Endometrial adenocarcinoma in a double uterus has rarely been reported.We had a very rare case of double uterus with endometrial adenocarcinoma involving onehemiuterus and endometrial hyperplasia involving another hemiuterus. By report this case, wewant to share our experiance. The abnomal anatomy of the uterine cavities could have madeadequate biopsy difficult and endometrial cancer is clinically suspected but histology fails toconfirm the diagnosis.
Adenocarcinoma* ; Biopsy ; Diagnosis ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Female ; Uterus*

OBJECTIVE: To compare the expression of CD44 V6 in normal endometrium, endometrial hyperplasia, and endometrial cancer and to evaluate CD44 variant 6 for prognostic marker. METHODS: Seventy six endometrial samples at Korea University Anam Hospital from 1991 to 2001 (37 normal endometrium, 15 endometrial hyperplasia, and 24 endometrial cancer) were immunohistochemically investigated for the expression of variant 6, isoform of CD44. Immunoreactivity scores were generated by multiplication of the values for the immunopositivity and immunointensity. RESULTS: CD44 V6 was detected in 19/37 cases of normal endometrium (only secretory phase), 1/15 endometrial hyperplasia, and 24/24 endometrial cancer. Immunoreactivity was higher in well differentiated endometrial cancer, while no association was noted with cancer stage. CONCLUSION: CD44 V6 expression in normal endometrium is observed in the secretory phase. Detection of expression of CD44 V6 may be useful for the early diagnosis of endometrial cancer and may be an useful prognostic marker.
Early Diagnosis ; Endometrial Hyperplasia* ; Endometrial Neoplasms* ; Endometrium* ; Female ; Korea

BACKGROUNDThe aim of this study was to compare specimen adequacy of SAP-1 provided for cytology with that of dilation and curettage (D & C) or hysteroscopy for histology, and evaluate the accuracy of combining endometrium sampling by SAP-1 and liquid-based cytology using SurePath preparation for screening endometrial carcinoma and its precursor.

METHODSEndometrial specimens from women (n = 1514) with risk factors were obtained using an SAP-1 device for cytological analysis; histological samples were obtained from 375 of these women who underwent D & C or hysteroscopy. Cytological specimens were prepared to liquid-based smear using SurePath technology and stained by Papanicolaou. Histological samples were processed in routine pathology and stained by hematoxylin and eosin.

RESULTSAdequate specimens for cytology were obtained from 1458/1541 patients (96.3%), while adequate samples for pathology were obtained from 285/375 patients (76%). However, for postmenopausal women, 1006 of 1045 cytology (86.3%) were adequate, 153 of 238 histology (64.3%) were adequate, it was easier to collect cytological specimens than histological specimens (P < 0.05). The accuracy of endometrial cytology for detecting endometrial carcinoma and its precursor was 92.4% (sensitivity, 73%; specificity, 95.8%; positive predictive value, 75%; and negative predictive value, 95.3%).

CONCLUSIONSEndometrial cytology using SAP-1 sampling and SurePath preparation may be a reliable approach for screening patients with endometrial carcinoma and its precursor.

Adult ; Biopsy ; methods ; Cytodiagnosis ; methods ; Endometrial Hyperplasia ; diagnosis ; Endometrial Neoplasms ; diagnosis ; Female ; Humans ; Specimen Handling ; methods

OBJECTIVE: The aim of our study is to determine clinical factors and sonographic findings associated with endometrial hyperplasia or cancer (EH+) in premenopausal and perimenopausal women. METHODS: A total of 14,340 transvaginal ultrasonography examinations of 9,888 healthy premenopausal and perimenopausal women were included in this retrospective study. One hundred sixty-two subjects underwent endometrial biopsy based on abnormal uterine bleeding (AUB), sonographic endometrial abnormalities (thickened endometrium, endometrial mass, or endometrial stripe abnormality), or both. The clinical factors and sonographic endometrial abnormalities were evaluated with regard to EH+. RESULTS: Histologically verified EH+ was found in fourteen subjects (8.6%); ten cases of endometrial hyperplasia (EH) without atypia, three cases of EH with atypia (AEH), and one case of endometrial cancer. Neither clinical factors nor AUB were associated with EH+ (P=0.32) or AEH+ (P=0.72). Of sonographic findings, endometrial stripe abnormality was significantly associated with EH+ (P=0.003) and marginally associated with AEH+ (P=0.05), but a thickened endometrium was not associated with EH+ (P=0.43). CONCLUSION: Endometrial stripe abnormality is a significant factor to predict EH+ in healthy premenopausal and perimenopausal women with and without AUB. However, simple measurement of endometrial thickness has a limited role in this capacity.
Biopsy ; Diagnosis ; Endometrial Hyperplasia* ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Mass Screening* ; Retrospective Studies ; Ultrasonography* ; Uterine Hemorrhage

OBJECTIVE: To determine the incidence of benign, hyperplastic, and malignant endometrial polyps and whether particular clinical parameters are associated with malignancy in the polyps. METHODS: Four hundred and forty nine patients who were suspected as endometrial polyps by hysteroscopy underwent hysteroscopic guided removal over 12 months period were retrieved. The medical records and histopathological findings were reviewed. Statistical analysis was performed. RESULTS: Histologically, among 360 (80.1%) polypoid lesions, 353 polyps (75.1%) were benign; 16 polyps (3.5%) had simple or complex hyperplasia, only 1 polyp (0.2%) had hyperplasia with atypia (considered as premalignant lesions), and 6 polyps (1.3%) were cancerous. Non polypoid lesions were found in 89 (19.9%) cases. Older age, postmenopausal status were associated with pre-malignant or malignant changes significantly, but presence of abnormal uterine bleeding, multiplicity, larger sizes (>1.5cm) were not a predictor of malignancy in the polyp. CONCLUSIONS: Age and menopausal status may increase the risk of premalignant and malignant polyps. Although the risk of malignancy is low, we should pay attention to postmenopausal women with endometrial polyps regardless of the symptoms, and we prefer hysteroscopic resection for the exact diagnosis.
Diagnosis ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Female ; Humans ; Hyperplasia ; Hysteroscopy ; Incidence ; Medical Records ; Polyps* ; Uterine Hemorrhage

Endometrial stromal sarcoma (ESS) is a mesenchymal neoplasm that usually occurs as a primary tumor of the uterine corpus, but rarely arises in other sites, such as the ovary, pelvic cavity, mesentery, omentum and intestine. Herein, we present a rare case of low-grade ESS presented as prevesical mass. A 60-yr-old woman who had undergone total hysterectomy for endometriosis eleven years ago was presented with incidentally detected prevesical pelvic mass. Since malignant transformation of urachal remnants was possible, the mass was suspected to be a urachal tumor. Extraction of the mass was performed, and the histopathologic diagnosis was low-grade ESS. In summary, prevesical tumor is rare but in patients with endometriosis, we suggest endometriosis and its possible malignant changes should be taken into account in the differential diagnosis of prevesical mass.
Diagnosis, Differential ; Endometrial Neoplasms/*diagnosis/pathology/ultrasonography ; Endometriosis/diagnosis ; Female ; Humans ; Hysterectomy ; Middle Aged ; Sarcoma, Endometrial Stromal/*diagnosis/pathology/ultrasonography ; Urachus/abnormalities ; Urinary Bladder Neoplasms/diagnosis

It is often difficult to conclude that improvements in survival with time are due to a screening programme alone. Although a reduction in the death rate from a given cancer may reflect the benefits of early detection or improved treatment, the benefits may also result from lead time bias and over-diagnosis, the former resulting in longer survival of screen-identified cancers because the time before the cancer would have been clinically diagnosed is included in calculations. Furthermore, recent reviews on randomised clinical trials of cancer screening have provided strong evidence that misclassifications in causes of death have been a major problem, leading to an over-estimation of the effectiveness (or alternatively an under-estimation of potential harm) of screening.
Cervix Neoplasms/*diagnosis ; Endometrial Neoplasms/diagnosis ; Female ; Genital Neoplasms, Female/*diagnosis/epidemiology/mortality ; Human ; Incidence ; Ovarian Neoplasms/diagnosis ; Risk

OBJECTIVE: To characterize the sonographic findings of endometrial polyp and to differentiate it from other endometrial lesions. METHODS: Using transvaginal sonography, preoperative sonographic findings of pathologically proven endometrial polyp in 24 patients were retrospectively evaluated for the size, margin, echogenicity, nature (cystic, solid, mixed), and blood flow signal by color Doppler sonography (CDS). The t-test was used to check the statistical significance for Resistive index (RI) between endometrial polyp and other endometrial lesions. RESULTS: Of 110 patients studied for abnormal vaginal bleeding, 24 (21.9%) patients had endometrial polyps, 4 (3.6%) patients had secretory phased endometriums, 4 (3.6%) patients had submucosal myomas, 4 (3.6%) had retained placentaes, 1 (0.9%) had endometrial hyperplasia, 1 (0.9%) had blood clot, 1 (0.9%) had endometrial carcinoma and 71 (64.6%) patients had normal findings. The sonographic findings of endometrial polyp were well defined (24 patients), round (16 patients), hyperechoic (20 patients), and solid mass (21 patients). Using transvaginal CDS, the location of blood flow (9 patients) showed a single feeding artery with a mean RI of 0.60. There were no statistical significant differences between endometrial polyp and other endometrial lesions in arterial waveform (mean RI: 0.6) by transvaginal CDS (p>0.05). CONCLUSION: Endometrial polyp has a characteristic sonographic appearance of a well-defined, hyperechoic round mass by transvaginal sonography. In addition, it contains a single feeding vessel to the vascular stalk with a characteristic color Doppler signal detected by transvaginal CDS. These findings enable us to make differential diagnosis from other endometrial lesions.
Arteries ; Diagnosis, Differential ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Myoma ; Placenta, Retained ; Polyps* ; Retrospective Studies ; Ultrasonography* ; Uterine Hemorrhage ; Uterus

OBJECTIVE: We investigated the features of endometrial hyperplasia with concurrent endometrial cancer that had been diagnosed by endometrial sampling. Further, we attempted to identify an accurate differential diagnostic method. METHODS: We retrospectively studied 125 patients who underwent a diagnostic endometrial biopsy or were diagnosed after the surgical treatment of other gynecological lesions, such as leiomyoma or polyps. Patients were diagnosed between January 2005 and December 2013 at Busan Paik Hospital. Clinical and histopathological characteristics were compared in patients who had atypical endometrial hyperplasia with and without concurrent endometrial cancer. RESULTS: The patients were grouped based on the final pathology reports. One hundred seventeen patients were diagnosed with endometrial hyperplasia and eight patients were diagnosed with endometrioid adenocarcinoma arising from atypical hyperplasia. Of the 26 patients who had been diagnosed with atypical endometrial hyperplasia by office-based endometrial biopsy, eight (30.8%) were subsequently diagnosed with endometrial cancer after they had undergone hysterectomy. The patients with endometrial cancer arising from endometrial hyperplasia were younger (39.1 vs. 47.2 years, P=0.0104) and more obese (body mass index 26.1+/-9.6 vs. 23.8+/-2.8 kg/m2, P=0.3560) than the patients with endometrial hyperplasia. The correlation rate between the pathology of the endometrial samples and the final diagnosis of endometrial hyperplasia was 67.3%. CONCLUSION: In patients with atypical endometrial hyperplasia, the detection of endometrial cancer before hysterectomy can decrease the risk of suboptimal treatment. The accuracy of endometrial sampling for the diagnosis of concurrent endometrial carcinoma was much lower than that for atypical endometrial hyperplasia. Therefore, concurrent endometrial carcinoma should be suspected and surgical intervention should be considered in young or obese patients who present with atypical endometrial hyperplasia.
Biopsy* ; Busan ; Carcinoma, Endometrioid ; Diagnosis ; Endometrial Hyperplasia ; Endometrial Neoplasms* ; Female ; Humans ; Hyperplasia* ; Hysterectomy ; Leiomyoma ; Pathology ; Polyps ; Retrospective Studies

OBJECTIVES: We studied peritoneal fluid and serum LDH levels to identify patients with ovarian carcinoma and differentiate them from patients with benign ovarian tumor or other gynecological tumors. METHODS: From July 1998 to May 1999, peritoneal fluid and serum LDH, serum CA-125 levels were measured in 95 patients: 11 with ovarian carcinoma, 2 with borderline ovarian tumor, 45 with benign ovarian tumor, 2 with endometrial carcinoma, 21 with CIS, 7 with cervical cancer and 7 with uterine myoma. RESULTS: Peritoneal fluid LDH and serum LDH and CA-125 levels in ovarian cancer patients were significantly higher than those in patients with benign ovarian tumor and other gynecological tumors(p<0.05). Peritoneal fluid LDH demonstrated higher sensitivity(100%) and greater diagnostic efficiency(86%) than serum LDH(73% and 84%, respectively) or serum CA-125.(82% and 83%, respectively) CONCLUSION: Peritoneal fluid LDH, compared to serum LDH and serum CA-125, presented the greatest diagnostic efficiency in discriminating ovarian cancer from benign ovarian tumor and, therefore, it may be efficient as a biochemical marker in diagnosis of ovarian cancer, even in early stages of the disease.
Ascitic Fluid* ; Biomarkers ; Diagnosis ; Endometrial Neoplasms ; Female ; Humans ; Lactic Acid* ; Leiomyoma ; Ovarian Neoplasms* ; Uterine Cervical Neoplasms