Adiponectin is a hormone secreted exclusively by adipocytes, and obesity is an established risk factor for endometrial cancer. We have, thus, evaluated the association of adiponectin with the occurrence of endometrial cancer. Questionnaire information and blood samples were taken before treatment from 84 women with newly diagnosed, histologically confirmed endometrial cancer and 84 control women who were admitted for minor gynecologic problems, mainly pelvic prolapse. Adiponectin levels were measured by immunoassay. The results were analyzed through multiple logistic regression and controlled for known risk factors for endometrial cancer, leptin, as well as major components of the IGF system (IGF-I, IGF-II, and IGF-binding protein 3). Among control women, there was no significant association of adiponectin with age or parity. Although there was no association of adiponectin with endometrial cancer among women 65 yr or older, there was an inverse, fairly strong, and statistically significant inverse association among younger women. Among women younger than 65 yr, an increase of adiponectin by 1 SD was associated with a more than 50% reduction of the risk for endometrial cancer [odds ratio (OR) 0.44; 95% confidence interval (CI) 0.24-0.81], even after controlling for body mass index and other potential confounders. Among all women, the adjusted OR for a 1 SD increase in adiponectin was not significant (OR, 0.78; 95% CI, 0.56-1.10) but was significant for a one quintile increase in adiponectin (OR, 0.74; 95% CI, 0.56-0.97). In women younger than 65 yr, among whom obesity represents a powerful risk factor for endometrial cancer, adiponectin is inversely and significantly related to the risk of this disease. This association is independent of possible effects of major components of the IGF system, leptin, body mass index, sociodemographic variables, and known endometrial cancer risk factors. Future studies are needed to prove causality and provide insight on both the mechanism of action of this hormone and its potential role in endometrial cancer.

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BACKGROUND The objective of the current study was to determine the diagnostic cytomorphologic criteria for liquid‐based cytology and to evaluate the reproducibility and usefulness of the cytologic diagnosis in endometrial lesions. METHODS A total of 162 direct endometrial samplings taken from postmenopausal women were evaluated by 2 skilled cytopathologists in endometrial cytology. The cytologic diagnosis was made according to the 1994 classification scheme of the World Health Organization. After establishment of the criteria, three additional cytopathologists without any experience in liquid‐based endometrial cytology examined the same cases to determine interobserver variability. The intraobserver variability also was evaluated by all the observers. RESULTS The cytomorphologic criteria were established in the following four diagnostic categories: atrophic endometrium, hyperplasia without atypia, hyperplasia with atypia, and adenocarcinoma. The overall interobserver agreement was nearly perfect with a κ value of 0.89 during the checking round and ranged from moderate to substantial with κ values of 0.48–0.80, respectively, in the other diagnostic rounds (P < 0.0001); hyperplasia with atypia was found to be the most difficult category to identify correctly. Furthermore, the intraobserver agreement ranged from substantial to perfect with κ values of 0.61–1.00 in all diagnostic rounds (P < 0.0001). CONCLUSIONS Liquid‐based cytology allows for standardized and reproducible endometrial preparations, which in turn allows the application of common diagnostic criteria among cytopathologists. Furthermore, liquid‐based cytology in combination with endometrial sampling could be a useful tool for the outpatient diagnosis of endometrial lesions, which could reduce unnecessary curettage. Cancer (Cancer Cytopathol) 2005. © 2005 American Cancer Society.

Pavlakis K, Messini I, Vrekoussis T, Panoskaltsis T, Chrysanthakis D, Yiannou P & Voulgaris Z
(2011) Histopathology 58, 966–973
MELF invasion in endometrial cancer as a risk factor for lymph node metastasis Aim:  To investigate whether the microcystic, elongated and fragmented (MELF) pattern of myometrial invasion encountered in certain endometrioid endometrial carcinomas can be considered as a risk factor for lymph node metastasis. Methods and results:  A total of 351 cases of total abdominal hysterectomy and bilateral salpingo‐oophorectomy with/without lymphadenectomy or lymph node sampling, performed for endometrioid endometrial adenocarcinoma, were included in this study. The existence of MELF invasion, vascular invasion, fibromyxoid stromal reaction and lymph node metastasis were recorded. Immunohistochemistry for endothelial and epithelial markers was performed on selected cases. MELF invasion was identified in 20 (10.81%) and 13 cases (13.13%) treated without and with lymphadenectomy, respectively. All these cases were either well or moderately differentiated carcinomas, stages IA–II (without considering lymph node status). Positive lymph nodes were detected in seven of 13 MELF‐positive (53.84%) and six of 86 MELF‐negative cases (6.97%) This observation was statistically significant. Of the seven MELF‐positive tumours with lymph node metastasis, three cases exhibited intravascular tumour emboli while four showed a fibromyxoid stromal reaction. Conclusion:  MELF pattern invasion was found to be related statistically to lymph node metastasis. Nevertheless, further studies are needed in order to evaluate the clinical significance of this observation.