Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale
Objective: Progestin-based therapy is common for patients with endometrial neoplasia who desire fertility preservation, but some patients ultimately require surgery. Intraoperative assessment, which can use gross lesion size, may impact the extent of surgery performed. We sought to characterize the...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Gynecologic Oncology Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578921000527 |
| _version_ | 1818673304962072576 |
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| author | Yang Hu Ahmed N. Al-Niaimi Alain Cagaanan Elizabeth A. Sadowski David M. Kushner Paul S. Weisman Stephanie M. McGregor |
| author_facet | Yang Hu Ahmed N. Al-Niaimi Alain Cagaanan Elizabeth A. Sadowski David M. Kushner Paul S. Weisman Stephanie M. McGregor |
| author_sort | Yang Hu |
| collection | DOAJ |
| description | Objective: Progestin-based therapy is common for patients with endometrial neoplasia who desire fertility preservation, but some patients ultimately require surgery. Intraoperative assessment, which can use gross lesion size, may impact the extent of surgery performed. We sought to characterize the extent to which grossly identified lesions in the setting of progestin therapy correspond to microscopic findings. Methods: Thirteen hysterectomy specimens with progestin-treated atypical hyperplasia or endometrioid carcinoma were identified. Clinicopathologic factors were collected by chart review. Slides were assessed for the extent to which decidualized stroma (DS) comprised grossly identified lesions and comparisons were drawn with tumor size, age, and menopausal status. Results: Mass lesions were described in 11 cases with a median of 4.5 cm (range 1–8.2) and the 2 cases without discrete masses had diffuse thickening. Two patients had only focal residual hyperplasia despite having mass lesions (7 & 2.2 cm). DS was more prominent in premenopausal patients (median 65%, range 10–90%) than in postmenopausal patients (median 18%, range 10–40%; p = 0.06). The distribution of DS throughout mass lesions was variable. Conclusions: Large mass lesions following progestin therapy may histologically consist of DS with little to no residual neoplastic disease, such that perceived tumor size does not necessarily reflect extensive residual disease, especially in pre-menopausal patients. Intraoperative gross assessment alone may lead to unnecessary lymphadenectomy and/or oophorectomy, but this can potentially be prevented by using frozen section. |
| first_indexed | 2024-12-17T07:53:40Z |
| format | Article |
| id | doaj.art-b50f11387a594d998abf7c1bbd415c0d |
| institution | Directory Open Access Journal |
| issn | 2352-5789 |
| language | English |
| last_indexed | 2024-12-17T07:53:40Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj.art-b50f11387a594d998abf7c1bbd415c0d2022-12-21T21:57:46ZengElsevierGynecologic Oncology Reports2352-57892021-05-0136100747Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary taleYang Hu0Ahmed N. Al-Niaimi1Alain Cagaanan2Elizabeth A. Sadowski3David M. Kushner4Paul S. Weisman5Stephanie M. McGregor6University of Wisconsin-Madison Medical Scientist Training Program, USAUniversity of Wisconsin-Madison Department of Obstetrics and Gynecology, USA; University of Wisconsin Carbone Cancer Center, USAUniversity of Wisconsin-Madison Department of Pathology and Laboratory Medicine, USAUniversity of Wisconsin Carbone Cancer Center, USA; University of Wisconsin-Madison Department of Radiology, USAUniversity of Wisconsin-Madison Department of Obstetrics and Gynecology, USA; University of Wisconsin Carbone Cancer Center, USAUniversity of Wisconsin Carbone Cancer Center, USA; University of Wisconsin-Madison Department of Pathology and Laboratory Medicine, USAUniversity of Wisconsin Carbone Cancer Center, USA; University of Wisconsin-Madison Department of Pathology and Laboratory Medicine, USA; Corresponding author at: Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, B1793 WIMR, Madison, WI 53705-2281, USA.Objective: Progestin-based therapy is common for patients with endometrial neoplasia who desire fertility preservation, but some patients ultimately require surgery. Intraoperative assessment, which can use gross lesion size, may impact the extent of surgery performed. We sought to characterize the extent to which grossly identified lesions in the setting of progestin therapy correspond to microscopic findings. Methods: Thirteen hysterectomy specimens with progestin-treated atypical hyperplasia or endometrioid carcinoma were identified. Clinicopathologic factors were collected by chart review. Slides were assessed for the extent to which decidualized stroma (DS) comprised grossly identified lesions and comparisons were drawn with tumor size, age, and menopausal status. Results: Mass lesions were described in 11 cases with a median of 4.5 cm (range 1–8.2) and the 2 cases without discrete masses had diffuse thickening. Two patients had only focal residual hyperplasia despite having mass lesions (7 & 2.2 cm). DS was more prominent in premenopausal patients (median 65%, range 10–90%) than in postmenopausal patients (median 18%, range 10–40%; p = 0.06). The distribution of DS throughout mass lesions was variable. Conclusions: Large mass lesions following progestin therapy may histologically consist of DS with little to no residual neoplastic disease, such that perceived tumor size does not necessarily reflect extensive residual disease, especially in pre-menopausal patients. Intraoperative gross assessment alone may lead to unnecessary lymphadenectomy and/or oophorectomy, but this can potentially be prevented by using frozen section.http://www.sciencedirect.com/science/article/pii/S2352578921000527Atypical hyperplasiaEndometrial cancerProgestinTreatment effectLymphadenectomy |
| spellingShingle | Yang Hu Ahmed N. Al-Niaimi Alain Cagaanan Elizabeth A. Sadowski David M. Kushner Paul S. Weisman Stephanie M. McGregor Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale Gynecologic Oncology Reports Atypical hyperplasia Endometrial cancer Progestin Treatment effect Lymphadenectomy |
| title | Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale |
| title_full | Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale |
| title_fullStr | Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale |
| title_full_unstemmed | Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale |
| title_short | Prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor: A cautionary tale |
| title_sort | prominent decidualization following progestin treatment for endometrial hyperplasia and carcinoma as a mimic of large residual tumor a cautionary tale |
| topic | Atypical hyperplasia Endometrial cancer Progestin Treatment effect Lymphadenectomy |
| url | http://www.sciencedirect.com/science/article/pii/S2352578921000527 |
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