Prognostic significance of estrogen and progesterone receptors expression in myometrium of patients with endometrial cancer

Cilj istraživanja: Istražiti prognostički značaj izraženosti estrogenskih i progesteronskih receptora u miometriju bolesnica s endometrijskim karcinomom. Nacrt studije: U periodu od 1. svibnja 2005. do 1. svibnja 2015. prikupljeni su podatci bolesnica s karcinomom endometrija koje su histerektomirane u Klinici za tumore KBC sestara milosrdnica u Zagrebu i bolesnica histerektomiranih zbog drugih razloga. Praćena je izraženost estrogenskih i progesteronskih receptora u tumoru i miometriju, dob ispitanica, veličina tumora, histološki tip, histološki gradus, cervikalni prodor, dubina prodora u miometrij, limfovaskularni prodor, zahvaćenost limfnih čvorova i FIGO klinički stadij. Ispitanici i metode: Skupina je brojala 69 bolesnica s endometrijskim karcinomom i 69 zdravih žena. Prosječna dob bolesnica bila je 65,7 ± 10, a zdravih 64,35 ± 8,89 godina. Ukupno vrijeme praćenja bilo je 120 mjeseci, a gledalo se petogodišnje preživljenje. Dobiveni podatci su obrađeni χ2 testom, Fisherovim egzaktnim testom, multifaktorijalna analiza i Kaplan-Meierovovim testom na razini statističke značajnosti P30 mm 68,3%. Skupina bolesnica s Tipom I endometrijskog karcinoma ima vjerojatnost preživljenja 87,1%, a sa seroznim/papilarnim EC (Tip II) 44,1%. Vjerojatnost petogodišnjeg preživljenja za tumorski gradus je: G1 = 95,2%; G2 = 80,4%; G3 = 49,3%. Skupina bolesnica s cervikalnom invazijom ima 57,1% vjerojatnosti preživljenja, a bez 78,4%. Bolesnice s tumorskim prodorom u miometrij 50 % vjerojatnost je 58,1%. Vjerojatnost preživljenja s tumorski pozitivnim limfnim čvorovima je 55,6%, a s negativnim 84,4%. Preživljenje bolesnica bez limfovaskularnog prodora je 90,2%, a s prodorom je 54,5%. Skupina s FIGO 1 - 2 ima vjerojatnost preživljenja 81,1%, a FIGO 3 - 4 49,1%. Vjerojatnost preživljenja skupine s endometrijskim karcinomom i negativnim ER u tumoru je 58,9%, pozitivnim ER 86%, negativnim PR 63,5%, a pozitivnim PR 84,2%. Preživljenje s negativnim ER u miometriju je 50%, a pozitivnim ER 80,4%, te negativnim PR 66,7%, a pozitivnim PR 77,4%. Zaključak: Status estrogenskih i progesteronskih receptora u miometriju bolesnica s endometrijskim karcinomom nije stabilan prognostički čimbenik.Objectives: To conduct research on prognostic significance of estrogen and progesterone receptors expression in myometrium of patients with endometrial cancer. Study Design: Data was collected from patients from the Zagreb Cancer Clinic. The period covered was from 1st May 2005 to 1st May 2015. The following was considered: expression of estrogen and progesterone receptors in tumor and myometrium, age of examinees, tumor size, histological type, histological grade, cervical penetration, penetration depth in myometrium, lymphovascular space invasion, lymph node involvement, and FIGO stage. Participants and Methods: The group comprised of 69 patients with endometrial cancer and 69 healthy women. The mean age of the patients was 65.7 ± 10 and the mean age of the healthy examinees stood at 64.35 ± 8.89 years. The total monitoring period was 120 months and five year survival rate was considered. Data processing used was χ2 test, Fisher's exact test, multi-factor analysis and log-rank test. The level of statistical significance was p 30mm it was 68.3%. A group of patients with endometrial cancer type I had a survival rate of 87.1%, while those with a serous / papillary type II EC had a survival rate of 44.1%. The rate of five-year survival for tumor grade was: G1 = 95.2%; G 2 = 80.4%; G3 = 49.3%. The group of patients with cervical invasion had 57.1% survival rate and those without it 78.4%. The patients with tumor penetration in myometrium 50% had the survival rate of 58.1%. The survival rate of those with tumor positive lymph nodes was 55.6%, whereas for those tumor negative it was 84.4%. The survival rate of patients with no lymphovascular invasion was 90.2% and in case of the invasion it was 54.5%. The survival rate amongst the group with FIGO stages I to II stood at 81.1% and for the group with FIGO stages III – IV it was 49.1%. The survival rate of the group with endometrial cancer and negative ER in tumor was 58.9%, for those with positive ER it stood at 86%, for those with negative PR it was 63.5%, while for those with positive PR it was 84.2%. The survival rate for those with negative ER in myometrium was 50%, for those with positive ER it was 80.4% and for the women with negative PR it stood at 66.7%, whereas for those with positive PR it was 77.4%. Conclusion: ER and PR status in myometrium of patients with EC is not a stable prognostic factor. Key words: endometrial cancer, estrogen receptors, progesterone receptors, myometrium, survival rat

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze

Karcinom stidnice kod mlade žene i terapija multiple skleroze: prikaz slučaja

Vulvar cancer is a rare disease among young women. Risk factors for vulvar cancer are smoking, chronic dermatitis and human papilloma virus infection. However, no correlation between multiple sclerosis and increased risk of cancer has been established. We present a case of vulvar cancer in 35 year old women with multiple sclerosis. Radical vulvectomy with right-sided inguinofemoral lymphadenectomy was performed. Pathohistological analysis confi rmed the diagnosis of a squamous cell carcinoma, grade II, International Federation of Gynecology and Obstetrics (FIGO) IB. Adjuvant radiotherapy was not indicated. After two years of follow up, there was no evidence of the recurrence. The occurrence of vulvar cancer in multiple sclerosis patients may be coincidental. Nevertheless, the long term use of immunomodulatory drugs in multiple sclerosis and incidence of cancer may be associated.Karcinom stidnice je rijetka bolest u mladih žena. Rizični faktori za karcinom stidnice su pušenje, kronični dermatitis i infekcija humanim papiloma virusom. Nije dokazana povezanost između multiple skleroze i povećanog rizika za razvoj karcinoma. Opisujemo slučaj karcinoma stidnice u 35-godišnje žene koja boluje od multiple skleroze. Učinjena je radikalna vulvektomija s desnostranom ingvinofemoralnom limfadenektomijom. Patohistološka analiza potvrdila je dijagnozu planocelularnog karcinoma, gradus II, FIGO 1B. Adjuvantna radioterapija nije bila indicirana. Nakon dvije godine praćenja, nema znakova povrata bolesti. Pojava karcinoma stidnice u mlade bolesnice s multiplom sklerozom, može biti koincidencija. Moguća je povezanost dugotrajnog korištenja imunomodulatornih lijekova u multiploj sklerozi i incidencije karcinoma

An Incidental Finding of Unicornuate Uterus with Unilateral Ovarian Agenesis during Laparoscopy in Patient who Gave Birth to Eleven Children: A Case Report

Congenital uterine anomalies are often asymptomatic. They may present with infertility, recurrent miscarriage, preterm delivery, abnormal lie in pregnancy and other obstetric complications. We report the case of a 38-year old patient with unicornuate uterus without rudimentary horn and with unilateral left ovarian agenesis and unilateral left renal agenesis who gave birth to eleven children. Anomaly was incidentally diagnosed during laparoscopic sterilization

Rak jajnika, jajovoda i potrbušnice: kirurško liječenje

Surgery is the cornerstone of eff ective management of the ovarian, tubal and peritoneal cancer. In 2014 the International Federation of Gynecology and Obstetrics (FIGO) published a new classifi cation collectively covering cancer of ovary, fallopian tube and peritoneum as well as malignant ovarian germ cell tumors and malignant sex-cord stromal tumors. Comprehensive surgical staging according to the 2014 FIGO classifi cation system plays an important role in management of apparently early stage of ovarian, tubal and peritoneal cancer. Primary debulking (cytoreductive) surgery followed by paclitaxel and platinum based combination chemotherapy is the cornerstone of the advanced-stage disease treatment. In cases of suboptimal primary cytoreduction, interval debulking surgery performed after two to four cycles of chemotherapy based on the clinical judgment of the gynecologic oncologist is second att empt to achieve optimal cytoreduction. Secondary cytoreductive surgery can be considered in patients with platinum-sensitive locally recurrent ovarian cancer. The volume of residual tumor remaining after these surgical approaches is one of the most important independent prognostic factors for survival.Kirurško liječenje je temelj uspješnog liječenja raka jajnika, jajovoda i potrbušnice. Međunarodno federacija ginekologa i opstetričara (FIGO) u 2014. godini objavila je novu klasifi kaciju koja zajedno obuhvaća rak jajnika, jajovoda, potrbušnice, zloćudne tumore zametnih stanica i zloćudne tumore specijalizirane strome jajnika. Kirurško stupnjevanje bolesti prema FIGO 2014 klasifi kaciji je ključno u liječenju raka jajnika, jajovoda i potrbušnice naizgled ranog stadija bolesti. Primarna citoredukcijska kirurgija i dodatno liječenje kemoterapijom je standardni pristup uznapredovaloj bolesti. Prilikom suboptimalne citoredukcije tijekom primarnog kirurškog zahvata “interval debulking surgery” nakon drugog do četvrtog ciklusa kemoterapije, ovisno o procjeni ginekološkog onkologa, drugi je pokušaj postizanja optimalne ciotredukcije. Sekundarna citoredukcijska kirurgija dolazi u obzir kod pacijentica koje su osjetljive na kemoterapiju, a imaju lokalni povrat bolesti. Veličina rezidualnog tumorskog tkiva nakon kirurških zahvata je najznačajniji prognostički čimbenik na koji se može utjecati tijekom liječenja

Uloga laparoskopije u liječenju raka jajnika

Laparoscopy is usually undertaken in young women with adnexal disease that is believed to be benign, but found to be malignant at surgery. Some surgeons use laparascopy for staging, but mainly for presumed stage I or II ovarian cancer. Also, laparoscopy can be useful for selecting women who can be optimally debulked at primary surgery. There are some concerns about using laparoscopic approach in women with ovarian cancer: port-site metastasis, possibility of intraoperative rupture of tumor and eff ect of pneumoperitoneum. Studies showed that rate of port-site metastasis after laparoscopic surgery in women with ovarian cancer is low and usually occurs when there is peritoneal carcinomatosis or distant metastatic disease. Also, it seems that laparoscopy with CO(2) pneumoperitoneum does not reduce the overall survival in women with intraabdominal metastases. Preoperative rupture, surface capsular invasion and positive peritoneal cytology are more relevant in terms of prognosis than intraoperative rupture, but further research is needed. Conventional laparoscopy and robotic-assisted laparoscopy are comparable in both early and advanced disease. These approaches are not inferior to laparotomy and they are acceptable access in selected patients.Laparoskopija se najčešće koristi kod žena za koje se mislilo da imaju benignu bolest, ali se tijekom operacije ispostavilo da se radi o malignoj bolesti. Neki kirurzi koriste laparoskopski pristup za stupnjevanje bolesti i to najčešće za pretpostavljeni I ili II stadij. Također, laparoskopija može biti korisna za odabir žena kojima se može primarno napraviti „debulking“. Postoji nekoliko briga prilikom korištenja laparoskopskog pristupa: pojava metastaza na mjestu ulaska troakara, mogućnost intraoperacijske rupture tumora i učinak pneumoperitoneuma. Studije su pokazale da je udio metastaza na mjestu ulaska troakara nizak i da se najčešće javlja kod žena koje imaju karcinomatozu peritoneuma i udaljene metastaze. Također, čini se da laparoskopija s CO2 pneumoperitoneumom ne smanjuje ukupno preživljenje žena s intraabdominalnim metastazama. Preoperacijska ruptura, površinska invazija kapsule i pozitivan peritonealni ispirak su važniji za prognozu od intraoperacijske rupture, no daljnja istraživanja su potrebna. Konvencionalna i laparoskopija pomoću robota su usporedivei u ranoj i u proširenoj bolesti.Ovi pristupi nisu inferiorni laparotomiji i prihvatljivi su kod odabranih pacijenata

Uloga laparoskopije u liječenju raka jajnika

Laparoscopy is usually undertaken in young women with adnexal disease that is believed to be benign, but found to be malignant at surgery. Some surgeons use laparascopy for staging, but mainly for presumed stage I or II ovarian cancer. Also, laparoscopy can be useful for selecting women who can be optimally debulked at primary surgery. There are some concerns about using laparoscopic approach in women with ovarian cancer: port-site metastasis, possibility of intraoperative rupture of tumor and eff ect of pneumoperitoneum. Studies showed that rate of port-site metastasis after laparoscopic surgery in women with ovarian cancer is low and usually occurs when there is peritoneal carcinomatosis or distant metastatic disease. Also, it seems that laparoscopy with CO(2) pneumoperitoneum does not reduce the overall survival in women with intraabdominal metastases. Preoperative rupture, surface capsular invasion and positive peritoneal cytology are more relevant in terms of prognosis than intraoperative rupture, but further research is needed. Conventional laparoscopy and robotic-assisted laparoscopy are comparable in both early and advanced disease. These approaches are not inferior to laparotomy and they are acceptable access in selected patients.Laparoskopija se najčešće koristi kod žena za koje se mislilo da imaju benignu bolest, ali se tijekom operacije ispostavilo da se radi o malignoj bolesti. Neki kirurzi koriste laparoskopski pristup za stupnjevanje bolesti i to najčešće za pretpostavljeni I ili II stadij. Također, laparoskopija može biti korisna za odabir žena kojima se može primarno napraviti „debulking“. Postoji nekoliko briga prilikom korištenja laparoskopskog pristupa: pojava metastaza na mjestu ulaska troakara, mogućnost intraoperacijske rupture tumora i učinak pneumoperitoneuma. Studije su pokazale da je udio metastaza na mjestu ulaska troakara nizak i da se najčešće javlja kod žena koje imaju karcinomatozu peritoneuma i udaljene metastaze. Također, čini se da laparoskopija s CO2 pneumoperitoneumom ne smanjuje ukupno preživljenje žena s intraabdominalnim metastazama. Preoperacijska ruptura, površinska invazija kapsule i pozitivan peritonealni ispirak su važniji za prognozu od intraoperacijske rupture, no daljnja istraživanja su potrebna. Konvencionalna i laparoskopija pomoću robota su usporedivei u ranoj i u proširenoj bolesti.Ovi pristupi nisu inferiorni laparotomiji i prihvatljivi su kod odabranih pacijenata

Rak jajnika, jajovoda i potrbušnice: kirurško liječenje

Surgery is the cornerstone of eff ective management of the ovarian, tubal and peritoneal cancer. In 2014 the International Federation of Gynecology and Obstetrics (FIGO) published a new classifi cation collectively covering cancer of ovary, fallopian tube and peritoneum as well as malignant ovarian germ cell tumors and malignant sex-cord stromal tumors. Comprehensive surgical staging according to the 2014 FIGO classifi cation system plays an important role in management of apparently early stage of ovarian, tubal and peritoneal cancer. Primary debulking (cytoreductive) surgery followed by paclitaxel and platinum based combination chemotherapy is the cornerstone of the advanced-stage disease treatment. In cases of suboptimal primary cytoreduction, interval debulking surgery performed after two to four cycles of chemotherapy based on the clinical judgment of the gynecologic oncologist is second att empt to achieve optimal cytoreduction. Secondary cytoreductive surgery can be considered in patients with platinum-sensitive locally recurrent ovarian cancer. The volume of residual tumor remaining after these surgical approaches is one of the most important independent prognostic factors for survival.Kirurško liječenje je temelj uspješnog liječenja raka jajnika, jajovoda i potrbušnice. Međunarodno federacija ginekologa i opstetričara (FIGO) u 2014. godini objavila je novu klasifi kaciju koja zajedno obuhvaća rak jajnika, jajovoda, potrbušnice, zloćudne tumore zametnih stanica i zloćudne tumore specijalizirane strome jajnika. Kirurško stupnjevanje bolesti prema FIGO 2014 klasifi kaciji je ključno u liječenju raka jajnika, jajovoda i potrbušnice naizgled ranog stadija bolesti. Primarna citoredukcijska kirurgija i dodatno liječenje kemoterapijom je standardni pristup uznapredovaloj bolesti. Prilikom suboptimalne citoredukcije tijekom primarnog kirurškog zahvata “interval debulking surgery” nakon drugog do četvrtog ciklusa kemoterapije, ovisno o procjeni ginekološkog onkologa, drugi je pokušaj postizanja optimalne ciotredukcije. Sekundarna citoredukcijska kirurgija dolazi u obzir kod pacijentica koje su osjetljive na kemoterapiju, a imaju lokalni povrat bolesti. Veličina rezidualnog tumorskog tkiva nakon kirurških zahvata je najznačajniji prognostički čimbenik na koji se može utjecati tijekom liječenja

Gastrointestinalni stromalni tumor koji oponaša ginekološku patologiju: prikaz slučaja

Diagnosis of gastrointestinal stromal tumors (GISTs) of the terminal part of the small intestine on ultrasound examination can be difficult because of their similarity in appearance to gynecological tumors. We present a case of a 49-year-old asymptomatic female patient with GIST of the small intestine, which presented as a pelvic mass, mimicking an ovarian tumor. Tumor was diagnosed during the control check up and ultrasound gynecological examination. Computed tomography (CT) showed tumor mass in the pelvis on the right and free fluid in the lesser pelvis. During the surgery, exploration of the abdominal cavity displayed tumor of the terminal part of the small intestine (ileum). The uterus and both adnexes were normal. The patient was treated by resection of the terminal part of the small intestine and termino-terminal anastomosis. Immunohistochemical evaluation demonstrated positive vimentin, positive CD117, and negative CD 34. In the presence of a pelvic mass, especially if other unusual anamnestic data are present, the possibility of other than a gynecologic tumor has to be considered.Dijagnozu gastrointestinalnih stromalnih tumora (GIST) završnog dijela tankog crijeva teško je postaviti ultrazvučnim pregledom jer su izgledom nalik ginekološkim tumorima. Opisujemo slučaj 49-godišnje asimptomatične bolesnice s GISTom tankog crijeva koji se prikazuje kao tvorba u zdjelici i oponaša tumor jajnika. Tumor je dijagnosticiran na kontrolnom i ultrazvučnom ginekološkom pregledu. Kompjutorizirana tomografija (CT) otkrila je tumorsku tvorbu u zdjelici i slobodnu tekućinu maloj zdjelici. Pretraživanjem trbušne šupljine tijekom operacije otkriven je tumor završnog dijela tankog crijeva (ileuma). Maternica i adneksi bili su zdravi. Bolesnici je napravljena resekcija završnog dijela tankog crijeva i termino-terminalna anastomoza. Imunohistokemijska analiza pokazala je pozitivnu reakciju na vimentin i CD117; te negativnu na CD 34. Kad je u zdjelici prisutna tvorba; osobito ako su i drugi anamnestički podaci neuobičajeni; treba uzeti u obzir mogućnost da je riječ o nekom drugom; a ne ginekološkom tumoru