Adult ; Endometrial Neoplasms ; surgery ; Female ; Fertility ; physiology ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy Outcome ; Sarcoma, Endometrial Stromal ; surgery

Objective: To analyze the clinical efficacy of fertility-preserving therapy in patients with atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EC). Methods: The general condition, pathological type, treatment plan, tumor outcomes and pregnancy outcomes of 110 patients with AEH and EC treated with fertility-preserving therapy in Peking University People's Hospital from December 2005 to September 2019 were retrospectively analyzed. Kaplan-Meier and Log rank tests were used for survival analysis. Results: The response rate of 110 cases of AEH (62 cases) and EC (48 cases) was 94.5% (104/110) after fertility-preserving therapy. There were 93 cases (84.5%) achieved complete response and 11 cases (10.0%) achieved partial response, and the recurrence rate was 29.0% (27/93). The complete response rates of AEH and EC were 90.3% (56/62) and 77.1% (37/48), respectively, without significant difference (P=0.057). The recurrence rates of EC were significantly higher than that of AEH (40.5% vs 21.4%; P=0.022). Forty-one patients with complete response had pregnancy intention, the pregnancy rate was 70.7% (29/41), and the live birth rate was 56.1% (23/41). The live birth rate of AEH was 68.2% (15/22) and that of EC was 42.1% (8/19), the difference was statistically significant (P=0.032). The pathological type was related with the recurrence (P=0.044). Conclusions: Patients with AEH and EC can obtain high complete response rate and pregnancy rate after fertility-preserving therapy. The recurrence rate of EC is higher than that of AEH, while the live birth rate of AEH is higher than that of EC.
Endometrial Hyperplasia/surgery* ; Endometrial Neoplasms/surgery* ; Female ; Fertility ; Fertility Preservation ; Humans ; Pregnancy ; Retrospective Studies

No abstract available.
Endometrial Neoplasms/*surgery ; Female ; Humans ; *Lymph Node Excision

OBJECTIVETo report the first case of laparoendoscopic single-site surgery (LESS) for gynecologic malignancy in China and discuss the application of LESS in minimally invasive gynecologic surgery.

METHODSA 57-year-old postmenopausal woman presented with vaginal bleeding for 5 years and diagnostic curettage revealed endometrial cancer. Staged LESS for endometrial cancer was performed using a single multiple-channel port (Tri-port) inserted through a solitary 2.5 cm upper umbilicus incision.

RESULTSThe operation was completed successfully. The total operative time was 4.5 h, the duration of the LESS procedure was 4.0 h, and the establishment of the operative access took 1.0 h. No other port incision or transfer to open procedure was needed. The intraoperative blood loss was 100 ml. Bowel peristalsis and micturition recovered 2 days after the operation, and the peritoneal drainage tube was removed 4 days after the operation without vaginal bleeding. No obvious scar was left on the surface of umbilicus.

CONCLUSIONLESS can be a promising minimally invasive approach to effective management of benign and malignant gynecological diseases.

China ; Endometrial Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Middle Aged ; Uterine Neoplasms ; surgery

Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woman with FIGO Stage IVb Grade 2 endometrial adenocarcinoma which metastasized to left lower extremity bone. She received an amputation of left lower extremity below the knees, and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by systemic chemotherapy, radiation therapy to the pelvis and progestational agent. She had a complete response to above treatments, and disease-free survival for 10 months. After recurrence, she received chemotherapy, radiotherapy and progestational agent once again. She had lived 56 months and is still alive by the time of report. Metastasis of endometrial carcinoma to extremity bone can rarely occur and should be considered when the patient with endometrial carcinoma complained of unexplained pain and swelling associated with extremity bone.
Bone Neoplasms ; pathology ; secondary ; surgery ; Endometrial Neoplasms ; complications ; pathology ; surgery ; Female ; Humans ; Middle Aged

OBJECTIVETo study the optimal position and method for ovarian transposition and its benefits and indications.

METHODSWe performed ovarian transposition in 34 patients from August 1989 to December 2000. Twelve patients were diagnosed with stage Ib to IIa cervical cancer, 4 had stage Ia endometrial carcinoma, 12 had stage III to IV endometriosis, 4 had myoma of uterus, 1 had dysfunctional uterine bleeding, and 1 had an ovarian granulosa cell tumor. Surgery went as follows: the ovary was dissociated by clamp, the skin was incised and a tunnel was made, then the ovary was translocated to the subcutaneous site. In the cases of benign lesions, the ovarian vessel pedicel went in through the abdominal cavity, but in malignant tumors, it went out through the peritoneum.

RESULTSIn both cases (benign lesions or malignant tumors), the short-term and long-term endocrine function of the translocated ovary remained normal. Furthermore, patients could supervise their translocated ovary themselves.

CONCLUSIONSSubcutaneous ovary transposition might prevent not only implantation of gastrointestinal cancer but also the extension of pelvic carcinoma to the ovary. Because of the shallow transposition and the incision scar, it is easy for patients to supervise themselves. Moreover, the site of the ovary is easy to locate for ultrasound examinations. Thus, it can obtain the goal of early prevention for cancer. Subcutaneous ovarian transposition with skin incision is the optimal selection and suitable for all patients with various gynecologic diseases in which ovary removal is not necessary.

Adult ; Endometrial Neoplasms ; surgery ; Endometriosis ; surgery ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Hysterectomy ; Ovary ; surgery ; Prognosis ; Uterine Cervical Neoplasms ; surgery

Carcinoma, Endometrioid/pathology* ; Carcinoma, Neuroendocrine/surgery* ; Carcinoma, Small Cell/surgery* ; Endometrial Neoplasms/pathology* ; Female ; Humans ; Ovarian Neoplasms/surgery* ; Uterus/pathology*

Adult ; Aged ; Algorithms ; Endometrial Neoplasms ; metabolism ; mortality ; surgery ; Female ; Humans ; Middle Aged ; Receptors, Estrogen ; metabolism ; Sarcoma, Endometrial Stromal ; metabolism ; mortality ; surgery ; Treatment Outcome

Female ; Humans ; Sarcoma, Endometrial Stromal/surgery* ; Transcription Factors/genetics* ; Endometrial Neoplasms/surgery* ; DNA-Binding Proteins ; Co-Repressor Proteins ; Repressor Proteins/genetics*

OBJECTIVETo investigate the clinicopathologic features and the prognostic factors of endometrial stromal sarcoma (ESS).

METHODS55 cases of endometrial stromal sarcoma were reviewed and categorized into 3 pathologic types based on the related literatures, i.e., low grade endometrial stromal sarcoma (LGESS), undifferentiated endometrial sarcoma with nuclear uniformity (UES-U) and undifferentiated endometrial sarcoma with nuclear pleomorphism (UES-P). Meanwhile, the pathologic features were reviewed, including fibroid, myoid, mucoid, and epithelioid differentiation and mitotic index. Clinical and follow-up data were collected.

RESULTSIn endometrial stromal sarcoma, two or three pathologic types co-existed in one case, including 12.8% (5/39) of LGESS, 5/9 of UES-U, and 5/7 of UES-P. Mitotic index varied in different regions of one tumor from rare to high. Multi-differentiation was also commonly seen in ESS. The numbers of cases in LGESS, UES-U and UES-P were 39, 9 and 7, with recurrence rate of 51.6% (16/31), 5/6 and 2/3, respectively. There was no death case in LGESS, and 2 cases were died in UES-U and UES-P, respectively. In the 2 death cases of UES-U, both had focus of UES-P. There was a significant difference in the recurrence rate between cases with different mitotic index (≥ 10/10 HPF and < 10/10 HPF, P = 0.009), especially in LGESS group. All death cases had high mitotic index (> 30/10 HPF).

CONCLUSIONSIt is a common phenomenon in ESS that two or three pathologic types may exist in one case, especially in UES-U and UES-P. And multi-differentiation is also commonly seen in ESS. So adequate pathologic sampling is important for pathologists to make a correct diagnosis of ESS in daily work. The recurrence rates are significantly higher in cases with high mitotic index, especially in LGESS. In addition, the presence of UES-P and high mitotic index may increase the risk of death in the patients.

Adult ; Aged ; Aged, 80 and over ; Cell Differentiation ; Endometrial Neoplasms ; classification ; pathology ; surgery ; Endometrial Stromal Tumors ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Middle Aged ; Mitotic Index ; Neoplasm Recurrence, Local ; Sarcoma, Endometrial Stromal ; classification ; pathology ; surgery ; Survival Rate ; Young Adult