Gökşen Görgülü

Analysis of vanishing endometrial cancer by pathological types

AbstractPurposeWe asked why endometrial cancer sometimes vanishes.MethodsA total of 454 patients diagnosed with endometrioid‐type endometrial cancer (EC) (via endometrial sampling) and treated in our clinic over the past 5 years were enrolled. The patients were divided into two groups: vanishing and residual, depending on whether a tumor was detected in the postoperative hysterectomy specimen. Patient age, numbers of pregnancies and deliveries, menopausal status, systemic disease status, hemogram parameters, International Federation of Gynecology and Obstetrics (FIGO) grade, and invasion status (evident on magnetic resonance imaging [MRI]) were compared between the groups.ResultsECs vanished in 42 (9.25%) patients. The vanishing rates were 19.7% (37/187) in FIGO grade 1 patients, 2.1% (5/238) in grade 2 patients, and 0% (0/29) in grade 3 patients. The average age was lower in the vanishing than the residual group, but the premenopausal status and grade 1 tumor rates were higher (both p < 0.001). An absence of invasion (as revealed by MRI) was more common in the vanishing group (p < 0.001). No recurrence developed in the vanishing group, but recurrences were noted in 3.3% (14/412) of the residual group. There were no significant between‐group differences in any of the numbers of pregnancies or births, systemic disease status, or hemogram parameters (all p > 0.05).ConclusionVanishing EC is more likely in premenopausal women with endometrioid grade 1 EC (as revealed by endometrial biopsy) who lack myometrial invasion on MRI.

Perspectives from Hysterectomy Specimens on the Hidden Malignancy Risk in HSIL Patients with Surgical Margin Continuity

Background and Objectives: We aim to examine the histopathological results following hysterectomy performed due to insufficient cervical tissue in patients diagnosed with high-grade squamous intraepithelial lesions (HSILs) who underwent the loop electrosurgical excision procedure (LEEP) and cold-knife conisation (CKC) and exhibited continuity at the surgical margin and residual disease. Materials and Methods: Thirty-four patients who underwent hysterectomy due to insufficient cervical tissue and had HSILs at the surgical margin were included in this study. The following information was analysed: age, body mass index (BMI), parity, menopausal status (premenopausal/postmenopausal), smoking history, smear result, HPV result, colposcopic cervical biopsy result, transformation zone information, LEEP+Endocervical Curettage (ECC) histopathological result, CKC+ECC histopathological result, hysterectomy material histopathological result, presence or absence of cervical glandular involvement, and presence or absence of residual lesions in the hysterectomy material. Results: The mean (±SD) age of the study cohort was 46.7 ± 8.3 years, the mean BMI was 27.4 ± 2.3 kg/m2, and the mean parity was 2.5 ± 0.7. According to the results of the hysterectomy performed on these 34 patients, in whom Cervical Intraepithelial Neoplasia 3 (CIN3) continuity at the surgical margin and the inability to perform re-excision were determined, 8 patients (23.5%) had CIN2, 19 patients (55.9%) had CIN3, 3 patients (8.8%) had adenocarcinoma in situ, and 4 patients (11.8%) had squamous cell carcinoma (SCC). Histopathological examinations of the hysterectomy specimens revealed negative surgical margins in all patients, while glandular involvement was present in 13 patients (34.2%). Conclusions: It should be borne in mind that patients with HSILs showing continuity at the surgical margin may have an underlying squamous cell carcinoma. These patients should be carefully evaluated for hysterectomy if they do not have sufficient cervical tissue for repeat excisional procedures.

Endometroid type endometrial cancer after surgery: unravelling the interplay of sleep, fatigue, and psychological well‐being

Abstract Background Endometrioid carcinoma, originating in the endometrium glandular cells, is often detected early and treated by surgery. However, post‐treatment life quality remains poorly studied, explicitly focusing on sleep quality, fatigue, and depression. Methods In this cross‐sectional, observational study, 147 female patients with endometrioid‐type endometrial carcinoma were evaluated using standardised tools—Pittsburgh Sleep Quality Index (PSQI), Fatigue Assessment Scale (FAS), and Beck Depression Inventory (BDI). Patients were categorised based on sleep quality and depression levels. The study employed correlation and regression analyses to examine the relationships among these variables. Results No correlations were found between sociodemographic or lifestyle variables and sleep quality, fatigue, or depression ( P > 0.05). A strong correlation was identified between PSQI and FAS ( r = 0.623; P  < 0.001), PSQI and BDI ( r = 0.291; P  < 0.001), and FAS and BDI ( r = 0.413; P  < 0.001). Fatigue and tumour grade were potential predictors of poor sleep. Sleep quality and depression predicted fatigue, while only fatigue was a predictor for depression. Radiotherapy and external radiation rates were notably higher in the mild depression group. Conclusions Our study suggests an imperative for integrated multi‐disciplinary approaches that focus on medical and psychological aspects of patient care to enhance long‐term well‐being and quality of life.

Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer?

Abstract Objective The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. Materials and Methods The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo‐oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. Results Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA‐125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients ( p  = 0.036). Conclusion Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.