Search

Background. The histologic grade of endometrial adenocarcinoma is related to the aggressiveness of the tumor and probability of death from disease. However, the ideal system for assignment of histologic grade remains controversial. In 1988, the International Federation of Gynecology and Obstetrics (FIGO) revised its recommendations for grading typical endometrial adenocarcinoma, such that grade is determined primarily by the architecture of the tumor and secondarily modified in the presence of 'notable nuclear atypia'; this phrase, however, has never been defined, and therefore the prognostic validity of this system is unknown. Methods. Seven hundred and fifteen women with clinical Stage I and occult Stage II endometrial adenocarcinomas (excluding serous or clear cell type) entered on a Gynecologic Oncology Group protocol, and those treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy, and selective pelvic and para-aortic lymph node sampling formed the study population. All cases were centrally reviewed and assigned an architectural grade and a nuclear grade using specific criteria. The FIGO grade was then determined. The various grading methods were examined based on ability to stratify patients into groups with differing rates of disease progression and relative survival at five years. Results. The architectural grade, nuclear grade, and FIGO grade of tumors each were used to separate patients into groups with statistically significant different rates of progression of disease and relative survival. The FIGO modification of architectural grade resulted in the reassignment of 44 patients into a higher grade. The outcome for these 44 was worse than for the remaining patients in the initial grade but was similar to the group into which they were moved. Conclusions. If clearly specified criteria for architectural and nuclear grading are used and 'notable nuclear atypia' is defined as grade 3 nuclei, the 1988 FIGO grading system has prognostic utility. The authors recommend this system as the standard method for the grading of typical endometrial adenocarcinoma.

Background. A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma wa done by the Gynecologic Oncology Group from 1979-1988. Methods. After all eligibility criteria were met, 453 cases were evaluable analyzed for prognostic factors. Results. Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). Fifty-nine tumors were leiomyosarcomas (LM). The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed. The recurrence rate for all MMT was 53% (HO,44%, HE,63%). The recurrence rate for LM was 71%. The site of the first recurrence included the pelvis in 21% of MMT and 14% in LM. Factors significantly related to progression-free interval (PFI) by univariate analysis among MMT were adnexal spread, lymph node metastases, tumor size, lymphaticvascular space involvement, histologic grade, cell type, age, peritoneal cytologic findings, and depth of uterine tumor site of invasion. The prognostic factors based on multivariate analysis were adnexal spread, lymph node metastases, histologic cell type (HO versus HE), and grade of sarcoma. For LM, the mitotic index was the only factor significantly related to PFL. Cancer 1993; 71-1702-9.

Excellent article ("The Matter With Myths" by Philip Klein, TAS, July/August 2009). There are two topics that I wish the author had expanded to areas that are seldom mentioned in [...]

Endometrial Cancer-The High-Risk Early-Stage Patient THE ARTICLE by Fu and co-workers is a comprehensive synopsis of the endometrial cancer problem, touching most of the recent developments in the areas of [...]