• The Korean Journal of Cytopathology
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• v.11 no.1
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• pp.1-10
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• 2000

The purpose of this study is to describe the cellular characteristics of endometrial hyperplasia without/with atypia in cervical smears. These cellular features were compared with those of normal endometrium and endometrial carcinoma. We reviewed 265 cervical smears : 64 normal proliferative endometrium, 118 endometrial hyperplasia without atypia, 21 endometrial hyperplasia with atypia, and 62 endometrial adenocarcinoma. Of these smears, 72(27.2%) smears which had diagnostic endometrial epithelial cells were selected for this study. The cytologic abnormalities about cellularity, background, changes in cellular architecture, alterations in nuclear size, anisokaryosis, chromatin pattern, nucleoli, cytoplasmic vacuoles, and mitosis were observed. Nuclear enlargement(1.6 to 2 times of the nucleus in the intermediate squamous cell) and anisokaryosis(${\geq}$2 fold in size variation) were highly suggestive of endometrial hyperplasia without/with atypia. The nuclei from endometrial hyperplasia with atypia were more coarsely granular in chromatin patterns than hyperplasia without atypia(33.3% vs 3.4%). Micronucleoli were observed in all endometrial conditions, but the presence of macronucleoli were more suggestive of hyperplasia with atypia(22.2%) and adenocarcinoma(55%). The changes in cellular architecture(loss of polarity, uneven internuclear distance, overlapping and loose arrangement) were seen in hyperplasia with atypia and adenocarcinoma. Characteristically, bloody background was seen in endometrial hyperpiasia, and cellular detritus or granular proteinaceous material was only observed in endometrial adenocarcinoma. Mitoses were also observed in adenocarcinoma. In conclusion, although there is no single parameter useful for the cytologic differential diagnosis of endometrial lesions, combined cytologic evaluation can be used to diagnose hyperplasia cytologically.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2797-2801
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• 2014

Background: Endometrial adenocarcinoma is the most common gynecological cancer in the Western world and its incidence appears to be rising. However, population-based studies on endometrial cancer providing survival estimates by age, histology, and stage in Asia have been sparse. The aim of this study was to evaluate the clinicopathological data and survival for patients with endometrial adenocarcinoma treated at three institutions in Yazd, Iran. Materials and Methods: Medical and anatomicopathological records at the Department of Pathology and Radiotherapy of the Shahid Sadoughi University of Medical Sciences and Madar private hospital, between 2005 and 2012 were reviewed. All cases of endometrial adenocarcinoma were included. The Kaplan-Maier method was used for survival analysis and Cox proportional hazards model for multiple regression analysis. Results: The study included 84 patients. Stages I, II, III, and IV were identified in 65.4%, 21.5%, 11.9% and 1.2%, respectively. Disease-free survival rate was $73.9{\pm}3.77$ months (95% confidence interval, 64.51-83.22 months) and relapse occurred in 12.3% of the patients. The overall survival rate was $78.2{\pm}3.65$ months (95% confidence interval, 71.0-85.3 months). A multivariate analysis revealed that stage and grade were associated with overall survival. Conclusions: In this survival analysis of patients with endometrial cancer, we found that the prognosis of endometrial cancer was fair but strongly varied by stage and grade, and moderately varied by histology and age.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.5935-5939
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• 2013

Our study is to determine the presence of endometrial intraepithelial neoplasia (EIN) in endometrial biopsy specimens classified by the 1994 World Health Organization (WHO) criteria for endometrial hyperplasia. Endometrial biopsy specimens that were stained with hematoxylin and eosin (HE) were examined and categorized by the WHO 1994 criteria and for the presence of EIN as defined by the International Endometrial Collaborative Group. ${\beta}$-catenin expression was examined by immunohistochemistry. A total of 474 cases of HE stained endometrial biopsy tissues were reviewed. There were 379 cases of simple endometrial hyperplasia, 16 with simple atypical endometrial hyperplasia, 48 with complex endometrial hyperplasia, and 31 with complex atypical endometrial hyperplasia. Among the 474 endometrial hyperplasia cases, there were 46 (9.7%) that were classified as EIN. Of these 46 cases, 11(2.9%) were classified as simple endometrial hyperplasia, 1 (6.3%) as simple atypical endometrial hyperplasia, 6 (12.5%) as complex endometrial hyperplasia, and 28 (90.3%) as complex atypical endometrial hyperplasia. EIN was associated with a higher rate of ${\beta}$-catenin positivity than endometrium classified as benign hyperplasia (72% vs. 22.5%, respectively, P<0.001), but a lower rate than endometrial adenocarcinoma (72% vs. 96.2%, respectively, P<0.001). In benign endometrial hyperplasia, high ${\beta}$-catenin expression was noted in the cell membranes, whereas in EIN and endometrial adenocarcinoma high expression was noted in the cytoplasm. In conclusion, EIN is more accurate than the WHO classification for the diagnosis of precancerous lesions of the endometrium.

• The Korean Journal of Cytopathology
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• v.1 no.2
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• pp.121-128
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• 1990

Endometrial papillary serous carcinoma (EPSC) is a distinct variant of endometrial adenocarcinoma that histologically resembles ovarian serous papillary adenocarcinoma and has an aggressive clinical course. Usually, the tumor is diagnosed at the advanced stage. The tumor has well confused with metastatic ovarian tumor of identical histology. Dignosis of EPSC should be considered when the cervico-vaginal smear reveals nomerous papillary clusters of tumor cells with macronucleoli and psammoma bodies. Recently, we have experienced two cases of EPSC diagnosed on cervico-vaginal smears, which revealed characteristic cytologic features including numerous papillary clusters of tumor cells with macronucleoli. The cytologic diagnoses were confirmed on histologic sections.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.5
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• pp.2217-2220
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• 2014

Purpose: To evaluate the survival outcome of early stage endometrioid adenocarcinoma of the endometrium with risk factors for locoregional recurrence treated with combined pelvic external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) after comprehensive surgery. Materials and Methods: Post-operative radiotherapy by pelvic EBRT and VBT for early stage endometrioid endometrial carcinoma resulted in excellent pelvic control with acceptable complications. This study showed no significant relationships between age, stage, histologic grade and LVSI and overall survival rate. Results: The 5-year overall survival rate (OS) of early stage endometrioid type of endometrial carcinoma was 85.7%. Acute toxicity occurred in 38.1% of the patients, all of whom were grade 1 or 2. Total late toxicity developed in 42.9% of study group, in which 36.99% of them were grade 1-2 and 4.76% were grade 3-4. Conclusions: Post-operative radiotherapy by pelvic EBRT and VBT is acceptable for early stage endometrioid endometrial carcinoma, independent of age, stage, histologic grade and LVSI.

• The Korean Journal of Cytopathology
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• v.9 no.2
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• pp.147-153
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• 1998

We have investigated the cervicovaginal smears in order to define the cytologic features of uterine adenocarcinomas. Total 22 cases were reviewed(12 cases from the Sanggye Paik hospital, Inje university and 10 cases from the Korea Cancer Center Hospital) from January 1992 to December 1997. Five cases were endometrial adenocarcinomas and the remaining 17 cases were cervical adenocarcinomas. Seventeen cases of cervical adenocarcinomas were divided into endometrioid(6 cases), endocervical(7 cases), mixed endometrioid and endocervical(1 case), papillary (2 cases), and adenosquamous(1 case) carcinomas. The background of endocervical adenocarcinoma was hemorrhagic or inflammatory. The tumor diathesis was less prominent than that of the squamous cell carcinoma. The prominent features of the endocervical type adenocarcinomas were large and loose clusters, large intracytoplasmic vacuoles, and prominent overlapping and peripheral palisading of nuclei. In contrast, the endometrioid adenocarcinomas showed small and compact clusters, and small intracytoplasmic vacuoles. The detection rate of endometrial adenocarcinoma was lower than that of the endocervical adenocarcinoma.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.13
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• pp.5397-5400
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• 2015

Background: The aim of this study was to investigate the predictive value of white blood cells (WBC), the neutrophil to lymphocyte ratio (NLR), platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), platelet crit (PCT) and platelet to lymphocyte ratio (PLR) in discrimination between benign and malign endometrial lesions, and early and advanced stage endometrial adenocarcinomas. Materials and Methods: Data for 105 patients undergoing total abdominal or vaginal hysterectomy for benign uterine diseases and 114 patients surgically staged for endometrium adenocarcinoma at Ondokuz Mayis University, Department of Gynecology and Obstetrics, between 2008 and 2014, were collected. Parameters were preoperative and postoperative complete blood counts in the week prior to surgery with differentials including WBC, platelet count, platelet indices (MPV, PCT, PDW), NLR and PLR. Pathologic evaluations for both benign and malign endometrium lesions, grade of endometrium adenocarcinoma, tumor stage, presence of lymphovascular space invasion (LVI) were retrospectively analyzed. Results: Regarding definitive factors in discriminating patients with endometrium cancer from those with benign diseases, MPV was significantly increased in the malign group whereas there was a significant decrease in the PDW value compared to the benign group. The best cut-off value in differentiation of the benign and malign groups, malign cases were found to increase over the value of 7.54 for MPV, and under 37.8 for PDW. When definitive factors in discrimination of early stage endometrium cancer from advanced stage disease and LVI in the malign group were evaluated according to the ROC analysis, no significant relation was detected between blood parameters and the stage and the LVI of the disease. Conclusions: MPV and PDW may have predictive value in the discrimination of benign and malign endometrium diseases. Nevertheless, since there have been few reports on this topic, further large-scale prospective studies are necessary.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9405-9410
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• 2014

Purpose: To evaluate the prognostic impact of peritoneal washing cytology in patients with endometrial and ovarian cancers. Materials and Methods: We retrospectively identified 86 individuals with ovarian carcinomas, ovarian borderline tumors and endometrial adenocarcinomas. The patients had been treated at Shahid Sadoughi Hospital and Ramazanzadeh Radiotherapy Center, Yazd, Iran between 2004 and 2012. Survival differences were determined by Kaplan-Meier analysis. Multivariate analysis was performed using the Cox regression method. A p<0.05 value was considered statistically significant. Results: There were 36 patients with ovarian carcinomas, 4 with borderline ovarian tumors and 46 with endometrial carcinomas. The mean age of the patients was $53.8{\pm}15.2years$. In patients with ovarian carcinoma the overall survival in the negative cytology group was better than the patients with positive cytology although this difference failed to reach statistical significance (p=0.30). At 0 to 50 months the overall survival was better in patients with endometrial adenocarcinoma and negative cytology than the patients with positive cytology but then it decreased (p=0.85). At 15 to 60 months patients with FIGO 2009 stage IA-II endometrial andocarcinoma and negative peritoneal cytology had a superior survival rate compared to 1988 IIIA and positive cytology only, although this difference failed to reach statistical significance(p=0.94). Multivariate analysis using Cox proportional hazards model showed that stage and peritoneal cytology were predictors of death. Conclusions: Our results show good correlation of peritoneal cytology with prognosis in patients with ovarian carcinoma. In endometrial carcinoma it had prognostic importance. Additional research is warranted.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3737-3740
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• 2014

Background: Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia. Materials and Methods: A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test. Results: Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy. Conclusions: The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.17
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• pp.7011-7014
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• 2014

The polycystic ovary syndrome is the most common endocrinological disorder of reproductive age women with a prevalence of 5 to 8 %. The most common diagnostic criteria used for polycystic ovary syndrome are oligo- or an-ovulation, clinical and/ or biochemical signs of hyperandrogenism and polycystic ovaries. Hyperandrogenism results in increased estrogen levels and lack of cyclic progesterone due to anovulation and persistent stimulation of the endometrium may lead to endometrial hyperplasia or adenocarcinoma development. In this mini review, we aimed to evaluate the possible relationship between polycystic ovary syndrome and endometrial cancer.