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Karcinom endometrija zloćudna je novotvorina unutrašnjeg sloja maternice koji se u reproduktivnoj dobi žene ciklički zadebljava i ljušti pod utjecajem spolnih hormona – najčešće svaki mjesec. Najčešći je karcinom ženskog spolnog sustava. Prema službenim objavljenim podatcima za 2021. godinu/HZJZ, tijekom 2021. godine ukupno je od karcinoma endometrija oboljelo 5.810 žena što čini 18,40 % svih karcinoma te spada među četiri najčešća karcinoma u žena u našoj zemlji. Incidencija karcinoma endometrija približno iznosi 30.3/100,000 žena i ima tendenciju daljnjeg porasta. Drugi je najčešći karcinom u žena (iza karcinoma dojke) u dobi između 50 – 69 godina, a rizik obolijevanja raste sa životnom dobi. Oko 2/3 novotvorina javlja se u postmenopauzi, a tek oko 1/3 u razdoblju perimenopauze. Vrlo rijetko se nalazi u pacijentica mlađih od 40 godina. Predisponirajući rizični čimbenici za nastanak karcinoma endometrija su: starija životna dob, dijabetes, hipertenzija, pretilost, dugotrajna estrogenska dominacija (npr. kod dugotrajnih izostanaka menstruacije, amenoreja i anovulacija), PCOS, tumori koji stvaraju estrogene, Turnerov sindrom, estrogensko (mono – estrogensko) nadomjesno liječenje, nuliparitet (nerotkinje), karcinom dojke, karcinom kolona, liječenje tamoksifenom, genetski čimbenici rizika, kao što je Lynchov sindrom itd. Najznačajniji epidemiološki faktor je udruženost s dugotrajnom abnormalnom estrogenskom stimulacijom, bez kompenzirajuće gestagenske protuaktivnosti što pospješuje nekontrolirano dijeljenje stanica, smanjuje apoptozu i potiče malignu transformaciju endometrija. Glavni simptomi endometralnog karcinoma su: nepravilna vaginalna krvarenja ( 80 – 90%), purulentni (gnojni) ili roskasti iscjedak, bolovi u donjem dijelu trbuha itd. Nenormalna vaginalna krvarenja najčešći su rani simptom endometralnog karcinoma. Krvarenja u postmenopauzi u 40 – 60% slučajeva izazivaju sumnju na karcinom endometrija. Rano otkrivanje karcinoma najvažniji je preduvjet za uspješno liječenje i suzbijanje trajnih neželjenih i fatalnih posljedica. Redoviti godišnji ginekološki pregledi uvelike povećavaju vjerojatnost za pravovremeno otkrivanje i adekvatno liječenje. Ovisno o stadiju bolesti koji se definira na osnovu međunarodne FIGO klasifikacije ista se može liječiti operativnim zahvatom, radioterapijom, kemoterapijom ili svime navedenim. Svrha pisanja ovog završnog rada je iznošenje i sažimanje elementarnih saznanja o karcinomu endometrija, njegovoj prevenciji, ranom otkrivanje te trenutno dostupnim metodama liječenja. Endometrial cancer is a malignant neoplasm of the inner layer of the uterus, which in a woman's reproductive age cyclically thickens and peels under the influence of sex hormones – usually every month. It is the most common cancer of the female reproductive system. According to official published data for 2021/HZJZ, during 2021 a total of 5,810 women were diagnosed with endometrial cancer, which accounts for 18.40% of all cancers and is among the four most common cancers in women in our country. The incidence of endometrial cancer is approximately 30.3/100,000 womens and tends to increase further. After breast cancer, it is the second most common cancer in women between the ages of 50 and 69, and the risk of the disease increases with age. About 2/3 of neoplasms occur in postmenopause, and only about 1/3 in perimenopause. It is very rarely found in patients under the age of 40. Predisposing risk factors for endometrial cancer are: older age, diabetes, hypertension, obesity, long-term estrogen dominance (e.g. in long-term absence of menstruation, (amenorrhea and anovulation), PCOS, tumors that produce estrogens, Turner's syndrome, estrogenic (mono- estrogen) replacement therapy, nulliparity (infertility), breast cancer, colon cancer, tamoxifen treatment, genetic risk factors, such as Lynch syndrome, etc. The most significant epidemiological factor is the association with long-term abnormal estrogen stimulation, without compensating gestagenic counteractivity, which promotes uncontrolled cell division, reduces apoptosis and promotes malignant transformation of the endometrium. The main symptoms of endometrial cancer are: irregular vaginal bleeding (80 – 90%), purulent or rosy discharge, pain in the lower abdomen, etc. Abnormal vaginal bleeding is the most common early symptom of endometrial cancer. Postmenopausal bleeding in 40 – 60% of cases raises the suspicion of endometrial cancer. Early detection of cancer is the most important prerequisite for successful treatment and suppression of permanent unwanted and fatal consequences. Regular annual gynecological examinations greatly increase the probability of timely detection and adequate treatment. Depending on the stage of the disease, which is defined on the basis of the international FIGO classification, it can be treated with surgery, radiotherapy, chemotherapy or all of the above. The purpose of writing this thesis is to present and summarize elementary knowledge about endometrial cancer, its prevention, early detection and currently available treatment methods.

Endometrial cancer is the most common malignancy of the female reproductive tract. Lymph node metastases are an important prognostic factor in endometrial cancer. Several prognostic factors have been shown to correlate with lymph node metastasis, including depth of myometrial invasion, cervical infiltration, histologic grade of the tumor, tumor diameter, histology type, lymphovascular invasion, and positive peritoneal cytology. The aim of the study was to identify the histopathologic parameters that would indicate with greater certainty the possibility of metastases into lymph nodes, which would serve as a basis to assess whether patients should undergo lymphadenectomy or not. This retrospective study included patients with endometrial cancer having undergone surgery at the Oncology Institute of Vojvodina during the 2012-2018 period. The study included 120 patients having undergone hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. Among patients who had lymph node metastases, there were statistically significantly more patients (p2 cm), as well as histologic grade did not correlate with a higher incidence of lymph node metastases. In this study, both parametrial infiltration and the number of lymph nodes removed were found to have clinical relevance but not statistical significance., Karcinom endometrija je najčešći malignitet ženskog reproduktivnog trakta. Metastaze u limfnim čvorovima su jedan od najvažnijih prognostičkih čimbenika kod karcinoma endometrija.Pokazalo se da je nekoliko prognostičkih čimbenika u korelaciji s metastazama limfnih čvorova: dubina invazije miometrija, infiltracija cerviksa, histološki gradus tumora, promjer tumora, serozna histologija, limfovaskularna invazija i pozitivna peritonejska citologija. Cilj ovoga istraživanja bio je utvrditi one patohistološke parametre koji će s većom sigurnošću ukazati na mogućnost nastanka metastaza u limfnim čvorovima te na temelju kojih se može procijeniti treba li takvim bolesnicama raditi limfadenektomiju ili ne. Provedena je retrospektivna analiza bolesnica s karcinomom endometrija koje su operirane na Institutu za onkologiju Vojvodine u razdoblju od 2012. do 2018. godine. U istraživanje je uključeno 120 bolesnica kod kojih je napravljena histerektomija s obostranom adneksektomijom i pelvičnom limfadenektomijom. U skupini bolesnica koje su imale metastaze u limfnim čvorovima statistički su značajno više (p2 cm) kao i histološki gradus nisu bili udruženi s većom učestalošću metastaza u limfnim čvorovima. U našem istraživanju se klinički relevantnom pokazala i infiltracija parametrija, kao i broj odstranjenih limfnih čvorova, ali bez statističke značajnosti.

Endometrial cancer is the sixth most common cancer in women worldwide and fourth in Europe. Global estimates show rising incidence in both developed and developing countries. Standard surgical treatment leads to permanent loss of fertility. With current trends of reproductive-age women delaying childbearing, rising endometrial carcinoma incidence rates and a growing epidemic of obesity, research on conservative treatment remains a priority. Fertility-sparing treatment involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, both shown to be beneficial and safe in early-stage endometrial carcinoma. We present a case of a 40-year-old female with endometrial adenocarcinoma grade 1 diagnosed during infertility workup. After one year of levonorgestrel-releasing intrauterine devices and almost three years after initial diagnosis was made, pregnancy was achieved. Term elective C-section delivery was done and a healthy infant was born. Today, a 46-yearold female, with six years of disease-free survival, still opts for conservative treatment. Aim of this paper is to show how conservative management with steady follow up in highly motivated individuals could be a reliable option for females of reproductive age with endometrial malignancies. Concept of fertility-sparing treatment should give hope to patients with malignant disease and unfulfilled reproductive goals., Karcinom endometrija je šesti najčešće karcinom u žena u svijetu i četvrti najčešći u Europi. Bilježi se porast incidencije kako u razvijenim tako i u nerazvijenim državama svijeta. Klasično liječenje je kirurško i ono dovodi do trajnog gubitka reproduktivog potencijala. S obzirom na navedeno povećanje incidencije karcinoma, epidemiju pretilosti i kontinuirano povećanje dobi u kojoj se žene odlučuju na trudnoću, istraživanja konzervativnih metoda lječenja postaju prioritet. Liječenje sa svrhom očuvanja fertilnosti uključuje progestinske oralne preparate i levonorgestrelske intrauterine sustave, koji su se pokazali kao uspješni i sigurni u liječenju ranog stadija karcinoma endometrija. U ovom radu predstavljamo slučaj četrdesetogodišnje pacijentice s endometralnim adenokarcinomom maternice gradusa 1 otkrivenim tijekom obrade neplodnosti. Nakon jedne godine terapije levonorgestrelskim intrauterinim sistemom i tri godine nakon postavljanja dijagnoze pacijentica ostaje trudna. Elektivnim carskim rezom se porodi zdravo donošeno žensko dijete. Danas četrdesetšestogodišnja pacijentica, šest godina od inicijalne dijagnoze i dalje se odlučuje na konzervativnu terapiju. Cilj ovog rada je ukazati kako konzervativna terapija uz redovne kontrole kod visoko motiviranih pojedinaca može biti pouzdana opcija za karcinom endometrija kod žena reproduktivne dobi. Koncept liječenja uz očuvanje fertilnosti daje nadu pacijentima s malignom bolesti i neispunjenim reproduktivnim ciljevima.

We aimed to evaluate the depth of myometrial invasion preoperatively with transvaginal ultrasound, magnetic resonance imaging, and frozen section examination techniques in patients diagnosed with endometrial cancer. Our study included 65 patients. Transvaginal ultrasound and magnetic resonance imaging were performed in study patients in the preoperative period. Frozen section examination was performed in all hysterectomy samples obtained from all study patients. Data were analyzed with SPSS Statistics 22.0 program. The sensitivity of transvaginal ultrasound in determining the depth of myometrial invasion was 88.64%, specificity 90.48%, positive predictive value 95.12%, and negative predictive value 79.17%. For magnetic resonance imaging, the sensitivity was 63.64%, specificity 95.24%, positive predictive value 96.55%, and negative predictive value 55.56%. In addition to the frozen section examination, which is the gold standard in determining the myometrial invasion depth, transvaginal ultrasound and magnetic resonance imaging have become commonly used methods for this purpose in recent years. Ultrasound examination performed by an experienced specialist is superior to magnetic resonance imaging as it is fast, inexpensive, and associated with higher sensitivity., Cilj je bio prijeoperacijski procijeniti dubinu zahvaćenosti miometrija pomoću transvaginalnog ultrazvuka, magnetske rezonancije i metode smrznutih rezova u bolesnica s dijagnozom karcinoma endometrija. Istraživanje je obuhvatilo 65 bolesnica. Transvaginalni ultrazvuk i magnetska rezonancija provedeni su kod ovih bolesnica u prijeoperacijskom razdoblju. Ispitivanje smrznutih rezova provedeno je na uzorcima prikupljenim tijekom histerektomije kod svih bolesnica uključenih u istraživanje. Dobiveni podatci analizirani su programom SPSS Statistics 22.0. Osjetljivost transvaginalnog ultrazvuka u određivanju dubine zahvaćenosti miometrija bila je 88,64%, specifičnost 90,48%, pozitivna prediktivna vrijednost 95,12% i negativna prediktivna vrijednost 79,17%. Za magnetsku rezonanciju osjetljivost je bila 63,64%, specifičnost 95,24%, pozitivna prediktivna vrijednost 96,55% i negativna prediktivna vrijednost 55,56%. Uz metodu smrznutih rezova, koja je zlatni standard u određivanju dubine invazije miometrija, posljednjih godina se transvaginalni ultrazvuk i magnetska rezonancija često primjenjuju za ovu namjenu. Ultrazvučna pretraga koju provodi iskusni specijalist bolja je od magnetske rezonancije, jer je brza, osjetljivija i nije skupa.

The aldo-keto reductase (AKR) superfamily is gaining attention in cancer research. AKRs are involved in important biochemical processes and have crucial roles in carcinogenesis and chemoresistance. The enzyme AKR1C3 has many functions, which include production of prostaglandins, androgens and estrogens, and metabolism of different chemotherapeutics, AKR1C3 is thus implicated in the pathophysiology of different cancers. Endometrial and ovarian cancers represent the majority of gynecological malignancies in developed countries. Personalized treatments for these cancers depend on identification of prognostic and predictive biomarkers that allow stratification of patients. In this study, we evaluated the immunohistochemical (IHC) staining of AKR1C3 in 123 paraffin-embedded samples of endometrial cancer and 99 samples of ovarian cancer, and examined possible correlations between expression of AKR1C3 and other clinicopathological data. The IHC expression of AKR1C3 was higher in endometrial cancer compared to ovarian cancer. In endometrioid endometrial carcinoma, high AKR1C3 IHC expression correlated with better overall survival (hazard ratio, 0.19, 95% confidence interval, 0.06&minus, 0.65, p = 0.008) and with disease-free survival (hazard ratio, 0.328, 95% confidence interval, 0.12&ndash, 0.88, p = 0.027). In patients with ovarian cancer, there was no correlation between AKR1C3 IHC expression and overall and disease-free survival or response to chemotherapy. These results demonstrate that AKR1C3 is a potential prognostic biomarker for endometrioid endometrial cancer.

Karcinom endometrija (KE) najčešća je zloćudna novotvorina ženskog spolnog sustava i četvrti najčešći karcinom kod žena u zemljama razvijenog svijeta. U proteklom desetljeću incidencija KE bilježi porast od 2,4% i mortaliteta 1,9% godišnje. Ovaj neuspjeh u prevenciji i liječenju dijelom počiva na činjenici slabog razumijevanja heterogenosti i biološke raznolikosti ove zloćudne bolesti. The Cancer Genome Atlas Research Network nudi novu klasifikaciju KE kojom definira četiri podskupine karcinoma na temelju njihovih genetskih karakteristika. Integracija njihovih saznanja u postojeću klasifikaciju čini se nužna za stvaranje optimalne dijagnostičke i prognostičke klasifikacije. Ultramutirani tumori s velikim brojem somatskih mutacija unutar egzonuklearne domene DNA polimeraze epsilon (engl. polymerase epsilon exonuclease domain, POLE) i hipermutirani tumori s mikrosatelitnom nestabilnošću (engl. microsatellite instability, MSI), dvije su podskupine KE koji pokazuju visoku stopu ekspresija proteina programirane smrti 1 (engl. programmed death-1, PD-1) i njegova liganda (engl. programmed death ligand-1, PD-L1). Farmakološka inhibicija puta PD-1 / PD-L1 omogućava reaktivaciju imunološkog odgovora protiv tumora, odnosno smanjuje tumorom induciranu imunološku supresiju. Ova hipoteza je dala uspješne kliničke rezultate u drugim vrstama malignih bolesti kao što su nesitnostanični karcinomi pluća, melanom, karcinoma bubrega i mokraćnog mjehura. Nivolumab i pembrolizumab, oba monoklonska protutijela na PD-1 limfocitni receptor, dali su zadovoljavajuće preliminarne rezultate u imunoterapiji KE i znatno manju citotoksičnost od standardne adjuvantne terapije., Endometrial cancer (ED) is the most common malignancy of the female reproductive system and the fourth most common cancer in women in the developed world. In the past decade, the incidence of ED has increased by 2.4% and mortality by 1.9% per year. This failure in prevention and treatment rests in part on the fact of a poor understanding of the heterogeneity and biodiversity of this malignancy. The Cancer Genome Atlas Research Network provides a new classification of ED which defines four subgroups of cancers based on their genetic characteristics. The integration of their knowledge into the existing classification seems necessary to create an optimal diagnostic and prognostic classification. Ultramutated tumors with a large number of somatic mutations within the polymerase epsilon exonuclease domain (POLE) and hypermutated tumors with microsatellite instability (MSI) are two subgroups of the ED with significant expression of PD-1 (programmed death-1) and its ligand PD-L1 (programmed death ligand-1). Pharmacological inhibition of the PD-1 / PD-L1 pathway enables reactivation of the immune response against the tumor and therefore reduces tumorinduced immune suppression. This hypothesis has shown successful clinical outcomes in other types of malignancies such as non-small cell lung cancers, melanoma, kidney, and bladder cancers. Nivolumab and pembrolizumab, both monoclonal antibodies to the PD-1 lymphocyte receptor, give solid preliminary results in ED immunotherapy and significantly lower cytotoxicity than standard adjuvant therapy.

Cilj istraživanja: Ključni mehanizam odgovoran za progresiju karcinoma endometrija (KE) je aktivacija epitelno-mezenhimalne tranzicije (EMT), procesa kojim tumorske stanice stječu mezenhimalni fenotip. Glavnim obilježjem EMT smatra se gubitak adhezijske molekule E-kaderina, nuklearna akumulacija β-katenina i stjecanje N-kaderina. Takve tumorske stanice ulaze u kaskadu invazija-metastaziranje, a u metastazama prolaze obrnuti proces mezenhimalno-epitelne tranzicije (MET). Na histološkom nivou malo je podataka o značaju aberantnog izražaja ovih proteina u KE. Ispitanici i metode: U istraživanje je uključeno 86 bolesnica. Za imunohistokemijsku analizu napravljeni su tkivni rezovi primarnih tumora KE i njihovih metastaza te određen postotak i jačina obojanosti tumorskih stanica na E-kaderin, β-katenin i N-kaderin u centru tumora (CT), na invazivnoj fronti (IF), u limfovaskularnom prostoru (LVP) te u pripadajućim metastazama. Rezultati: Utvrđen je značajan pad izražaja E-kaderina od CT prema IF (p< 0.0001) uz istovremeno pojačan izražaj N-kaderina (p=0.005) što govori u prilog nastupu procesa EMT. Uočeno je smanjenje membranskog β-katenina od CT prema IF i LVP, dok nuklearni izražaj β-katenina nije potvrđen kao značajni pokazatelj EMT. Usporedbom u odnosu na IF u metastazama je dokazan ponovni izražaj E-kaderina (p=0.049) i gubitak N-kaderina (p=0.008) što govori u prilog aktivaciji MET. Negativni membranski β-katenin na IF povezan je s dubokom invazijom miometrija (p=0.004) i značajno kraćim preživljenjem bolesnica (p=0.0439). Zaključak: Rezultati ovog istraživanja doprinijeli su boljem razumijevanju E-kaderina, N-kaderina i β-katenina u procesu EMT i MET u KE. Imunohistokemijska analiza ispitivanih biljega dokazala je da postoji heterogenost u njihovom izražaju unutar tumora i u metastazama te poduprla hipotezu da je IF ključna tumorska regija u kojoj nastupa EMT. Objectives: The key mechanism responsible for the progression of endometrial carcinoma (EC) is the activation of epithelial-mesenchymal transition (EMT) a process which helps epithelial cells to acquire mesenchymal phenotype. One of the hallmarks of EMT is the loss of the adhesion molecule E-cadherin, nuclear accumulation of β-catenin and the acquisition of N-cadherin. Such tumor cells enter the invasion-metastasis cascade; while through the process of mesenchymal-epithelial transition (MET) re-establish their epithelial phenotype at distant sites. Little is known about aberrant expression of these proteins at histological level in EC. Patients and Methods: The study included 86 patients. For the immunohistochemical analysis tissue samples of primary tumors and their metastases were selected and the expression of E-cadherin, N-cadherin and β-catenin on the basis of percentage of positive tumor cells and staining intensity assessed in the central area (CA) of the tumor, at the invasive front (IF), in lymphovascular spaces (LVS) and metastases. Results: We found a significantly reduced expression of E-cadherin at the IF when compared to CA (p

Simple Summary We evaluated the potential of AKR1B1 and AKR1B10 as tissue biomarkers of endometrial cancer by assessing the immunohistochemical levels of AKR1B1 and AKR1B10 in tissue paraffin sections from 101 well-characterized patients with endometrioid endometrial cancer and 12 patients with serous endometrial cancer. Significantly higher immunohistochemical levels of AKR1B1 and AKR1B10 were found in adjacent non-neoplastic endometrial tissue compared to endometrioid endometrial cancer. The group of patients with both AKR1B1 and AKR1B10 staining above the median values showed significantly better overall and disease-free survival compared to all other patients. Multivariant Cox analysis recognized a strong AKR1B1 and AKR1B10 staining as a statistically important survival prediction factor in patients with endometrioid endometrial cancer. In contrast, we observed no significant differences in AKR1B1 and AKR1B10 staining in patients with serous endometrial cancer. Our results suggest that AKR1B1 and AKR1B10 have protective roles in endometrioid endometrial cancer and represent prognostic biomarker candidates. Abstract The roles of aldo-keto reductase family 1 member B1 (AKR1B1) and B10 (AKR1B10) in the pathogenesis of many cancers have been widely reported but only briefly studied in endometrial cancer. To clarify the potential of AKR1B1 and AKR1B10 as tissue biomarkers of endometrial cancer, we evaluated the immunohistochemical levels of AKR1B1 and AKR1B10 in tissue paraffin sections from 101 well-characterized patients with endometrioid endometrial cancer and 12 patients with serous endometrial cancer and compared them with the clinicopathological data. Significantly higher immunohistochemical levels of AKR1B1 and AKR1B10 were found in adjacent non-neoplastic endometrial tissue compared to endometrioid endometrial cancer. A trend for better survival was observed in patients with higher immunohistochemical AKR1B1 and AKR1B10 levels. However, no statistically significant differences in overall survival or disease-free survival were observed when AKR1B1 or AKR1B10 were examined individually in endometrioid endometrial cancer. However, analysis of AKR1B1 and AKR1B10 together revealed significantly better overall and disease-free survival in patients with both AKR1B1 and AKR1B10 staining above the median values compared to all other patients. Multivariant Cox analysis identified strong AKR1B1 and AKR1B10 staining as a statistically important survival prediction factor. Conversely, no significant differences were found in serous endometrial cancer. Our results suggest that AKR1B1 and AKR1B10 play protective roles in endometrioid endometrial cancer and show potential as prognostic biomarkers.

Karcinom endometrija četvrta je najčešća zloćudna bolest žena u RH, a incidencija javljanja u stalnom je porastu. Prognostički čimbenici za ovu bolest su brojni, a njihovo razumijevanje ograničeno. Cilj ovog istraživanja bio je analizirati angiogenezu i limfangiogenezu u karcinomu endometrija kroz utvrđivanje srednje gustoće malih krvnih žila (MVD) i limfnih žila (LVD) u centru tumora (CT) i na invazivnoj fronti (IF) te odrediti njihov prognostički značaj usporedbom s drugim poznatim prognostičkim čimbenicima. Analiziran je tumorski materijal 74 pacijentice s dijagnozom karcinoma endometrija koje su u periodu od 2002. do 2006. godine liječene na KBC Rijeka. Medijan dobi sudionica iznosio je 66 godina s rasponom od 33 do 89 godina. Vizualizacija krvnih žila postiguta je tretiranjem antitijelom CD 31 i kromogen crvenilom, dok su limfne žile vizualizirane antitijelom D2-40 i diaminobenzidinom. Uvidom u patohistološku i drugu medicinsku dokumentaciju, prikupljena su svi relevantni podaci za sudionice ovog istraživanja. Svjetlosnim mikroskopom evaluirana je gustoća krvnih i limfnih žila u CT i na IF tumora te prisutnost limfovaskularne invazije. Podaci su statistički obrađeni u programu MedCalc/Windows. Utvrđeno je da su MVD i LVD značajno više na IF karcinoma u odnosu na CT. MVD je značajno viša na IF u odnosu na LVD u svim promatranim skupinama tumora. U univarijantnoj analizi viši MVD CT i IF kao i prisutnost VI bili su povezani s pojavom recidiva bolesti, kraćim ukupnim preživljenjem i kraćim preživljavanjem bez povrata bolesti. VI u tumorskom tkivu karcinoma endometrija bio je nezavisni prognostički parametar pojave recidiva, ukupnog preživljenja i preživljavanja bez povrata bolesti kod bolesnica., Endometrial carcinoma is the fourth most common malignant disease in women in Croatia. Its incidence is constantly rising.Prognostic factors for this disease are numerous, but their understanding is limited. The aim of this research was to analyze angiogenesis and lymphangiogenesis in endometrial carcinoma by researching microvessel density (MVD) and lymphatic vessel density (LVD) both in the center of the tumor (CT) and on the invasive front (IF) and to determine their prognostic value through comparison with other known prognostic factors. Tumor material from 74 patients diagnosed with and treated for endometrial carcinoma between 2002. and 2006. on CHC Rijeka was analysed. Median age value was 66 with 33 as lowest and 89 as highest value. Blood vessel were visualized with CD 31 antibody and red chromogen kit, while lymphatic vessel were visualized with D2-40 antibody and diaminobenzidine. All the relevant dana was gathered by examining pathohistological and other medical documentation. MVD and LVD both in the CT and on the IF, as well as lymphovascular invasion were evaluated with optical microscope. The data was statistically analyzed with computer program MedCalc/Windows. MVD and LVD were significantly higher on the IF than in the CT. MVD, compared to LVD, is significantly higher on the IF in all tumor categories. Univariate analysis connects higher MVD CT and IF, as well as VI, with relapse of the disease, shorter overall survival and shorter relapse free survival. VI in the tumor tissue of endometrial carcinoma emerged as independent prognostic parametar of relapse occurence, overall survival and relapse free survival.

Purpose: Our aim was to determine the degree of agreement between preoperative and postoperative histologic type/ subtype and degree of tumor differentiation, and to determine the degree of upgrading and downgrading in relation to preoperative and postoperative histopathologic findings. Methods: We analyzed data on 393 patients. Data included age, preoperative and postoperative histologic type/subtype and histologic grade of tumor. Data on 317 patients were included in statistical processing. Results: Statistical analysis showed moderate agreement between preoperative and postoperative histologic type/subtype of endometrial carcinoma and low degree of agreement between preoperative and postoperative histologic grade of tumor. The lowest agreement in histologic grade was recorded in patients with histologic grade 1 (55.04%), while most accurate agreement was found in patients with grade 3 (73.33%). There was a low degree of agreement between preoperative and postoperative histologic grade in patients with endometrioid adenocarcinoma in both cases. The lowest accuracy in the agreement of histologic grade was in G1, while grades 2 and 3 were similar in the degree of agreement. Conclusions: There is moderate agreement of preoperative and postoperative histologic type/ subtype and low agreement of preoperative and postoperative histologic grade of tumor. The lowest degree of agreement was recorded for preoperatively G1 tumors and highest for preoperatively G3 tumors, which is important because of the clinical significance of tumor histologic grade 3., Namjena: Cilj nam je bio utvrditi stupanj podudaranja između prijeoperacijskog i poslijeoperacijskog histološkog tipa/ podtipa i stupnja diferenciranosti tumora te utvrditi stupanj nadgradnje i podgradnje u odnosu na prijeoperacijski i poslijeoperacijski patohistološki nalaz. Metode: Analizirali smo podatke 393 bolesnice. Podatci su uključivali dob, prijeoperacijski i poslijeoperacijski histološki tip/podtip i histološki stupanj tumora. U statističku obradu uključeno je 317 bolesnica. Rezultati: Statistička analiza pokazala je umjeren stupanj slaganja između prijeoperacijskog i poslijeoperacijskog histološkog tipa/ podtipa karcinoma endometrija te nizak stupanj slaganja između prijeoperacijskog i poslijeoperacijskog histološkog stupnja tumora. Najniži udjel u histološkom stupnju diferenciranosti bio je kod bolesnica s histološkom stupnjem G1 (55,04%), a najtočniji se slagao u skupini bolesnica s G3 (73,33%). U bolesnica s endometroidnim adenokarcinomom u oba slučaja postojao je nizak stupanj slaganja između prijeoperacijskog i poslijeoperacijskog histološkog stupnja. Najniža točnost u slaganju histološke ocjene bila je u G1, dok su stupnjevi 2 i 3 bili po stupnju slaganja slični. Zaključci: Postoji umjereno slaganje prijeoperacijskog i poslijeoperacijskog histološkog tipa/podtipa, a slabo je slaganje prijeoperacijskog i poslijeoperacijskog histološkog stupnja tumora. Najmanji stupanj slaganja utvrđen je za tumore G1 prijeoperacijski, a najviši za tumore G3 prijeoperacijski, što je važno zbog kliničkog značenja tumora histološkog stupnja 3.

The use of magnetic resonance imaging ( MRI) in gynecological oncology is rapidly expanding. Pelvic MRI has excellent soft tissue contrast and multiplanar imaging ability to demonstrate either normal or pathological processes. In gynecological oncology the rapidly evolving role of MRI includes not only diagnosis but also disease staging, planning of therapy and monitoring response to treatment. We perform around 350 preoperative gynecology MRI annually, mostly in patients with suspected malignancy. In this paper we review the role of MRI in endometrial, cervical and ovarian cancer, Svakodnevno raste uporaba magnetske rezonancije (MR) u ginekološkoj onkologiji. MR zdjelice ima odličnu prostornu i kontrastnu rezoluciju za prikaz kako fi zioloških tako i patoloških procesa. Sve je veća uključenost MR pregleda ne samo u dijagnostici već i u određivanju stadija bolest i praćenju terapije. U našem radiološkom odjelu obavi se oko 350 preoperativnih ginekoloških MR pregleda godišnje, najčešće kod pacijenata sa sumnjom na malignu bolest. U ovom radu osvrnuti ćemo se na ulogu MR u karcinomima endometrija, grlića maternice i jajnika.

UVOD. Karcinom endometrija je bolest od koje u svijetu godišnje oboli 142 000 žena, a 42 000 umre. Najvažniji klinički i patološki prognostički čimbenici koji upućuju na lošu prognozu bolesti su kirurški stadij bolesti, dob bolesnice, histološki tip, stupanj diferencijacije, dubina miometrijske invazije, limfovaskularna invazija, veličina tumora i ekspresija estrogenskih i progesteronskih receptora. CILJ RADA. Cilj je rada istražiti odnos limfovaskularne invazije s pojavom recidiva bolesti. Pojam limfovaskularne invazije podrazumijeva nazočnost tumorskih stanica u prostorima strome obloženima endotelom. MATERIJAL I METODE. U studiju su uključene 73 pacijentice liječene u razdoblju od 1999. do 2008. godine u Klinici za tumore, Zagreb (61) i Kliničkom bolničkom centru Split (12). Studija je provedena kao retrospektivna, na osnovu kliničkih i patohistoloških podataka. Analizirane su prognostičke vrijednosti: dob bolesnica, histološki tip karcinoma, stupanj diferencijacije karcinoma, stadij bolesti (FIGO 1988) i limfovaskularna invazija. Osnovicu analize je činila multivarijatna analiza povezanosti promatranih varijabli s pojavom recidiva bolesti uporabom različitih oblika rekurzivnog particioniranja implementiranih kao party, rpart i mvpart moduli. REZULTATI. Univarijatna analiza pokazala je statistički značajnu povezanost histološkog tipa karcinoma, stupnja diferencijacije karcinoma, stadija bolesti (FIGO 1988) i limfovaskularne invazije s recidivom bolesti. Party algoritam izdvaja limfovaskularnu invaziju kao jedini čimbenik povezan s pojavom recidiva bolesti. Rpart i mvpart izdvajaju stadij bolesti kao najvažniji čimbenik povezan s recidivom bolesti. ZAKLJUČAK. Limfovaskularna invazija je značajan neovisan čimbenik povezan s pojavom recidiva karcinoma endometrija.

Clij ove studije je bio istražiti izražaja proteinskih produkata proliferacijskog gena Ki-67 i supresorskog gena NM23 u karcinomu endometrija, te ispitati njihovo značenje kao prognostičkih čimbenika povrata bolesti i duljine preživljenja. Istražena je i povezanost izražaja Ki-67 i NM23 gena s kliničko-patološkim karakteristikama tumora (histološki tip, histološki stupanj diferencijacije (gradus), dubina invazije miometrija, invazija krvnih i/ili limfnih žila, broj mitoza, prisustvo patoloških mitoza i kliničko-patološki stadij bolesti).

Gigantocelularni karcinom endometrija-prikaz slučaja.

Opisane su dvije bolesnice s karcinomom svijetlih stanica endometrija. Kod prve bolesnice 63 godine stare radilo se o drugom stupnju proširenosti, a kod druge 49 godina stare o I stupnju. Obje su bile u postmenopauzi i liječene su zračenjem i operativnim zahvatom te je prva do sada živa i bez tumora preko 8 godina, a druga preko 7 mjeseci. Raspravlja se o nazivlju i morfogenezi tog tumora te spominju do sada objavljeni slučajevi.