title: Coexistence of adenomyosis and endometrioid endometrial cancer: Role in surgical guidance and prognosis estimation.
abstract: The aim of the current study was to diagnose the concomitant presence of adenomyosis (AM) in endometrioid endometrial cancer (EEC) in order to evaluate its value as an oncological prognostic marker. A retrospective analysis of 289 patients diagnosed with EEC who underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic-lymphadenectomy was conducted. The total cohort included 37 patients in Group A (those with concomitant AM and EEC) and 252 patients in Group B (those affected only by EEC). The following factors were evaluated: Presence or absence of AM, tumor grade, depth of myometrial invasion, tumor size, lymphovascular space involvement, lymph node status, peritoneal cytology, concomitant detection of endometrial atypical-hyperplasia or polypoid endometrial features and tumor stage according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Uterine examination of different sections of uterine cervix, corpus, myomas and cervical or endometrial polyps was performed. The diagnosis of AM was confirmed when the distance between the lower border of the endometrium and the foci of the endometrial glands and stroma was >2.5 mm. Parametric and nonparametric statistical tests were performed when possible; continuous variables were analyzed using a Student's t-test, and categorical variables were analyzed by the χ2test or Fisher's exact test. The association between FIGO stage and group was determined to be significant: 83.8% of Group A patients were categorized as FIGO stage I, vs. 68.7% of Group B patients. In addition, Group A was associated with lower grades in FIGO stage, myometrial invasion, lymphovascular space involvement, lymph node involvement and tumor size. The findings suggest that the intraoperative evaluation of the presence of AM in patients with EEC may aid surgeons in estimating oncological risk and in selecting the most appropriate surgical treatment.
authors.affiliation: Department of Women's and Children's Health, Complex Operative Unit of Gynecology and Obstetrics, University of Padua, Padua 35128, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dall'asta
authors.affiliation: Department of Women's and Children's Health, Complex Operative Unit of Gynecology and Obstetrics, University of Padua, Padua 35128, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: DI Gangi
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Giordano
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Costanza
authors.initials: C
authors.lastname: Migliavacca
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Monica
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Merisio
authors.affiliation: Department of Women's and Children's Health, Complex Operative Unit of Gynecology and Obstetrics, University of Padua, Padua 35128, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
authors.affiliation: Department of Obstetrics and Gynecology, Complex Operative Unit of Gynecology and Obstetrics, University of Verona, Verona 37121, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Quaranta
authors.affiliation: Department of Women's and Children's Health, Complex Operative Unit of Gynecology and Obstetrics, University of Padua, Padua 35128, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.affiliation: Department of Surgical Sciences, Complex Operative Unit of Gynecology and Obstetrics, University of Parma, Parma 43125, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Berretta
keywords: adenomyosis; endometrioid endometrial cancer; intraoperative estimating risk; prognostic factors