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UTERINE SARCOMA: A RARE CAUSE OF UTERINE INVERSION
S120
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
475
477
LAPAROSCOPIC PARAAORTIC LYMPHADENECTOMY IN GYNAECOLOGICAL CANCER
EXPRESSION OF MÜLLERIAN INHIBITING SUBSTANCE TYPE II RECEPTOR (MISR II) AND ANTIPROLIFERATIVE EFFECTS OF MIS ON HUMAN CERVICAL CANCER
J.S. Jimenez, C. Guillen, C. Perez, J.L. Muñoz, C. Alvarez, G. Lopez, C. Gonzalez. Hospital 12 de Octubre, Obstetricia y Ginecología, Madrid, Spain Objectives: Evaluation results laparoscopic paraortic lymphadenectomy. Methods: The group is constituted by 34 consecutive-patients technique laparoscopy outpost by oncological cervix-endometrial-ovary processes. Procedure: Evaluation of operability with intention to try. Lymphadenectomy took place paraortic transperitoneal from primitive iliac artery to left renal vein. We realise retrospective analysis. Results: The indication of lymphadenectomy was endometrial adenocarcinoma (high degree, serous papillary, cel. Clear) 64%cases, advanced cervix cancer (IB2, IIandIII) 22% and the rest are initial stage ovary cancer. The average was 51 years (rank 30-81); the average body index of mass was of 32. The procedure was completed in all the cases, one case was made to laparotomy by vascular accident. The sanguineous lost estimation was of 120 cc (70-350) with an average reduction of the number of haemoglobin of 1,7 (0,1-3.9) The average time of the procedure was 72 minutes (50-110), the number average of lymphatic nodules was 8 (4-14). one case we found metastasis preaortic ganglion that also he was positive in the pelvic ones. We had two vascular complications (5,8%) one of theme was resolute by laparoscopyc by injury in cava vein digs and other injury, in right ovarian artery in aorta exit, was sutured by laparotomy. Conclusions: The laparoscopy boarding of minimum invasion, can supply a suitable radical answer to gynaecological oncology procedures in selected patients. The advantages of this procedure include low morbidity, a shorter hospital stance, less haematic lows, a shorter post-operative period of the recovery without significant increase of complications. Keywords: Paraaortic lymphadenectomy, laparoscopy, gynaecological cancer.
E.K. Oh, J.Y. Song, D.J. Kwon, Y.O. Lew, E.J. Kim, J.H. Kim. Catholic University of Korea, Seoul, Korea, Republic of Objective: To analyze expression of MISR II and receptor mRNA in cervical neoplasia, to demonstrate the growth inhibition of cervical cancer cells by administration of highly purified MIS. Materials & methods: RT-PCR, ISH, IHC, MTT assay, Flow cytometry, and annexin-V-FITC staining method were used for 20 cervical tissues with 10/ml MIS. Results: Expression of MISR II protein and mRNA on normal cervical and cervical carcinoma tissues was confirmed. The strongest expression was shown on cervical squamous carcinoma, followed by normal cervical tissues and adenocarcinoma tissues, respectively. MTT assay showed the negative correlation between the MIS exposure time and the viability of cervical cells (P=0.008). The changes in cell cycle distribution after MIS exposure at 24 hours and 48 hours demonstrated that S and G2 M phases were decreased, G0 G1 and sub G0 G1 phases were increased. Therefore, MIS plays an important role in inducing cellular apoptosis by causing arrest at G1 phase and increasing cells at sub G0 G1 phase. Annexin-V-FITC staining methods showed that cellular apoptosis were 10.44% and 12.89% after 24 hours and 48 hours of MIS exposure in cervical carcinoma cells. There was a negative correlation between cellular survival and MIS exposure time. Conclusion: This study demonstrates that MISR II is present on normal cervical and cervical carcinoma tissues, and MIS shows receptor-mediated anti-proliferative capability on cervical cells in vitro. MIS may be used as a biological modifier or therapeutic modulator on MISR II-expressed tumors in future. Keywords: MIS; MISRII; cervical carcinoma; immunohistochemistry; in situ hybridization.
476 PARANEOPLASTIC DERMATOMIOSYTIS IN A POSTMENOPAUSAL WOMAN
478 UTERINE SARCOMA: A RARE CAUSE OF UTERINE INVERSION
C. Perez, J.S. Jiménez, L. Marqueta, C. Guillen, C. Alvarez, G. Lopez, J.M. Hernandez. Hospital 12 de Octubre, Obstetricia y Ginecología, Madrid, Spain Objectives: To present a case of dermatomyositis in a postmenopausalwoman as a paraneoplastyc disorder due to an endometrial adenocarcinoma. Methods: Case report and literature review. Results: Edometrial cancer is the second most common gynecologic malignancy in the developed countries. Although the incidence of disease has remained stable, the death rate has increased. Dermatomyositis is an idiopathic inflammatory myopathy. Evidence supports that ocult cancer may be present in up to a 60% of patients with dermatomyositis. Most of the malignancies are located on the genital tract: ovarian, breast and uterus. Clinical prognostic factors that can predict malignancy are elderly age, female sex, cutaneous vasculitis, rapid onset-progress of disease, lack of response to therapy, extended cutaneos lesions and lack of serological abnormalities.We present the case of a postmenopausal woman with dermatomiosytis followed during more than one year, showing lack of response to therapy. Gynaecological ecography was compatible with an endometrial polyp. Although she denied postmenopausal metrorragy a diagnostic hysteroscopy was performed, showing a suspicious-looking mass. The biopsy was compatible with endometrial adenocarcinoma.Deferred pathological findings after surgical treatment reported villoglandular adenocarcinoma G1 Ib N0 Mo. One year and three months after, the patient is free of disease with clinical improvement of the dermatitis. Conclusions: In women with dermatomyositis transvaginal ultrasound is essential because of its simplicity and safety. If we suspect endometrial pathology, in the presence of abnormal metrorrhagia or if there is no improvement with treatment an hysteroscopy must be performed to assess the endocervical canal and uterine cavity. Keywords: Endometrial cancer, hysteroscopy, dermatomiosytis.
J. Mechery, E. Crosbie, R. Slade. Hope Hospital, Salford, Obstetrics and Gynaecology, Manchester, United Kingdom Objectives: Non-puerperal uterine inversion is rare and is estimated to account for just 17% of all cases. Most cases of uterine inversion are encountered during the puerperium. Rarely, uterine inversion may complicate the presentation and management of a uterine sarcoma. Methods: A 71 year old woman was admitted as an emergency with heavy post menopausal bleeding. She was very overweight, with a BMI of 41. An ultrasound scan showed an enlarged uterus with a thickened endometrium of 23mm and normal adnexae. She underwent examination under anaesthesia, hysteroscopy and endometrial curettage. Histological examination indicated benign adenofibroma of the endometrium. Some weeks later she was readmitted to hospital for a repeat examination under anaesthetic. This showed a necrotic mass prolapsing through the cervix. Biopsies were taken but histological assessment was not possible because the tissue was so degenerate and necrotic. An MR scan showed a grossly enlarged uterus with distended endometrial and endocervical cavities. Despite her previously benign histopathology, malignancy was suspected and a laparotomy was undertaken. At laparotomy, a completely inverted uterus was found with a fungating necrotic mass expanding the vagina. She had radical hysterectomy and bilateral salpingo-oophoectomy. Results: Histology showed stromal adenosarcoma of the uterus. There was no lymphovascular space involvement and the excision margins were clear of disease. She made an excellent post-operative recovery. Conclusions: This report describes a case of uterine inversion diagnosed at the time of surgery in a patient with a uterine sarcoma. Keywords: Uterine inversion, Uterine sarcoma.
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
475
477
LAPAROSCOPIC PARAAORTIC LYMPHADENECTOMY IN GYNAECOLOGICAL CANCER
EXPRESSION OF MÜLLERIAN INHIBITING SUBSTANCE TYPE II RECEPTOR (MISR II) AND ANTIPROLIFERATIVE EFFECTS OF MIS ON HUMAN CERVICAL CANCER
J.S. Jimenez, C. Guillen, C. Perez, J.L. Muñoz, C. Alvarez, G. Lopez, C. Gonzalez. Hospital 12 de Octubre, Obstetricia y Ginecología, Madrid, Spain Objectives: Evaluation results laparoscopic paraortic lymphadenectomy. Methods: The group is constituted by 34 consecutive-patients technique laparoscopy outpost by oncological cervix-endometrial-ovary processes. Procedure: Evaluation of operability with intention to try. Lymphadenectomy took place paraortic transperitoneal from primitive iliac artery to left renal vein. We realise retrospective analysis. Results: The indication of lymphadenectomy was endometrial adenocarcinoma (high degree, serous papillary, cel. Clear) 64%cases, advanced cervix cancer (IB2, IIandIII) 22% and the rest are initial stage ovary cancer. The average was 51 years (rank 30-81); the average body index of mass was of 32. The procedure was completed in all the cases, one case was made to laparotomy by vascular accident. The sanguineous lost estimation was of 120 cc (70-350) with an average reduction of the number of haemoglobin of 1,7 (0,1-3.9) The average time of the procedure was 72 minutes (50-110), the number average of lymphatic nodules was 8 (4-14). one case we found metastasis preaortic ganglion that also he was positive in the pelvic ones. We had two vascular complications (5,8%) one of theme was resolute by laparoscopyc by injury in cava vein digs and other injury, in right ovarian artery in aorta exit, was sutured by laparotomy. Conclusions: The laparoscopy boarding of minimum invasion, can supply a suitable radical answer to gynaecological oncology procedures in selected patients. The advantages of this procedure include low morbidity, a shorter hospital stance, less haematic lows, a shorter post-operative period of the recovery without significant increase of complications. Keywords: Paraaortic lymphadenectomy, laparoscopy, gynaecological cancer.
E.K. Oh, J.Y. Song, D.J. Kwon, Y.O. Lew, E.J. Kim, J.H. Kim. Catholic University of Korea, Seoul, Korea, Republic of Objective: To analyze expression of MISR II and receptor mRNA in cervical neoplasia, to demonstrate the growth inhibition of cervical cancer cells by administration of highly purified MIS. Materials & methods: RT-PCR, ISH, IHC, MTT assay, Flow cytometry, and annexin-V-FITC staining method were used for 20 cervical tissues with 10/ml MIS. Results: Expression of MISR II protein and mRNA on normal cervical and cervical carcinoma tissues was confirmed. The strongest expression was shown on cervical squamous carcinoma, followed by normal cervical tissues and adenocarcinoma tissues, respectively. MTT assay showed the negative correlation between the MIS exposure time and the viability of cervical cells (P=0.008). The changes in cell cycle distribution after MIS exposure at 24 hours and 48 hours demonstrated that S and G2 M phases were decreased, G0 G1 and sub G0 G1 phases were increased. Therefore, MIS plays an important role in inducing cellular apoptosis by causing arrest at G1 phase and increasing cells at sub G0 G1 phase. Annexin-V-FITC staining methods showed that cellular apoptosis were 10.44% and 12.89% after 24 hours and 48 hours of MIS exposure in cervical carcinoma cells. There was a negative correlation between cellular survival and MIS exposure time. Conclusion: This study demonstrates that MISR II is present on normal cervical and cervical carcinoma tissues, and MIS shows receptor-mediated anti-proliferative capability on cervical cells in vitro. MIS may be used as a biological modifier or therapeutic modulator on MISR II-expressed tumors in future. Keywords: MIS; MISRII; cervical carcinoma; immunohistochemistry; in situ hybridization.
476 PARANEOPLASTIC DERMATOMIOSYTIS IN A POSTMENOPAUSAL WOMAN
478 UTERINE SARCOMA: A RARE CAUSE OF UTERINE INVERSION
C. Perez, J.S. Jiménez, L. Marqueta, C. Guillen, C. Alvarez, G. Lopez, J.M. Hernandez. Hospital 12 de Octubre, Obstetricia y Ginecología, Madrid, Spain Objectives: To present a case of dermatomyositis in a postmenopausalwoman as a paraneoplastyc disorder due to an endometrial adenocarcinoma. Methods: Case report and literature review. Results: Edometrial cancer is the second most common gynecologic malignancy in the developed countries. Although the incidence of disease has remained stable, the death rate has increased. Dermatomyositis is an idiopathic inflammatory myopathy. Evidence supports that ocult cancer may be present in up to a 60% of patients with dermatomyositis. Most of the malignancies are located on the genital tract: ovarian, breast and uterus. Clinical prognostic factors that can predict malignancy are elderly age, female sex, cutaneous vasculitis, rapid onset-progress of disease, lack of response to therapy, extended cutaneos lesions and lack of serological abnormalities.We present the case of a postmenopausal woman with dermatomiosytis followed during more than one year, showing lack of response to therapy. Gynaecological ecography was compatible with an endometrial polyp. Although she denied postmenopausal metrorragy a diagnostic hysteroscopy was performed, showing a suspicious-looking mass. The biopsy was compatible with endometrial adenocarcinoma.Deferred pathological findings after surgical treatment reported villoglandular adenocarcinoma G1 Ib N0 Mo. One year and three months after, the patient is free of disease with clinical improvement of the dermatitis. Conclusions: In women with dermatomyositis transvaginal ultrasound is essential because of its simplicity and safety. If we suspect endometrial pathology, in the presence of abnormal metrorrhagia or if there is no improvement with treatment an hysteroscopy must be performed to assess the endocervical canal and uterine cavity. Keywords: Endometrial cancer, hysteroscopy, dermatomiosytis.
J. Mechery, E. Crosbie, R. Slade. Hope Hospital, Salford, Obstetrics and Gynaecology, Manchester, United Kingdom Objectives: Non-puerperal uterine inversion is rare and is estimated to account for just 17% of all cases. Most cases of uterine inversion are encountered during the puerperium. Rarely, uterine inversion may complicate the presentation and management of a uterine sarcoma. Methods: A 71 year old woman was admitted as an emergency with heavy post menopausal bleeding. She was very overweight, with a BMI of 41. An ultrasound scan showed an enlarged uterus with a thickened endometrium of 23mm and normal adnexae. She underwent examination under anaesthesia, hysteroscopy and endometrial curettage. Histological examination indicated benign adenofibroma of the endometrium. Some weeks later she was readmitted to hospital for a repeat examination under anaesthetic. This showed a necrotic mass prolapsing through the cervix. Biopsies were taken but histological assessment was not possible because the tissue was so degenerate and necrotic. An MR scan showed a grossly enlarged uterus with distended endometrial and endocervical cavities. Despite her previously benign histopathology, malignancy was suspected and a laparotomy was undertaken. At laparotomy, a completely inverted uterus was found with a fungating necrotic mass expanding the vagina. She had radical hysterectomy and bilateral salpingo-oophoectomy. Results: Histology showed stromal adenosarcoma of the uterus. There was no lymphovascular space involvement and the excision margins were clear of disease. She made an excellent post-operative recovery. Conclusions: This report describes a case of uterine inversion diagnosed at the time of surgery in a patient with a uterine sarcoma. Keywords: Uterine inversion, Uterine sarcoma.