which suggest that dasatinib-induced PE does not correlate with generalised fluid retention and may be mediated by an immune mechanism. Moreover dasatinib-induced PE are usually exudates and are believed to respond to steroids. In summary in this series PE occurred more frequently in patients with a previous history of autoimmunity and imatinib-related dermatological side effects; both observations support the notion that PE secondary to dasatinib therapy may have an auto-immune pathogenesis.

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