scholarly journals Preoperative and postoperative histopathological findings in patients with endometrial hyperplasia

2007 ◽  
Vol 60 (7-8) ◽  
pp. 372-376 ◽  
Author(s):  
Biljana Djordjevic ◽  
Zorica Stanojevic ◽  
Vesna Zivkovic ◽  
Dusan Lalosevic ◽  
Jasmina Gligorijevic ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Atypical Hyperplasia ◽  
Histopathological Diagnosis ◽  
Cytological Atypia ◽  
Histopathological Findings ◽  
Female Patients

Introduction. The aim of this study was to analyze and compare the histopathological findings in curettage and hysterectomy specimens, to evaluate the accuracy of histopathological diagnosis in curettage specimens, and to determine the frequency of coexisting endometrial carcinoma in patients with histopathological diagnosis of endometrial hyperplasia. Material and methods. Curettage and hysterectomy specimens of 135 female patients with initially diagnosed endometrial hyperplasia were retrospectively analyzed and compared. Results. Simple hyperplasia was found in 49 patients (36.3%), complex hyperplasia in 14 (10.4%), simple atypical hyperplasia in 24 (17.8%), and complex atypical hyperplasia in 48 (35.5%) patients. After hysterectomy, 59 (43.7%) patients were found to have simple hyperplasia, 12 (8.9%) complex hyperplasia, 15 (11.1%) simple atypical hyperplasia, 18 (20.7%) complex atypical hyperplasia, and 21 (15.5%) endometrial carcinoma. The accuracy of histopathological diagnosis of endometrial hyperplasia in curettage specimens was 82.2-89.6% and dependent on the types of hyperplasia. The frequency of coexisting endometrial carcinoma was significantly higher (p<0.001) in patients with atypical hyperplasia than in patients with hyperplasia without cytological atypia. After hysterectomy, coexisting endometrial carcinoma was found in 27.8% of patients with histopathological diagnosis of atypical hyperplasia in curettage specimens. In contrast to simple atypical hyperplasia, the frequency of coexisting endometrial carcinoma was significantly higher (p<0.05) in complex atypical hyperplasia. Conclusion. The frequency of coexisting endometrial carcinoma in hysterectomy specimens in patients with histopathological diagnosis of atypical hyperplasia in curettage specimens was relatively high and it should be taken into account when planning therapy. .

scholarly journals IMMUNOHISTOCHEMICAL STUDY ON PTEN AND CYCLIN D1 IN NON-NEOPLASTIC AND NEOPLASTIC ENDOMETRIAL LESIONS

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Alpana Laisom ◽  
Gayatri Pukhrambam ◽  
Yumnam Shameen ◽  
Ningthibi Akoijam ◽  
Prasanta Sinam ◽  
...  
Keyword(s):  
Cyclin D1 ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Precancerous Lesions ◽  
Atypical Hyperplasia ◽  
Histopathological Diagnosis ◽  
Phosphatase And Tensin Homolog ◽  
Tensin Homolog ◽  
Endometrial Carcinomas

Abstract Introduction: Endometrial carcinoma (EC) is the most common gynaecological malignancy in developed countries and has been classified into two groups, type 1 and type 2.  Type 1 or endometrioid endometrial carcinomas (EECA) accounts for 80% of EC and are thought to develop following a continuum of premalignant lesions ranging from endometrial hyperplasia without atypia (EH) and atypical hyperplasia (AH). PTEN (phosphatase and tensin homolog), a tumor suppressor gene is commonly inactivated in 83 % of endometrioid carcinoma and 55% of precancerous lesions. Cyclin D1, a cell cycle regulator is overexpressed in about 40% of endometrial carcinomas. Aim: To study the expression of PTEN (Phosphatase and tensin homolog) and Cyclin D1 in non-neoplastic and neoplastic endometrial lesions by immunohistochemistry (IHC). Methods: A 2 year cross-sectional study (September 2017 to August 2019) on 115 endometrial samples was done in the Department of Pathology, RIMS. Histomorphological features and IHC expression of PTEN and Cyclin D1 in the various endometrial lesions were studied and evaluated, data collected in IBM SPSS Statistics 21 was statistically analyzed using Chi - square  and Fisher’s Exact test. Results: Out of the 115 cases, 47(40.9%) were diagnosed as benign proliferative endometrium, 20(17.4%) benign secretory endometrium, 21(18.3%) hyperplasia without atypia, 15(13.0%)  atypical hyperplasia and 12(10.4%) endometrial carcinoma with an age group spanning from 26-68 years (mean age = 46.4).  Following IHC staining, 91.7%(11/12) and 83.3%(10/12) cases of EC and 80%(12/15) and 73.3%(11/15) cases of AH showed complete loss of PTEN expression and Cyclin D1 overexpression, respectively when compared to other benign lesions and was statistically significant  (p < .001). Conclusion: Loss of PTEN and Cyclin D1 overexpression was seen in a significant number of EECA and AH, suggesting both as an early event in endometrial carcinogenesis. Therefore, we propose the use of PTEN and Cyclin D1 immunostaining as an adjunct to histopathological diagnosis as it may be informative in the identification and further management of  premalignant endometrial  lesions that are likely to progress to carcinoma Keywords: PTEN, Cyclin D1, endometrial hyperplasia, endometrial carcinoma, endometrioid endometrial carcinomas.

scholarly journals Loss of ten-eleven translocation 1 (TET1) expression as a diagnostic and prognostic biomarker of endometrial carcinoma

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259330
Author(s):  
Nien-Tzu Liu ◽  
Cherng-Lih Perng ◽  
Yu-Ching Chou ◽  
Pi-Shao Ko ◽  
Yi-Jia Lin ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Expression Profiles ◽  
Gynecological Cancer ◽  
Dna Demethylation ◽  
Atypical Hyperplasia ◽  
Mrna Levels ◽  
Normal Endometrium ◽  
Expression Score

Endometrial carcinoma (EC) is the most common gynecological cancer. However, there is currently no routinely used biomarker for differential diagnosis of malignant and premalignant endometrial lesions. Ten-eleven translocation (TET) proteins, especially TET1, were found to play a significant role in DNA demethylation, via conversion of 5-methylcytosine (5-mC) to 5-hydroxymethylcytosine (5-hmC). TET1, 5-mC, and 5-hmC expression profiles in endometrial carcinogenesis are currently unclear. We conducted a hospital-based retrospective review of the immunohistochemical expression of TET1, 5-mC, and 5-hmC in 181 endometrial samples. A “high” TET1 and 5-hmC expression score was observed in all cases of normal endometrium (100.0% and 100.0%, respectively) and in most samples of endometrial hyperplasia without atypia (90.9% and 78.8%, respectively) and atypical hyperplasia (90.6% and 93.8%, respectively), but a “high” score was found in only less than half of the EC samples (48.8% and 46.5%, respectively). The TET1 and 5-hmC expression scores were significantly higher in normal endometrium and premalignant endometrial lesions than in ECs (p < 0.001). A “high” 5-mC expression score was observed more frequently for ECs (81.4%) than for normal endometrium (40.0%), endometrial hyperplasia without atypia (51.5%), and atypical hyperplasia (53.1%) (p < 0.001). We also found that TET1 mRNA expression was lower in ECs compared to normal tissues (p = 0.0037). TET1 immunohistochemistry (IHC) scores were highly proportional to the TET1 mRNA levels and we summarize that the TET1 IHC scoring can be used for biomarker determinations. Most importantly, a higher TET1 score in EC cases was associated with a good overall survival (OS) rate, with a hazard ratio (HR) of 0.31 for death (95% confidence interval: 0.11–0.84). Our findings suggest that TET1, 5-mC, and 5-hmC expression is a potential histopathology biomarker for the differential diagnosis of malignant and premalignant endometrial lesions. TET1 is also a potential prognostic marker for EC.

COMPARISON OF ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA & WHO CLASSIFIED ENDOMETRIAL HYPERPLASIA IN PREDICTING THE RISK OF PROGRESSION TO ENDOMETRIAL CARCINOMA

2021 ◽  
pp. 59-61
Author(s):  
Bansi Kavar ◽  
Neeru Dave
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Intraepithelial Neoplasia ◽  
Atypical Hyperplasia ◽  
Cytological Atypia ◽  
Endometrial Intraepithelial Neoplasia ◽  
Risk Of Progression ◽  
Classi Cation ◽  
Cation System ◽  
Sampling Procedures

Background: Endometrial hyperplasia is the precursor lesion of most endometrial cancers of endometrioid type. The most commonly used classication system for endometrial hyperplasia is WHO 1994 classication system in which architecture disruption and cytological atypia are used to identify four types of endometrial hyperplasia including simple or complex hyperplasia with or without atypia. Newer EIN diagnosis by cytological atypia is of great consideration for the progression to endometrial cancer. Material And Methods: The study consists of 100 cases of WHO classied endometrial hyperplasia for period of 4 yrs from 2015 to 2019. Type of sampling procedures- dilation & curettage, endometrial biopsy and fractional curettage. Objective: 1. To discuss revised criteria for recognition of endometrial intraepithelial neoplasia (EIN). 2. To nd out the sensitivity of endometrial intraepithelial neoplasia (EIN) classication in predicting the risk of malignancy. Results: This study consists of 100 cases of endometrial hyperplasia. Patients were mostly postmenopausal & presented with abnormal vaginal bleeding. From WHO classied endometrial lesions, 2 out of 35 cases of simple typical hyperplasia, 10 out of 14 cases of complex typical hyperplasia,12 out of 20 cases of simple atypical hyperplasia and 20 out of 21 cases of complex atypical hyperplasia were reclassied as EI N. Conclusion: To estimate the risk of progression to carcinoma and guide clinical management, the histo-pathologic diagnosis of endometrial hyperplastic lesion is very important, specially the diagnosis of EIN lesions. EIN carries a much greater risk of progression to endometrial cancer than other WHO classied endometrial hyperplasia.

scholarly journals Immunohistochemical Expression of “HE4” in Endometrial Hyperplasia versus Endometrial Endometrioid Carcinoma

2021 ◽  
Vol 9 (A) ◽  
pp. 669-675
Author(s):  
Amany Talaat Abd El-Hamed ◽  
Samira Abd-Allah Mahmoud ◽  
Ahmed A. Soliman ◽  
Dina F. El-Yasergy
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Prognostic Significance ◽  
Atypical Hyperplasia ◽  
Cancer Tissue ◽  
Endometrioid Carcinoma ◽  
Immunohistochemical Expression ◽  
Atypical Endometrial Hyperplasia ◽  
Strong Expression

Aim Endometrial cancer is the most common cancer of the female genital tract. No effective biomarkers currently exist to allow for an efficient risk classification of endometrial carcinoma. Human epididymis protein 4 (HE4) overexpression is first observed in ovarian cancer tissue and subsequent research has shown that the HE4 overexpression has also been observed in patients with endometrial carcinoma. To our knowledge, this marker was evaluated in small number of research studies in cases of endometrial carcinoma versus hyperplasia. This has inspired us to test for immunohistochemical expression of HE4 in endometrial endometrioid carcinoma and hyperplastic endometria and to correlate HE4 expression with various prognostic pathological parameters including International Federation of Gynecology and Obstetrics (FIGO) grading and staging. Methods Immunohistochemical staining for HE4 was performed on paraffin-embedded sections of forty cases of endometrial endometrioid carcinoma and thirty cases of endometrial hyperplasia: including 15 cases of non-atypical hyperplasia and 15 cases of atypical hyperplasia. A histochemical score was used to evaluate HE4 expression by the tumor cells. Results In this study, HE4 overexpression level was significantly higher in endometrial endometrioid carcinoma than endometrial hyperplasia and significantly higher than non-atypical endometrial hyperplasia (P<0.05). HE4 strong expression was detected in 20% of atypical endometrial hyperplasia, but no statistical significance was detected between atypical hyperplasia and endometrial carcinoma. HE4 overexpression showed statistically significant positive correlation with FIGO grading, FIGO staging, and depth of myometrial invasion. Conclusion: During interpretation of endometrial biopsies of atypical hyperplasia, HE4 strong expression might raise the possibility of the presence of coexisting adenocarcinoma not biopsied or even warning of a near future malignant transformation. Also, strong expression of HE4 by tissue biopsy of adenocarcinoma should be reported as this might predict higher grade and stage of the tumor, a point that should be considered by surgeons while performing hysterectomy. These results should be further confirmed by extending the study on a large scale, correlation of HE4 expression with the molecular classification of Tumor Cancer Genome Atlas and long term follow up are required to establish the prognostic significance of HE4 expression in endometrial carcinoma and atypical hyperplasia. Keywords: Endometrial carcinoma, Endometrial hyperplasia, HE4, Immunohistochemistry.

scholarly journals Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1003
Author(s):  
Adrian Carabineanu ◽  
Claudia Zaharia ◽  
Alexandru Blidisel ◽  
Razvan Ilina ◽  
Codruta Miclaus ◽  
...  
Keyword(s):  
Oral Anticoagulant ◽  
Endometrial Hyperplasia ◽  
Uterine Bleeding ◽  
Initial Diagnosis ◽  
Common Source ◽  
Histopathological Diagnosis ◽  
Anticoagulant Treatment ◽  
Female Patients ◽  
Atypical Endometrial Hyperplasia ◽  
Cellular Atypia

Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions.

scholarly journals Pyruvate Kinase M2 Expression: A Potential Metabolic Biomarker to Differentiate Endometrial Precancer and Cancer That Is Associated with Poor Outcomes in Endometrial Carcinoma

2019 ◽  
Vol 16 (23) ◽  
pp. 4589
Author(s):  
Lai ◽  
Chou ◽  
Lin ◽  
Yu ◽  
Ou ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Pyruvate Kinase ◽  
Poor Prognosis ◽  
Endometrial Hyperplasia ◽  
Atypical Hyperplasia ◽  
Poor Overall Survival ◽  
Normal Endometrium ◽  
Cytoplasmic Staining ◽  
Pyruvate Kinase M2 ◽  
Poor Outcomes

Background: Pyruvate kinase M2 (PKM2) is a regulator of the processes of glycolysis and oxidative phosphorylation, but the roles that it plays in endometrial cancer remain largely unknown. This study evaluated the PKM2 expression in normal endometrium, endometrial hyperplasia, and endometrial carcinoma, and its prognostic value was investigated in endometrial carcinoma patients. Methods: A hospital-based retrospective review was conducted to examine the immunohistochemical PKM2 distribution in 206 endometrium samples from biopsies or hysterectomies. The immunoreactivity of PKM2 was divided into groups of low and high scores according to the extent and intensity of staining. Results: Intense cytoplasmic staining was observed for the PKM2 protein in malignant endometrial lesions. A high PKM2 score was observed in many endometrial carcinoma samples (50.0%), but there was a low percentage in endometrial atypical hyperplasia (12.5%). High PKM2 expression was not found in the normal endometrium (0.0%) nor endometrial hyperplasia without atypia (0.0%). The PKM2 protein score was significantly higher in endometrial carcinoma samples than premalignant endometrial lesions (p < 0.001). Notably, higher PKM2 scores in cases of endometrial carcinoma correlated with poor overall survival (p = 0.006), and the hazard ratio for death was 3.40 (95% confidence interval, 1.35–8.56). Conclusions: Our results indicate that the prevalence of PKM2high tumor cells in endometrial carcinoma is significantly associated with worse prognostic factors and favors a poor prognosis. The expression of PKM2 is also a potential histopathological biomarker for use in the differential diagnosis of malignant and premalignant endometrial lesions.

scholarly journals Concurrent Endometrial Carcinoma in Hysterectomy Specimens in Patients with Histopathological Diagnosis of Endometrial Hyperplasia in Curettage Specimens

2015 ◽  
Vol 86 (10) ◽  
pp. 753-758 ◽  
Author(s):  
Mehmet Dolanbay ◽  
Mehmet Kutuk ◽  
Semih Uludag ◽  
Ayça Bulut ◽  
Mahmut Ozgun ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Histopathological Diagnosis

Aberrant Expression of the Von Hippel-Lindau Gene in Human Endometrial Hyperplasia and Endometrial Carcinoma

2011 ◽  
Vol 21 (3) ◽  
pp. 430-434 ◽  
Author(s):  
Jian-Ying Xu ◽  
Wei-Jie Zhu ◽  
Xiao-Zhe Cao ◽  
Xian-Feng Li ◽  
Jin Wu
Keyword(s):  
Endometrial Carcinoma ◽  
Western Blotting ◽  
Endometrial Hyperplasia ◽  
Atypical Hyperplasia ◽  
Mrna Levels ◽  
Simple Complex ◽  
Normal Endometrium ◽  
Aberrant Expression ◽  
Vhl Gene ◽  
Von Hippel Lindau

IntroductionThe purpose of this study was to determine whether aberrant expression of the von Hippel-Lindau (VHL) gene in human hyperplastic and malignant endometrial tissues was involved in endometrial carcinogenesis.MethodsFresh tissue samples of endometrial hyperplasia consisting of simple (n = 26), complex (n = 23), and atypical hyperplasia (n = 20); endometrial carcinoma (n = 17); and normal endometrium (n = 40) were measured using Western blotting and real-time reverse transcription polymerase chain reaction. Paraffin-embedded sections of endometrial hyperplasia (n = 90), endometrial carcinoma (n = 30), and normal endometrium (n = 60) were detected by immunohistochemical method.ResultsVon Hippel-Lindau staining was present in the cytoplasm of epithelial cells and stroma. A decreased expression of VHL mRNA in endometrial hyperplasia from simple, complex, to atypical hyperplasia was observed. There were statistical differences on VHL messenger RNA (mRNA) levels among simple, complex, and atypical hyperplasia (P < 0.01). The VHL mRNA levels in endometrial carcinoma were significantly lower than those in normal endometrium, simple hyperplasia, or complex hyperplasia (P < 0.01) but similar to those in atypical hyperplasia (P > 0.05). Von Hippel-Lindau protein levels by Western blotting and staining intensity by immunohistochemistry were coincident with the VHL mRNA levels.ConclusionsAberrant expression of the VHL gene is associated with the risk of endometrial hyperplasia progressing to endometrial carcinoma, and its expression levels are useful as a predictive indicator for endometrial carcinoma.

scholarly journals EVALUATION OF ESTROGEN AND PROGESTERONE RECEPTORS (ER, PR) IN ENDOMETRIAL HYPERPLASIAAND CARCINOMA- AN IMMUNOHISTOCHEMICAL STUDY

2020 ◽  
pp. 74-77
Author(s):  
Waziha Ahmed ◽  
Geetanjali Gogoi ◽  
Sabari Devi
Keyword(s):  
Endometrial Carcinoma ◽  
Hormonal Therapy ◽  
Endometrial Hyperplasia ◽  
Progesterone Receptors ◽  
Uterine Cavity ◽  
Atypical Hyperplasia ◽  
Biochemical Basis ◽  
Proliferation And Differentiation ◽  
Pathologic Lesions ◽  
Cancer Precursors

The endometrium which lines the uterine cavity is one of the most dynamic tissues in the human body. Proliferation and differentiation of the endometrial glands and stroma are regulated by steroid hormones mainly estrogen and progesterone. Endometrial hyperplasia is a heterogeneous set of pathologic lesions that range from mild, reversible glandular proliferations to direct cancer precursors. Endometrial carcinoma is one of the most common gynecologic malignancies in industrialized and developing countries and is generally accepted to be an endocrine related neoplasm. Understanding the biochemical basis of endometrial responsiveness to hormones in such patients is fundamental to designing a successful medical therapy. The estrogen receptor (ER) and progesterone receptor (PR) are measured by biochemical and immunohistochemical methods . Immunohistochemistry (IHC) is a semiquantitative method for determination of protein expression. The technique is inexpensive and relatively quick to perform. Immunohistochemistry was done in this study to evaluate the expression of ER, PR in cases of Endometrial hyperplasia and Endometrial Carcinoma. A total of 42 cases were evaluated immunohistochemically which included 32 cases of Non atypical hyperplasia, 7 cases of Atypical hyperplasia and 3 cases of Endometrial carcinoma. The expression of ER/PR was maximal for cases of Non atypical hyperplasia, followed by atypical hyperplasia and least for endometrial carcinoma. Those can be benefited from hormonal therapy, especially atypical hyperplasia cases, whose progression can be halted by hormonal therapy.

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