SFGH 5.2 pearls: Endometrial CA and pulm nodules

  • Endometrial carcinoma is the most common gyn malignancy in developed countries, with the main risk factor being excess estrogen (endogenous from obesity or exogenous hormone replacement therapy with estrogen)
    • Survival depends on stage, with stage IV survival at 5 year between 20-60%
  • Most cases present with uterine bleeding, and screening for asymptomatic women is not recommended except in women with Lynch syndrome
    • Pap smear is only about 50% sensitive for uterine cancer
    • Most women have disease confined to the uterus on diagnosis (68%)
    • Remember that CT is not a good imaging modality for uterine abnormalities – pelvic or transvaginal ultrasound is more sensitive, though endometrial cancer can only be diagnosed with tissue (EMB or hysterectomy sample)
  • Cocci testing – immunodiffusion for cocci IgM and IgG is a very specific, but not very sensitive test, as not all exposed patients will develop antibodies and antibody formation can lag behind the clinical presentation.
    • If either IgM or IgG immunodiffusion tests are qualitatively positive, complement fixation should be done subsequently for quantitative analysis
    • Comp fix is often called “the IgG test”! This test provides titers based on depletion of compliment that results when cocci antibodies and antigen form an immune complex in an infected patient
      • Most patients with extrapulmonary cocci have comp fix titers of 1:16 or greater
  • Histo is most common in Central and North America, with the North American hot spots including the Ohio and Mississippi River valleys.
    • Pulmonary histo should be on your ddx for patients with mediastinal or hilar LAD or masses, pulmonary nodules, cavitary lung lesions, and pulm symptoms with arthritis/arthralgia and erythema nodosum and often shares a ddx with TB, sarcoid and lung cancer
      • It’s important to rule out histo when you’re considering a sarcoid diagnosis, as giving steroids for sarcoid in a patient who actually has histoplasmosis can lead to disseminated infection
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