Znaczenie ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych dla rokowania u chorych z gruczolakorakiem endometrialnym endometrium

Objectives: To assess the prognostic significance of Ki-67 expression in the tissue microarray method (TMA) for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC). Material and methods: The study examined 159 consecutive patients aged 37-86 (62.82±9.95) with EEC stages I-III according to FIGO, treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery, and constructed into the TMA recipient blocks. Using TMA method, the relationship between Ki-67 expression, DFS and OS was examined. DFS was defined as a period from primary surgery until relapse. OS was defined as a period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE; KE/1673/12). Results: The follow-up time varied between 3 - 60 months (51.42±15.87). In 31 patients (19.50%) the relapse of was diagnosed 1–59 months (24.97±16.08) after commencement of the treatment. During follow-up 32 patients (20.12%) died. DFS and OS were 80.50% and 79.88%, respectively. The lack of Ki-67 expression was found in 37 cases (23.27%) while in 122 patients (76.73%) the expression was present (p20% was present in 76 cases, 26 cases and 20 cases, respectively. Positive correlation between the expression of Ki-67 and staging was present (r=0.353; pCel pracy: Celem pracy była ocena znaczenia rokowniczego obecności i wielkości ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych (TMA) dla przeżycia wolnego od choroby (DFS) oraz przeżycia ogólnego (OS) chorych z gruczolakorakiem endometrialnym endometrium (GEE). Materiał i metody: Grupę badaną stanowiło 159 chorych. Wykorzystując metodę TMA, oceniono zależność między obecnością i wielkością ekspresji Ki-67 a DFS i OS. Wyniki: Okres obserwacji wynosił 3-60 miesięcy (51,42±15,87). DFS i OS wynosiły odpowiednio 80,50% i 79,88%. Brak ekspresji Ki-67 stwierdzono w 37 przypadkach (23,27%), a obecność ekspresji Ki-67 u 122 chorych (76,73%;

Effectiveness of tissue microarray technique for the assessment of estrogen and progesterone receptors expression in endometrioid endometrial cancer – preliminary report

Objectives: To assess the effectiveness of the donor-block biopsies with a 2 mm-size needle in endometrioid endometrial cancer (EEC) in the tissue microarray (TMA) technique and the application of the TMA for estrogen receptors (ER) and progesterone receptors (PR) expression in EEC. Material and methods: The study examined EEC tissues from 60 patients. Tissue cores, 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks and constructed into the TMA recipient block. The presence of EEC tissue in the TMAs was analyzed, and the ER and PR expressions were examined. Results: EEC tissue in TMAs was confirmed in 56 cases (93.33%). In 49 of them (81.67%), both cores presented with cancer tissues. In 4 cases (6.67%) EEC tissue was absent. All cases with ECC present on the TMA slides were appropriate for the ER and PR analysis. In 29 EEC cases (51.98%) both ER and PR were expressed. In 3 cases (5.36%) only ER was expressed, in 8 cases (14.29%) only PR was expressed, and in 16 cases (28.57%) ER and PR were assessed as negative. Conclusions: Two 2 mm-sized tissue cores from donor-block biopsies constructed into the TMA recipient block were sufficient to diagnose EEC and enabled the assessment of ER and PR expression in 93.3% of the cases. The use of the described TMA technique makes the immunohistochemical study of EEC easier and more timeefficient

Endometrioid endometrial cancer – the prognostic value of selected clinical and pathological parameters

Objectives: to assess the relationship between selected clinical and pathological factors and disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer patients. Material and methods: A retrospective review of 262 patients aged 37-86 (6.0±9.0) was performed. Selected clinical and pathological data were correlated with DFS and OS. Results: Follow-up was 8-123 months (64.9±27.1). In 4 patients (1.5%) clinical progression was diagnosed during the treatment. In 43 patients (16.4%) relapse was diagnosed 2-61 months (23.9±15.7) after commencing treatment. DFS and OS were 82.1% and 81.3% respectively. In univariate analysis worse DFS was related to older patients (p=0.007) and non-radical surgery (

Znaczenie ekspresji receptorów progesteronowych i estrogenowych ocenianej metodą mikromacierzy tkankowych dla rokowania u chorych z gruczolakorakiem endometrioidalnym endometrium

Objectives: To assess prognostic significance of progesterone receptors (PR) and estrogen receptors (ER) expression in the tissue microarray (TMA) technique for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC). Material and methods: The study included 151 consecutive patients, aged 37-86 years (62.80±9.99), with the EEC in stages I-III (FIGO), treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards, they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery, and constructed into the TMA recipient blocks. Using TMAs, the expression of PR and ER was examined and presented as Total Score (TS). The TS was determined by adding the intensity and marker distribution scores in a given case. The relationship between PR and ER expression, DFS and OS was examined. DFS was defined as the period from primary surgery until relapse. OS was defined as the period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE). Results: Lack of the PR and ER expression was found in 46 cases (30.46%) and 67 cases (44.37%), respectively. The expression of the PR and ER was weak in 24 cases (15.89%) and 22 cases (14.57%), respectively. Strong PR and ER expression was found in 81 patients (53.65%) and 62 patients (41.06%), respectively. Follow-up after surgery varied from 3 to 60 months (50.95±16.36). In 30 patients (19.87%) relapse was diagnosed 1–54 months (22.17±15.59) after surgery. During follow-ups, 29 patients (19.21%) died. In univariate analysis better DFS was related to the presence of PR (p=0.010), higher TS of PR (HR=0.81; 95% CI 0.71-0.94), the presence of ER (p=0.001) and higher TS of ER (HR=0.88; 95% CI 0.78-0.99). DFS differed significantly between the groups: without PR and ER expression (A), with presence of the PR but not ER expression (B), with the ER but not PR expression (C) and with the PR and ER expression (D) (p=0.004). In univariate analysis OS was not related to PR expression (p=0.110), TS of PR (HR= 0.89; 95% CI 0.80-1.02) and ER expression (p=0.070). TS of ER was connected to better OS (HR= 0.83; 95%CI 0.72-0.96). The OS differed between groups A, B, C and D (p=0.006). In multivariate analysis variants of PR/ER expression influenced the DFS (p=0.039) and OS (p=0.016). Conclusions: The expression of the PR and ER can significantly affect therapeutic decisions in selected patients with EEC. In EEC, common assessment of PR and ER expression is of higher prognostic value, than compared to single evaluation of PR and ER receptors.Cel pracy: Celem pracy była ocena znaczenia rokowniczego obecności i wielkości ekspresji receptorów estrogenowych (ER) i progesteronowych (PR) ocenianej metodą mikromacierzy tkankowych (TMA) dla przeżycia wolnego od choroby (DFS) oraz przeżycia ogólnego (OS) chorych z gruczolakorakiem endometrioidalnym endometrium (GEE). Materiał i metody: Grupę badaną stanowiło 151 chorych. Wykorzystując metodę TMA, oceniono zależność między obecnością i wielkością ekspresji ER i PR a DFS i OS. Wyniki: W analizie jednoczynnikowej stwierdzono zależność między wzrostem DFS a obecnością PR (p=0,010), wzrostem wskaźnika całkowitego (TS) ekspresji PR (HR=0,81; 95%CI 0,71-0,94), obecnością ER (p=0,001) i wzrostem TS ekspresji ER (HR=0,88; 95%CI 0,78-0,99). Stwierdzono występowanie różnic w DFS między grupami: bez ekspresji PR i ER (A), z ekspresją PR bez ekspresji ER (B), z ekspresją ER bez ekspresji PR(C), z ekspresją PR i ER (D) (p=0,004). Nie wykazano związku obecności PR (p=0,11), TS ekspresji PR (HR= 0,89; 95%CI 0,80-1,02) i ekspresji ER (p=0,07) z OS w analizie jednoczynnikowej. TS ekspresji ER było istotnym czynnikiem ochronnym, sprzyjającym dłuższemu OS (HR= 0,83; 95%CI 0,72-0,96). Stwierdzono różnice w OS między grupami: A, B, C i D (p=0,006). W analizie wieloczynnikowej kombinacje ekspresji PR/ER istotnie wpływały na DFS (p=0,039) i OS (p=0,016). Wnioski: Określenie ekspresji PR i ER może być istotnym elementem wpływającym na decyzje terapeutyczne u części chorych na GEE. Jednoczesna ocena ekspresji PR i ER ma większą wartość kliniczną od oceny tylko PRlub tylko ER

Glandular cancer of the cervix or endometrial cancer – difficulties in diagnostics

According to the epidemiological data, a tendency for rising cervical adenocarcinoma morbidity, especially among young women, has recently been observed. The efficacy of routinely used screening methods in detecting glandular precancerous lesions is significantly lower than in planoepithelial lesions. Many authors emphasize a worse outcome in cervical adenocarcinoma patients when compared with the patients with squamous cell cancer. Endometrial cancer is one of the most common gynecologic malignancies in Poland – affecting menopausal women. An early symptom of this cancer is an abnormal bleeding pattern in women of childbearing age or bleeding after menopause. The selection of the type and methods of endometrial cancer treatment are crucial factors influencing the final effectiveness of treatment. The article presents a case report – patient (age 31) who after cervical conization was diagnosed with cervical adenocarcinoma. Based on the diagnosis, the patient was qualified to Wertheim’s operation (radical hysterectomy with pelvic lymphadenectomy with paracervical tissue). There were no complications during or after surgery. The final histopathological report proved endometrial clearcell adenocarcinoma. We discussed diagnostic difficulties and the recommended treatment for both types of cancer. We should also remember that the final pathology report determines postoperative treatment.Jak wynika z danych epidemiologicznych, w ostatnim czasie obserwuje się wzrost częstości występowania raka gruczołowego szyjki macicy, szczególnie u młodych kobiet. Skuteczność rutynowo stosowanych metod przesiewowych w wykrywaniu zmian prekursorowych jest w przypadku adenocarcinoma zdecydowanie niższa niż w przypadku zmian płaskonabłonkowych. Wielu autorów zwraca uwagę na mniej korzystne przeżycia chorych na raka gruczołowego w porównaniu z chorymi na raka płaskonabłonkowego. Rak trzonu macicy jest jednym z najczęstszych nowotworów złośliwych u kobiet w Polsce; dotyczy głównie pacjentek w wieku około- i pomenopauzalnym. Wczesne objawy tego nowotworu to nieprawidłowy schemat krwawień z dróg rodnych u kobiet w wieku reprodukcyjnym lub krwawienie po menopauzie. Skuteczność walki z rakiem endometrium zależy od wyboru rodzaju i sposobu leczenia. W pracy przedstawiono opis przypadku 31-letniej pacjentki, u której po konizacji szyjki macicy rozpoznano raka gruczołowego szyjki macicy. Ze względu na powyższy wynik histopatologiczny pacjentkę zakwalifikowano do operacji sposobem Wertheima. Zabieg i przebieg pooperacyjny bez powikłań. Ostateczny wynik histopatologiczny wskazywał na raka gruczołowego jasnokomórkowego trzonu macicy (adenocarcinoma clarocellulare). Na podstawie zaprezentowanego opisu przypadku omówiono trudności diagnostyczne dotyczące różnicowania raków gruczołowych szyjki i trzonu macicy oraz prawidłowe sposoby postępowania w obu typach nowotworów. Należy mieć na uwadze, że ostateczny wynik histopatologiczny wpływa na postępowanie pooperacyjne

Czy zamienne stosowanie klasyfikacji zaawansowania nowotworów endometrium według Międzynarodowej Federacji Ginekologów i Położników z 1988 roku i z 2009 roku może prowadzić do istotnych pomyłek klinicznych?

Introduction: Since 2009 the new FIGO Staging System of endometrial cancer, which changed the previousFIGO 1988 Staging System, has been present. Unfortunately, parallel use of both classifications is observed.Aim of study: to assess whether parallel use of the 2009 and the 1988 FIGO staging systems can causesignificant therapeutic mistakes in patients with endometrioid endometrial cancer.Material and methods: We analysed 262 patients with endometrioid endometrial cancer. The endometrialcancers were staged in both classifications. We analysed possible therapeutic mistakes caused by diverse nomenclature.Results: The patients at low risk, intermediate risk, and high risk for relapse were presented in: 110 (41.6%),109 (42.0%) and 43 (16.4%) cases, respectively. The possibility of inappropriate qualification for adjuvant treatmentoccurred in 102 patients (38.9%) if they were staged in the FIGO 1988 classification and interpreted as theFIGO 2009 classification, and similarly, in 65 patients (24.8%) if they were staged in the FIGO 2009 classificationand interpreted as the FIGO 1988 classification. The risk of a decision mistake in terms of the adjuvant treatmentdue to diverse nomenclature was observed commonly in 167 patients (63.7%).Conclusions: The common use of both FIGO staging systems for endometrioid endometrial cancer cancause significant therapeutic mistakes in terms of the adjuvant treatment. There is a need to use only the newFIGO 2009 Staging System for endometrial cancer and stop using the FIGO 1988 Staging System to avoid therapeuticmistakes

The Usefulness of Cell-Based and Liquid-Based Urine Tests in Clarifying the Diagnosis and Monitoring the Course of Urothelial Carcinoma. Identification of Novel, Potentially Actionable, RB1 and ERBB2 Somatic Mutations

Bladder cancer is one of the most common cancers in global statistics. One of the issues associated with this disease is the high incidence of cases with delayed diagnosis and what factors correlate with worse treatment outcomes. A possible reason for this may be the rather limited availability of non-invasive diagnostic tools. This short communication presents a case of a 68 year old male patient after an ineffective therapy, carried on for several years with symptoms commonly associated with prostate overgrowth that masked a carcinoma in situ of the urinary bladder. Implementation of several diagnostic techniques, including urine sediment cytology, immunocytochemistry, the fluorescence in situ hybridisation technique, the Bladder EpiCheck test and whole-genome sequencing, enabled the establishment of a correct diagnosis, implementation of appropriate treatment and provision of patient-friendly monitoring. The described case emphasises the usefulness of cell-based and liquid-based urine tests in bladder cancer diagnostic procedures