Postmenopausal Bleeding and Endometrial Changes: Clinical Significance?

Introduction: Postmenopausal bleeding is a common complaint from women seen in general practice, although majority of them, will have no major problem. Objective: Study of endometrium in postmenopausal women with suspicious sonographic endometrial changes. Comparison of findings in asymptomatic women and those who reported metrorrhagia. Methods: Consultation of outpatient medical records of 487 women undergoing endometrial study (sonohysterography, hysteroscopy), between January/2004 and July/2010. Patients were subdivided into two groups: women with (G1) and without (G2) complaints of postmenopausal metrorrhagia. Results: G1 and G2 comprises 78 and 409 women, respectively. G1: 23.1% normal uterine cavity, 74.3% benign pathology (majority endometrial polyps) and 2.6% of them endometrial carcinoma. G2: 14.4% normal uterine cavity, 83.7% benign pathology (majority endometrial polyps), 1.4% endometrial hyperplasia and endometrial carcinoma in 0.49%. Conclusion: Postmenopausal metrorrhagia is associated with an increased risk of endometrial malignancy, in relation to asymptomatic, although represents a minority of the population. To highlight the existence of premalignant and malignant pathology in asymptomatic endometrial thickening.

Ki-67 Proliferation Index in Gastric Cancer - Biologic Significance

Objectives/Introdution: Ki-67 protein has been used as an indicator of proliferation activity in tumor cells. In gastric cancer the prognostic value has not been fully understood. This study was designed to assess the biologic significance of Ki-67 proliferation index (PI) in gastric cancer. Material/Methods: Seventy-two patients with gastric cancer were evaluated. These patients underwent gastric resection, and the tumor tissue was stained immunohistochemically. Ki-67 PI was defined as the percentage of tumor cells positive for Ki-67. Ki-67 PI was correlated with clinicopathological characteristics and patient survival. Results: A low Ki-67 PI (less than or equal to 50%) was associated with poorly differentiated histology - diffuse type (p=0.009) and signet ring cells (p=0.004) - and younger age (p=0.022). A worse prognosis in patients with low Ki-67 PI was also found (a mean survival of 41.8 vs 63 months for high Ki-67 PI group), but not statistically significant (p=0.623, log rank test). Discussion/Conclusion: We found an inversely correlation between Ki-67 PI and histological differentiation grade. Patients in group with low Ki-67 PI are younger, with poorly differentiated histology and have a lower mean survival. Like other studies already suggested, we may have two different tumors phenotypes - highly invasive with low proliferative capability, and less invasive potential with higher proliferative ability. However, in this sample, no significant prognostic value was achieved between both.