Eighty-eight women visiting a gynecologist were tested for an estrogen receptor B-variant allele. The women were ethnically and racially homogeneous to a large degree. They were from a suburb of Long Island, and most were white. The 12% incidence of hypertension in women with the estrogen receptor wild-type allele is comparable to the 13-32% incidence in the general population of women aged 55-64 years. However, the 48% incidence of hypertension in women with the estrogen receptor B-variant allele is considerably higher than in the general population of women in this age group. We conclude that the presence of the estrogen receptor B-variant allele might have increased the prevalence of hypertension in the women in this study. T he prevalence of hypertension in men and women is different and depends on age. In subjects aged 25-54 years, hypertension is more prevalent in men; but in subjects older than 54 years, hypertension is more prevalent in women.1 At least one gene has been implicated in the genesis of hypertension.
2We recently documented the existence of a variant allele of the human estrogen receptor (ER) gene. We reported that women with breast cancer and this variant allele had a high incidence of spontaneous abortion.
3The variant gene differs from the wild-type gene within the B domain. 4 A single point mutation, a guanine-to-cytosine transition at position 261, causes a silent mutation in codon 87.
5-6 Of interest is the fact that the unmutated sequence, GCG, codes least frequently for alanine in humans (7.1% of cases); the silently mutated codon GCC codes most frequently (29.5% of cases).7 No doubt another mutation, segregating with the silent mutation, plays a role in producing the high incidence of spontaneous abortion.We now report that the ER B-variant allele is associated with hypertension in women. Furthermore, women with the variant allele are significantly younger than those without the variant.
MethodsTo identify the B-variant, we used the polymerase chain reaction to amplify genomic DNA around the polymorphic region of the ER gene, followed by allelespecific oligonucleotide hybridization. This analysis used DNA obtained from blood lymphocytes of women, as we have described.8 Both the wild-type and variant alleles were specifically identified in the genotyping.Eighty-eight women of all ages visiting a gynecologist were studied. Women were excluded if they had cancer or other serious illness. A nurse or physician made a single measurement of blood pressure. The technicians genotyping the blood lymphocyte DNA were blinded as to the blood pressure status of the patients. The women were ethnically and racially homogeneous to a large degree. They were from a suburb of Long Island, and most were white. None of the women who were approached refused to participate in the study.A woman was classified as hypertensive if she had a systolic blood pressure ^140 mm Hg and a diastolic blood pressure £90 mm Hg or if she was being treated for hypertension with antihypertensive medications. She was classif...
The results suggest that G3 EAC has a slightly more favorable survival than UPSC and CC but predictably does poorer than G1-2 EAC. Further research is warranted to determine if G3 EAC should be reclassified as a type II cancer.
For endometrial cancer (EC), most surgeons rely on intraoperative frozen section (IFS) to determine the risk of nodal metastasis and necessity of lymphadenectomy. IFS remains a weak link in this practice due to its susceptibility to diagnostic errors. As a less invasive alternative, sentinel lymph node (SLN) mapping and ultra-staging have gradually gained acceptance for EC. We aimed to establish the SLN success rate, negative predictive value, and whether SLNs provide useful information for cases misdiagnosed on IFS. From 2013 to 2017, 100 patients (63 low-risk and 37 high-risk EC) underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN. Among them, 56 had additional pelvic lymphadenectomy. A total of 337 SLNs were obtained in 86 cases: 55 bilaterally and 31 unilaterally. The remaining 14 cases failed because of patient obesity or leiomyoma. Pathology ultra-staging detected 2 positive SLNs from 2 patients (1 with isolated tumor cells, 1 with micrometastases). One of 773 nonsentinel pelvic nodes was positive on the contralateral hemi-pelvis in a patient who was mapped unilaterally, resulting in negative predictive value of 100%. During IFS, tumor grade and/or depth of myometrial invasion was misdiagnosed in 22 cases (22%). These errors would have resulted in under-staging in 10 high-risk patients or over-staging in 4 low-risk patients. SLNs were mapped in these misestimated patients, with one revealing metastases. SLN provides invaluable information on nodal status while detecting occult metastases in cases misdiagnosed on IFS. Our findings justify the incorporation of SLN in initial surgery for EC as an offset to IFS diagnostic errors, minimizing their negative impact on patient care.
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