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Synchronous endometrial and tube cancer
EMAS2017 / Maturitas 100 (2017) 93–202
episode of bleeding in postmenopause. All women undergone biopsy and had a histology result, with blind curettage, hysteroscopy followed by curettage or biopsy by hysteroscopy, and some of them hysteroscopy and resectoscopy. In 40 cases the biopsy revealed neoplasia of endometrium, 38 cases with different types of adenocarcinoma, and in 2 cases adenosarcoma. The hysteroscopy had a positive predictive value of 51% and a negative predictive value of 87.7% in diagnostic the malignancy in this study group. The age of patients with endometrial carcinoma it was significant higher than the other patients with non-malignant reasons of bleeding (p < 0.0001, CI 95%: 7.01–12.58), the difference between the two median ages in these group is almost 10 years. Conclusion: Hysteroscopy is the golden standard in evaluation of the uterine cavity in postmenopausal bleeding. New techniques and diagnostic devices help in evaluating the cavity even in advance age. The importance of correct diagnosis and sampling is equal important at advance ages were the risk of endometrial neoplasia is increase and also in the groups with risks for endometrium transformation is increased (obesity, diabetes, hypertension, tamoxifen treatment) and for endometrium surveillance. Keywords: Metrorrhagia in postmenopause; Bleeding in postmenopause; Endometrial biopsy; Adenocarcinoma of endometrium; Hysteroscopy http://dx.doi.org/10.1016/j.maturitas.2017.03.203 P104 The hypoechogenic image inside the endometrial cavity during menopause Corina Grigoriu, Simona Albu, Iuliana Ceausu ∗ , Cristina Vasiliu, Irina Horhoianu University of Medicine and Pharmacy, Ob/Gyn, Bucharest, Romania Introduction: In several asymptomatic menopausal patients, in which routine annual transvaginal screening is performed, we may observe a small hypoechogenic image inside the endometrial cavity, with an atrophic endometrium nearby. On the other hand, some patients with several minor complaints-like vaginal uncolored or pink-colored discharge, may have the same endometrial image. Method: We prospectively observed 37 asymptomatic routine screened menopausal patients and 19 patients with some minor complaints (discharge, unspecific lower abdominal pain), in which atrophic endometrium was described, beneath an hypoechogenic endometrial image (2–6 mm). Vaginal cultures and cervical cytology were negative. MRI was performed in 14 out of the 19 symptomatic patients, due to small follicular images in the ovaries, all of them were negative. Results: We suggested a follow up for the next twelve months, performing ultrasound examinations and vaginal cultures every three months. In four of the symptomatic patients we observed a growing endometrium (over 5 mm) and we performed endometrial aspiration (Pippelle) – in two cases early stage endometrial adenocarcinoma was diagnosed. Conclusion: Although a hypoechogenic image associated with an atrophic endometrium is in most cases irrelevant, being related to an isolated secretion of the endometrial glands, our experience suggests that follow-up is valuable especially in symptomatic patients. http://dx.doi.org/10.1016/j.maturitas.2017.03.204
179
P105 High grade endometrial cancer. The same risk factors? Laura Baquedano 1,∗ , Pluvio Jesús Coronado 2 , Maria Jesús Martinez-Maestre 3 , Yasmina José 1 , Diego Judez 4 , Miguel Angel Ruiz-Conde 1 1
Hospital Universitario Miguel Servet, Zaragoza, Spain 2 Hospital Clinico San Carlos, Madrid, Spain 3 Hospital Virgen del Rocío, Sevilla, Spain 4 Hospital Alca˜ niz, Teruel, Spain Endometrial carcinoma (EC) has classically been divided into two groups: type I (good prognosis and estrogen dependent) and type II (worst prognosis and independent estrogen). The aim of the study is to analyze the risk factors associated with all types of highgrade EC. Methods: Retrospective multicentre cohort study in three Spanish hospitals (Hospital Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Sevilla). We studied the risk factors associated with high grade EC: endometrioid G3 (CEG3), serous (CS), clear cells (CCC) and mixed mesodermal tumors (TMMM). Differences between subtypes were analyzed and depending on whether it was EC type I/II. Results: Diabetes, obesity, nulliparity and use of hormonal replacement therapy showed no significant difference between all subtypes. TMMM was less frequently associated with hypertension and conversely it showed greater association with the use of tamoxifen in patients with breast cancer. Conclusions: Risk factors associated with high-grade CE are similar in types I and II. Tamoxifen is especially associated with TMMM. http://dx.doi.org/10.1016/j.maturitas.2017.03.205 P106 Synchronous endometrial and tube cancer Laura Baquedano ∗ , Francisco Villalobos, Ignacio Adiego, Patricia Rubio, Laura Cotaina, Miguel Angel Ruiz-Conde Hospital Universitario Miguel Servet, Zaragoza, Spain Synchronous tumors of the endometrium and ovary are a wellknown and well described entity, but the series with cases of endometrial cancer (EC) and fallopian tubes cancer (TC) are much more limited. It is important to exclude it from metastatic disease because it implies therapeutic and prognostic implications. We report two patients with concurrent endometrial and tube cancer and how the diagnosis was made that one of them was synchronic tumors and metastases in the other. Size, deep myometrial invasion, lymphovascular space affectation and the presence of lymphatic metastasis were important factors in the differential diagnosis. http://dx.doi.org/10.1016/j.maturitas.2017.03.206
episode of bleeding in postmenopause. All women undergone biopsy and had a histology result, with blind curettage, hysteroscopy followed by curettage or biopsy by hysteroscopy, and some of them hysteroscopy and resectoscopy. In 40 cases the biopsy revealed neoplasia of endometrium, 38 cases with different types of adenocarcinoma, and in 2 cases adenosarcoma. The hysteroscopy had a positive predictive value of 51% and a negative predictive value of 87.7% in diagnostic the malignancy in this study group. The age of patients with endometrial carcinoma it was significant higher than the other patients with non-malignant reasons of bleeding (p < 0.0001, CI 95%: 7.01–12.58), the difference between the two median ages in these group is almost 10 years. Conclusion: Hysteroscopy is the golden standard in evaluation of the uterine cavity in postmenopausal bleeding. New techniques and diagnostic devices help in evaluating the cavity even in advance age. The importance of correct diagnosis and sampling is equal important at advance ages were the risk of endometrial neoplasia is increase and also in the groups with risks for endometrium transformation is increased (obesity, diabetes, hypertension, tamoxifen treatment) and for endometrium surveillance. Keywords: Metrorrhagia in postmenopause; Bleeding in postmenopause; Endometrial biopsy; Adenocarcinoma of endometrium; Hysteroscopy http://dx.doi.org/10.1016/j.maturitas.2017.03.203 P104 The hypoechogenic image inside the endometrial cavity during menopause Corina Grigoriu, Simona Albu, Iuliana Ceausu ∗ , Cristina Vasiliu, Irina Horhoianu University of Medicine and Pharmacy, Ob/Gyn, Bucharest, Romania Introduction: In several asymptomatic menopausal patients, in which routine annual transvaginal screening is performed, we may observe a small hypoechogenic image inside the endometrial cavity, with an atrophic endometrium nearby. On the other hand, some patients with several minor complaints-like vaginal uncolored or pink-colored discharge, may have the same endometrial image. Method: We prospectively observed 37 asymptomatic routine screened menopausal patients and 19 patients with some minor complaints (discharge, unspecific lower abdominal pain), in which atrophic endometrium was described, beneath an hypoechogenic endometrial image (2–6 mm). Vaginal cultures and cervical cytology were negative. MRI was performed in 14 out of the 19 symptomatic patients, due to small follicular images in the ovaries, all of them were negative. Results: We suggested a follow up for the next twelve months, performing ultrasound examinations and vaginal cultures every three months. In four of the symptomatic patients we observed a growing endometrium (over 5 mm) and we performed endometrial aspiration (Pippelle) – in two cases early stage endometrial adenocarcinoma was diagnosed. Conclusion: Although a hypoechogenic image associated with an atrophic endometrium is in most cases irrelevant, being related to an isolated secretion of the endometrial glands, our experience suggests that follow-up is valuable especially in symptomatic patients. http://dx.doi.org/10.1016/j.maturitas.2017.03.204
179
P105 High grade endometrial cancer. The same risk factors? Laura Baquedano 1,∗ , Pluvio Jesús Coronado 2 , Maria Jesús Martinez-Maestre 3 , Yasmina José 1 , Diego Judez 4 , Miguel Angel Ruiz-Conde 1 1
Hospital Universitario Miguel Servet, Zaragoza, Spain 2 Hospital Clinico San Carlos, Madrid, Spain 3 Hospital Virgen del Rocío, Sevilla, Spain 4 Hospital Alca˜ niz, Teruel, Spain Endometrial carcinoma (EC) has classically been divided into two groups: type I (good prognosis and estrogen dependent) and type II (worst prognosis and independent estrogen). The aim of the study is to analyze the risk factors associated with all types of highgrade EC. Methods: Retrospective multicentre cohort study in three Spanish hospitals (Hospital Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Sevilla). We studied the risk factors associated with high grade EC: endometrioid G3 (CEG3), serous (CS), clear cells (CCC) and mixed mesodermal tumors (TMMM). Differences between subtypes were analyzed and depending on whether it was EC type I/II. Results: Diabetes, obesity, nulliparity and use of hormonal replacement therapy showed no significant difference between all subtypes. TMMM was less frequently associated with hypertension and conversely it showed greater association with the use of tamoxifen in patients with breast cancer. Conclusions: Risk factors associated with high-grade CE are similar in types I and II. Tamoxifen is especially associated with TMMM. http://dx.doi.org/10.1016/j.maturitas.2017.03.205 P106 Synchronous endometrial and tube cancer Laura Baquedano ∗ , Francisco Villalobos, Ignacio Adiego, Patricia Rubio, Laura Cotaina, Miguel Angel Ruiz-Conde Hospital Universitario Miguel Servet, Zaragoza, Spain Synchronous tumors of the endometrium and ovary are a wellknown and well described entity, but the series with cases of endometrial cancer (EC) and fallopian tubes cancer (TC) are much more limited. It is important to exclude it from metastatic disease because it implies therapeutic and prognostic implications. We report two patients with concurrent endometrial and tube cancer and how the diagnosis was made that one of them was synchronic tumors and metastases in the other. Size, deep myometrial invasion, lymphovascular space affectation and the presence of lymphatic metastasis were important factors in the differential diagnosis. http://dx.doi.org/10.1016/j.maturitas.2017.03.206