Search

Objective To determine the value of gynaecological cytology and CA 125 level in preoperatively predicting extrauterine malignancy in endometrial cancer. Methods This retrospective study evaluated 225 women with endometrial cancer that underwent surgery between January 1996 and January 2010 at the Centre hospitalier universitaire de Sherbrooke. CA 125 level, gynaecological cytology, and histopathological data were available for each patient. Statistical analyses relied on chi-square test and Fisher exact test, as well as on a multivariate logistical regression model. Results At diagnosis, 163 patients (72.5%) presented with a stage 1 malignancy. A correlation between bad prognosis histopathological factors (grade 3, lymphovascular invasion and myometrial invasion ≥ 50%, lymph-node metastases at histology: clear cell, seropapillary and undifferentiated, P=0.05) and the combination of an increased CA 125 level (≥ 35 U/mL) and an abnormal gynaecological cytology (glandular anomalies) was discovered. Moreover, an extrauterine malignancy is found in 69.4% of patients with an increased CA 125 level and an abnormal gynaecological cytology, compared to 19.6% of patients with normal results (P Conclusion The preoperative evaluation of women with endometrial cancer should include routine evaluation of CA 125 level and routine gynaecological cytology, since the combination of these two tests offers crucial data on the probability of a stage FIGO ≥ 2 illness, thus facilitating preoperative triage of high risk patients. A pelvic or para-aortic lymphadenectomy should be offered to patients with increased CA 125 level and abnormal gynaecological cytology by a competent professional.

U femme de 53 ans presentait, depuis une semaine, un ecoulement vaginal abondant, une microrragie et une sensation de lourdeur vaginale. Au moment de l’examen pelvien, nous avons constate la presence de multiples bulles, dont le diametre variait de 0,5 cm a 1,0 cm, le long des parois vaginales (Figure 1). La mise en culture des ecoulements a donne des resultats negatifs pour ce qui est du trichomonas et de la gardnerella; la mise en œuvre de colorations speciales (PAS, PAS-d, Grocott, Ziehl et gram) a egalement donne des resultats negatifs. Un diagnostic de vaginite emphysemateuse a subsequemment ete confirme par biopsie. Cette pathologie inhabituelle se presente typiquement sous forme de bulles bleues vaginales sur une base erythemateuse, avec ou sans symptomes de vaginite. Sur le plan histologique, on constate de faibles espaces kystiques dans la lamina propria, entoures de cellules geantes s’accompagnant d’un epithelium pavimenteux normal1 (Figure 2). Bien que cette pathologie puisse etre prise en charge avec succes au moyen de metronidazole oral (500 mg, deux fois par jour pendant sept jours), comme dans le cas present, elle peut egalement se resorber spontanement.