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J Einenkel - One of the best experts on this subject based on the ideXlab platform.
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Risk of progression in complex and atypical endometrial Hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment
2020Co-Authors: L C Horn, U Schnurrbusch, K Bilek, Bettina Hentschel, J EinenkelAbstract:Abstract. Horn L-C, Schnurrbusch U, Bilek K, Hentschel B, Einenkel J. Risk of progression in complex and atypical endometrial Hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004;14:348-353. In most cases, the endometrioid adenocarcinoma of the endometrium is preceded by Hyperplasia with different risk of progression into carcinoma. The original histologic slides from 560 consecutive cases with complex and atypical Hyperplasia were re-examined to assess the interobservercorrelation. The Hyperplasias were analyzed separately for their likelihood of progression to carcinoma in patients with and without progestogen hormonal therapy. In all cases, a fractional re-curreting was performed to establish the state of the disease. The leading symptom was vaginal bleeding in 65.5% of the cases in the postmenopausal period. Eighty-six percent of the patients presented with obesity (BMI > 30 kg/m 2 ), 23% had had an exogeneous use of estrogens. Twenty-two cases were reclassified as simple Hyperplasia and excluded from further analysis. The interobserver-correlation was 91% for complex, 92% for atypical Hyperplasia, and 89% for endometrioid carcinoma, representing an overall correlation of 90%. Two percent of the cases with complex Hyperplasia (8/390) progressed into carcinoma and 10.5% into atypical Hyperplasia. Fifty-two percent of the atypical Hyperplasias (58/112) progressed into carcinomas. In the case of progestogen treatment (n = 208; P < 0.0001) 61.5% showed remission confirmed by re-curetting, compared with 20.3% of the cases without hormonal treatment (n = 182; P < 0.0001). Endometrial Hyperplasia without atypia is likely to respond to hormonal treatment. Especially in postmenopausal situation, atypical Hyperplasia should be treated with total hysterectomy
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risk of progression in complex and atypical endometrial Hyperplasia clinicopathologic analysis in cases with and without progestogen treatment
International Journal of Gynecological Cancer, 2004Co-Authors: L C Horn, U Schnurrbusch, K Bilek, Bettina Hentschel, J EinenkelAbstract:In most cases, the endometrioid adenocarcinoma of the endometrium is preceded by Hyperplasia with different risk of progression into carcinoma. The original histologic slides from 560 consecutive cases with complex and atypical Hyperplasia were re-examined to assess the interobserver-correlation. The Hyperplasias were analyzed separately for their likelihood of progression to carcinoma in patients with and without progestogen hormonal therapy. In all cases, a fractional re-curreting was performed to establish the state of the disease. The leading symptom was vaginal bleeding in 65.5% of the cases in the postmenopausal period. Eighty-six percent of the patients presented with obesity (BMI > 30 kg/m(2)), 23% had had an exogeneous use of estrogens. Twenty-two cases were reclassified as simple Hyperplasia and excluded from further analysis. The interobserver-correlation was 91% for complex, 92% for atypical Hyperplasia, and 89% for endometrioid carcinoma, representing an overall correlation of 90%. Two percent of the cases with complex Hyperplasia (8/390) progressed into carcinoma and 10.5% into atypical Hyperplasia. Fifty-two percent of the atypical Hyperplasias (58/112) progressed into carcinomas. In the case of progestogen treatment (n = 208; P < 0.0001) 61.5% showed remission confirmed by re-curetting, compared with 20.3% of the cases without hormonal treatment (n = 182; P < 0.0001). Endometrial Hyperplasia without atypia is likely to respond to hormonal treatment. Especially in postmenopausal situation, atypical Hyperplasia should be treated with total hysterectomy.
Fulvio Zullo - One of the best experts on this subject based on the ideXlab platform.
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Congruence Between 1994 WHO Classification of Endometrial Hyperplasia and Endometrial Intraepithelial Neoplasia System
American Journal of Clinical Pathology, 2019Co-Authors: Antonio Travaglino, Antonio Raffone, Gabriele Saccone, Massimo Mascolo, Maurizio Guida, Antonio Mollo, Luigi Insabato, Fulvio ZulloAbstract:OBJECTIVES To assess congruence between World Health Organization (WHO) 1994 and endometrial intraepithelial neoplasia (EIN) classification systems of endometrial Hyperplasia. METHODS Systematic review and meta-analysis were performed by searching electronic databases for studies that classified endometrial Hyperplasia according to both WHO 1994 and EIN systems. Congruence was based on the rate of specimens classified as EIN in WHO categories, which should be virtually 0.000 in nonatypical Hyperplasia (NAH) and 1.000 in atypical Hyperplasia (AH). Subgroup analyses were performed based on architecture complexity. RESULTS Eight studies with 1,352 Hyperplasias were included. Congruence with EIN criteria was fair in NAH (0.241) and moderate in AH (0.815). Subgroup analyses of NAH showed high congruence in simple NAH (0.065), null in complex NAH (0.517), null in simple AH (0.148), and high in complex AH (0.901). CONCLUSIONS WHO 1994 system is not congruent with the EIN system and cannot be directly translated into a dual classification.
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loss of b cell lymphoma 2 immunohistochemical expression in endometrial Hyperplasia a specific marker of precancer and novel indication for treatment a systematic review and meta analysis
Acta Obstetricia et Gynecologica Scandinavica, 2018Co-Authors: Antonio Travaglino, Antonio Raffone, Gabriele Saccone, Antonio Mollo, Luigi Insabato, Giuseppe De Placido, Fulvio ZulloAbstract:INTRODUCTION: Endometrial Hyperplasia is differentiated into benign or premalignant. Two histological classifications are used for this purpose: World Health Organization (WHO) classification, based on cytological atypia, disregarding glandular complexity, and endometrial intraepithelial neoplasia (EIN) classification, based on several different parameters. B-cell lymphoma 2 (Bcl-2) loss has been studied as immunohistochemical marker with the aim of improving the differential diagnosis between benign and premalignant Hyperplasia. We aimed to evaluate: (A) Bcl-2 loss as marker of endometrial precancer, by assessing it in proliferative endometrium, benign Hyperplasia, premalignant Hyperplasia, and endometrial cancer; (B) the diagnostic accuracy of Bcl-2 in the differential diagnosis between benign and premalignant endometrial Hyperplasia; (c) how the results change according to the histological classification and the thresholds of Bcl-2 expression used. MATERIAL AND METHODS: Electronic databases were searched from their inception to March 2018. All studies assessing Bcl-2 immunohistochemistry in endometrial specimens were included. RESULTS: In total, 20 observational studies assessing 1,278 specimens were included. Bcl-2 loss rates were not significantly different between proliferative endometrium and benign Hyperplasia (P = 0.12) and between premalignant Hyperplasia and endometrial cancer (P = 0.53). Among Hyperplasias, Bcl-2 loss was significantly associated with premalignancy, according to both the WHO (OR = 4.39; P < 0.00001) and EIN classifications (OR = 6.07; P = 0.01), and also with architecture complexity (OR = 2.06; P = 0.02). Using the WHO classification, Bcl-2 loss showed low diagnostic accuracy in detecting premalignant Hyperplasia (area under the curve [AUC] = 0.708), with a sensitivity of 0.41, a specificity of 0.81, a positive likelihood ratio of 3.22, and a negative likelihood ratio of 0.69. Using the EIN classification, accuracy was high (AUC = 0.938), with a sensitivity of 0.18, a specificity of 0.97, a positive likelihood ratio of 5.16 and a negative likelihood ratio of 0.86. Thresholds of Bcl-2 expression not involving a complete loss showed lower diagnostic accuracy with a slight increase in sensitivity, but a severe decrease in specificity. CONCLUSIONS: B-cell lymphoma 2 loss is a marker of endometrial precancer, with a high specificity and high diagnostic accuracy if the EIN classification is used. Thresholds of Bcl-2 expression not involving a complete loss should not be considered. Bcl-2 loss in endometrial Hyperplasia may be a novel indication for treatment when precancerous features are ambiguous in a histological examination. Bcl-2 loss correlates better with EIN classification than with the WHO classification, suggesting that glandular complexity is an important precancerous feature.
Setsuo Hirohashi - One of the best experts on this subject based on the ideXlab platform.
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natural history and prognosis of adenomatous Hyperplasia and early hepatocellular carcinoma multi institutional analysis of 53 nodules followed up for more than 6 months and 141 patients with single early hepatocellular carcinoma treated by surgical resection or percutaneous ethanol injection
Japanese Journal of Clinical Oncology, 1998Co-Authors: Michiie Sakamoto, Setsuo HirohashiAbstract:BACKGROUND The natural history and posttherapeutic outcome of adenomatous Hyperplasia and early hepatocellular carcinoma have rarely been analyzed. METHODS Fifty-three hepatic tumors diagnosed as adenomatous Hyperplasia or early hepatocellular carcinoma and followed up for more than 6 months and 141 patients with single early hepatocellular carcinoma treated by surgical resection or ethanol injection were collected retrospectively and analyzed. RESULTS Some of the adenomatous Hyperplasias developed to early and to advanced hepatocellular carcinoma. Tumors tended to grow faster in the order adenomatous Hyperplasia, early hepatocellular carcinoma and advanced hepatocellular carcinoma, with respective mean (SD) tumor volume doubling times of 21.2 (10.7), 13.9 (11.7) and 6.0 (5.2) months. Overall survival rates at 5 years in 53 patients treated by surgery and 88 patients treated by ethanol injection were 89.6 and 71.9%, respectively. CONCLUSION Progression of adenomatous Hyperplasia and early HCC was confirmed pathologically. Early HCC was shown to have a good prognosis.
L C Horn - One of the best experts on this subject based on the ideXlab platform.
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Risk of progression in complex and atypical endometrial Hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment
2020Co-Authors: L C Horn, U Schnurrbusch, K Bilek, Bettina Hentschel, J EinenkelAbstract:Abstract. Horn L-C, Schnurrbusch U, Bilek K, Hentschel B, Einenkel J. Risk of progression in complex and atypical endometrial Hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004;14:348-353. In most cases, the endometrioid adenocarcinoma of the endometrium is preceded by Hyperplasia with different risk of progression into carcinoma. The original histologic slides from 560 consecutive cases with complex and atypical Hyperplasia were re-examined to assess the interobservercorrelation. The Hyperplasias were analyzed separately for their likelihood of progression to carcinoma in patients with and without progestogen hormonal therapy. In all cases, a fractional re-curreting was performed to establish the state of the disease. The leading symptom was vaginal bleeding in 65.5% of the cases in the postmenopausal period. Eighty-six percent of the patients presented with obesity (BMI > 30 kg/m 2 ), 23% had had an exogeneous use of estrogens. Twenty-two cases were reclassified as simple Hyperplasia and excluded from further analysis. The interobserver-correlation was 91% for complex, 92% for atypical Hyperplasia, and 89% for endometrioid carcinoma, representing an overall correlation of 90%. Two percent of the cases with complex Hyperplasia (8/390) progressed into carcinoma and 10.5% into atypical Hyperplasia. Fifty-two percent of the atypical Hyperplasias (58/112) progressed into carcinomas. In the case of progestogen treatment (n = 208; P < 0.0001) 61.5% showed remission confirmed by re-curetting, compared with 20.3% of the cases without hormonal treatment (n = 182; P < 0.0001). Endometrial Hyperplasia without atypia is likely to respond to hormonal treatment. Especially in postmenopausal situation, atypical Hyperplasia should be treated with total hysterectomy
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risk of progression in complex and atypical endometrial Hyperplasia clinicopathologic analysis in cases with and without progestogen treatment
International Journal of Gynecological Cancer, 2004Co-Authors: L C Horn, U Schnurrbusch, K Bilek, Bettina Hentschel, J EinenkelAbstract:In most cases, the endometrioid adenocarcinoma of the endometrium is preceded by Hyperplasia with different risk of progression into carcinoma. The original histologic slides from 560 consecutive cases with complex and atypical Hyperplasia were re-examined to assess the interobserver-correlation. The Hyperplasias were analyzed separately for their likelihood of progression to carcinoma in patients with and without progestogen hormonal therapy. In all cases, a fractional re-curreting was performed to establish the state of the disease. The leading symptom was vaginal bleeding in 65.5% of the cases in the postmenopausal period. Eighty-six percent of the patients presented with obesity (BMI > 30 kg/m(2)), 23% had had an exogeneous use of estrogens. Twenty-two cases were reclassified as simple Hyperplasia and excluded from further analysis. The interobserver-correlation was 91% for complex, 92% for atypical Hyperplasia, and 89% for endometrioid carcinoma, representing an overall correlation of 90%. Two percent of the cases with complex Hyperplasia (8/390) progressed into carcinoma and 10.5% into atypical Hyperplasia. Fifty-two percent of the atypical Hyperplasias (58/112) progressed into carcinomas. In the case of progestogen treatment (n = 208; P < 0.0001) 61.5% showed remission confirmed by re-curetting, compared with 20.3% of the cases without hormonal treatment (n = 182; P < 0.0001). Endometrial Hyperplasia without atypia is likely to respond to hormonal treatment. Especially in postmenopausal situation, atypical Hyperplasia should be treated with total hysterectomy.
Monica Morrow - One of the best experts on this subject based on the ideXlab platform.
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Annals of Surgical Oncology, 12(9): 689)696 DOI: 10.1245/ASO.2005.04.037 Ductal Lavage Findings in Women With Mammographic Microcalcifications Undergoing Biopsy
2008Co-Authors: Seema A Khan, Michele Bryk, Monica MorrowAbstract:Background: We designed a prospective study to assess the likelihood that early lesions presenting as mammographic calcifications could be accessed for cytological diagnosis by ductal lavage (DL). Methods: Consenting women with calcifications (Breast Imaging Reporting and Data System 4 or 5) underwent DL of fluid-yielding ducts (FYDs) before stereotactic core or excisional biopsy. The DL catheter was used to inject.2 to 1mL of Isovue 300 into the duct to determine whether the FYD corresponded to the duct containing calcifications (designated overlap). Additional FYDs were injected, if possible, until overlap was identified. DL cytology was compared with histology. Results: Twenty women were enrolled (mean age, 54.2 years); the mean size of the calcification-bearing area was 190 mm 2. The histological findings were as follows: 1invasive cancer, 9 ductal carcinomas-in-situ (DCIS), 5 atypical Hyperplasias, and 5 usual Hyperplasias or fibrocystic changes. Four women had no FYD. In 15 women who underwent DL and ductography, overlap of dye and calcifications was seen in 4 (27%): 1fibrocystic change, 1 Hyperplasia, 1atypical Hyperplasia (cytological diagnosis mildly atypical), and 1DCI
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ductal lavage findings in women with mammographic microcalcifications undergoing biopsy
Annals of Surgical Oncology, 2004Co-Authors: Seema A Khan, Elizabeth L. Wiley, Ritu Nayar, Michele Bryk, Judy A Wolfman, Lewis Segal, Stephanie Benjamin, Monica MorrowAbstract:We designed a prospective study to assess the likelihood that early lesions presenting as mammographic calcifications could be accessed for cytological diagnosis by ductal lavage (DL). Consenting women with calcifications (Breast Imaging Reporting and Data System 4 or 5) underwent DL of fluid-yielding ducts (FYDs) before stereotactic core or excisional biopsy. The DL catheter was used to inject .2 to 1 mL of Isovue 300 into the duct to determine whether the FYD corresponded to the duct containing calcifications (designated overlap). Additional FYDs were injected, if possible, until overlap was identified. DL cytology was compared with histology. Twenty women were enrolled (mean age, 54.2 years); the mean size of the calcification-bearing area was 190 mm2. The histological findings were as follows: 1 invasive cancer, 9 ductal carcinomas-in-situ (DCIS), 5 atypical Hyperplasias, and 5 usual Hyperplasias or fibrocystic changes. Four women had no FYD. In 15 women who underwent DL and ductography, overlap of dye and calcifications was seen in 4 (27%): 1 fibrocystic change, 1 Hyperplasia, 1 atypical Hyperplasia (cytological diagnosis mildly atypical), and 1 DCIS (cytological diagnosis benign). Of the remaining 8 DCIS lesions, 4 had no nipple aspiration fluid, 1 showed extravasation, and 3 were lavaged but the duct did not overlap. These results are consistent with data from women undergoing mastectomy for larger invasive cancer and DCIS and show that cancer-containing ducts do not yield nipple fluid in most cases.
