[1213] Patients with Vaginal Recurrence of Low Grade Endometrial Adenocarcinoma Do Not Have the Usual High Risk Factors Found in Patients with Other Recurrences: A Multi-Institutional Study

Elizabeth J Moschiano, Elizabeth D Euscher, Andres A Roma, Rouba Ali-Fehmi, Elizabeth E Frauenhoffer, Delia P Montiel, Insun Kim, Bojana Djordjevic, Denise A Barbuto, Anais Malpica, Sun R Hong, Elvio G Silva. Cedars-Sinai Medical Center, Los Angeles, CA

Background: The most common site of recurrence of low grade endometrial adenocarcinoma is the vagina; however, there is no clear explanation of how the tumor cells colonize the vagina.
Design: In this multi-institutional study we compiled data from 113 patients from 1991-2011 with FIGO 1 and 2 endometrial adenocarcinomas with recurrence, and 187 control cases that did not recur and had similar follow-up time (44 and 59 months, respectively). We further stratified this group and compared multiple risk factors for patients with vaginal recurrence, patients with recurrence in other sites, and control patients.
Results: There were no significant differences in the age of patients, type of surgical procedure, gross appearance or grade of the neoplasm.
There were significant differences in many high risk factors associated with extravaginal recurrence compared with our control group and patients with vaginal recurrence. These include average tumor size, average depth of myoinvasion, presence of microcystic, elongated and fragmented (MELF) pattern of myoinvasion, presence of lymphovascular invasion (LVSI), documented cervical involvement, and death secondary to disease (DOD).

Risk factors in cases and controls:

Site of Recurrence	Tumor Size (cm)	Depth Myoinvasion (%)	MELF n(%)	LVSI n(%)	Cx Involvement n(%)	DOD
Extravaginal	8.1	50	39(54.2)	51(70.8)	32(44.4)	30(41.7)
Vaginal	3.9	28	12(29.3)	9(22)	10(25)	4(9.8)
Controls	4.1	27	61(32.6)	49(26.2)	15(8)	0(0)

Conclusions: 1. The known risk factors in low grade endometrial adenocarcinoma for patients with vaginal recurrence are similar to control cases, not to those of patients with recurrences in other sites.
2. The only parameter seen in patients with vaginal recurrence that is significantly different than controls is the presence of cervical involvement (25% vs 8%).
3. Only 9.8% of patients with vaginal recurrence died of disease. This suggests that this site of recurrence is not an indication of aggressive behavior.
4. The presence of increased cervical involvement, but absence of other high risk factors and low incidence of mortality in patients with vaginal recurrence raises the hypothesis of contamination of the vagina during the surgical procedure.
Category: Gynecologic & Obstetrics

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 178, Monday Morning