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Objective: Retrospective clinical and pathomorphological analysis of patients undergoing surgery due to endometrial carcinoma; analysis of the correlation between histological grading of endometrial cancer and selected pathomorphological results., Material and Methods: Statistical analysis was based on the pathomorphological results in a group of 353 patients operated because of endometrial carcinoma at the Clinical Department of Gynecologic Oncology Medical University of Lodz, between 2003 and 2013. A possible correlation between histological grading, clinical staging, myometrial infiltration, parametrial invasion and nodal metastases to ilio-obturator lymph nodes was investigated., Results: Among poorly differentiated carcinomas G3, myometrial infiltration above half of its thickness was observed in 67.44% of the cases, whereas in the G2 and G1 groups it was detected in 60.82% and 39.33% of the affected individuals, respectively. Parametrial invasion was found in 24.39% of G3 cases, i.e. 4.23 times more often than in G2 (5.76%) and 10.65 times more often than in G1 (2.29%). Nodal metastases to ilio-obturator lymph nodes were present in 27.50% of poorly 10.86% of moderately and 8.11% of well-differentiated carcinomas. Uterine appendages were infiltrated in 23.25% of G3 cases--3.45 times more than in G2 (6.73%) and 6.82 times more than in G1 (3.4 1%)., Conclusions: Histologic grading for carcinoma at the time of diagnosis is significantly related to clinical staging. No correlation between patient age and carcinoma grading or its clinical staging was observed. Risk of lymph node invasion for well-differentiated carcinomas is similar to the risk for moderately differentiated carcinomas, and should also be an indication for lymphadenectomy in that group of patients.

Background: Detection of micrometastases in sentinel lymph nodes (SLN) extends our knowledge of lymphatic spread in endometrial cancer, although its clinical significance has not yet been confirmed., Objectives: The aim of study was to determine the incidence of SLN micrometastases and to analyze the association between micrometastases and disease relapse., Material and Methods: Fifty-four patients with endometrioid endometrial cancer underwent routine surgical therapy and sentinel lymph node biopsy (SLNB). SLNB was performed using two techniques: cervical injection of 99mTc-labelled albumin or blue dye and fundal injection of blue dye. SLNs were subjected to ultrastaging with immunohistochemistry (AE1/AE3, 150µm)., Results: At least one SLN was detected in 51 patients (94.4%) and bilateral SLN detection was achieved in 80.4%. Nodal macrometastases were found in 3 patients (6.3%). SLNB enabled us to detect nodal macrometastases in 2 out of those 3 patients. In the third case, detection of SLN micrometastasis allowed to correctly determine the nodal status, thus avoiding the false negative result of SLNB. In 48 patients with detected 184 SLNs, there were 4 patients (8.3%) with micrometastases and 4 (8.3%) with ITC foci. No significant associations between the presence of risk factors (grade, myometrial invasion, cervical invasion, lymphovascular space invasion) and incidence of micrometastases and/or ITC foci in SLNs were found., Conclusions: Detection of micrometastases may result in lower false-negative rate, thus increasing SLNB safety.

Objective: The main goal of our study was to identify the earliest and specific genetic changes which could be associated with an increased risk of neoplastic transformation in a group of patients with endometrial hyperplasia. Another goal was to characterize genetic changes associated with advanced forms of cancer., Material and Methods: The study involved forty-four (44) female patients, including five (5) patients with no histopathologically confirmed hyperplastic features, twenty-six (26) patients with histopathologically confirmed endometrial hyperplasia, and thirteen (13) patients with diagnosed carcinoma of the endometrium. The study was conducted using a custom-made 4x180 K microarray of BlueGnome., Results: Copy number variations (CNV) were found in the cases without endometrial hyperplasia. Such changes occur with varying frequency in the genome of healthy female population. Significant genome imbalance was identified in the twenty-six (26) (100%) patients with diagnosed hyperplasia and in eleven (11) subjects (84.6%) with diagnosed endometrial cancer. Other not yet reported, changes localized in characteristic regions of the genome were also found.

Objectives: The aim of present study was to determine expression of cyclin E in endometrial hyperplasia without atypia, atypical endometrial hyperplasia and endometrial cancers in comparison with expression of cyclin E in atrophic endometrium of postmenopausal women. We have also estimated relationship between cyclin E expression and prognostic factors for endometrial cancer such as: histological type, cancer stage and histological grade., Material and Methods: 154 women were enrolled into study Women were divided into 4 groups. The first group consist of 38 women with endometrial hyperplasia without atypia, the second group consist of 18 women with atypical endometrial hyperplasia. The third group comprise 62 women with endometrial cancer and the forth 36 women with atrophic endometrium. Cyclin E expression was estimated in formalin-fixed, paraffin-embedded tissues obtained from enrolled women with the use of immunohistochemical techniques. We estimated labelling index (LI) - the number of cells that stained for cyclin E in relation to all cells at the certain field of view., Results: Medians of labelling indices of cyclin E in atrophic endometrium, endometrial hyperplasia with atypia, atypical endometrial hyperplasia end endometrial cancer were 13.7%, 34.7%, 62%, 72.2% respectively These differences were statistically significant. In our study we haven't found relationship between cyclin E expression and histological type of tumour (p = 0.186), cancer stage (p = 0.186) and histological grade (p = 0.539) CONCLUSIONS: In the carcinogenesis of endometrial tumours in postmenopausal women there is a progressive disorder in mechanisms regulating cell cycle. It seems impossible to use cyclin E as prognostic factor for endometrial cancer.

Introduction: Influence of histamine on tumor development remains obscure. The exact mechanism of this action is not known. Different data indicate high concentrations of histamine in tumor tissues, such as malignant melanoma, breast cancer, colon carcinoma, lymphomas and leukemia. To the best of our knowledge, the literature offers no reports about the role of histamine and of differences between expression patterns of histamine-related genes in endometrial cancer, Aim: The aim of the study was a comparative analysis of the gene expression profile involved with histaminergic system in endometrioid endometrial cancer in relation to histologically normal endometrium, and identification of differentiation genes whose transcriptional activity significantly differs in pathomorphological grades G1,G2, G3 of endometrial cancer as compared to the control group., Material and Methods: Total RNA was extracted from 24 endometrial probes using TRIzol reagent (Invitrogen). The expression profile of 119 transcripts associated with histaminergic system was assessed using oligonucleotide microarrays of HG-U 133A (Affymetrix). After normalization of the results with RMA Express software, differentiation genes were mined by the use of one-way analysis ANOVA and U Mann-Whitney test carried out in Gene Spring 11.5 software., Results: Among 119 transcripts, 14 expressed more than 1.5-fold change and were significant at p<0.05 in endometrioid endometrial cancer in relation to the normal endometrium. Further analysis led to the identification of differentially expressed genes in grades G1, G2 and G3 of endometrial adenocarcinoma as compared to the control group, which were specific for each of the studied groups in grade G1 (CPA3), in grade G2 (HNMT LYN, DPT ITPKB, RASA4, APR RAB1 1FIP1, YWHAZ, VAMP8, RAB25) and in grade G3 (HRH3)., Conclusions: Our results confirmed the role of the histaminergic system in the pathogenesis of endometrial adenocarcinoma. The observed differences in the expression of those genes, depending on the grade of adenocarcinoma, may indicate an important role of the isolated differentiation genes in endometrial tumorigenesis.

Objectives: The metastatic ability of tumors is characteristic for malignant neoplasms and constitutes the main cause of therapeutics failures. Metastasis formation involves the sequence of processes such as proteolytic degradation of the basement membrane, migration, intravasation, extravasation, proliferation and angiogenesis. Cadherins and integrins are groups of proteins directly involved in these processes. In the present study we analyzed the mRNA expression of CDH1 and ITGB1 genes by real-time polymerase chain reaction (RT-PCR). The study included 106 endometrial carcinomas. CDH1 and ITGB1 mRNA expression was found in all of the studied samples. Generally the CDH1 and ITGB1 mRNA expression was significantly higher in well-differentiated rather than poorly differentiated tumors., Materials and Methods: The mRNA expression levels of CDH1 and ITGB1 in series of 83 samples of endometrial carcinoma were studied by real time RT-PCR method. Statistical analysis of the obtained results was performed., Results: CDH1 and ITGB1 gene expression was observed in all examined tissues and was correlated with cancer malignancy (G). In high grade malignant tumors (G1), CDH1 and ITGB1 gene expression was the highest, in G2 and G3 tumors the expression of both genes was gradually lowering. Moreover the statistically significant correlation between CDH1 and ITGB1 gene expression was observed. (Spearman test, r=0.29, p

The Aim: The aim of the study was to determine the value of SUVmax by PET/CT measured before surgery with special focus on FIGO stage, myometrial invasion, grading and risk stratification., Methods: A total of 90 women, aged 37-84 (mean 65.1 +/- 9.5) with endometrial cancer (FIGO I and II) underwent 18F FDG PET/CT imaging before surgery SUVmax of the primary tumor was assessed and compared with histological prognostic factors (FIGO stage, grading, myometrial invasion, risk group)., Results: The mean SUVmax in the study group was 13.95 +/- 5.49. SUVmax was significantly higher with high FIGO stage (p=0,0009), deep myometrial invasion (p=0.0005), high grade (p=0.0331) and high risk tumors (0.0007). Patients with the poor prognosis had significantly higher SUVmax values., Conclusions: The preoperative SUVmax measurements of the primary tumor of endometrial cancer may give additional clinical and prognostic information about risk factors and poor prognosis. High value of SUVmax might be useful in making noninvasive diagnoses and deciding the appropriate therapeutic strategy for patients with endometrial cancer However there is not enough evidence that it could in fact replace surgical staging.

Objectives: To assess the prognostic significance of Ki-67 expression in the tissue microarray method (TMA) for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC)., Material and Methods: The study examined 159 consecutive patients aged 37-86 (62.82 +/- 9.95) with EEC stages I-III according to FIGO, treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards they were subsequently treated and examined at the Regional Cancer Center Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery and constructed into the TMA recipient blocks. Using TMA method, the relationship between Ki-67 expression, DFS and OS was examined. DFS was defined as a period from primary surgery until relapse. OS was defined as a period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE; KE/1673/12)., Results: The follow-up time varied between 3-60 months (51.42 +/- 15.87). In 31 patients (19.50%) the relapse of was diagnosed 1-59 months (24.97 +/- 16.08) after commencement of the treatment. During follow-up 32 patients (20.12%) died. DFS and OS were 80.50% and 79.88%, respectively The lack of Ki-67 expression was found in 37 cases (23.27%) while in 122 patients (76.73%) the expression was present (p < 0.001). The expression of Ki-67 in 1-10%, 11-20% and > 20% was present in 76 cases, 26 cases and 20 cases, respectively Positive correlation between the expression of Ki-67 and staging was present (r = 0.353; p < 0.001). In EEC patients with no relapse diagnosed during follow-up the expression of Ki-67 was present in 7.63 +/- 7.57% of EEC cells, when compared to 23.06 +/- 22.93% in EEC patients in relapsed disease (p < 0.001). The relationship between increased Ki-67 expression and increased grading was not statistically significant (r = 0.149; p = 0.061). The expression of Ki-67 did not depend on patient age (r = 0.040; p = 0.617). In univariate analysis negative correlation was found between the expression of Ki-67 and DFS (p < 0.001) and OS (p = 0.01). In multivariate analysis worse DFS was related to higher staging of EEC (p < 0.0 01) and increased expression of Ki-67 (p < 0.001). Worse OS was related to higher staging in multivariate analysis (p < 0.001). Ki-67 expression was not related to OS in multivariate analysis. Age of patients and grading of the EEC were not related to DFS and OS., Conclusions: The expression of the Ki-67 can significantly affect therapeutic decisions in selected EEC patients. The high Ki-67 expression in EEC patients is related to increased risk of relapse. The TMA technique is a good method for the assessment of the Ki-67 in studies conducted in EEC patients and makes it easier to carry out immunohistochemistry in large populations of patients.

Objectives: To assess prognostic significance of progesterone receptors (PR) and estrogen receptors (ER) expression in the tissue microarray (TMA) technique for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC)., Material and Methods: The study included 151 consecutive patients, aged 37-86 years (62.80 +/- 9.99), with the EEC in stages I-III (FIGO), treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards, they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery and constructed into the TMA recipient blocks. Using TMAs, the expression of PR and ER was examined and presented as Total Score (TS). The TS was determined by adding the intensity and marker distribution scores in a given case. The relationship between PR and ER expression, DFS and OS was examined. DFS was defined as the period from primary surgery until relapse. OS was defined as the period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE)., Results: Lack of the PR and ER expression was found in 46 cases (30.46%) and 67 cases (44.37%), respectively. The expression of the PR and ER was weak in 24 cases (15.89%) and 22 cases (14.57%), respectively. Strong PR and ER expression was found in 81 patients (53.65%) and 62 patients (41.06%), respectively. Follow-up after surgery varied from 3 to 60 months (50.95 +/- 16.36). In 30 patients (19.87%) relapse was diagnosed 1-54 months (22.17 +/- 15.59) after surgery. During follow-ups, 29 patients (19.21%) died. In univariate analysis better DFS was related to the presence of PR (p = 0.010), higher TS of PR (HR = 0.81; 95% CI 0.71-0.94), the presence of ER (p = 0.001) and higher TS of ER (HR = 0.88; 95% CI 0.78-0.99). DFS differed significantly between the groups: without PR and ER expression (A), with presence of the PR but not ER expression (B), with the ER but not PR expression (C) and with the PR and ER expression (D) (p = 0.004). In univariate analysis OS was not related to PR expression (p = 0.110), TS of PR (HR = 0.89; 95% CI 0.80-1.02) and ER expression (p = 0.070). TS of ER was connected to better OS (HR = 0.83; 95% CI 0.72-0.96). The OS differed between groups A, B, C and D (p = 0.006). In multivariate analysis variants of PR/ER expression influenced the DFS (p = 0.039) and OS (p = 0.016)., Conclusions: The expression of the PR and ER can significantly affect therapeutic decisions in selected patients with EEC. In EEC, common assessment of PR and ER expression is of higher prognostic value, than compared to single evaluation of PR and ER receptors.

Objectives: To assess the effectiveness of the donor-block biopsies with a 2 mm-size needle in endometrioid endometrial cancer (EEC) in the tissue microarray (TMA) technique and the application of the TMA for estrogen receptors (ER) and progesterone receptors (PR) expression in EEC., Material and Methods: The study examined EEC tissues from 60 patients. Tissue cores, 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks and constructed into the TMA recipient block. The presence of EEC tissue in the TMAs was analyzed, and the ER and PR expressions were examined., Results: EEC tissue in TMAs was confirmed in 56 cases (93.33%). In 49 of them (81.67%), both cores presented with cancer tissues. In 4 cases (6.67%) EEC tissue was absent. All cases with ECC present on the TMA slides were appropriate for the ER and PR analysis. In 29 EEC cases (51.98%) both ER and PR were expressed. In 3 cases (5.36%) only ER was expressed, in 8 cases (14.29%) only PR was expressed, and in 16 cases (28.57%) ER and PR were assessed as negative., Conclusions: Two 2 mm-sized tissue cores from donor-block biopsies constructed into the TMA recipient block were sufficient to diagnose EEC and enabled the assessment of ER and PR expression in 93.3% of the cases. The use of the described TMA technique makes the immunohistochemical study of EEC easier and more time-efficient.

Objectives: To assess the relationship between selected clinical and pathological factors and disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer patients., Material and Methods: A retrospective review of 262 patients aged 37-86 (6.0 +/- 9.0) was performed. Selected clinical and pathological data were correlated with DFS and OS., Results: Follow-up was 8-123 months (64.9 +/- 27.1). In 4 patients (1.5%) clinical progression was diagnosed during the treatment. In 43 patients (16.4%) relapse was diagnosed 2-61 months (23.9 +/- 15.7) after commencing treatment. DFS and OS were 82.1% and 81.3% respectively. In univariate analysis worse DFS was related to older patients (p = 0.007) and non-radical surgery (p < 0.001). In multivariate analysis worse DFS was related to older patients (HR = 1.058; 95% CI = 1.024-1.093; p < 0.001), younger at menopause (HR = 0.910; 95% CI = 0.851-0.973; p = 0.006), with higher staging (HR = 2.639; 95% CI = 1.968-3.539; p < 0.001) operated non-radically (HR = 0.220; 95% CI = 0.096-0.504; p < 0.001). In univariate analysis worse OS was connected with older patients (p = 0.018), diabetes type II (p = 0.019) and non-radical surgery (p < 0.001). In multivariate analysis worse OS was related to younger age at menopause (HR = 0.932; 95% CI = 0.873-0.996; p = 0.039), diabetes type II (HR = 2.372; 95% CI = 1.260-4.466; p = 0.008), higher staging (HR = 2.053; 95% CI = 1.482-2.845; p < 0.001), and non-radical surgery (HR = 0.240; 95% CI = 0.091-0.636; p = 0.004)., Conclusions: Relapsed endometrial cancer developed in 90.7% during four years after commencing treatment. In 79.1% of these patients distant metastases were present. Most significant prognostic factors were radicality of surgery age of patients and staging. The presence of diabetes type II and early menopause were connected with worse prognosis.

It is known that G-CSF not only stimulates the granulopoiesis but also regulates the functions of mature neutrophils. Indirect evidence of this might be the increase of the activity of granulocyte enzymes participating in phagocytosis and killing tumor cells. The purpose of this investigation was to evaluate in the plasma of breast cancer patients the level of adhesion molecule--sL-selectin, as a measure of maturate granulocyte activity and MPO--enzyme of granulocyte, responsible for the cytotoxicity. Additionally we have investigated the plasma level of G-CSF which can increase in the cancers. We tested 17 patients with I stage endometrial cancer and 19 patients with I stage cervical cancer. Plasma samples were drawn before operation. The control group consisted of 20 healthy women. The plasma levels of sL-selectin, myeloperoxidase and G-CSF were measured using a sensitive sandwich ELISA system. In gynecological cancer patients sL-selectin concentration was decreased, but myeloperoxidase concentration increased in comparison to the control group. G-CSF level in group with endometrial cancer was similar to the control group, but in group with cervical cancer was significantly lower. These results suggest that ability of granulocyte binding to cancer cells is decreased but cytotoxicity is increased, at lack of stimulation by of G-CSF.

Objectives: The aim of this study was to investigate, by means of cDNA macroarrays, the expression profile of genes coding the ECM proteins in endometrial cancer., Material and Methods: Tissue specimens were collected during surgical procedures. 40 patients were operated due to endometrial cancer and 9 patients because of uterine myomas. RNA was isolated and reverse transcriptase reaction with radioisotope labeling of cDNA were performed. PCR reaction was performed with labeled cDNA. All steps of macroarray hybridization were done according to the protocol. Statistical analysis was done with different tests, including artificial neural network method., Results: The level of ECM protein genes expression in normal endometrial tissue was compared to the expression of these genes in endometrial cancer specimens. Statistical significances were found only for fibronectin and osteonectin genes and for both genes decreased expression was observed in cancer tissues (p = 0.009, p = 0.0003, respectively). Moreover fibronectin and osteonectin genes expression decreased along with increase of clinical staging and histological grading of the endometrial cancer but no statistical significance for this trend was found., Conclusions: Decreased expression of fibronectin and osteonectin genes, when compared to normal endometrial tissue expression, in endometrial cancer may play an important role as a stimulus for disease development and, on the other hand, may be used as an additional marker for the progression of the disease.

Objective: The aim of this study was to evaluate selected clinical, histological and diagnostic factors as prognostics of time and location of endometrial cancer recurrence. We also attempted to design a more efficient follow-up protocols for patients with recurrent endometrial cancer., Methods: A retrospective review of 196 patients with recurrent endometrial cancer treated at the Department of Gynecologic Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, was done. Recurrence was analyzed by site, presence or absence of symptoms and methods of detection. We focused our attention on the impact of specific disease characteristics on pattern and risk of recurrence., Results: Vast majority of recurrences (88%) occurred within the first 3 years after the primary treatment, whereas 71% within the first two years after the completion of the treatment. More than half of the patients (55%) were symptomatic when relapse occurred, while no statistically significant differences were found in time to relapse between the symptomatic and the asymptomatic group. Disease-free time observed when vaginal relapse occurred was significantly shorter compared to distant sites (p = 0.049). Histological maturity of primary tumor seems to be a prognostic of disease-free time (p = 0.039). Also patients with histological type I and II seem to have different courses of the disease (p = 0.064). Among recurrent endometrial cancer cases, pelvic examination, abdominal or pelvic ultrasound and chest x-ray could detect 95% of relapses., Conclusions: A follow-up program in the first three years after the primary treatment of endometrial cancer is useful in detecting recurrent disease. There is no reason to use an intensive program of follow-up in patients with low risk primary disease. Pelvic examination, vaginal and abdominal ultrasound, chest x-ray are good and not expensive methods in relapse detection. There is no clinical justification for the routine use of the Pap smear in the follow-up of patients with endometrial cancer.

Objectives: To evaluate apurinic/apyrimidinic sites (AP), one of the oxidative stress markers in normal and cancerous human endometrium and determine whether AP sites could be a molecular marker of endometrial cancer advancement., Material and Methods: AP sites were investigated in DNAs of 33 endometrial cancer (EC) and 20 noncancerous endometrial samples using Oxidative DNA Damage Kit Quantitative (Kamiya Biomedical Company)., Results: Mean AP sites in noncancerous endometrium was 6.0 +/- 1.21 per 105 base pair. In EC group the mean AP sites level was greater than estimated in the reference group containing proliferative, secretory and hyperplastic endometrial samples (p < 0.05). There was no relation between AP sites and EC FIGO grading or the depth of the uterine wall neoplastic invasion., Conclusions: In EC mean AP sites level is greater than estimated in noncancerous endometrium. AP sites are not a molecular marker of EC advancement.

Objectives: The aim of this study was to evaluate the influence of the selected pyrimidine compounds on the activity of thymidine phosphorylase (TP) of normal and tumor endometrial cells., Materials and Methods: Influence of 28 chemical compounds on the TP activity in the cytosol of the endometrial cells was studied by the spectrophotometric method. The studied group comprised postmenopausal women with endometrial cancer: adenocarcinoma endometrialis (Adeno Ca E). The second group included women with normal endometrium after surgery due to non-oncologic reasons., Results: The most potent inhibitor of TP activity from cancer and endometrium was synthesized 5-bromo-6-acetyloaminouracil, which at the 0.2 mM concentration, by 0.2 mM concentration thymidine reduced the cytosol TP activity by about 80%. 5-bromo-6-aminouracil, 5-nitrouracil and 5-bromouracil reduced this TP activity in statistically significant manner. From among synthesized 1-N-allyloxymethylpyrimidine derivatives 1-N-allyloxymethylthymine was the strongest inhibitor of the TP activity in endometrium, and 1-N-allyloxymethyl-4-hydrokxy-5-nitro-6-oxopyrimidine in endometrial cancer respectively. The most potent activators of TP in endometrial cancer was 5-bromodeoxyuridine and 1-N-allyloxymethyl-5-nitrouracil, which increased the TP activity about 100%. 5-fluorodeoxyuridine, 5-jododeoxyuridine and 2'-deoxyuridine activated the TP in statistically significant manner too, but stronger in case of endometrial cancer than in normal endometrium. The synthesized 5-bromo-6-acetyloaminouracil strongly inhibited the TP activity of endometrial cells and might be useful in reducing endometrial cancer angiogenesis. On the other hand 5-bromodeoxyuridine and the synthesized 1-N-allyloxymethyl-5-nitrouracil might increase the effect of antitumor therapy with the cytostatics. These conclusions ought to be confirmed by analyzing more tumor cases.

Objective: Aim of the study was to assess the usefulness of ultrasound endometrial thickness measurement in the diagnosis of endometrial pathology in women with abnormal peri- and postmenopausal bleeding., Material and Methods: Material included 182 patients whose endometrium sample was obtained for analysis. Patients were divided into six groups according to histological findings., Results: Correlation between thickness of endometrium and histological diagnostic was sought. Wide and partially covered range of endometrium thickness were found in the observed groups. In carcinoma group the highest were maximal and average values. The difference in average thickness of endometrium in carcinoma and hyperplasia groups when compared to the remaining groups proved to be statistically significant A value of cut down ultrasound measured endometrial thickness to exclude endometrial cancer was 9 mm., Conclusion: Ultrasound measurement of endometrial thickness is not sufficient to increase effectiveness of endometrial pathology diagnosis in women with abnormal peri- and postmenopausal bleeding.

Endometrial carcinoma is among the most frequently diagnosed gynecological malignancies in highly developed countries. Research has been conducted for 20 years to define the molecular pathology of this disease and much is already known, but adequate prognostic, diagnostic, and monitoring markers are still missing. Recently, mitochondrial research opened a new perspective. The participation of abnormalities of those organelles and mutations of the mitochondrial genome has been defined in some types of cancer and is still under investigation. MtDNA mutations are also found in endometrial adenocarcinoma, although their impact on cell physiology has not been determined so far. Some processes involving mitochondria are widely known and described in numerous papers. These include electron transport and apoptosis, but others await further research. A forward genetics approach has been used in a wide spectrum of projects in which cancer tissue samples were collected from subjects with defined diagnoses and metabolic abnormalities and mtDNA mutations were checked. Thanks to this approach, characteristic patterns of mitochondrial disruption have been assigned to specific types of cancer. This review focuses on the molecular characteristics of endometrial adenocarcinoma with special focus on mitochondrial abnormalities. Research on cancer molecular pathology in endometrial adenocarcinoma may lead to the development of specific screening and/or diagnostic markers.

The aim of the study was to present a new EIN classification of premalignant endometrial lesions. The diagnosis of precancerous disease of the endometrium remains non-standardized because the most widely used World Health Organisation classification is a poorly reproducible system, which does not specify objective architectural criteria for each category of hyperplasia and does not correspond to an appropriate clinical management (undertreatment, overtreatment of the lesions). The new proposed EIN diagnostic schema, based on integrated morphological, genetic molecular, objective histomorphometric (D-score) and clinical outcome studies, divides endometrial lesions into three categories: benign hyperplasia, endometrial intraepithelial neoplasia, and cancer.

Introduction: The risk of endometrial cancer recurrence is estimated to be about 20%. In most cases, such situations are recognized in the first 3 years after the primary treatment. Early detection of such episodes leads to effective treatment. The aim of this study was to evaluate some histoclinical factors in the risk of recurrence., Material and Methods: Between the year 2001 and 2003, 203 from 243 patients with endometrial cancer underwent surgery. All procedures were performed in accordance with surgical-pathological staging system. The following histoclinical factors were taken into account: age, number of deliveries, BMI, use of estrogens, co-morbidity, histoclinical type, grading and the spread of cancer inside the uterus, pelvis and retroperitoneal space., Results: 29 recurrences (14.3%) were found in all analyzed groups. The mean time of follow-up was 43 months. The mean time of recurrences was 16 months (9-51 months). Lymph node metastases were recognized in 28 patients (13.7%). The most important factors in the multivariate analysis were: type of histology (serous or clear cell cancer) and lymph node involvement. Recognizing 2 or more metastatic lymph nodes significantly increased the risk of recurrences., Conclusion: In patients with endometrial cancer the risk of recurrences increases when lymph node metastases are recognized. This risk is 5 times higher when 2 or more lymph nodes are involved, comparing with patients with one node metastasis. Four times higher recurrence risk is observed in serous or clear cell cancer, comparing with other histological types.

Objectives: Matrix metalloproteinases-2 and -9 (MMP-2 and MMP-9) are enzymes degrading collagen type IV and other components of the basement membrane. Their activity is suppressed by tissue inhibitors of metalloproteinases--TIMP-1 and TIMP-2. Substantial evidence indicates that MMP2 and MMP-9 play an important role in the spread of malignant tumours. The aim of the study was to evaluate the activity of MMP-2 and MMP-9 and contents of their inhibitors: TIMP-1 and TIMP-2 in endometrial cancer and normal endometrium., Material and Methods: Material for the study comprised 28 samples of endometrial cancers and 15 samples of normal endmetrium. A two-step method for extraction of MMPs was applied. The activity of MMP-2 and MMP-9 was measured with semi-quantitative zymography. TIMP-1 and TIMP-2 contents were measured with ELISA method., Results: Mean activity and activation ratio of MMP-9 was significantly higher in endometrial cancers compared with normal myometrium, whereas mean activity and activation ratio of MMP-2 did not differ significantly between investigated groups. Mean content of TIMP-1 and TIMP-2 did not differ between cancer and control tissues. No unequivocal association between activity of investigated MMPs or contents of their inhibitors and clinicopathological features of endometrial cancers was observed., Conclusions: Results of the study suggest that MMP-9 may play an important role in the progression of endometrial cancer, whereas MMP-2 does not seem to be involved in this process. Action of MMP-9 may be further enhanced by relative deficiency of TIMP-1.

The Aim: Women with high circulating estrogens concentration have increase risk of breast, endometrium and ovarian cancer, thus it is important to identify factors, including environmental and genetic variability that may be alter estrogen concentration., Material and Methods: In the present work the distribution of genotypes and frequencies of alleles of the T/C polymorphism of CYP19 and G/A polymorphism of COMT gene in subjects with endometrial cancer were investigated. Paraffin embedded tumour tissues was obtained from 151 postmenopausal women with endometrial cancer. The polymorphism's were determined by PCR-RFLP methods., Results: The distribution of the genotypes of the T/C and G/A polymorphism in both control and patients did not differ significantly (p > 0.05) from those predicted by the Hardy-Weinberg distribution. Additionally, there were no significant differences (p > 0.05) in genotype distributions and allele frequencies between subgroups assigned to histological stage., Conclusion: The results suggest that the CYP19 and COMT polymorphism may not be linked with appearance and development of endometrial cancer but further research, conducted on larger population, are needed to clarify this point.

The opinions about the causes of the endometrial carcinoma have changed since 1995, due to molecular biology progress. The findings concerning the recently discovered suppressor PTEN gene localized on the chromosome 10 -10q23.3, the product of which is a specific phosphatase are especially valuable. The loss of the gene function is directly linked with the genesis and progression of endometrial carcinoma, as well as cancers of other tissues and organs, including thyroid, breast, ovary, prostate or skin. Immunohistochemical studies with the use of the 6H2.1 antibody directed against the protein coded by the PTEN gene indicate that the protein cannot be found in more than half of the patients with endometrial carcinoma and its precursor--EIN. Mutations of the PTEN gene have also been detected in many young women with normal microscopic structure of the endometrial mucosa. Thus, a test for the absence of the PTEN gene product in the endometrial cells may be used for precise identification of early stages of carcinogenesis.

Endometrial carcinoma is one of the most commonly found cancers. In numerous kinds of cancers, tumor microvessel density correlates with clinical stage of disease and is considered as an independent prognostic factor. Evaluation of angiogenesis intensity in endometrial cancer also seems to be an independent prognostic factor and statistically correlates with FIGO stage of disease, histological type and grade of tumor, depth of myometrial invasion and metastasis. Activity of angiogenic factors in human tissues and serum provides additional reference concerning the growth and progression of endometrial cancer.

Objectives: The purpose of the research was to analyze the frequency and location of endometrial cancer recurrence in a group of women who underwent surgery due to neoplasm and frequency of relaparotomy because of the neoplasm recurrence., Materials and Methods: 292 women underwent operation in Dept. of Gynecology at Medical University of Gdansk due to endometrial cancer in clinical stage IA-IV by FIGO 1988 in the years of 1981-1996. All materials were analyzed using Microsoft Excel 97. The information was gathered from the following sources: case histories Dept.of Gynecology and Dept. of Oncology and Radiotherapy Medical University of Gdansk, case histories from Dept.of Radiotherapy Marine Hospital in Gdynia-Redlowo and questionnaires sent to patients., Results: The mentioned above group of 292 women underwent surgery. As far as 233 instances (79.8%) are concerned, only hysterectomy with bilateral oophorectomy was used, in 23 situations (7.9%)--also the lymph nodes biopsy was performed whereas in 10 cases (3.4%)--appendectomy and/or omentectomy. 24 women (8.2%) underwent Wertheim-Meigs operation and only 2 patients (0.7%)--with vaginal hysterectomy. 138 women were chosen to take part in the next stage of treatment. The regression of neoplasm illness was discovered among 13 patients (4.5%) with the apex of vagina being the most common place. The result comprised of 6 women--46.1% of all recurrences. All regressions happened 1-2 years after surgery. 5-year-survival for patients with regression was 23.1% which is 3 women. Relaparotomy due to neoplasm illness took part in 9 situations (3.1%). The danger of fatality grew up to 16 month after first surgical treatment; after this period of time the risk of dying went down., Conclusions: The recurrence of endometrial cancer can be observed among small group of patients (4.5%). When we concentrate the patients with regression of neoplasm disease, we can observe a high rate of fatality.

Objectives: The aim of study was to analyse results of treatment patients with uterine-confined endometrial cancer which underwent surgery and postoperative radiotherapy in Center of Oncology in Kraków between 1985 and 1997., Material and Methods: The research included a group of 650 women. All patients undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy and postoperative radiotherapy. 155 patients with intermediate-risk of recurrence (IA-G3, IB-G1, G2) received postoperative whole pelvic irradiation only. In the group of 495 patients with high-risk of recurrence (IB-G3, IC, II) 210 patients received brachytherapy vaginal cuff only and 285 patients whole pelvic and vaginal cuff irradiation., Results: In the group of patients with intermediate-risk of recurrence five NED survival was 93.5%. In the group of patients with high-risk of recurrence five NED survival was statistically lower in patients treated with brachytherapy vaginal cuff only (83.2% vs. 71.9%)., Conclusion: In uterine-confined endometrial cancer patients, with intermediate-risk of recurrence treated with surgery and postoperative whole pelvis irradiation, 5-year NED survival is above of 90%. In the group of patients with high-risk of recurrence the adjuvant treatment of choice is whole pelvic and vaginal cuff irradiation.

Unlabelled: There is no agreement if an incorrect endometrial ultrasound image without clinical symptoms or postmenopausal bleeding despite normal ultrasound results are the indications for histopathological diagnosis of endometrium to exclude its pathological hyperplasia., Objectives: The aim of the study was a comparison the compatibility of ultrasound results with histopathological examination of uterine scrapings in postmenopausal women., Material and Methods: The study included 659 postmenopausal women aged 41-85 (mean 61.5). They were divided into three groups. The first one counted 186 women (28.22%) with metrorrhagia and normal endometrial ultrasound image. The second one counted 293 women (44.46%) with only changes in ultrasound examination and the third one counted 180 women (27.31%) with metrorrhagia and incorrect ultrasound image of endometrium. As an incorrect ultrasound images the endometrial thickness above 5 mm, especially with non-homogenous structure, polyps and fluid in uterine cavity, were assumed. Each examined women had a D&C with consecutive histopathological evaluation of the tissue material., Results: The endometrial cancer was the most frequent in the third group--in 29 examined women (16.11%) and was significantly rare in the first and second groups: 9 women (4.84%) and 2 women (0.68%), respectively. The most frequent (in 19 from 107 women--17.75%) the cancer was recognized in cases of endometrial hyperplasia, especially when ultrasound image of endometrium was non-homogenous and irregular, and the rarest was in the cases of affirmed fluid in uterine cavity (1 from 22 examined women--4.5%)., Conclusions: The endometrial cancer is the frequent in women with postmenopausal bleeding and endometrial hypertrophy in ultrasound examination, especially when endometrial image is non-homogenous and irregular. However, the rarest endometrial cancers were affirmed in postmenopausal women with ultrasound image of fluid in uterine cavity with thin endometrium.

Objectives: The aim of the study was to analyse results of surgical treatment patients with stage IA-G1, G2 endometrial cancer treated in Center of Oncology in Kraków between 1985 and 1997., Materials and Methods: The research included a group of 44 women. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) without complementary treatment., Results: Five NED survival was 95.5%. During the 5-year follow-up period 2 patients died, I of myocardial infarction and 1 of cerebral hemorrhage., Conclusion: Total abdominal hysterectomy and bilateral salpingo-oophorectomy are the treatment of choice for stage IA-G1, G2 endometrial cancer.

Objectives: The purpose of the study was assessing prognostic value of AgNORs expression in endometrial cancer., Materials and Methods: The study was performed in a group of 90 patients, diagnosed with endometrial cancer, treated in Clinic of Gynecological Oncology in Wrocław. Silver nucleolar organizer regions (AgNORs) were stained in paraffin-embedded samples, using Ploton method modified by Oefner., Results: The mean number of AgNORs was 2.76 +/- 0.46. To assess the possible influence of AgNORs expression, patients were divided into three groups, based on the mean number of AgNORs: I- <2.3; II- 2.3-3; III- >3. The differences in the outcome between these groups were not significantly different. The mean number of AgNORs in the group of patients with distant metastases and progression did not differ (2.72). The highest mean number of AgNORs (3.38) was observed in patients with local failure., Conclusions: At this point in time, there is inadequate evidence to use AgNORs as predictive factors in patients with endometrial cancer further studies are warranted.

During the past few decades, a variety of diagnostic methods for endometrium direct sampling have been developed. One of these new techniques is endometrial brush biopsy (uterobrush). The principal aim of uterobrush is early detection of endometrial carcinomas and their precursors, but it may be also used to follow up the patients undergoing hormone replacement therapy (HRT). So far, there are only few clinical reports evaluating uterobrush as a technique useful in monitoring endometrial cytology during HRT. In this study the world literature on using brush biopsy to monitor endometrial condition of women receiving HRT has been reviewed.

Objectives: In the paper authors present indications and results of using diagnostic and operative hysteroscopy in the clinical practise and compare histological result with introductory diagnosis of ultrasonography and hysteroscopy., Materials and Methods: In period of 01.06.1998-01.09.2002 148 hysteroscopy were done with in 58 diagnostic and 90 operative histeroscopies. Received material was sent to histological research., Results: non-pathologic change was diagnosed in 37 women, 43 endometrial polyps, 20 submucous myomas, 5 polyps and myomas together., Conclusions: 1. Most often observed change in intrauterine pathology were endometrial polyps and submucous myomas. 2. In a few cases only hysteroscopy let us discover the reason of pathological bleedings from the uterus. 3. hysteroscopy has become the method necesary in some cases of gynaecological pathology.

There are only few papers describing extrauterine localisation of endometrial tumor sarcoma. Pathogenesis of this tumor is still not clear. Most of the authors suggest the heterotopic Mullerian ducts to be the origin of such tumors. We describe a case of 53 year old woman with endometrial tumor sarcoma localized in the mesenterium of the colon. Diagnostic problems and differential diagnosis is presented. The authors suggest to immunohistochemical methods (CK desmin) to facilitate diagnosis.

One of the principal features of the malignant process is the ability of the tumor to form metastases. In case of endometrial cancer pelvic and paraaortic lymph nodes and ovaries are the most frequent sites of metastases. In some cases metastases to the distant sites like the lungs and liver occur. The diagnosis of stage IVB disease bears a poor prognosis. Only a form of palliative treatment is usually offered to those unfortunate woman. The authors present a case of successful surgical treatment an isolated liver metastasis from endometrial cancer.

Unlabelled: One of the reasons for not commencing or withdrawal of HRT in women is their fear for breast and endometrial cancers. Does ultrasonographic valuation guarantee sufficiently patient's safety? Most investigators do not recommend further endometrial diagnostics with endometrial thickness less than 4 mm. Endometrial biopsy is advised in cases of irregular uterine bleedings with normal endometrial image or when any endometrial pathology is suspected. In Poland the most frequently performed procedure of endometrial diagnostics is D&C. Our proposition was to offer endometrial biopsies to all patients who were taken HRT for more than 5 years or, despite having strong climacteric ailments, refused to take it because of their cancerophobia., Aim of Study: To evaluate the usefulness of aspiration endometrial biopsy in women after menopause qualified for HRT., Material and Methods: In 84 females, being postmenopausal (amenorrhoeic for at least 12 months) and qualified for HRT, aspiration endometrial biopsies were performed in outpatient clinics. Age of women ranged 46-63 years, mean 57.3. Attained results were compared to ultrasonographic endometrial evaluation. Such factors as patient's age, menopausal age (years from last menstrual period) and previous administration of HRT were taken into our account (maintaining a 3-month wash-out interval). In 74% of women we have got a material being sufficient for histological evaluation. Form clinical point of view the most important for us was to exclude a proliferative or neoplastic process within endometrium. One of endometrial polyps was omitted in USG study, we were surprised also while detecting endometrial carcinoma cells in endometrium below 3.5 mm. In one postoperative slide the cells of endometrial ovarian carcinoma (with infiltrated Fallopian tube) were detected., Conclusion: Endometrial biopsy seems to be a useful, effective and cheap method of endometrial diagnostics also in women after menopause.

Objectives: Validity of the sentinel node concept in patients with cervical, endometrial and vulvar cancer., Material and Methods: 47 cases of FIGO stage I and II cervical cancer, 33 cases of first clinical stage of endometrial cancer and 37 patients with FIGO stage I and II of vulvar cancer. In cervical and vulvar cancer preoperative lymphoscyntygraphy and intraoperative lymphatic mapping with blue dye and handheld gamma probe were performed. In patients with endometrial cancer intraoperative lymphatic mapping with blue dye injected into the cervix and into the uterine corpus subserously were done. In the last 10 cases radiolabeled nannocolloid were administered and the patients underwent preoperative lymphoscyntygraphy and intraoperative radio detection of sentinel node. Sentinel nodes were labeled as blue, radioactive, or blue/radioactive., Results: In cervical cancer sensitivity of the dye and radiocolloid methods was 94%, specificity 100% and negative predictive value 97%. Out of 33 cases of endometrial cancer sentinel node was identified in 29 (87.87%) patients. None of women with histological negative sentinel node had metastases in the rest of lymph nodes resected. Sentinel node was detected in all cases of vulvar cancer. The status of sentinel nodes were representative for all lymph node resected., Conclusions: Concept of sentinel node may be applied first of all for vulvar cancer and also for cervical and endometrial cancer.

Objective: In senium the increase in the incidence of most malignant neoplasms, as well as gynecological cancers is found. In this period of life the vast number of women do not apply for the preventive and follow-up examinations, which increases the number of malignant diseases diagnosed at advanced clinical stages. The coexisting another diseases often limits the possibility of the operative treatment in those cases., Design: To assess the profile of malignant tumors of the genital tract and their treatment in women above 70 year old., Material and Methods: 61 women aged from 71 yrs. to 88 yrs. treated operatively between 1997-2001 due to gynecological cancers were included into the study. The structure and detectability of the neoplasms, as well as the type of performed surgical procedures were analysed., Results: 30 endometrial cancers (49.2%), 16 ovarian cancers (26.2%), 14 vulvar cancers (22.9%) and 1 cervical cancer were diagnosed and surgically treated. The endometrial cancer stage I was detected in 18 cases, stage II in 4 cases and stage III in 8 cases. In each case the radical operation was done (total hysterectomy, lymphadenectomy and appendectomy). The ovarian cancer stage I was detected in 3 cases, stage II in 2 cases, stage III in 5 cases, and stage IV in 6 cases. Only in 5 cases out of this group the radical surgery was performed (total hysterectomy, omentectomy and appendectomy). The vulvar cancer stage I was detected in 2 cases, stage II in 11 cases, and FIGO stage III in 4 cases. In each of these women the vulva and bilateral inguinal lymph nodes were resected, and in 2 cases additionally at the same time the Miles operation was performed. The cervical cancer clinical stage I was detected, and the Wertheim operation was performed., Conclusions: The most often diagnosed malignant neoplasm in women above 70 yrs. was the endometrial cancer. The worst first-time diagnosis structure was observed in the ovarian cancer, what significantly decreased the ability of surgical treatment in this group.

Estrogen target genes play essential role among pathogenetic and prognostic factors of endometrial adenocarcinoma; and among them estrogen receptor genes. Although prevailing estrogen receptor type is ER-alpha in endometrium, transduction of signal carried by estrogens can be also mediate by ER-beta, which biological meaning relies on modulation of ER-alpha transcriptional activity. There is hypothesized that ER-beta can keep under control mitogenic activity mediating by ER-alpha. The aim of the study was qualitative and quantitative analysis of wtER-beta and ER-beta/delta 5-6, ER-beta/delta 6 isoforms in endometrial adenocarcinoma. Material used in the study included specimens obtained from 27 female: group I--normal endometrium (n = 12), group II--endometrial adenocarcinoma (n = 15). RNA was extracted from the analyzed material using phenol-chloroform method by Total RNA Prep Plus. Qualitative analysis was performed basing on RT-PCR reaction and polyacrylamide gel electrophoreses. For all RNA extracts of the samples examined RT-PCR was performed with a sequence detector ABIPRISMTM7700--Perkin-Elmer Applied Biosystems (RT: 600 C-30 min; PCR: 950 C-5 min, 40 cycles: 950 C-30s, 600 C-1 min, and 720 C-10 min) in order to determine the number of RNA copies (which corresponds to the number of cDNA copies) for wtER-beta and ER-beta/delta 5-6 and ER-beta/delta 6. Specificity of QRT-PCR reaction was determined by delimitation of melting temperature of all examined amplimers (ABI PRISM7000, Qu-antiTect SYBR Green RT-PCR Kit) and by sequence analysis using ABI PRISM377 DNA Sequencer. Wild-type of estrogen receptor beta and ER-beta/delta 5-6, ER-beta/delta 6 isoforms--coming into alternative splicing of mRNA, presented both, in proliferative endometrium and endometrial adenocarcinoma. Copy number of wtER-beta mRNA was significantly (p < 0.05, Mann-Whitney U test) lower in comparison with proliferative endometrium and correlated with decrease of ER-beta/delta 6 mRNA copy number (r = 0.85; p < 0.05). Preliminary results confirming decrease of wtER-beta, ER-beta/delta 5/6 and ER-beta/delta 6 mRNA copy number in endometrial adenocarcinoma can show their relationship with high risk of carcinogenesis.

Aim of the Study: Comparison of sonohysterography vs. outpatients diagnostic hysteroscopy in evaluation postmenopausal patient with persistent abnormal ultrasounds images after endometrial curettage revealed normal histological result., Materials and Methods: Material consisted of 47 postmenopausal women age 44-91 years, diagnosed because of abnormal uterine bleeding and/or suspicious endometrial ultrasonographic pictures performed a month after curettage. Patients were evaluated by diagnostic sonohysterography (without analgaesia) and outpatients diagnostic hysteroscopy (local analgaesia). Outcomes of sonohysterography and hysteroscopy were compared with results of histological examinations of specimen (hysteroscopical biopsy, hysteroscopical resection or hysterectomy). Sensitivity and specificity of two diagnostic methods were compared., Results: Intrauterine cause of abnormal ultrasonographic picture was disclosed by sonohysterography in 35 (74.46%) cases. Suspicious of focal endometrial carcinoma in SIS was reported in 1 (2.12%) case. Sensitivity of SIS in relation to all pathology was 0.97, specificity 0.90. Sensitivity and specificity amounted in relation to: polyps 1.00 and 0.83, hyperplasia 0.84 and 0.95. There was no significant statistical differences in sensitivity and specificity between SIS and diagnostic hysteroscopy., Conclusion: Diagnostic hysteroscopy and sonohysterography have the same diagnostic potential in evaluation of endometrium. Both methods are useful in patient with unsuspected histological results of the specimens. Ultrasonographic pictures imitating endometrial carcinoma or endometrial hyperplasia in most cases are connected with endometrial polyp. Advantage of applying liquid medium in SIS seems surpass the risk of passage of cells of carcinoma to peritoneal cavity.

Affectivity of activity of wild-type estrogen receptors forms depends not only from transcriptional activity of their encoding genes, but also from participation of ERs isoforms in entire ERs mRNA pool. Estrogen receptor mRNA isoforms are essential intracellular factor regulating cellular answer of estrogen. ERs expression, as well as the mRNA splice variants, may influence the biological properties of some tumors and affect their ability to respond to estrogen and antiestrogen therapies. The aim of the study was qualitative and quantitative analysis and comparison of mRNA ER-alpha and their isoforms concentration profile in endometrial adenocarcinoma and normal endometrium as control group. The level of ER-alpha mRNA was estimated using RT-QPCR method in proliferative phase (n = 12) and endometrial adenocarcinoma (n = 15). Types of alternative mRNA ER-alpha splice variants were marked. Seven transcripts ER-alpha (ER-alpha/delta 2, ER-alpha/3, ER-alpha/delta 2-3, ER-alpha 4-ER-alpha/delta 7) were quantitatively evaluated. Proportional analysis of particular mRNA ER-alpha isoforms participation in entire pool of mRNA ER-alpha showed diminution of ER-alpha/delta 2, ER-alpha/delta 2-3, ER-alpha/delta 7 what correlated with simultaneous decrease of mRNA copy number in endometrial adenocarcinoma. Endometrial adenocarcinoma was also characterized by presence of isoforms not stepping out in investigated segments of normal endometrium: ER-alpha/delta 4, ER-alpha/delta 6 and ER-alpha/delta 5 being with factor about high transcriptional activity potential, are able to activate transcription of estrogen receptors target genes independently from ligad binding. Additional ER-alpha isoforms appearing in endometrial adenocarcinoma instead of wild-type ER? proves, that in chance of tumor transformation the number of potranscriptional modifications increases. One can not exclude that their number is connected with genetic changes starting carcinogenesis in endometrium. Changes of mRNA ER-alpha copy number and presence of definite isoforms may altered of signaling estrogen pathways.

Neo-angiogenesis seems to play an important role in the progression of ovarian cancer and in formation of distant metastases. Data from literature on role of phosphorylase in neoplasmatic disease and in neo-angiogenesis are controversial. In mammalian cytosole there are two different pirymidine nucleosyde phosphorylases: thymidine (PT) and uridine (PU). Both of them play important role in the metabolism of nucleosides as well as in the recycling of pyrimidine base. Recently thymidine phosphorylase is identified with platelet derived endothelial cell growth factor (PD-ECGF). It has been demonstrated, that PD-ECGF/PT influence on neo-angiogenesis and correlates with degree of neoplasmatic invasion. In literature the data about thymidine phosphorylase activity and its correlation with neoplasmatic angiogenesis in ovarian tumors are controversial. The aim of the study was to evaluate the activity of PT together with the intensity of angiogenesis in epithelial ovarian tumors. 42 patients with ovarian cancer were included into the study. The enzyme activity was measured in ovarian cancer tissue and in the serum in the spectrophotometer. Intratumoral microvessel density (IMD) was evaluated in tumor using immunohistochemical methods. 10 woman with normal ovaries, treated surgically due to non-oncological reasons served as a control. Activity of PT in ovarian tumor and in serum was compared to the control group. Correlation between the intensity of angiogenesis and PT activity in ovarian cancer was also investigated. Significantly higher PT activity was stated both in tumor and serum when compared to the control. Positive correlation between enzyme activity in the serum and neoplasmatic tissue was found. Surprisingly, the negative correlation between neo-angiogenesis and PT activity in ovarian cancer was observed. Neo-angiogenesis is higher in ovarian cancer, when compared to the group of borderline malignancy tumors. Positive correlation between PT activity and staging in ovarian cancer was observed. No correlation between grading and histopathological type of epithelial cancer was observed. PT activity and neo-angiogenesis evaluation might be useful in diagnostics of ovarian cancer.

Objectives: The aim of the study was the estimation of effect of pelvic and paraaortic lymphadenectomy on intensity of pain complains, and comparison of quantity of intraoperative and postoperative complications in groups of patients subjected and not subjected the lymphadenectomy., Material and Methods: We studied to 80 patients divided into two groups: 40 people with endometrial cancer, who were treated with total abdominal hysterectomy, salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy; and 40 people with uterine myomas or benign neoplasms of uterine adnexa, who were treated with abdominal hysterectomy and salpingo-oophorectomy, but without lymphadenectomy. The measure of intensity of pain complaints was twenty-four hour analgetic requirement of patients in postoperative period, counted by PCA (Patient Controlled Analgesia) pump (Perfusor fm Braun)., Results: Twenty-four hour consumption of morphine counted by PCA pump did not statistically differ in both groups of patients. Twenty-four hour consumption of morphine on kilogram of body mass was similarly too. We find 3 (3.8%) intraoperative and 15 (18.8%) postoperative complications. The number of complications did not statistical to differ in groups of patients subjected and not subjected lymphadenectomy., Conclusions: The inclusion of lymphadenectomy into the operation procedures did not increase of pain in the postoperative course. The percentage of intraoperative and postoperative complications in both groups was similar. The lymphadenectomy executed in specialised centres of oncological gynaecology is a safe intervention, with a low number of complications.

Reports on coexistence of the three cancers: a carcinoid of the appendix, myoma of the uterus and adenoma of the uterine cavity occurring in a female patient are exceptionally rare. Such a case may occur with a frequency of 2 every 10,000 hysterectomies. The patient was subjected to hysterectomy, appendectomy and had her obturator and iliac lymph nodes removed. Postoperative treatment comprised radiotherapy. It is estimated that on overall chance of 5 year survival is close to 50%. The overall good state of the patient, 4 years after operation, speaks for recommending this kind of treatment. The authors suggest that the carcinoid does not necessarily must be an inductor of a cancer of the endometrium and they indicate that a cancer of the endometrium is not an inductor of the carcinoid.

Objectives: Endometrial cancer is the most common gynecologic malignancy. The purpose of the study was to compare the reliability of different methods for diagnosing endometrial cancer., Design: A prospective study from January 1996 to September 1998., Materials and Methods: 264 women at risk of endometrial cancer with clinical indications for hysteroscopy with curettage participated in the study. They underwent different diagnostic methods: endometrial cytology (121 cases), endometrial biopsy (150) or ultrasonography (200). The accuracy of these methods was related to the following results obtained from hysteroscopy with curettage., Results: The results of the study suggest higher reliability of endometrial biopsy from cytology. The hysteroscopic diagnosis conforms with the histologic examination showed by the curettage. Endometrial cancer as the cause of post-menopausal bleeding can be excluded in cases with endometrial thickness of < or = 5 mm measured by vaginal ultrasonography., Conclusions: We concluded that the combination of hysteroscopy and endometrial biopsy may substitute for curettage and become the method of choice for the endometrium.

Objectives: The aim of the study was the clinical analysis of value of pelvic lymphadenectomy in surgical treatment of endometrial carcinoma., Material and Methods: The group of 420 women treated for of endometrial cancer in stage IA-IV by FIGO 1988 was analysed. All these women were operated in 2nd Dept. of Obstetrics and Gynecology Medical University of Gdańsk between 1981-2000. The subgroup of patients with pelvic lymphadenectomy was selected. The data were obtained from case histories., Results: The subgroup of patients on whom pelvic lymphadenectomy was performed was up 32.6% of all treated women (137 women). Neoplastic metastases were found in 27 cases (19.7%). All those patients were in clinical stage II-IV by FIGO 1988, and no earlier stage of endometrial cancer was found in that group. In every case myometrial invasion was more then 1/2 of myometrium. In 59.2% of neoplastic metastases high or medium differential adenocarcinoma were found., Conclusion: Pelvic lymphadenectomy has to be part of surgical treatment of endometrial cancer. Lymph nodes metastases are important prognostic factors. Myometrial invasion plays an important role as a risk factor of lymph nodes metastases.

Objective: Angiogenesis in malignant tumors is a prognostic factor associated with tumor growth and metastasis. Studies of angiogenesis in breast, prostate and lung cancer showed that neovascularisation correlates with likelihood of metastasis and recurrence. Our study was to evaluate microvessel density as a prognostic factor in endometrial cancer., Methods: Between 1995-1999, 58 women were treated for endometrial carcinoma. The primary treatment consisted of total abdominal hysterectomy, bilateral salpingoophorectomy and pelvic lymphadenectomy. The microscopic examination of paraffin blocks showed the areas of the deepest myometrial invasion. The microvessels within the invasive cancer were highlighted by means of immuno-cytochemical staining to detect CD-31 antigen., Results: Microvessel count was related to likelihood of recurrence. We found statistically significant differences between patients who died after operation and patients with nonrecurrence process. All patients were in the same stage and grade of endometrial carcinoma., Conclusion: Microvessel density index seems to be an important factor for planing postoperation treatment in endometrial carcinoma.

Objectives: Uterus body carcinoma ranks among to the most common malignant neoplasms. It is of special interest what kind of factor influences on the survival span of treated patients., Design: Evaluation of selected risk factors such as: age, obesity, clinical stage, type and histologic differentiation and proliferation depths on the 5-year survival span., Materials and Methods: /Due to our research we analyzed 280 endometrium samples of patients with the diagnosis of endometrial cancer, who*.../ Analysis was made on the group of 280 endometrium carcinoma patients, who were operated in the Department of Obstetrics and Women Diseases, University School of Medicine in Bydgoszcz in 1982-2000 period, 221 of the total number of patients (78.8%) were in the cancer stage I, while 33 (11.9%) in stage II, followed by 26 (9.3%) in stage III., Results: The highest percentage of 5-year survival time was observed in the group of patients under age of 50. In patients with the clinical stage I and proliferation depths under 1/2 of myometrum the percentage of 5-year survival time was 91%. Adenocarcinoma was the most common type of cancer and also with the best prognosis (81% of 5-year survival). Neither histologic differentiation G1 nor G2 have an influence on the survival time of operated patients., Conclusions: 1. The proliferation depths, histologic type of the endometrial carcinoma and clinical stage are the major prognostic factors for the uterus body carcinoma. 2. Endometrial carcinoma in the group of patients under age of 50 is connected with the higher percentage of five-year survival time.

Unlabelled: Tamoxifen is one of most common drugs for breast cancer therapy. But its weak estrogenic activity in endometrium can be the source of different abnormalities including even endometrial cancer., Objectives: The aim of this clinical trial was to compare ultrasound scan results, hysteroscopy and pathomorphological findings of tamoxifen treated patients with breast cancer who complained of bleeding., Materials and Methods: Analyzed group consisted of 10 patients treated for abnormal endometrium during breast cancer tamoxifen therapy., Results: Among 10 examined women 7 presented no pathological changes, there was 1 case of simple benign hypertrophy and 2 cases of endometrial polyps., Conclusions: There is no exact correlation between ultrasound scan results and pathomorphological findings in patients treated with tamoxifen for of breast cancer. Transvaginal ultrasound examination is not efficient screening test for endometrial abnormalities during tamoxifen therapy.

The aim of this paper is the presentation of the latest opinions on the lymph node mapping and the sentinel node localization in the female genital organ neoplasm. The current strategies of lymph node resection in gynecologic oncology have been presented. The methods of lymph node staining and detection has been expounded as well. The paper also contains the results of sentinel node localization in the vulvar, cervical and endometrial cancers.

Objectives: Most endometrioid, well differentiated cancers are positive for ER and PgR., Materials and Methods: By using specific monoclonal antiER, PgR, p53 and hsp 90 antibodies, immunohistochemical reaction was used to study paraffin-embedded specimens from 53 patients with primary endometrioid and clear cell cancers., Results: Most carcinomas with p53 overexpression showed no reactivities of ER and PgR., Conclusions: Presence of p53 and absence of steroid hormone receptors suggest a poor clinical prognosis for patients with endometrioid and clear cell cancers.

In the current study, PCNA and p53 proteins were immunohistochemically studied in the proliferative (n = 5), hyperplastic (n = 4) and neoplastic (n = 20) human endometrium. PCNA immunostaining was noted in 2 out of 5 (40%) proliferative, 4 out of 4 (100%) hyperplastic, and in 18 out of 20 (90%) neoplastic slides. Concomitant PCNA and p53 expression was reported in 12 out of 20 (60%) malignant tumors. All non-endometrioid neoplasms were PCNA-positive, suggested this proliferative marker is commonly expressed in the unfavorable histological types of endometrial cancer.