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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endometrial carcinoma in young women is a rare but well-documented clinicopathologic entity. Four cases revealed some unusual clinical and pathologic features. Patient 1 was the first recorded case of a young woman (aged 24) on maintenance peritoneal dialysis for chronic renal failure who developed endometrial carcinoma with nonvirilizing oligoovulatory polycystic ovarian enlargement. Following subtotal proctocolectomy for familial polyposis coli complicated by a colonic and rectal carcinoma, patient 2 developed, at age 24, a grade 3 endometrial carcinoma in the absence of any risk factors; she was still alive three years postoperatively despite the subsequent development of a grade 3 astrocytoma in the left temporal region. Patient 3 presented at age 32 after ten years of amenorrhea with the clinical features of the Stein-Leventhal syndrome and abnormal uterine bleeding related to a grade 1 endometrial carcinoma; she also had focal dysplasia and adenocarcinoma in situ of the endocervix. Patient 4, who had no risk factors, developed a grade 2 endometrial carcinoma at age 34 despite constant use of combined oral contraceptives for one year and intermittent exposure to them for the previous ten years. Endometrial carcinoma is a rare but important cause of abnormal uterine bleeding in young women; the prognosis can be improved only by prompt diagnosis and appropriate therapy.
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PMID:Endometrial carcinoma in young women. A report of four cases. 279 70

Unopposed endogenous and exogenous estrogenic stimulation has been considered by most investigators to have a role in the pathogenesis of carcinoma of the endometrium. Although a few cases of "sarcomas" of the endometrium that had developed in an estrogenic setting have been reported, a clear-cut association between estrogenic stimulation and these forms of endometrial cancer has not been established. We report six cases of endometrial sarcomas complicating ovarian thecomas, polycystic ovarian disease, or prolonged estrogen therapy. Three ovarian thecomas, which are considered to be estrogenic tumors, were associated with endometrial malignant mullerian mixed tumor, mullerian adenosarcoma, and low-grade stromal sarcoma in postmenopausal women. Polycystic ovarian disease, a condition characterized by unopposed estrinism due to the peripheral conversion of excessive androstenedione to estrone, was found in a 27-year-old infertile woman with an endometrial malignant mullerian mixed tumor. A pure osteogenic sarcoma of endometrial stromal origin developed in a 28-year-old woman with gonadal dysgenesis (Turner's syndrome) who had received estrogens for 18 years. The sixth woman, with an empty sella turcica after radiation therapy of a pituitary adenoma, had an endometrial mullerian adenosarcoma at the age of 40 years after 16 years of estrogen therapy. None of these patients had had pelvic radiation therapy. The evidence from this series of cases and from six additional cases identified in the literature suggests that the risk of endometrial sarcomas may be increased by estrogen therapy or endogenous disorders that lead to unopposed estrogenic stimulation of the uterus.
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PMID:Endometrial "sarcomas" complicating ovarian thecoma, polycystic ovarian disease and estrogen therapy. 298 76

A young woman with typical polycystic ovary syndrome (PCO) underwent laparotomy for moderately differentiated endometrial cancer. Specimens from the hyperplastic thecal and stromal tissue of the ovaries were incubated for 2 hours in the presence or absence of hCG, 100 IU/ml. Following incubation the tissue content of cyclic AMP and the amounts of progesterone (P), androstenedione (A), testosterone (T) and estradiol-17 beta (E2) in the incubation medium were analysed. For comparison, thecal cells from normal ovaries of regularly menstruating women were incubated under identical conditions. In vivo, the PCO ovaries secreted several-fold greater amounts of T than normal ovaries. In vitro, the thecal cells were much more active, steroidogenically, than the stromal cells of the PCO ovary. Furthermore, the hyperplastic thecal cells of the PCO ovary produced several-fold greater amounts of androgens, and appeared more sensitive to stimulation with hCG, as compared with thecal cells from normal ovaries. The results indicate that in women with PCO associated with endometrial cancer the hyperplastic thecal cells are a significant site of abnormal androgen production and abnormal sensitivity to gonadotropin.
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PMID:Ovarian steroid production in a woman with polycystic ovary syndrome associated with endometrial cancer. 299 46

Ten cases of endometrial carcinoma in young women aged 15 to 25 years are presented. Seven of these ten patients exhibited the clinical characteristics of Stein-Leventhal syndrome; of these, three had evidence of polycystic ovaries. Nine of the tumors were well-differentiated, adenoacanthomas (six) or adenocarcinomas (three) and limited to the endometrium. In one case, a moderately differentiated adenosquamous carcinoma involved an ovary and the pelvic wall. Treatment consisted of curettage and progestogens in three patients, one of whom later bore two children. The remainder of the women were treated with abdominal hysterectomy and bilateral salpingo-oophorectomy and/or radiation therapy. All patients for whom follow-up data are available are alive and well without evidence of disease. It is concluded that in selected young patients with well-differentiated endometrial carcinoma limited to the endometrium, conservative hormonal therapy and curettage may be adequate treatment and may preserve fertility.
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PMID:Endometrial adenocarcinoma in women under 25 years of age. 378 84

The hyperandrogenisms, and in particular those which accompany polycystic ovaries, should always be treated, because the risk of carcinoma of the endometrium and of the breast is increased in these cases. Sterility is inconstant, but can benefit from treatment.
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PMID:[Androgens and sterility]. 408 36

Menopausal disorders coincide with the onset of luteal insufficiency and the resulting relative hyperestrogenism. At this stage the risks to be assessed are mainly related to a worsening of the menstrual syndrome (heaviness of the legs, abdominal distention, water retention, mastodynia, depressive syndrome), cycle changes, or various genital types of hemorrhage requiring investigation for detection of a possible fibroma, hyperplasia, endometriosis, or genital cancer. Once the menopause is settled a reduction in estrogen levels comes with reactive increases in FSM and LM levels, and the principal risk is the development of a cancer. The role of endogenous (obesity, diabetes, Stein-Leventhal, adenomatous hyperplasia) or exogenous (prolonged estrogen therapy alone) estrogens has to be evaluated in endometrial cancer. Cancer of the vulva also appears to be more frequent in menopausal women (natural or artificial), as well as cervical cancer and cancer of the breast. There is an apparent increase in cardiovascular risks in untreated menopausal women, but this is still discussed, as to the benefits of estrogen therapy.
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PMID:[Menopausal risk factors (author's transl)]. 625 25

Endometrial carcinoma (EC) shows a worlwide trend toward increase in industrialized nations which cannot be explained solely by the longer life expectancy of women although the incidence of EC increases at later age (10-20/100,000 women overall; 1/1000 women in 50-70 year olds). Mortality rate of EC has decreased and 5-year survival rate has increased. Besides age factors and individual disposition, endocrine factors are important in the etiology of EC. Obesity effects estrogen metabolism: in extraglandular aromatization fo androstanedione estrone is formed which, in turn, is metabolized to estradiol in the endometrium. A higher plasma level of estradiol is found in obesity with a correspondingly lower sex hormonebinding globulin capacity. Anovulation, corpus luteum insufficiency (as in the polycystic ovary syndrome) and nulliparity are risk factors because of uninhibited estrogen-induced endometrial proliferation with increased cell-turnover rate. This may lead to precancerous conditions and EC. Whearas estrogens of themselves are not carcinogenic they promote EC; epidemiologic studies have shown an increased risk and incidence of EC in postmenopausal women on longterm estrogen therapy. Although these studies are thus far inconclusive there appears to be a dose and time-dependent risk factor. Continued administration carries a greater risk than cyclic administration. Risk and incidence increase with duration of use; likewise, a 1.25 mg dose of conjugated estrogens carries twice the risk of a smaller dose. On the other had, estrogen-related EC is diagnosed earlier and treated more successfully (92% survival). Progestins inhibit estrogen-induced proliferation; the incidence of endometrial and/or ovarian carcinoma related to the use of hormonal contraceptives has dropped since the advent and use of combination pills with their low estrogen content.
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PMID:[Current views on the epidemiology and etiology of endometrial carcinoma]. 635 Jan 18

A case of Stein-Leventhal syndrome is reported in a 37 year old Melanesian female. Endometrial carcinoma developed necessitating hysterectomy and bilateral salpingo-oophorectomy. The syndrome is due to disordered hormone synthesis in the ovary which results in excessive production of androstenedione and testosterone. The treatment of choice is patients wishing to conceive is to administer clomiphene citrate to induce ovulation. For remaining patients, hysterectomy and oophorectomy is preferred to wedge resection of the ovaries in order to prevent the risk of endometrial carcinoma, and as the latter operation has high rates of surgical complications with relatively few patients achieving regular ovulation.
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PMID:Stein-Leventhal syndrome complicated by endometrial carcinoma: a case report. 695 42

Endometrial carcinoma in young women is uncommon. The majority of cases occur in women who have been taking oestrogen-containing oral contraceptives, in those with the Stein-Leventhal syndrome, or in those with gonadal dysgenesis treated by long-term oestrogen replacement therapy. We have observed 4 women under 40 years of age with adenocarcinoma of the uterus in whom chromosomal abnormalities associated with Turner's syndrome were confirmed only after the diagnosis of carcinoma had been made. None of these had received replacement oestrogen therapy. It is postulated that chromosomal abnormalities in young women with endometrial carcinoma are more common than previously thought. As the disease in this group appears to behave in a benign fashion, a conservative approach to therapy is advocated.
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PMID:Endometrial carcinoma in young women. 695 43

This review of the connection between unopposed estrogen therapy for climacteric symptoms and the development of endometrial hyperplasia briefly outlines the history of the association, and then concentrates on clinical classification problems which muddy the attempts to come to a clear understanding of the relationship between estrogen replacement therapy (ERT) and endometrial cancer. Little agreement exists about the definition of endometrial pathology and of the malignant potentials of different types of hyperplasia. This paper classifies 4 types of hyperplasia: 1) cystic hyperplasia, which has the risk of malignant change of less than 2%; 2) adenomatous hyperplasia, which has a risk of malignant change from 12-25%; 3) atypical hyperplasia, which has a malignancy potential of 45%; and 4) carcinoma in situ, which is malignant. The following conditions are discussed as they are associated with endometrial hyperplasia and adenocarcinoma: 1) obesity; 2) anovulation; 3) late menopause; 4) Stein-Leventhal syndrome; 5) functioning ovarian tumors; and 6) diabetes history. In addition hypertension and cancers of the breast and ovary occur more often with endometrial cancer than would be expected by chance. The remainder of the paper discusses the administration of exogenous estrogens unopposed, exogenous progestins, and their concurrent use, especially in controlling menopausal symptoms. Prevention, diagnosis, and treatment of hyperplasia are discussed. In terms of prevention, a study showed that low-dose cyclical Premarin (.625 mg) resulted in an incidence of hyperplasia of 7% and with higher doses (1.25 mg) rose to 15%. The addition of d-norgestrel for 7 days to the high dose of Premarin reduced incidences to 3%, whereas estrogen plus low-dose norethindrone resulted in 0% incidence of cystic hyperplasia. It is recommended that the unopposed use of estrogens be avoided if possible, although short-term therapy up to 6 months is probably safe. Longer term therapy must have added progestogen, and endometrial sampling in the form of Vabra curettage should be performed every year in patients taking unopposed estrogens and every 3 years in patients taking combined estrogen therapy.
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PMID:Oestrogens and endometrial hyperplasia. 699 95


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