[Show abstract][Hide abstract] ABSTRACT: To test the efficacy of levonorgestrel-release intrauterine device (LNG-IUD) plus gonadotropin-releasing hormone (GnRH) for treating women aged <40 years with atypical endometrial hyperplasia (AEH) or presumed International Federation of Gynecology and Obstetrics stage IA limited to the endometrium, well differentiated (G1), endometrioid endometrial cancer (EC), who wish to preserve their fertility.
A prospective observational study was conducted. Treatment consisted on the insertion of an LNG-IUD for 1 year plus GnRH analogue for 6 months.
From January 1996 to June 2009, 20 and 14 patients with AEH and EC, respectively, were studied. Complete response rate was 95% in patients with AEH and 57.1% in women with EC-G1. A progression of the disease was observed in one (5%) and in four patients (28%) with AEH and EC, respectively. Four of 20 patients with AEH and 2 of 14 with EC-G1 experienced recurrences. The average relapse time was 36 months (range: 16-62 months). All of them were alive without evidence of disease at the last follow-up, mean: 29 months (range: 4-102 months). Nine women achieved 11 spontaneous pregnancies.
The combined treatment showed effectiveness in a substantial proportion of patients with AEH and EC. Close follow-up during and after treatment is crucial.
Full-text · Article · Sep 2010 · Annals of Oncology
[Show abstract][Hide abstract] ABSTRACT: Global Objective: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his/her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions.
Target Audience: Target learners for Home Study Courses are colposcopists in clinical practice and may include gynecologists, family physicians, pathologists, residents in training in any one of these specialties, gynecologic oncologists, and mid-level providers such as nurse practitioners, physician's assistants, and certified nurse midwives.
ACCME Accreditation: The ASCCP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
CME Credit: The ASCCP designates this education activity for a maximum of 1 AMA PRA Category I Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Management of Conflicts of Interest and Contributed Funds: As an accredited provider of continuing medical education credit, the American Society for Colposcopy and Cervical Pathology (ASCCP) is required to comply with the Accreditation Council for Continuing Medical Education's Standards of Commercial Support and has implemented a management process to ensure that anyone who is in a position to affect the content of the educational activity (e.g., authors, planners, etc.) has disclosed to us all relevant financial relationships with any commercial interest and has ensured that those relationships do not influence the presentation materials. All authors have agreed to base their presentations on best available evidence. The ASCCP discloses to learners any financial relationship(s) to health care-related commercial interests existing within the past 12 months to include the following information: (1) the name of the individual, (2) the name of the commercial interest, and (3) the nature of the relationship the person has with each commercial interest. The Editor reviews the case-study materials for possible bias, and potential conflicts of interest are resolved before the formal submission to the Journal for publication. Any discussion of off-label use of products is noted when appropriate, as is discussion of any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Disclosures of these commitments and/or relationships are published immediately before the presentation of the case-study materials so those learners intending to participate in the activity may formulate their own judgments regarding the presentation. Under ASCCP policy, a Home Study Course will not be accepted from an author who does not agree to either disclose or amend material to eliminate potential bias identified by the Editor.
Disclosures: Lori Lowe, MD (author), R. Kevin Reynolds, MD (author), Mario Sideri, MD (author), L. Stewart Massad, MD (Accreditation and Enduring Materials Chair), Amy E. Mason (Home Study Course Staff Administrator), Kathleen G. Poole (ASCCP, Executive Director), Thomas M. Julian, MD (Journal of Lower Genital Tract Disease Executive Editor), and Sandra Smith (Journal of Lower Genital Tract Disease Administrative Assistant to the Editor) have no such financial relationship or conflict of interest to report.
Hope K. Haefner, MD (author): Merck & Co., Inc. (speakers' bureau, honorarium).
Mark Spitzer, MD (Home Study Course Editor): Merck & Co., Inc. (honorarium); Elsevier (book author, royalty); speakers' bureau, consultant; SABK (book author, royalty).
Disclaimer: The clinical history and images in the Home Study Course may represent an actual case, but not always. To improve educational quality, some gross, cytological, or histological images may come from photographic libraries. Good teaching cases are often difficult to obtain, and we encourage our readers to submit cases with high-quality images to the Home Study Course Editor or Executive Editor to consider for publication.
Acknowledgment: Images courtesy of Hope K. Haefner, MD, and Lori Lowe, MD.
No preview · Article · Sep 2009 · Journal of Lower Genital Tract Disease