Med Bull Sisli Etfal Hosp. 2019; 53(3): 252-255 | DOI: 10.14744/SEMB.2019.55770

Investigation of Extra-Uterine Tumor Dissemination of Endometrial Cancers with Myometrial Invasion Less Than 50% According to Histologic Subtypes

Alpaslan Kaban¹, Samet Topuz², Baki Erdem³, Hamdullah Sözen², Yavuz Salihoglu^2
1Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital, Istanbul, Turkey
²Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul, Turkey
³Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey

Objectives: This study aims to investigate the rates of extra-uterine metastases of non-endometrioid endometrial tumors limited to the half of the myometrium.
Methods: Patients operated for endometrial cancer between 2005-2015 in two gynecologic oncology centers were screened from clinical archives. The inclusion criteria were serous, clear cell, undifferentiated or carcinosarcoma histologies and less than half myometrial invasion. Each histological type was analyzed for adnexal metastasis, lymph node metastasis (pelvic/paraaortic) and omental metastasis.
Results: A total of 116 patients with the median age of 64 (34-72) were examined. Of the patients, 57 were serous (49.1%), 29 were clear cell (25.0%), 27 were carcinosarcoma (23.3%) and 3 (2.6%) were undifferentiated histologic type. Adnexal metastasis (over/tuba) was detected in 15 patients (12.9 %), nodal metastasis in 10 patients (8.6%), and omental metastasis in 15 patients (12.9%). The rates of adnexal metastases were calculated as 14% for serous type, 10% for clear cell type and 11% for carcinosarcoma. Omental metastasis rates were 11% for serous type, 17% for clear cell type and 15% for carcinosarcoma. The rates of extra-peritoneal nodal metastases were calculated as 12% for serous type, 7% for clear cell type and 4% for carcinosarcoma.
Conclusion: According to the findings obtained in this study, the rates of extra-uterine metastasis are high for serous, clear cell or carcinosarcoma types even in the early period. However, the lymph node metastasis in the carcinosarcoma seems to be lower. A comprehensive staging surgery should be planned for these patients, regardless of the depth of myometrial invasion.

Keywords: Endometrial cancer, extrauterine metastasis; myometrial invasion.

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Myometrial invazyonu yarýdan az olan endometrium kanserlerinde histolojik tipe göre uterusun dýþýna tümör yayýlýmýnýn araþtýrýlmasý

Alpaslan Kaban¹, Samet Topuz², Baki Erdem³, Hamdullah Sözen², Yavuz Salihoglu^2
1Ýstanbul Eðitim Araþtýrma Hastanesi, Kadýn Hastalýklarý ve Doðum, Ýstanbul
²Ýstanbul Týp Fakultesi Kadýn Hastalýklarý ve Doðum, Ýstanbul
³Kanuni Eðitim Araþtýrma Hastanesi, Kadýn Hastalýklarý ve Doðum, Ýstanbul

Amaç: Myometriuma invazyon oraný %50 den az olan non-endometrioid endometrial tümörlerin ekstra uterin metastaz oranlarýný araþtýrmak
Yöntemler: 2005-2015 yýllarý arasýnda iki jinekolojik onkoloji merkezinde endometrial kanser nedeniyle opere edilen hastalar klinik arþivlerden tarandý. Çalýþmaya dahil etme kriterleri seröz, berrak hücre, undiferansiye veya karsinosarkom histolojileri ve yarýdan az miyometriyal invazyon idi. Her histolojik tip adneksiyal metastaz, lenf nodu metastazý (pelvik / paraaortik) ve omental metastaz için analiz edildi.
Bulgular: Medyan yaþý 64 (34-72) olan toplam 116 hasta incelendi. Hastalarýn 57'si seröz (% 49.1), 29'u berrak hücreli (% 25.0), 27'si karsinosarkom (% 23.3), 3'ü (% 2.6) ise andiferansiye histolojik tipteydi. 15 hastada (% 12.9) adneksal metastaz (over / tuba), 10 hastada nodal metastaz (% 8.6) ve 15 hastada (% 12.9) omental metastaz saptandý. Adneksiyal metastaz oranlarý seröz tip için % 14, berrak hücre tipi için % 10 ve karsinosarkom için % 11 olarak hesaplandý. Omental metastaz oranlarý seröz tip için % 11, berrak hücre tipi için% 17 ve karsinosarkom için% 15 idi. Ekstra peritoneal nodal metastaz oranlarý seröz tip için% 12, berrak hücre tipi için % 7 ve karsinosarkom için% 4 olarak hesaplandý.
Sonuç: Bu çalýþmaya göre erken dönemde bile seröz, berrak hücreli veya karsinosarkom tiplerinde omental metastaz veya adneksal metastaz oranlarý yüksektir. Bununla birlikte, karsinosarkomdaki lenf nodu metastazý daha düþük görünmektedir. Bu hastalar için miyometriyal invazyonun derinliðine bakýlmaksýzýn kapsamlý bir evreleme ameliyatý planlanmalýdýr.

Anahtar Kelimeler: Endometrial kanser, myometrial invazyon, ekstrauterin metastaz

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