THURSDAY, SEPTEMBER 7 103

Conclusion: Hyperinsulinemia and insulin resistance are the common features found in women with EAH. Gn-Rh agonist therapy leads not only to reducing of sex steroids but also to the improvement of insulin sensitivity.

P4.06.10 LOCALIZATION OF ESTRONE SULFATASE IN ENDOMETRIAL HYPERPLASIA AND ENDOMETRIAL CARCINOMA B Y. Ishizuka, H. Sasaki, T. Tanaka. Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, Japan, 105-8461.

Objectives: The tissue localization of Estrone Sulfatase (ES) which participates in the final step of estrogen synthesis in endometrial hyperplasia and endometrial carcinoma has not been determined, nor has been clarified the role of ES in the onset of these lesions. Thus the present study was carried out to clarify these issues. Study Methods: Immunostaining was performed using anti-ES monoclonal antibody (KM1049). Paraffin-embedded sections, obtained from 37 women with endometrial hyperplasia, 20 with normal endometrium, and 11 with carcinoma of the uterine body, were examined. Results: In the normal endometrium, the functional layer was negative in all cases, and the basal layer was positive in 30% (6120). ES was detected in all layers in ES-positive cases with endometrial hyperplasia, and the positive rate was 51.4% (19137) in the endometrial hyperplasia group. The positive rate was 66.7% (619) in the cases of atypical hyperplasia and 46.4% (13128) in the cases of a simple or complex type of endometrial hyperplasia without atypia. ES was detected in 72.7% (8111) of women with carcinoma of the uterine body. Stainability differed between gland ducts, even in the same specimens of endometrial hyperplasia, and it was found that the severer the atypia of the duct, the stronger the stainability. Conclusion: ES was significantly more expressed as atypia and malignancy became severer. These results suggested that the expression of estrone sulfatase may involve the onset and growth of endometrial hyperplasia as well as the onset of carcinoma of the uterine body.

P4.06.11 MALIGNANT LYMPHOMA OF UTERUS: A CASE REPORT WITH REVIEW OF LITERATURE A.Anrawal (l), G. Ofili (l), T.L. Allan (2), B.S. Mann (3), Law Hospital NHS Trust, Carluke, UK. (1) Dept. of Gynaecology; (2) Dept. of Haematology; (3) Dept. of Pathology

The female genital tract is rarely the site of initial manifestation of malignant lymphomas. Most genital lymphomas arise in the vagina or cervix whilst those of the uterine corpus are extremely rare. Patients usually present with bleeding, abdominal or pelvic discomfort or back pain but very infrequently the tumors are discovered as a result of a routine examination. Our patient was a 67.year-old postmenopausal lady presenting with a haematuria and upper abdominal pain. She had several investigations for haematuria including cystoscopy, IVU as well as renal and pelvic scan. Pelvic scan revealed an enlarged uterus with some calcification suggestive of a fibroid uterus. An abdominal hysterectomy was performed. Histopathology revealed Non-Hodgkin’s malignant lymphoma of the uterine corpus. She subsequently had post-operative chemotherapy. We present this case of Non-Hodgkin’s malignant lymphoma of the uterine corpus because of its rarity. We reviewed the relevant literature and management options will be discussed.

P4.06.12 OCCURRENCE OF METASTATIC LYMPH NODES IN PARAILIAC REGION IN ENDOMETRIAL CARCINOMA. Jacek Suzin, Andrzej Bienkiewicz, Leszek Gottwald Dept. of Gynecological Oncology, Inst. of Obst. and Gynecol., Medical University, 37 Wilenska st., 94-029 Lbdz, Poland.

Background: Endometrial cancer remains one of the leading cause of gynecologic malignancy mortality in Poland. Surgical procedure together with radiotherapy and hormonotherapy according to staging and grading are recommended in those cases. Surgical procedure consist of

radical hysterectomy with both adnexa, appendectomy and bilateral lymphadenectomy of parailiac region. Aim of study: We evaluated the efficacy of parailiac lymphadenectomy and occurence of metastatic adenocarcinoma in the removed nodes. Material and methods: We analysed 58 women aged 29-88 yr, with endometrial carcinoma confirmed by endometrial biopsy, who underwent surgical treatment in our dept. between 1997-1999. In all cases uterus and both adnexa were removed together with trial of bilateral parailiac lymphadenectomy. Results: In 42 cases bilateral parailiac lymphadenectomy was successful, in 10 cases only unilateral lymphadenectomy succeeded and in remaining 6 cases only fatty tissue was removed from parailiac region. In 5 cases in removed lymph nodes the metastases of endometrial carcinoma were found. In 2 cases metastases were bilateral. In 2 cases, were metastases were found, the infiltration of myometrium by endometrial carcinoma was only superficial, in 3 cases infiltration was profound and in 2 out of those 3 cases the uterine cervix was infiltrated. Among 12 women with profound infiltration of myometrium, and cervix involved, in 2 cases adenocarcinoma was found in parailiac lymph nodes. Conclusions: Presented data illustrate the difficulties in parailiac lymph nodes identification and their resection. The occurence of adenocarcinoma metastases in those nodes in 9% of our patients including those with the superficial infiltration of myometrium support the necessity of parailiac lymph nodes removal during surgery in endometrial carcinoma.

P4.06.13 PHOTODYNAMIC DETECTION OF ENDOMETRIAL CANCER P. De Jaco cl), M. Ceccarini (l), M. Giorgio (l), T. Ghi (l), C. Del Vecchio (l), D. Santini (2), L. Bovicelli (l), (1) S.Orsola-Malpighi, via Massarenti, 13, Bologna, Italy, 40100, (2) Istituto di Anatomia Patologica, Bologna, Italy.

Objectives: Photodynamic procedure is the use of a light beam with a proper wavelength to excite fluorescence in the cells. Some of these cells, when suitably illuminated, show a spontaneous fluorescence (auto- fluorescence) whereas for other cells prior instillation of a photosensitizer is requested (induced fluorescence). Amino-levulinic acid is a valid photo-sensitizer since it is selectively picked and converted in Protoporphirin IX from target cells. Such cells when illuminated under Argon produce a red light. ALA uptake from tumoral cells seems to be more rapid and selective. Some Authors have used this technique for urothelial carcinoma: intravesical instillation of ALA enabled to detect under violet light illumination (1=406.7 nm) 100% of neoplastic lesions, with a specificity of 68.5% (1). ALA has been also proposed to map micromestastasis of ovarian cancer: in mice with ovarian malignancies of human origin, fluorescent peritoneal nodules were detected in all cases (2). Considering selective uptake of ALA from endometrial cells, some Authors have proposed an endometrial photo- ablation. No study concerning photodynamic detection of endometrial cancer has been published so far in the literature. The aim of our study is to analyse those endometrial areas that, due to the high concentration of Protoporfirin IX, appear fluorescent under Argon light (D-Light). During hysteroscopy, this procedure is supposed to select normal tissue from cancerous one, allowing the operator an accurate topographic description and a reliable pre-surgical staging of the tumour. Study Methods: In our Centre seven patients (mean age 64.3 years) were evaluated. In four of these patients (three with a benign endometriopathy and one with a Gl well-differentiated adenocarcinoma) auto- fluorescence under blue light (Xenon 300 W-D Light- Karl Storz) was examined. In the other three patients, two cases of well-differentiated (Gl) endometrial adenocarcinoma and one case of well-differentiated mixed serous-papilliferous endometrioid adenocarcinoma, intrauterine instillation of ALA, differently among the three patients, was performed before surgery. Doses and exposure times to the ALA were stepwise increased (concentrations varying from 1.5 to 3 to 4%, during 30 or 40 minutes). Topical instillation of the ALA was carried on by a hysterosonography catheter (7 Fr) and then, retracted the catheter, an assessment of the cavity was performed using a 30” angle, 3 mm diametre hysteroscope (Xenon 300 W, Karl Storz). Results: In the first group of four patients, either in tumoral or in non- tumoral endometrial cells, we were unable to demonstrate any auto- fluorescence. Concerning the use of the ALA and the induced fluorescence, in our investigation neoplastic areas have never been