Document Type : Original Article
1 Department of Gynecology Oncology ,Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Gynecology Oncology, Emam Khomeini Hospital, Ahvaz University of Medical Sciences, Ahvaz , Iran;Department of Gynecology Oncology, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Gynecology Oncology, Tehran University of Medical Sciences, Tehran, Iran
In 2008,from the total of 40100 new cases of endometrial
cancer ,approximately 7470 deaths were
The incidence of ovarian metastasis in women
with clinical stage I endometrial cancer has been
reported by most studies to be approximately 5%
The purpose of this study was to examine the rate and clinic- pathological characteristics of ovarian metastasis of endometriod type endometrial cancer.
From the Tehran Gynecology Oncology ward in Vali-E- Asr Hospital cancer registry data base, were retrospective reviewed the medical records and pathologic reports during the period from 1990 to 2009.
Totally 210 patients fulfilled the criteria and thus they were included in the study. Patients with serous papillary or clear cell tumor histology, with the evidence of extra uterine spread other than to the adenxa, were excluded from further evaluation. All of the patients had a total abdominal hysterectomy and bilateral salpingo - oophorectomy.
This study was approved by the Ethics Committee of Tehran University of Medical Sciences . All information gathered from the hospital records were considered confidential. Statistical analysis was performed using the SPSS software (version 18).
The obtained data from patients with endometriod type endometrial cancer with and without ovarian metastasis were compared in Chi-square and Fisher’s Exact tests. Probability values less than 0.05 were considered as statistically significant.
The mean age at the time of diagnosis was 53 years (range: 28-72).
Seventeen cases (8.1%) were identified to have ovarian metastasis.
The histologic grade was well differentiated (G1) in 84 (40%) patients, moderately differentiated (G2) in 95 (45.2%) patients and poorly differentiated (G3) in 31 (14.8%) patients.
Eighty five (40.5%) patients had invasion of less than one-half of the myometrial thickness and 125(59.5%) had greater than one-half of the myometrial invasion.
The incidence of ovarian metastasis was 0.00%,
12.6% and 16.1% in patients with well, moderately and
poorly differentiated; respectively (p<0.001,
In myometrial invasion less than 50%, only 1.2%
of the patients had ovarian metastasis , while in
invasion greater than 50%, ovarian metastasis
was reported in 13.3% of the patients (p<0.02,
Ovarian metastasis was the same in both the nulliparous and multiparous women. Also it showed no difference in the premenopausal and menopausal women.
Ovarian metastasis according to grade
|Grade||With ovarian metastasis||Without ovarian metastasis||Total|
|% within grade||16.1%||83.9%||100.0%|
|% within grade||12.6%||87.4%||100.0%|
|% within grade||0.0%||100%||100.0%|
|% within grade||8.1%||91.9%||100.0%|
Ovarian metastasis according to myometrial invasion
|With ovarian metastasis||Without ovarian metastasis||Total|
|% within myometr||1.2%||98.8%||100.0%|
|% within myometr||8.1%||91.9%||100.0%|
For young women diagnosed with endometrial cancer, possible infertility and estrogen deprivation present difficult challenges for both patients and practitioners. Our data suggest that the risk of ovarian metastasis is low in women with well to moderately differentiated endometriod type endometrial cancer with myometrial invasion less than one half of myometrium.
In a Surveillance, Epidemiology and End Results
Database (SEER) analysis by Wright et al.
Zhou et al. suggested that ovarian metastasis rate
of patients at clinical stages I and IІ is high, most
are concealed and hard to be diagnosed by visual
check, and the prognosis of patients with ovarian
metastasis is not good. Therefore, one must be
careful to retain ovaries of the young endometrial
carcinoma patients (
Chen and Anderson suggested a reappraisal of
the rationale of castration in young patients. They
retrospectively reviewed 30 patients with endometrial
carcinoma under the age of 40. Ovarian malignancy
was seen in only two instances of advanced
disease. In their viewpoint, the low risk of ovarian
metastasis in young women with stage І disease
suggests that thorough surgical staging, hysterectomy
with ovarian preservation, is the treatment of
Chai et al. believe that many pathologic types
of young endometrial carcinoma in patients
under 45 are endometrioid adenocarcinoma,
related with the long term non-allopathic estrogen
stimulation, and that most are combined
with hyperplasia of endometrium, and
the prognosis is good, especially for patients
younger than 35 (
Therefore, to young patients at the early stage without high risk factors, if they have no ovarian metastatic by biopsy, we can retain their ovary.
According to findings of this research, ovarian preservation may be offered to the selected young patients who want to retain ovarian function, with a preoperative histological diagnosis well to moderately differentiated endometriod type endometrial cancer, myometrial invasion limited to less than one half of the myometrium, no gross intraoperative extrauterine tumor spread and no gross abnormality in bilateral ovaries.It is also recommended to the patients who have no inherited predisposition to breast or ovarian cancer. This strategy offers the potential for future oocyte retrieval and can leave the door open for pregnancy from a surrogate mother. Also, with the consent agreement of patient, we can remove and freeze ovarian tissue for possible future use without recurrence risk of ovarian cancer.