RESUMO
Molecular genetic evidence indicates that endometrial carcinoma likely develops as the result of a multistep process of oncogene activation and tumor suppressor gene inactivation. These molecular alterations appear to be specific for Type I (endometrioid) and Type II (non endometrioid) cancers. Type I cancers are characterized by mutation of PTEN, KRAS2, defects in DNA mismatch repair, as evidenced by the microsatellite instability phenotype, and a near diploid karyotype. Type II cancers often contain mutations of TP53 and Her-2/neu and are usually nondiploid. The clinical value of many of these molecular markers is now being tested and it may help to refine diagnosis and establish an accurate prognosis. Furthermore, some of these tumor biomarkers constitute the targets for emerging therapies. Transtuzumab against Her-2/neu and bevacizumab against VEGF overexpressing carcinomas are among the promising novel treatments. Additional translational research is needed to identify molecular and genetic alterations with potential for therapeutic interventions.
Assuntos
Adenocarcinoma/etiologia , Transformação Celular Neoplásica/genética , Neoplasias do Endométrio/etiologia , Neoplasias Hormônio-Dependentes/etiologia , Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/genética , Adenocarcinoma/terapia , Antineoplásicos/uso terapêutico , Terapia Combinada , Reparo do DNA/genética , Neoplasias do Endométrio/irrigação sanguínea , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/terapia , Estrogênios , Feminino , Regulação Neoplásica da Expressão Gênica , Genes erbB-2 , Genes p53 , Instabilidade Genômica , Humanos , Histerectomia , Repetições de Microssatélites , Mutagênese , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/fisiologia , Neoplasias Hormônio-Dependentes/irrigação sanguínea , Neoplasias Hormônio-Dependentes/genética , Neoplasias Hormônio-Dependentes/terapia , Neovascularização Patológica/genética , Neovascularização Patológica/fisiopatologia , Oncogenes , PTEN Fosfo-Hidrolase/genética , PTEN Fosfo-Hidrolase/fisiologia , Ploidias , Progesterona , Receptores de Estrogênio/genética , Receptores de Estrogênio/fisiologia , Receptores de Progesterona/genética , Receptores de Progesterona/fisiologiaRESUMO
Propusemos avaliar a importância da densidade vascular e impedância do fluxo sangüíneo nas artérias tumorais e uterinas, detectada por ultra-sonografia Doppler tríplex em relação à presença de fatores prognósticos em cancer de endométrio. Foram incluídas no estudo 61 mulheres (média etária de 65,9 anos) com diagnóstico histológico prévio da doença. Ultra-sonografia transvaginal com Doppler pulsado e de amplitude foi realizada sendo registrados os IR e a densidade vascular definida previamente com valor de 1 quando não se identificavam vasos, 2 quando escassos vasos eram detectados e 3 quando numerosos vasos estavam presentes (> 5) / We proposed to evaluate the importance of the vascular density and impedance by the sanguineous flow in the uterine and tumoral arteries, detected by triplex Doppler sonography, in relation to the presence of prognostic factors in endometrial cancer. There were included in the study 61 women (average age of 65.9 years) with previous histologic diagnosis of disease. Transvaginal ultrasonography with pulsed and amplitude Doppler were executed, being registered the RI and vascular density defined previously with the value of 1, when the vessels were not identified, 2 when rare vessels were detected and 3 when numerous sanguineous vessels were present (>5)...
Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Estadiamento de Neoplasias , Neoplasias do Endométrio/irrigação sanguínea , Ultrassonografia Doppler Dupla , Prognóstico , Fluxo Sanguíneo Regional , Resistência VascularRESUMO
The objective of the study was to quantify vessels and to relate them to the degree of histologic differentiation in endometrial adenocarcinoma. We studied 35 cases of which ten were G1, 13 G2 and 12 G3 adenocarcinomas. The control group consisted of 11 atrophic and 10 proliferative endometria. From each case two histologic sections were obtained: one for hematoxylin-eosin staining and the other for immunohistochemical study with anti-CD34. Vessel count was performed by morphometric study. Mean vessel count was 15.3 for G1; 19 for G2 and 22.7 for G3 adenocarcinomas; in the control group it was 11.6 for atrophic and 13.2 for proliferative endometria. Slightly differentiated adenocarcinoma presented greater angiogenesis than normal and well-differentiated carcinoma. In contrast, moderately differentiated carcinoma showed greater angiogenicity as related to normal endometrium, but did not differ from other tumoral endometria.