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Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Budd–Chiari syndrome (BCS) is a rare condition, usually associated with hematological disorders such as thrombotic diathesis and hypercoagulability. Serum CA-125 level is an established tumor marker of ovarian malignancy; however, cases of primary BCS may also show raised CA-125 levels. BCS in a case of ovarian carcinoma is usually primary in nature due to hypercoagulable state, and raised CA-125 levels with tender hepatomegaly in a treated case of ovarian carcinoma usually imply metastatic recurrence in the liver. However, our case demonstrates an atypical secondary cause of BCS in such a patient caused by extrinsic compression of IVC due to recurrent disease. Case presentation: We report an unusual case of a 69-year-old female who presented with nausea and abdominal pain. She had a 7-year-old history of endometrioid carcinoma of the right ovary for which she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node dissection along with adjuvant chemotherapy. Currently, she had right hypochondrium tenderness, deranged liver function tests (LFT) and raised CA-125 levels, which raised suspicion of hepatic metastasis. However, CECT abdomen revealed peripheral mottled enhancement of liver with multifocal extrahepatic tumor deposits, one of them causing compression of inferior vena cava (IVC) implying a diagnosis of secondary Budd–Chiari syndrome. Conclusions: In a background of treated ovarian malignancy with raised CA-125 levels and deranged LFT, primary suspicion is of hepatic tumor recurrence. However, in our case, radiological investigation revealed diagnosis of secondary Budd–Chiari syndrome due to perihepatic metastatic recurrence with the absence of frank intrahepatic lesions. [ABSTRACT FROM AUTHOR]

Introduction: Ifosfamide (IFX) is an alkylating drug used for chemotherapy to manage a wide range of malignancies including testicular, ovarian, head-and-neck cancers, lymphomas, and sarcomas. Central nervous system (CNS) toxicity is known to occur in 10%-40% of patients who are administered high doses of IFX. CNS toxicity includes an encephalopathy with underlying nonconvulsive status epilepticus manifesting with altered sensorium, mental confusion, seizures, ataxia, visual hallucinations, akinetic mute state extrapyramidal features, or coma. Case Report: We describe the case of a 65-year-old woman with a rapidly evolving confusional state and progressive decline in the fluency of speech progressing to mutism immediately after IFX chemotherapy. Results: Electroencephalogram (EEG) revealed evidence of nonconvulsive status epilepticus. The patient was managed with anticonvulsants, discontinuing IFX, and intravenous methylene blue infusion. Subsequently, the patient had significant improvement to an alert state with normalization of EEG abnormality. Conclusion: CNS toxicity following IFX usually manifests within 24 h of the drug administration, although clinical manifestations of toxicity may occur up to 4-6 days and a significant number of these patients may have a nonconvulsive status as the cause of the encephalopathy. Patients with encephalopathy following IFX should be evaluated with early EEG to assess for the presence or absence of a nonconvulsive status. Patients with a positive EEG would benefit from prompt and aggressive anticonvulsant therapy along with cessation of IFX therapy with or without intravenous methylene blue administration. [ABSTRACT FROM AUTHOR]

Background: Metastases from endometrial carcinoma to the lungs are uncommon and cavitating metastases are even rarer. In some cases, lung cavitating metastases may resemble diffuse "Cheerios in the lung." Case presentation: A 58-year-old woman, smoker, with a history of hysteroannessiectomy and pelvic lymphadenectomy for a low stage endometrial endometrioid adenocarcinoma, came under our attention for dry cough without fever that persisted for over three months, and computed tomography (CT) revealed diffuse cavitating lung metastases resembling "Cheerios in the lung". After standard chemotherapy proved ineffective, Lenvatinib plus Pembrolizumab (immunotherapy) was administrated, leading to the disappearance of all lung nodules, leaving behind a diffuse emphysematous-like pattern. Conclusions: This case is a rare example of metastatic endometrioid adenocarcinoma, manifested with chronic dry cough, with "Cheerios in the lung" appearence. The metastases responded well to immunotherapy, resulting in the regression of nodules into areas of diffuse emphysematous-like changes. [ABSTRACT FROM AUTHOR]

Introduction: Primary fallopian tube neoplasms are usually rare, and they are the rarest of all female genital tract neoplasms. According to the WHO classification, papillomas, adenofibroma, cystadenoma, cystadenofibroma, and metaplastic papillary tumors belong to the group of benign tumor masses that arise from the fallopian tubes. Methods: In our case, during an abdominal hysterectomy in a 45-yearold woman suspicious of endometrial adenocarcinoma, a right tubal mass was incidentally found. Results: Microscopic findings revealed features of serous papillary adenofibroma. Serous papillary adenofibroma is a very rare tumor. Till date, only a few cases have been reported worldwide, more so in the presence of endometrial malignancy. Conclusion: Serous papillary adenofibroma is often an incidental finding; thus, it is important to gross the specimen minutely to look for any such finding in the adnexa to avoid missing out on such rare neoplasm. [ABSTRACT FROM AUTHOR]

Introduction: Primary fallopian tube neoplasms are usually rare, and they are the rarest of all female genital tract neoplasms. According to the WHO classification, papillomas, adenofibroma, cystadenoma, cystadenofibroma, and metaplastic papillary tumors belong to the group of benign tumor masses that arise from the fallopian tubes. Methods: In our case, during an abdominal hysterectomy in a 45-yearold woman suspicious of endometrial adenocarcinoma, a right tubal mass was incidentally found. Results: Microscopic findings revealed features of serous papillary adenofibroma. Serous papillary adenofibroma is a very rare tumor. Till date, only a few cases have been reported worldwide, more so in the presence of endometrial malignancy. Conclusion: Serous papillary adenofibroma is often an incidental finding; thus, it is important to gross the specimen minutely to look for any such finding in the adnexa to avoid missing out on such rare neoplasm. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses Hormonal contraceptives, such as the hormonal intrauterine device (IUD), can help perimenopausal women manage symptoms and improve their quality of life. These contraceptives not only prevent unwanted pregnancies but also provide noncontraceptive benefits like treating abnormal uterine bleeding, relieving vasomotor symptoms and menstrual migraines, protecting against bone loss and endometrial issues, and reducing the risk of musculoskeletal issues and mood disorders.

The article informs Contraceptives, such as oral contraceptives, hormonal IUDs, and copper IUDs, offer protection against gynecological cancers, including endometrial, ovarian, and colorectal cancers. Women who have used oral contraceptives have a lower risk of these cancers, and the longer the duration of use, the greater the protection. Hormonal IUDs can also prevent endometrial cancer, while copper IUDs reduce the risk of cervical, endometrial, and ovarian cancers.

Purpose: This study investigated the effects of peripheral neuropathy symptoms, self-care ability, and disturbances to daily life on quality of life (QoL) among gynecological cancer patients undergoing chemotherapy. Methods: The participants included 144 patients with gynecological cancer undergoing anticancer chemotherapy at a tertiary hospital in Seoul, South Korea, from December 1, 2021 to January 28, 2022. Convenience sampling was used to recruit patients who had received 4 or more cycles of chemotherapy using a paclitaxel-platinum regimen, and a self-reported questionnaire was used to collect data. Descriptive statistics, the t-test, analysis of variance, Scheffé test, Pearson correlation coefficients, and multiple regression analysis were performed. Results: Most of the participants had ovarian cancer (70.1%) or endometrial cancer (14.6%), and the most common number of treatment cycles was 6 to 10 (29.2%). The mean QoL (60.83±19.89) was greater than the midpoint. The regression model analyzing the patients' QoL was statistically significant (F=15.38, p<.001) with an explanatory power of 56.7%. Self-care ability (β=.39, p<.001), disturbances to daily life (β=--.38, p<.001), the duration of peripheral neuropathy symptoms (β=2.14, p=.034), and regular exercise (β=--2.12, p=.036) were found to significantly affect QoL. Conclusion: Efforts to improve the self-care ability of gynecological cancer patients who have experienced peripheral neuropathy after receiving chemotherapy and mitigate disturbances to their daily life can improve their QoL. Healthcare professionals should identify peripheral neuropathy symptoms and examine the effects of the symptoms on patients' daily lives. Improving the self-care ability of patients and alleviating their limitations in daily life may improve QoL. [ABSTRACT FROM AUTHOR]

• We delineate the case screening and dataset generation processes, along with offering guidance for visually inspecting MRI images in DICOM format outside hospital settings. Furthermore, we elaborate on the annotation and data-saving procedures required to create a compatible dataset for our computer model. • Due to the sequential nature of MRI images, we employ a classification approach to categorize them into two groups: images portraying tumors and those without. This foundational step is pivotal for subsequent segmentation experiments, crucial for achieving swift segmentation of image sequences. • Through meticulous consideration, we selected a segmentation model tailored to lesion characteristics and image features. This decision yielded our highest segmentation accuracy to date and offers potential support for imaging physicians in clinical diagnosis decisions. Endometrial cancer, one of the three major malignant tumors of the female genitalia, has seen an increase in incidence in recent years. The 5-year survival rate for early endometrial cancer is approximately 80% to 90%. In clinical practice, the accurate segmentation of endometrial cancer tumors is crucial for assessing the extent of hyperplasia and guiding treatment decisions. Developing a deep learning (DL)-based tumor segmentation method for Magnetic Resonance Imaging (MRI) sequences in cases of Endometrial Cancer (EC) can significantly improve the accuracy and efficiency of this process. We proposed an multi-task framework: ECMS-Net. We established a classification model based on the Transformer algorithm to discern images containing tumors within the sequence and U2-Net segmentation model was trained to perform automated and precise segmentation of early endometrial cancer tumor regions. Our results show that we have firstly proposed a sequence classification method and achieved an accuracy of 0.985 and this is the best result of the study so far, followed by a tumor segmentation maxF1 value of 0.970, which highlights the excellent performance of our proposed method. The entire experimental process aligns closely with the demands of the clinical imaging department, promising to enhance the efficiency of medical professionals, alleviate workload stress, and better cater to the requirements of the medical field. [ABSTRACT FROM AUTHOR]

Sentinel lymph node (SLN) biopsy algorithm has been routinely applied in all endometrial endometrioid tumors, however, no studies analyzed the feasibility of SLN mapping in endometrioid variants (EV), which included villoglandular, secretory, ciliated cell, mucinous, and squamous differentiation. This study aimed to demonstrate the feasibility of SLN biopsy in EV of EC. All patients undergoing minimally invasive surgical treatment for early-stage EC were included in the study. Patients were divided into 2 study groups: Group 1 which included patients with EV, and Group 2 which included patients with typical endometrioid histology. A propensity match analysis was performed according to age (≥65 years vs. no), BMI (≥30 kg/m2 vs. no), and LVSI (present vs. absent). After a 1:5 propensity-matched analysis, a total of 458 patients were identified (Group 1 n = 77, Group 2 n = 381). Overall detection rate was not statistically significant between the EV and the typical endometrioid group (94.8% vs. 92.4%, p = 0.319). Furthermore, neither bilateral nor unilateral detection rate was different between the two groups (70.1% vs. 74.8%, p = 0.267, and 23.4% vs. 17.8%, p = 0.120). BMI ≥30 kg/m2 was the only factor influencing SLN failure (p = 0.013). SLN technique showed excellent sensitivity in both the EV (100% sensitivity, p < 0.001) and the typical endometrioid unit (93.8% sensitivity, p < 0.001). SLN research/detection for EV of endometrial cancer is a feasible and highly sensitive technique. Obesity was confirmed to be a risk factor for SLN failure. •SLN research for EV is a feasible and highly sensitive technique. •Obesity was a risk factor for SLN failure even in EV cases. •Empty packets were more frequently associated with EV compared to typical endometrioid subtypes. [ABSTRACT FROM AUTHOR]

To investigate the blood levels of adipokines in obese patients with endometrial cancer who have and have not undergone omentectomy. Between September 2017 and September 2019, the study recruited 54 patients with endometrial cancer. Measurements were taken of blood levels of human leptin, perilipin-1, adiponectin, adipolin, resistin, visfatin, and estrone preoperatively and postoperatively before adjuvant therapy or at the end of one month. The serum samples were separated by centrifugation for 10 mins at 3,000 revolutions/min, then stored at −80 °C until assay. In this prospective study, a total of 54 endometrial cancer patients were analyzed in two separate groups according to the omentectomy status. Comprehensive staging surgery with omentectomy and without omentectomy was performed in 26 patients and 28 patients, respectively. The age, body mass index, body fat index, waist circumference, and skin thickness values of the patients with and without omentectomy were found to be similar. No statistically significant difference was determined between the patients with and without omentectomy in respect of the blood level of the adipokines measured preoperatively. A strong statistically significant correlation was determined between the pre and postoperative levels of Human Leptin (p = 0.002), perilipin-1(p = 0.001), adipolin (p < 0.001), adiponectin (p < 0.001), resistin (p = 0.001), visfatin (p < 0.001), and estrone (p = 0.004) (r = −0.43, −0.47, 0.75, 0.84, −0.47, - 0.58, −0.41, respectively) Omentectomy affected the postoperative blood levels of adipokines in obese patients with endometrial cancer. As omentectomy may have some positive effects on metabolism in these patients, it may be considered during endometrial cancer surgery due to the possible positive metabolic effects. • The coexistence of endometrial cancer with obesity is common. • Omentectomy changed blood levels of adipokines. • Adipokines have a critical role on the metabolism of glucose or lipid [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the risk factors for pelvic lymph node metastasis (LNM) and para-aortic LNM in non-endometrioid endometrial cancer (non-EEC). A total of 283 patients with non-EEC hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2020 were included. Various characteristics were retrospectively analyzed in relation to LNM. Univariable and multivariable logistic regression analysis revealed cervical stromal invasion (OR = 3.441, 95% CI = 1.558–7.6, p = 0.002), myometrial invasion ≥1/2 (OR = 2.661, 95% CI = 1.327–5.337, p < 0.006), lymphovascular space involvement (LVSI) (OR = 4.118, 95% CI = 1.919–8.837, p < 0.001), positive peritoneal cytology (OR = 2.962, 95% CI = 1.344–6.530, p = 0.007), CA125 (OR = 1.002, 95% CI = 1–1.004, p = 0.026) were the independent risk factors for pelvic LNM. And myometrial invasion ≥1/2 (OR = 5.881, 95% CI = 2.056–16.427, p = 0.001), LVSI (OR = 4.962, 95% CI = 1.933–12.740, p = 0.001), adnexal (OR = 5.921, 95% CI = 2.003–17.502, p = 0.001) were the independent risk factors for para-aortic LNM. With the increase of independent risk factors, the rates of LNM were increased significantly. Cervical stromal invasion, myometrial invasion ≥1/2, LVSI, positive peritoneal cytology, and CA125 were risk factors for pelvic LNM. Myometrial invasion ≥1/2, LVSI and involvement of the adnexa were risk factors for para-aortic LNM which could provide a good basis to help predict which non-EEC patients are at higher risk for LNM. • This article constructs a predictive model for non-endometrioid endometrial cancer pelvic lymph node metastasis. • This article constructs a predictive model for non-endometrioid endometrial cancer para-aortic lymph node metastasis. • With the increase of independent risk factors, the rates of LNM were increased significantly. [ABSTRACT FROM AUTHOR]

The incidence of endometrial cancer in the UK has risen steeply since the 1990s. It is not one but several different diseases with different aetiologies, histological and molecular characteristics and prognosis. Survival has improved significantly over several decades but outcomes for 25% of women remain poor. Surgery is the main treatment. Radiotherapy and chemotherapy are used to reduce recurrence, and for upfront treatment in selected cases. Following years of debate about the role of lymphadenectomy, sentinel node surgery now offers accurate surgical staging without the morbidity of systematic lymphadenectomy. Advances in laboratory analysis of tumours are likely to improve care further. Molecular characterisation now offers better risk stratification and a tailored approach to the use of post-operative treatment. The introduction of widespread testing of tumours for genetic abnormalities, improves identification of at-risk families. The traditional model of hospital follow-up has also been replaced with a more patient-centred risk-stratified approach. [ABSTRACT FROM AUTHOR]

In 2020, endometrial cancer continues to be the most common gynecologic malignancy in the United States. The majority of endometrial cancer is low grade, and nearly 1 of every 8 low-grade endometrial cancer diagnoses occurs in women younger than 50 years with early-stage disease. The incidence of early-stage, low-grade endometrial cancer is increasing particularly among women in their 30s. Women with early-stage, low-grade endometrial cancer generally have a favorable prognosis, and hysterectomy-based surgical treatment alone can often be curative. In young women with endometrial cancer, consideration of ovarian conservation is especially relevant to avoid both the short-term and long-term sequelae of surgical menopause including menopausal symptoms, cardiovascular disease, metabolic disease, and osteoporosis. Although disadvantages of ovarian conservation include failure to remove ovarian micrometastasis (0.4%-0.8%), gross ovarian metastatic disease (4.2%), or synchronous ovarian cancer (3%-5%) at the time of surgery and the risk of future potential metachronous ovarian cancer (1.2%), ovarian conservation is not negatively associated with endometrial cancer-related or all-cause mortality in young women with early-stage, low-grade endometrial cancer. Despite this, utilization of ovarian conservation for young women with early-stage, low-grade endometrial cancer remains modest with only a gradual increase in uptake in the United States. We propose a framework and strategic approach to identify young women with early-stage, low-grade endometrial cancer who may be candidates for ovarian conservation. This evidence-based schema consists of a 2-step assessment at both the preoperative and intraoperative stages that can be universally integrated into practice. [ABSTRACT FROM AUTHOR]

Over the past decade, our understanding of endometrial cancer has changed dramatically from the two-tiered clinicopathologic classification system of type I and type II endometrial cancer through to the four distinct molecular subtypes identified by The Cancer Genome Atlas (TCGA) in 2013. In both systems there is a small subset of endometrial cancers (serous histotype/high numbers of somatic copy number abnormalities) that account for a disproportionately high percentage of endometrial cancer related deaths. This subset can be identified in routine clinical practice by first identifying the approximately one-third of endometrial cancers that are either ultramutated/POLEmut tumors, with pathogenic mutations in the exonuclease domain of POLE, or hypermutated/MMRd tumors, with loss of DNA mismatch repair. Immunostaining for p53 stratifies the remaining endometrial cancers into those with wild-type staining pattern and those with mutant pattern staining (p53abn endometrial cancer). This latter group of p53abn endometrial cancer is the subject of this review. Most p53abn endometrial cancers are serous type and high grade, but it also includes other histotypes and lower grade tumors, and has consistently been associated with the poorest clinical outcomes. Although it only accounts for 15% of all endometrial cancer cases, it is responsible for 50-70% of endometrial cancer mortality. A better understanding of the molecular alterations in the p53abn subgroup, beyond the ubiquitous and definitional TP53 mutations, is required so we can identify better treatments for these most aggressive endometrial cancers. Recent evidence has shown improved survival outcomes with the addition of chemotherapy compared with radiation alone in p53abn endometrial cancers. Opportunities for targeted therapy for p53abn endometrial cancers also exist with a proportion of p53abn endometrial cancers known to have homologous recombination deficiency (HRD) or human epidermal growth factor 2 (HER2) overexpression/amplification. This review will provide an overview of our current understanding of p53abn endometrial cancer. for a significant number of women with advanced disease or more aggressive histological types, the prognosis remains poor. Molecular classification has provided an entirely new way of looking at endometrial cancer with important diagnostic, prognostic, and therapeutic implications. In this review we will focus on p53abn endometrial cancer, the most aggressive endometrial cancer in this new era of molecular classification. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic inflammatory condition of reproductive age which can lead to infertility and chronic pelvic pain. The pathophysiology of endometriosis-associated infertility is not well understood and it appears to be multi-factorial; mechanical, inflammatory, hormonal, genetic and environmental processes can disturb each step of the normal reproductive physiology; folliculogenesis, ovulation, sperm function, gamete transport, fertilization and implantation. Medical management has limited role for women with endometriosis wishing to conceive. The ongoing pregnancy rate for infertile women with milder forms of the disease is improved by surgery. Surgical management for symptoms associated with severe disease and endometrioma in infertile women needs careful consideration of possible benefits and associated risks. Endometriosis-associated infertility is a recognised indication for assisted conception treatment. [ABSTRACT FROM AUTHOR]

Limited data suggests lower uterine segment involvement (LUSI) in endometrial cancer may be associated with other poor prognostic factors. We assessed the unclear impact of LUSI on prognosis in endometrial cancer. ology: A revision of pathological samples following surgical staging between the years 2002–2022 was performed and clinical data collected from patients' records. Characteristics and outcomes of women with and without LUSI were compared and analysed. Kaplan Meyer survival curves compared overall survival (OS) and progression-free survival (PFS). 429 women were included, of which 45 (10.5%) had LUSI. No differences were found between the groups regarding demographic or clinical characteristics. LUSI was significantly associated with lympho-vascular space invasion (40% vs. 22% p = 0.01), lymph node involvement (6.4% vs. 9.1%, p = 0.05), shorter PFS (4 vs. 5.5 years, p = 0.01) and OS (5.6 vs. 11.5 years, p = 0.03). Multivariate analysis showed higher hazard ratios for OS and PFS (1.55 95%CI 0.79–3.04 and 1.29 95%CI 0.66–2.53, respectively) but these were insignificant even in a sub-analysis of endometrioid histology (1.76 95%CI 0.89–3.46 and 1.35 95%CI 0.69–2.65, respectively). A trend towards decreased PFS and OS was demonstrated in the Kaplan Meyer survival curves for all cases (log rank test p = 0.5 and 0.29 respectively), endometrioid histology (log rank test p = 0.06 and 0.51 respectively) and early-stage disease (log rank test p = 0.63 and 0.3 respectively). LUSI may be related to poorer outcome of endometrial cancer and may represent an additional factor to consider when contemplating adjuvant treatment, especially in endometrioid-type and early-stage disease. [ABSTRACT FROM AUTHOR]

The Division of Cancer Prevention and the Division of Cancer Biology at the National Cancer Institute and the Gynecologic Health and Disease Branch in the National Institute of Child Health and Human Development organized a workshop in April 2019 to explore current insights into the progression of gynecologic cancers from benign conditions. Working groups were formed based on 3 gynecologic disease types: (1) Endometriosis or Endometrial Cancer and Endometrial-Associated Ovarian Cancer, (2) Uterine Fibroids (Leiomyoma) or Leiomyosarcoma, and (3) Adenomyosis or Adenocarcinoma. In this report, we highlight the key questions and current challenges that emerged from the working group discussions and present potential research opportunities that may advance our understanding of the progression of gynecologic benign conditions to cancer. [ABSTRACT FROM AUTHOR]

Heart disease and cancer are the leading causes of death in the United States. In women, the clinical appearance of both entities-coronary heart disease and cancer (breast, endometrium, and ovary)-escalate during the decades of the midlife transition encompassing the menopause. In addition to the impact of aging, during the interval between the age of 40 and 65 years, the pathophysiologic components of metabolic syndrome also emerge and accelerate. These include visceral adiposity (measured as waist circumference), hypertension, diabetes, and dyslipidemia. Osteoporosis, osteoarthritis, sarcopenia, depression, and even cognitive decline and dementia appear, and most, if not all, are considered functionally related. Two clinical reports confirm the interaction linking the emergence of disease: endometrial cancer and metabolic syndrome. One describes the discovery of unsuspected endometrial cancer in a large series of elective hysterectomies performed in aged and metabolically susceptible populations. The other is from the Women's Health Initiative Observational Study, which found a positive interaction between endometrial cancer and metabolic syndrome regardless of the presence or absence of visceral adiposity. Both provide additional statistical support for the long-suspected causal interaction among the parallel but variable occurrence of these common entities-visceral obesity, heart disease, diabetes, cancer, and the prevalence of metabolic syndrome. Therefore, 2 critical clinical questions require analysis and answers: 1: Why do chronic diseases of adulthood-metabolic, cardiovascular, endocrine-and, in women, cancers of the breast and endometrium (tissues and tumors replete with estrogen receptors) emerge and their incidence trajectories accelerate during the postmenopausal period when little or no endogenous estradiol is available, and yet the therapeutic application of estrogen stimulates their appearance? 2: To what extent should identification of these etiologic driving forces require modification of the gynecologist's responsibilities in the care of our patients in the postreproductive decades of the female life cycle? Part l of this 2-part set of "expert reviews" defines the dimensions, gravity, and interactive synergy of each clinical challenge gynecologists face while caring for their midlife (primarily postmenopausal) patients. It describes the clinically identifiable, potentially treatable, pathogenic mechanisms driving these threats to quality of life and longevity. Part 2 (accepted, American Journal of Obstetrics & Gynecology) identifies 7 objectives of successful clinical care, offers "triage" prioritization targets, and provides feasible opportunities for insertion of primary preventive care initiatives. To implement these goals, a reprogrammed, repurposed office visit is described. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Given the growing interest in sentinel node mapping (SLN) biopsy in Endometrial Cancer (EC) patients, many efforts have been made to maximize the SLN bilateral detection rate. However, at present, no previous research assessed the potential correlation between primary EC location in the uterine cavity and SLN mapping. In this context, this study aims to investigate the possible role of intrauterine EC hysteroscopic localization in predicting SLN nodal placement. EC patients surgically treated from January 2017 to December 2021 were retrospectively analyzed. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN mapping. During hysteroscopy, the location of the neoplastic lesion was described as follows: uterine fundus (comprising the most cranial portion of the uterine cavity up to the tubal ostium including the cornual areas), corpus uteri (from the tubal ostium to the inner uterine orifice), and diffuse (when the tumor invades more than 50% of the uterine cavity). Three hundred ninety patients met the inclusion criteria. The tumor pattern diffused to the whole uterine cavity was statistically associated with SLN uptake on common iliac lymph nodes (OR 2.4, 95%CI 1–5.8, p = 0.05). Patients'age is an independent factor associated with SLN failure (OR: 0.95, 95%CI 0.93–0.98, p < 0.001). The study showed a statistically significant association between EC hysteroscopically spread throughout the whole uterine cavity and SLN uptake at the common iliac lymph nodes. Furthermore, patient age negatively affected the SLN detection rate. [ABSTRACT FROM AUTHOR]

Endometrial cancer incidence rates are continuing to rise and approximately 40 % of all cases being preventable. A major contributing factor to this is the current obesity epidemic. Surgery remains the cornerstone of treatment and minimal access techniques have established themselves as the gold-standard. Routine lymphadenectomy for all disease stages has not been demonstrated to benefit overall survival. Risk stratification and personalized approaches to patient treatment are becoming more of a necessity, especially in younger women who may wish to preserve their fertility. Genomic profiling is starting to change the way we consider endometrial cancer, which may help direct treatment modalities in the future. Priority setting the research agenda will help guide future research and allow us to further tackle this common gynaecological malignancy. [ABSTRACT FROM AUTHOR]

Uterine sarcomas comprise a small percentage of uterine malignancies. The most common uterine sarcoma is leiomyosarcoma (LMS). Early stage uterine LMS is curable with complete hysterectomy with removal of an intact uterus. Patients with metastatic disease may achieve tumor responses with improvements in quality of life, but long-term remissions are rare. In this review article, I outline adjuvant therapies for early stage resected uterine LMS, as well as treatment of metastatic disease. [ABSTRACT FROM AUTHOR]

• Circulating adiponectin and leptin were significantly associated with risk of cancer. • Adiponectin was inversely related with breast, colorectal, and endometrial cancer. • Leptin was associated with increased risk of endometrial and kidney cancer. • There was no relationship between circulating IL-6, TNF-α, and resistin and cancer. Obesity can influence on carcinogenesis through alterations in adipokines and subsequent inflammatory changes. This meta-analysis was aimed to comprehensively assess the association between circulating adipokines and risk of obesity-related cancers. Pubmed and Embase were searched up to October 2017 for observational studies investigating the relationship between adipokines and cancers. Pooled odds ratio and the corresponding 95% confidence interval was estimated through the meta-analysis using a random-effects model. Findings A total of 93 observational studies (adiponectin = 60, high molecular weight adiponectin = 9, leptin = 39, IL-6 = 16, TNF-α = 10, and resistin = 17) were included. Adiponectin was significantly associated with decreased risk of cancer (pooled OR 0.70, 95% CI 0.60–0.80; I2 = 71.9%; P heterogeneity <0.01). Leptin was significantly associated with increased risk of cancer (1.26, 1.05–1.51; I2 = 65.7%; P heterogeneity <0.01). For each 5 μg/ml increase in adiponectin and 5 ng/ml increase in leptin, the pooled OR was 0.88 (0.83–0.93; I2 = 80.2%; P heterogeneity <0.01) and 1.05 (1.01–1.09; I2 = 67.9%; P heterogeneity <0.01)), respectively. There was nonlinear dose-response association (P nonlinearity for adiponectin = 0.01; P nonlinearity for leptin = 0.003).IL-6 (1.09, 0.94–1.25), TNF- α (1.65, 0.99–2.74), and resistin (1.28, 0.78–2.11) was not associated with risk of cancer. By cancer site and type, highest category of adiponectin was associated with decreased risk of breast (OR 0.74, 0.60-0.91), colorectal (0.74, 0.60–0.91), and endometrial cancer (0.49, 0.34–0.72). Higher leptin was associated with increased risk of endometrial (1.88, 1.24–2.87) and kidney cancer (2.07, 1.51–2.83). Our study suggests that adiponectin and leptin may play a role in the etiology of cancer. [ABSTRACT FROM AUTHOR]

Intrauterine Contraceptive Devices with multifaceted application potential is a need of an hour. Although, copper-based IUDs exert an effective contraceptive as well as anticancer effects in a long-term basis, but also results in multiple complications. In this regard, RISUG® a polymer based contraceptive device has been introduced as a suitable alternative. However, its potential to impart protective effects against development of endometrial cancer still remains unexplored. This article presents the hypothesis on this unexplored domain and provides scientific facts to support the hypothesis. The mechanism of anticancerous activity is hypothesized that RISUG® involves its lipid membrane destabilizing activity. This activity is modulated by both, the cellular microenvironment and lipid bilayer composition. Acidic environment along with the significantly higher fluidic nature of lipid bilayer of the cancerous cells make them more prone to lipid solubilisation effect of RISUG®. We here present an in-depth insight into the factors that would favour faster solubilisation of cancer cell membrane, thereby exerting an anticancer effect. [ABSTRACT FROM AUTHOR]

Objective: To identify the superior surgical procedure for endometrial polypectomy based on network meta-analysis.Method: Literature retrieval was conducted in globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating the clinical effects of respective surgical procedure for endometrial polypectomy. Surgical parametric data, including operative time, success rates and complications, were quantitatively pooled and estimated based on the Bayesian theorem. The values of surface under the cumulative ranking (SUCRA) probabilities regarding each parameter were calculated and ranked by various procedures. Node-splitting analysis was performed to test the inconsistency of the main results and publication bias was assessed by examining funnel-plot symmetry.Results: After a detailed review, 8 RCTs containing 5 different procedures were finally included for network meta-analysis. The results indicated that hysteroscopic morcellation possessed the highest possibility of revealing best clinical effects on operative time (SUCRA, 0.49), success rate (SUCRA, 0.90) and complications (SUCRA, 0.50). Moreover, node-splitting analysis and funnel-plot symmetries illustrated no inconsistency or obvious publication bias in the current study.Conclusions: Current evidence demonstrated that hysteroscopic morcellation showed optimal potential superior clinical effects for endometrial polypectomy compared to other procedures. However, high-quality large sample trials are still expected, and new investigations on other relative procedures in this field should be included in the future. [ABSTRACT FROM AUTHOR]

Objectives: To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer. Methods/materials: We included 850 women with endometrioid endometrial cancer from the prospective IETA study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases. Results: The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with MI ≥ 50% (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011). Conclusions: Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases. [ABSTRACT FROM AUTHOR]

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Intermenstrual and post-coital bleeding are very common presenting complaints among women of reproductive age. The majority of cases of unscheduled bleeding in premenopausal women result from benign conditions such as endometrial polyps, infection or from oral contraceptive use. Cervical and endometrial cancers however are associated with abnormal bleeding and therefore it is essential that women with these symptoms are evaluated carefully. The single most important stage in the assessment of women with unscheduled bleeding is a vaginal speculum examination; the presence of bleeding should not delay this essential investigation. Women with risk factors for endometrial malignancy or symptoms suggestive of gynaecological pathology may warrant ultrasound examination and/or endometrial biopsy. This review discusses three common causes of intermenstrual and postcoital bleeding and outlines some of the important considerations in the assessment and management of these patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinicopathological characteristics, treatment, survival, and prognosis of endometrial cancer in women aged ≤40 years.Methods: Women who underwent surgery for endometrial cancer at a single high-volume cancer center between January 1995 and December 2014 were retrospectively reviewed. Women aged >40, patients with missing data, and those who did not undergo surgical staging were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival and progression-free survival.Results: A total of 40 patients with endometrial cancer were assessed. The median age at diagnosis was 38 (range, 21-40) years, and most of the uterine tumors found were early-stage (85%), low-grade (67.5%), and endometrioid carcinomas (97.5%). The median serum cancer antigen 125 level was 10.9 IU/mL (range, 3-1284 IU/mL). Optimal cytoreductive surgery was achieved in 35 patients (87.5%). All patients underwent total abdominal hysterectomy, and 97.5% of the patients underwent hysterectomy plus bilateral salpingo-oophorectomy. Among the total group of 40 patients, 21 (52.5%) underwent pelvic and para-aortic lymph node dissection, and 15 (37.5%) underwent only pelvic lymph node dissection. Multivariate analysis confirmed that a cancer antigen 125 level ≥35 was the only independent prognostic factor for both progression-free survival (hazard ratio, 22.997; 95% confidence interval, 1.783-296.536; p = 0.016) and overall survival (hazard ratio, 22.541; 95% confidence interval, 1.75-290.364; p = 0,017).Conclusions: Our study demonstrated that a cancer antigen 125 level ≥ 35 is the only independent prognostic factor for both progression-free survival and overall survival in patients aged ≤40 years with endometrial cancer. [ABSTRACT FROM AUTHOR]

Abnormal bleeding around the time of the menopause is common and usually due to fluctuating sex-hormone levels. However, it may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. As such all will need uterine assessment which may include transvaginal scan combined with endometrial biopsy, and hysteroscopy. Having excluded (pre) cancer, treatment can then be offered. Medical treatment options include tranexamic acid to reduce blood loss, low-dose contraceptive Pills, the levonorgestrel intra-uterine device and cyclic progestins. Surgical options include resecting sub-mucus fibroids hysteroscopically, endometrial ablation and hysterectomy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of body mass index (BMI) on endometrial tumor pathology, stage and complication rate and to identify individual prognostic factors, such as BMI, in types I and II endometrial cancer. Design: Register study included all Danish women who underwent surgery for uterine cancer or atypical endometrial hyperplasia (International Classification of Diseases-10 codes D070, DC549) 2005 to 2012 (n = 6003). Main Outcome Measures: Impact of BMI on type I and II endometrial cancer survival. Materials and Methods: Danish Gynecological Cancer Database data on women with type I and II endometrial cancer were retrieved. Kaplan-Meier plot was used to illustrate differences in survival in relation to BMI. Log-rank test was used to demonstrate difference between the curves. Cox regression hazard model was used to estimate hazard ratios (HR) of the effect of BMI on overall survival. Results: Four thousand three hundred thirty women were included. Women with type I cancer had a significantly better overall survival compared with those with type II cancer. Low BMI was associated with increased mortality in type I (HR, 2.07; 95% confidence interval [CI], 1.20–3.55), whereas in type II both low (HR, 1.68; 95% CI, 1.03–2.74) and high BMI (BMI, 30–35: HR, 1.54; 95% CI, 1.01–2.26 and BMI >40: HR, 2.15; 95% CI, 1.12–4.11) were significantly associated with increased mortality. Conclusion: Abnormal BMI is associated with increased mortality in subtypes of endometrial cancer. Underweight was associated with increased overall mortality in both types I and II, whereas obesity only disclosed a significant impact on overall mortality in type II. [ABSTRACT FROM AUTHOR]

Background: Standard treatment for patients with endometrial intraepithelial neoplasia (EIN) is a hysterectomy, which has a 43% risk of concomitant endometrial cancer on final pathology. General gynecologists and gynecologic-oncologists perform hysterectomies; however, patients who have a hysterectomy for EIN with a general gynecologist and are found to have cancer may require a second surgery by a gynecologic-oncologist to complete staging. There is ongoing discussion regarding whether patients with EIN should be provided the option to receive the initial hysterectomy with a gynecologic-oncologist.Objective: This study aimed to better understand if patients with EIN should be initially referred to a gynecologic-oncologist for treatment. We examined the cost-effectiveness of hysterectomy by general gynecologists vs gynecologic-oncologists for patients with EIN.Study Design: We created a decision-analytical model using TreeAge Pro software to compare outcomes between hysterectomies by general gynecologists and those by gynecologic-oncologists in patients with EIN. Our theoretical cohort contained 200,000 patients, an estimate of the number of individuals diagnosed with EIN each year in the United States. Outcomes included costs, quality-adjusted life years, primary lymph node dissection, secondary lymph node dissection, surgical site infection, and perioperative mortality. We assumed that surgical morbidity and mortality were the same under generalist and specialist care and applied costs of travel and lost work for those seeing a gynecologic-oncologist. We performed univariable sensitivity analyses and multivariable probabilistic sensitivity analysis to assess the model's robustness given the uncertainty of model inputs.Results: In our theoretical cohort of 200,000 patients with EIN, hysterectomy with a gynecologic-oncologist was associated with a decrease of 10,811 second surgeries for lymph node dissection, 87 surgical site infections, and 9 perioperative mortalities. When hysterectomy was performed by a general gynecologist, 9 fewer patients had a lymph node dissection because of perioperative mortalities that occurred before lymph node dissection with a gynecologic-oncologist. Hysterectomy with a gynecologic-oncologist was the dominant, cost-effective strategy because it saved $116 million and increased quality-adjusted life years by 180. In our univariable analyses, hysterectomy with a gynecologic-oncologist was cost-saving and increased quality-adjusted life years over a wide range of probabilities and costs for lymph node dissection, surgical site infection, and perioperative mortality. However, hysterectomy with a gynecologic-oncologist was only a cost-effective and cost-saving strategy in just over 50% of multivariable simulations, demonstrating that there is significant uncertainty in the model's cost-effectiveness.Conclusion: In our model, hysterectomy with a gynecologic-oncologist for patients with EIN was associated with cost savings and increased quality-adjusted life years. Our study supports that patients undergoing hysterectomy for EIN at institutions using Mayo criteria to determine need for lymphadenectomy may benefit from surgery with a gynecologic-oncologist rather than a general gynecologist to reduce costs and adverse events associated with a second surgery. [ABSTRACT FROM AUTHOR]

This review on the impact of obesity on gynaecological surgery highlights the effect of obesity on various aspects of reproductive health including fertility, heavy menstrual bleeding, pelvic floor dysfunction and endometrial cancer. We discuss the anaesthetic concerns surrounding the obese patient requiring surgery, and the technical aspects of operating on the obese patient including laparoscopic and open surgery. The intraoperative and postoperative complications associated with obesity are also explored. [ABSTRACT FROM AUTHOR]

Endometrial cancer is the most common gynaecological malignancy, and an understanding of its presentation and management options is required for all gynaecologists. The surgical management of endometrial cancer has expanded to include laparoscopic surgery, and debate is ongoing regarding the merits of pelvic and para-aortic lymphadenectomy. Our understanding of the biology of endometrial cancer may help determine which women may benefit most from chemo- or hormonal therapy in an adjuvant setting. Pelvic radiation is associated with improved local control. Combination therapy with radiation and chemotherapy is under evaluation. The use of sentinel lymph node sampling is an area for further research and development. [ABSTRACT FROM AUTHOR]

Background: The accuracy of sentinel lymph node mapping has been shown in endometrial cancer, but studies to date have primarily focused on cohorts at low risk for nodal involvement. In our practice, we acknowledge the lack of benefit of lymphadenectomy in the low-risk subgroup and omit lymph node removal in these patients. Thus, our aim was to evaluate the feasibility and accuracy of sentinel node mapping in women at sufficient risk for nodal metastasis warranting lymphadenectomy and in whom the potential benefit of avoiding nodal procurement could be realized.Objective: To evaluate the detection rate and accuracy of fluorescence-guided sentinel lymph node mapping in endometrial cancer patients undergoing robotic-assisted staging.Study Design: One hundred twenty-three endometrial cancer patients undergoing sentinel lymph node sentinel node mapping using indocyanine green were prospectively evaluated. Two mL (1.0 mg/mL) of dye were injected into the cervical stroma divided between the 2-3 and 9-10 o'clock positions at the time of uterine manipulator placement. Before hysterectomy, the retroperitoneal spaces were developed and fluorescence imaging was used for sentinel node detection. Identified sentinel nodes were removed and submitted for touch prep intraoperatively, followed by permanent assessment with routine hematoxylin and eosin levels. Patients then underwent hysterectomy, bilateral salpingo-oophorectomy, and completion bilateral pelvic and periaortic lymphadenectomy based on intrauterine risk factors determined intraoperatively (tumor size >2 cm, >50% myometrial invasion, and grade 3 histology).Results: Of 123 patients enrolled, at least 1 sentinel node was detected in 119 (96.7%). Ninety-nine patients (80%) had bilateral pelvic or periaortic sentinel nodes detected. A total of 85 patients met criteria warranting completion lymphadenectomy. In 14 patients (16%) periaortic lymphadenectomy was not feasible, and the mean number of pelvic nodes procured was 13 (6-22). Of the 71 patients undergoing pelvic and periaortic lymphadenectomy, the mean nodal count was 23.2 (8-51). Of patients undergoing lymphadenectomy, 10.6% had lymph node metastasis on final hematoxylin and eosin evaluation. Notably, the sentinel node was the only positive node in 44% of cases. There were no cases in which final pathology of the sentinel node was negative and metastatic disease was detected upon completion lymphadenectomy in the non-sentinel nodes (no false negatives), yielding a sensitivity of 100%. Of the 14 sentinel nodes ultimately found to harbor metastases, 3 were negative on touch prep, yielding a sensitivity of 78.6% for intraoperative detection of sentinel node involvement. In all 3 of the false-negative touch preps, final pathology detected a single micrometastasis (0.24 mm, 1.4 mm, 1.5 mm). As expected, there were no false-positive results, yielding a specificity of 100%. No complications related to sentinel node mapping or allergic reactions to the dye were encountered.Conclusion: Intraoperative sentinel node mapping using fluorescence imaging with indocyanine green in endometrial cancer patients is feasible and yields high detection rates. In our pilot study, sentinel node mapping identified all women with Stage IIIC disease. Low false-negative rates are encouraging, and if confirmed in multi-institutional trials, this approach would be anticipated to reduce the morbidity, operative times, and costs associated with complete pelvic and periaortic lymphadenectomy. [ABSTRACT FROM AUTHOR]

Background: Radiation therapy has long been part of the treatment of endometrial cancer. Despite the long history of radiation use, prospective trials in the United States and Europe have been unable to demonstrate a survival benefit with adjuvant radiotherapy compared with observation. Whereas radiation has been associated with a decreased rate of locoregional failure, the treatment is also associated with substantial toxicity. However, a randomized trial published in 2010 demonstrated that, compared with external beam radiation therapy (EBRT), vaginal brachytherapy was less toxic and as effective in reducing locoregional relapses.Objective: We examined patterns of use of external beam radiation therapy for women with high intermediate risk endometrial cancer.Study Design: We examined the use of external beam radiation therapy in women registered in the National Cancer Data Base with high intermediate risk, stage I endometrial cancer treated from 2008 through 2012. High intermediate risk was defined as age > 60 years with a stage IA, grade 3 tumors or stage IB, grade 1 or 2 tumors. Multivariable models of EBRT use were developed.Results: Among 8242 women, 915 (11.1%) received EBRT, 2614 (31.7%) were treated with brachytherapy, and 4713 (57.2%) did not receive any adjuvant radiation. The use of EBRT was 18.1% in 2008 and declined to 8.6% in 2012, whereas the use of brachytherapy rose each year from 26.5% in 2008 to 37.6% in 2012 (P < .0001). External beam radiation was administered to 7.9% of patients with stage IA/grade 3 tumors, 8.8% of those with stage IB/grade 1 cancers, and to 15.2% of women with stage IB/grade 2 neoplasms (P < .0001). EBRT was utilized in 10.1% of women who underwent lymphadenectomy compared with 22.0% who did not undergo lymphadenectomy (P < .0001). In a multivariable model, black women were more likely to receive EBRT than white women (relative risk [RR], 1.33; 95% confidence interval [CI], 1.03-1.70). Similarly, patients in the eastern United States, those treated at community cancer centers and comprehensive community cancer programs, patients in metropolitan areas, and those diagnosed in earlier years were more likely to undergo EBRT. Patients with stage IB/grade 2 tumors (RR, 1.96; 95% CI, 1.65-2.32) were more likely to receive EBRT than those with stage IA/grade 3 neoplasms. Those women who did not undergo lymphadenectomy were more than twice as likely to receive EBRT compared with those who had a lymphadenectomy (RR, 2.32; 95% CI, 1.99-2.72).Conclusion: Despite data from randomized trials, approximately 9% of women with high intermediate risk of endometrial cancer continue to receive EBRT. Performance of lymphadenectomy is associated with a lower likelihood of external beam radiation therapy. [ABSTRACT FROM AUTHOR]

The effects of the natural and synthetic estrogens have been studied for a long time but the data regarding estrogen related chemicals (endocrine disrupting chemicals, EDCs) and their effects on reproductive system are scarce. EDCs are hormone like agents that are readily present in the environment, which may alter the endocrine system of humans and animals. Approximately 800 chemicals are known or suspected to have the potential to function as EDC. Potential role of EDCs on reproductive disease has gained attention in medical literature in recent years. We hypothesize that exposure to low doses of EDCs in a chronic manner could cause hormone dependent genital cancers including ovarian and endometrial cancer. Long term exposure to low concentrations of EDCs may exert potentiation effect with each other and even with endogenous estrogens and could inhibit enzymes responsible for estrogen metabolism. Exposure time to these EDCs is essential as we have seen from Diethylstilbestrol experience. Dose-response curves of EDCs are also unpredictable. Hence mode of action of EDCs are more complex than previously thought. In the light of these controversies lower doses of EDCs in long term exposure is not harmless. Possibility of this relationship and this hypothesis merit further investigation especially through in vivo studies that could better show the realistic environmental exposure. With the confirmation of our hypothesis, possible EDCs could be identified and eliminated from general use as a public health measure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the interaction between extent of lymph node dissection (LND) and overall survival (OS) in patients with various histologic types of uterine cancer.Methods: We retrospectively identified 834 patients who had primary surgery in our institution for uterine carcinosarcoma (CS), papillary serous (UPSC) and endometrioid adenocarcinoma between 1984 and 2009. Stage, grade, total lymph node count (LNC), positive LNC, adjuvant therapy, age, race and OS were collected. OS was calculated using the Kaplan-Meier method. Predictive factors were compared with the log rank test and Cox regression analysis.Results: Our cohort included 158 patients with CS, 115 patients with UPSC and 561 patients with endometrioid adenocarcinoma. Of the cohort, 38% of the patients had Stage III or IV disease. LND was performed in 73% of patients with CS, 68% of patients with UPSC and 79% of patients with endometrioid adenocarcinoma. LND was performed in 82% of Stage I-II and in 68% of Stage III-IV cases. The median total LNC was 13 (range 1-75) and there was no significant difference in the total LNC between the different histologies. Median OS was 21 months for CS, 18 months for UPSC and 200 months for patients with endometrioid adenocarcinoma. A positive association between the total and positive LNC was present in all three histologic types (Spearman coefficient, p < 0.001). The cohort was divided in quartiles based on the total LNC and a Kaplan-Meier survival analysis was performed. A continuum of improved OS was noted in correlation with increased LNC. OS was 27 months for the group with 0 nodes, 112 months for the group with 1-8 nodes, 117 months for the group with 9-16 nodes and 196 months for the group with >17 nodes. Doubling the total LNC was associated with 28% risk of death reduction (HR 0.724, CI 0.66-0.794, p < 0.001) for the first year and 14% risk reduction (HR 0.858, CI 0.761-0.967, p = 0.012) for the second year.Conclusions: In our cohort, the performance of LND is associated with improved OS. This effect appears to be uniform across pathology types. The extent of the LND is inversely correlated with the risk of death for the first 2 years. [ABSTRACT FROM AUTHOR]

Background: To assess the efficacy of different treatment modalities on the outcome of patients with low-grade endometrial stromal sarcoma (LG-ESS).Methods: Patients with LG-ESS who received hysterectomy from March 1991 to December 2013 were retrospectively analyzed. The associations between clinicopathologic variables and disease free survival (DFS) were evaluated.Results: One hundred and fourteen patients met the eligibility requirements. All patients received hysterectomy as the main treatment, 17.5% (20/114) of patients received ovarian preservation, and 62.3% (71/114) of patients received lymphadenectomy. Fifty-six patients received chemotherapy, 36 patients received radiotherapy, and 11 patients received endocrine therapy. The median follow-up duration was 40 months. The 5-year and 10-year DFS rates were 91.8% and 77.4%, respectively. The 5-year and 10-year overall survival rates were 96.7% and 96.7%, respectively. Univariate analyses showed that there were no risk factors associated with DFS. Lymphadenectomy, lymph node status, ovarian preservation, chemotherapy, radiotherapy, and endocrine therapy had no significant effect on DFS.Conclusions: Hysterectomy has been the mainstay of treatment for LG-ESS. The optimal treatment strategy in LG-ESS remains to be determined. [ABSTRACT FROM AUTHOR]