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Analysis of the 2nd symposium "Anomalies of fatty acids, ageing and degenerating pathologies".

The second symposium on anomalies of fatty acids, ageing and degenerating pathologies for the French-speaking community was held during January 2002 in Paris (France) and reunited more than 200 participants, including a majority of medical practitioners. It was organised around 8 conferences treating the following subjects: a general presentation of the metabolism of fatty acids and their biological functions (in particular polyunsaturated fatty acids or PUFA), the exploration of PUFA in man during situations of nutritional and pathological disequilibrium, and the importance of PUFA in the aetiology and prevention of pathophysiologies such as cardiovascular, autoimmune and inflammatory diseases, diabetes and obesity, cancer and certain neuropsychiatric affections such as depression. Indeed, even though edible fatty acids present a common energetic function, by beta-oxidation, and a structural function, as a constituent of membrane lipids, some of them have a more specific role as an essential nutrient. These are essential fatty acids including the two families of polyunsaturated fatty acids (n-6 and n-3 PUFA). Their metabolism leads to the synthesis of derivatives found in cellular membranes (structural role) and oxygenated molecules, the eicosanoids, whose main action is of the same type as that of hormones. These derivatives and oxygenated molecules also regulate different metabolic pathways by modulating the expression of target genes via activation of specific transcription factors. Due to their quality and their quantity in food, the PUFA may interfere with the incidence of a large number of pathologies whose causes are varied (cardiovascular and inflammatory diseases, cancers, neuropathologies, ...). The particular interest in nutrition of PUFA of the n-3 series (or omega3) and in particular of long-chain derivatives mainly found in high quantity in fish oils (eicosapentaenoic acid and docosahexaenoic acid) is now widely confirmed for cardiovascular and inflammatory physiology and formed the subject of increasing investigations for prevention of certain pathologies of the central nervous system. In this paper, we are first going to recall the generalities of metabolism and functional properties of PUFA. Secondly, we will list the pathologies whose frequency and symptoms are susceptible to be corrected by the dietary intake of PUFA, notably by reaching the nutritional equilibrium between the family of linoleic acid (n-6 or omega6) and that of alpha-linolenic acid (n-3 or omega3).

Aging↗

Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses.

This study was conducted to investigate the association between uterine artery Doppler flow patterns and uteroplacental vascular pathology in normal and complicated pregnancies in view of the recently described concept of heterogeneous causes of hypertensive pregnancy complications. Forty-three women whose pregnancies were complicated by pre-eclampsia, the HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome and/or small for gestational age (SGA) fetuses and 27 women with normal pregnancies undergoing elective caesarean section were included. We obtained uterine artery Doppler waveforms at a mean of 4 days before delivery. Placental bed biopsies were obtained at caesarean section and analysed for physiological changes and pathological changes. We found that abnormal uterine artery Doppler flow was strongly associated with pregnancy complications. Absence of physiological changes was seen in 58 per cent of complicated pregnancies and 40 per cent of normal pregnancies. Pathological changes were seen in 58 per cent of complicated pregnancies and 53 per cent of normal pregnancies; they occurred in spiral arteries with and without physiological changes, and there was no significant correlation to Doppler results. In conclusion, absence of physiological changes is associated with abnormal uterine artery Doppler flow and pregnancy complications. However, there is a gradient in the severity of uteroplacental vascular pathology and the correlation with pregnancy complications is not as strong as previously thought. There is also a significant degree of uteroplacental vascular pathology in normal pregnancies with normal uterine artery Doppler flow. This variation may be partly due to sampling error, as a typical biopsy contains only one or two spiral arteries. We hypothesize that additional factors might be necessary to induce the clinical syndrome of pre-eclampsia.

Arteries↗

Pathological gambling: addiction or compulsion?

There is considerable debate about the appropriate conceptualization of pathological gambling and its place in psychiatric nosology. The authors examined the existing research on different areas of pathological gambling to find evidence for a particular model of this disorder. There are 2 dominant models of pathological gambling: as a nonpharmacologic addiction and as an obsessive-compulsive spectrum disorder. The data available from different areas seem to converge in suggesting that pathological gambling has characteristics that are similar to those of substance abuse, and less close to those of obsessive-compulsive disorder, although those conceptualizations are not mutually exclusive. An alternative model of pathological gambling is that it constitutes a heterogeneous disorder with some subtypes resembling obsessive-compulsive disorder, and other subtypes being closer to substance abuse disorders. Improved understanding of the conceptualization of this disorder may help improve the quality of the treatments available.

Gambling↗

Nipple aspirate cytology and pathologic parameters predict residual cancer and nodal involvement after excisional breast biopsy.

We previously demonstrated that abnormal nipple aspirate fluid (NAF) cytology predicted residual breast cancer (RC) and tumour size after excisional biopsy (EB), although normal NAF cytology did not exclude RC. Tumour size correlates with the risk of lymph node (LN) metastases. LN metastases provide prognostic information allowing medical and radiation oncologists to determine the need for adjuvant therapy. We hypothesized that pathologic factors known after EB, combined with NAF cytology, would predict with a high degree of accuracy the presence of RC and LN spread. NAF cytology and pathologic parameters: tumour distance from biopsy margins, multifocal and multicentric disease, sub-type of ductal carcinoma in situ (DCIS) or invasive cancer (IC), grade of DCIS or IC, tumour and specimen size, tumour and biopsy cavity location, presence or absence of extensive DCIS, and biopsy scar distance from the nipple were evaluated bivariately and then by logistic regression (LR) for their association with RC and involved LN (> or = 1 (+) LN, useful to determine chemotherapy need, and > or = 4 (+) LN, useful to determine radiation need to the chest and axilla). Data were analysed using NAF cytology alone, pathologic parameters alone, and NAF cytology and pathologic parameters combined. The combined LR model was superior in predicting residual cancer (94%) to LR models using NAF cytology (36%) or pathologic parameters (75%) alone. When only subjects with normal NAF cytology were evaluated by LR, the model was 92% sensitive in predicting RC. Tumour size and NAF cytology predicted which patients had > or = 1 (+) LN, whereas tumour and specimen size predicted which patients had > or = 4 (+) LN. We propose an algorithm which, if confirmed in a larger study, may allow clinicians to be more selective in their recommendations of re-excision breast biopsy or mastectomy.

Adult↗

A comparative histopathologic and immunohistopathologic evaluation of cremaster muscles from boys with various inguinoscrotal pathologies.

AIM: It has been hypothesized that the cremaster muscle (CM) might play a part in the pathogenesis of various inguinoscrotal pathologies such as undescended testis and hernia. A prospective study was carried out to determine if CM of boys with hydrocele, inguinal hernia, and undescended testis reveal any histopathological and immunohistopathological alterations. METHODS: Samples of CM from 29 patients presenting with inguinal hernia (15), undescended testis (9), and hydrocele (5), and CM from autopsies of boys without inguinal pathology (2), and samples of internal oblique muscles from patients undergoing laparotomy (3) were obtained. The biopsies were frozen in isopentane-cooled liquid nitrogen, cut in 6 micron sections and stored at -80 degrees C until processed. Sections were stained by hematoxylin-eosin, modified Gomori-trichrome, PAS, Oil Red-O, NADH, SDH and COX. All specimens were evaluated for seven parameters including variation in fibre size, presence of central nucleus, endomysial fibrosis, inflammation, presence of basophilic fibres, increase in perimysial connective tissue, and variation in fibre size between fascicules. The specimens were also evaluated for beta-spectrin, laminin alpha-1 chain, laminin alpha-2 chain, 43 kd distroglycan, and fetal myosin by immunofluorescence. The presence of each parameter was compared, individually and in combination, according to the ages and underlying pathologies. RESULTS: None of the internal oblique muscles were positive for any of the seven parameters. Only one of the two CM obtained during autopsy revealed a slight variation in fibre size. However, fibre size variation and increase in perimysial connective tissue were found in all but one CM from a patient with hernia. The presence or absence of parameters did not differ according to age. Comparison of the groups with inguinal hernia and undescended testis for each of the individual parameters did not reveal significant differences. However, the presence of four or more parameters in each CM was more commonly encountered among patients with undescended testis compared to patients with hernia (p < 0.05). The CM of patients with hydrocele suggested similar findings to patients with inguinal hernia. All of the specimens, regardless of origin, revealed normal sarcolemmal and basal laminal stainings, and fetal myosin was expressed in only two specimens which were obtained from an internal oblique muscle and the CM of a patient with an inguinal hernia. CONCLUSION: The CM of patients with inguinal hernia, hydrocele, and undescended testis reveal histopathological alterations. Furthermore, CM from patients with undescended testis reveal more profound alterations. Whether these alterations reflect a primary muscle pathology or a defect in innervation or changes secondary to inguinoscrotal pathology requires further study.

Child↗

[Pathological insertion of the placenta after the 20th week of pregnancy--its importance in the course of pregnancy and delivery].

The present paper reports on the results of sonographic diagnosis of a pathologic insertion of the placenta after the 20th week of pregnancy and its importance with regard to the course of pregnancy and birth. The conversion of a primarily pathologic placental insertion to a "normal" insertion at term depends on the severity of the placental insertion disorder and the date of diagnosis. The frequency of pathologic insertions after the 20th week of pregnancy amounted to 4.2% of the patients examined. The rate of conversion from pathologic to normal placental insertion was 91%, if marginal/partial and total placenta previa are accepted as definitive diagnoses at term. The insertion remained unchanged up to term in approximately 90% of the cases in which total placenta previa was sonographically diagnosed. The sonographic diagnosis of "pathologic insertion of the placenta" after the 20th week of pregnancy is associated with severe complications in the subsequent course of pregnancy and birth. There is a significant cluster of vaginal hemorrhage in the last trimester of pregnancy; cesarean deliveries are common; there are more cases of transfer to pediatric clinics, and the incidence of retarded fetal growth and perinatal mortality is higher. The present authors believe that where the diagnosis of placenta previa has been confirmed sonographically, prophylactic measures and, in the last resort, a planned cesarean delivery can contribute to a reduction in maternal morbidity and also to a decrease in perinatal morbidity and mortality.

Abortion, Spontaneous↗

[Gonarthrosis: is the role of pathological statics overestimated?].

UNLABELLED: 57 patients (15 males and 42 females) with osteoarthrosis and/or pathological statics of the knee were examined clinically and radiographically. The question was whether pathological statics (genu varum) act significantly in the pathogenicity of the condition. FINDINGS: a) In a large number of cases it was impossible to determine whether the static deviation were the cause of the osteoarthrosis or whether the reverse were the case. b) The frequency of development of osteoarthrosis in knees with pathological statics was not greater than in those with normal statics. c) The topography of the osteoarthrosis, which one would expect to be a function of the direction of static deviation, was not more frequent in genu varum than in statically normal knees. d) In unilateral genu varum, in some cases the same degree and topography of osteoarthrosis was observed in both knees. e) In a sufficient number of cases, the amount of osteoarthrosis was minimal in relation to the degree of static deviation. f) In genu varum, a deviation was located in the proximal portion of the tibia, whereas in genu valgum, the deviation was located in the distal portion of the femur. The findings "b, c, e" were verified statistically. These findings raise doubts as to the aetiology of pathological statics in the pathogenicity of osteoarthrosis of the knee. Pathological statics alone are not sufficient and probably require other factors for the development of osteoarthrosis.

Aged↗

[Prognosis in Ewing sarcoma patients with initial pathological fractures of the primary tumor site].

In this retrospective analysis, data of 52 patients with Ewing's sarcoma or PNET with a pathological fracture in the area of the primary tumor were evaluated. All patients were treated according to the trials CESS 81, CESS 86 P, CESS 86, CESS 91 P and EICESS 92 of the German Society of Pediatric Oncology and Haematology (GPOH). At the date of evaluation (15. September 1994) all patients had completed treatment and had been under observation for at least one year following diagnosis. The median follow-up time was 28 months. 22 patients were female, 30 male. The median age was 12 years. 75% of primary tumors had a volume of > or = 100 ml. 30 patients presented with fractures in proximal, 12 in central and 10 in distal parts of the skeleton. 10 patients had primary metastases. The histological definition was Ewing's sarcoma (including atypical Ewing's sarcoma) in 43 patients, PNET in 8 and small-cell osteosarcoma in 1 patient. For local therapy the patients underwent surgery, definitive radiotherapy or a combination of both. The percentage of primary metastases in the group of the patients with pathological fractures is comparable to the whole reference group. The present analysis focuses on those patients with pathological fractures who had no metastases at diagnosis. The relapse-free survival of patients with a pathological fracture and no primary metastases is 58%, the overall survival 65%. These rates are similar to those of the reference group of protocol patients without pathological fractures at diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Correlation of EUS measurement with pathologic assessment of neoadjuvant therapy response in esophageal carcinoma.

BACKGROUND: EUS-measured reduction in tumor size after neoadjuvant therapy has previously been correlated with downstaging and improved survival in patients with esophageal cancer. The aim of this study was to determine whether tumor changes measured by EUS correspond to pathologically assessed chemoradiotherapy-induced tumor regression. METHODS: Forty-one patients with esophageal cancer treated with combined modality treatment were studied. After initial EUS, patients completed a cisplatin/carboplatinum, 5-fluorouracil, and radiotherapy regimen and underwent repeat EUS before resection. A positive response on EUS was defined as a 50% reduction in maximal tumor cross-sectional area. Chemoradiotherapy-induced tumor regression was assessed in resection specimens by using a previously defined pathologic scoring system based on the extent of tumor proliferation into adjacent fibrosis. RESULTS: Pathologic tumor regression was present in 23, indeterminate in 5, and minimal or absent in 13 patients. EUS measured a positive response in 20 of 23 (87%) patients with CRT-induced tumor regression and a negative response in 10 of 13 (77%) patients with absent tumor regression (p < 0.001). EUS had a positive predictive value of 80% for pathologic tumor regression. CONCLUSIONS: Measurement of tumor size by EUS is a reliable clinical method for assessing pathologic tumor regression before surgery.

Adult↗

Tympanic membrane and middle ear pathologic correlates in mucoid otitis media.

OBJECTIVE: The goal of this study was to correlate tympanic membrane (TM) and middle ear (ME) pathologies in mucoid otitis media (MOM). METHODS AND MATERIAL: Forty ears with MOM and 56 control ears were retrospectively evaluated for TM and ME pathologies. Comparisons of TM thicknesses in MOM versus control ears were correlated with the Student t test; chi(2) analysis was used to correlate pathologic findings of the TM and ME. RESULTS: Thicknesses in all quadrants except the umbo were increased in MOM because of infiltration of inflammatory cells and fibrosis. The most common ME pathologies were granulation tissue and fibrosis. Significant correlations included (1) TM retraction and ME granulation tissue and fibrosis and (2) pars flaccida, posterosuperior, and anteroinferior thickness and ME granulation tissue and fibrosis. CONCLUSION: TM changes are likely to occur in patients with otitis media with effusion (MOM), and their presence is a strong indication of underlying ME pathology.

Adolescent↗

Pathologic analysis of routine tonsillectomy and adenoidectomy specimens.

OBJECTIVES: Recent literature has suggested that histopathologic analysis of routine tonsillectomy and adenoidectomy (T&A) specimens may be unnecessary. This study investigates T&A specimen handling practices in the United States between 1989 and 1999. METHODS: Surveys were sent to 4715 members of the American Academy of Otolaryngology. Surveys assessed practice type, pathologic processing practices (full, gross, no pathology), and reasons for change. The authors also performed a retrospective analysis of 1583 pediatric T&A specimens for evidence of occult malignancy. RESULTS: Practice types were 80% private, 12% academic, 6% salaried, and 2% military. Chi squared analysis revealed a significant increase (P < 0.001) in respondents ordering "gross only" and "no pathology." The retrospective analysis found no occult malignancies. CONCLUSIONS: There is a statistically significant increase in the number of otolaryngologists sending routine T&A specimens for "gross only" and "no pathology." There was no correlation between the type of practice and changes in pathologic analysis performed.

Adenoidectomy↗

Cardiac pathology in sudden unexpected infant death.

OBJECTIVES: To determine the spectrum of cardiac pathology and circumstances of death in infants with sudden unexpected death and to define the impact of sudden cardiac deaths to overall sudden infant death. STUDY DESIGN: Retrospective analysis of all autopsies of infants with sudden death 7 days to 2 years of age between January 1987 and December 1999 in the province of Québec (Canada). RESULTS: Eighty-two cases of sudden death with cardiac pathology were found, representing 10% of the total number of sudden infant deaths. A structural malformation was present in the majority of cases (54%); however, cardiac pathology in anatomically normal hearts was also common (46%). Most (64%) anatomic malformations were detected before death compared with 13% of nonstructural heart disease. Although a major proportion of children were found dead during sleep, a significant number were described as being awake at time of death (32%). CONCLUSIONS: Heart disease is present in a significant percentage of autopsies of infants with sudden death. Structural heart malformations predominate, although nonstructural pathologic features of the heart are common and usually unrecognized before an autopsy is performed. Cardiac pathologic features are frequent when the child is witnessed to be awake at the time of sudden death.

Autopsy↗

Murine malaria parasite sequestration: CD36 is the major receptor, but cerebral pathology is unlinked to sequestration.

Sequestration of malaria-parasite-infected erythrocytes in the microvasculature of organs is thought to be a significant cause of pathology. Cerebral malaria (CM) is a major complication of Plasmodium falciparum infections, and PfEMP1-mediated sequestration of infected red blood cells has been considered to be the major feature leading to CM-related pathology. We report a system for the real-time in vivo imaging of sequestration using transgenic luciferase-expressing parasites of the rodent malaria parasite Plasmodium berghei. These studies revealed that: (i) as expected, lung tissue is a major site, but, unexpectedly, adipose tissue contributes significantly to sequestration, and (ii) the class II scavenger-receptor CD36 to which PfEMP1 can bind is also the major receptor for P. berghei sequestration, indicating a role for alternative parasite ligands, because orthologues of PfEMP1 are absent from rodent malaria parasites, and, importantly, (iii) cerebral complications still develop in the absence of CD36-mediated sequestration, dissociating parasite sequestration from CM-associated pathology. Real-time in vivo imaging of parasitic processes may be used to evaluate the molecular basis of pathology and develop strategies to prevent pathology.

Adipose Tissue↗

Phosphoinositide 3-kinase(p110alpha) plays a critical role for the induction of physiological, but not pathological, cardiac hypertrophy.

An unresolved question in cardiac biology is whether distinct signaling pathways are responsible for the development of pathological and physiological cardiac hypertrophy in the adult. Physiological hypertrophy is characterized by a normal organization of cardiac structure and normal or enhanced cardiac function, whereas pathological hypertrophy is associated with an altered pattern of cardiac gene expression, fibrosis, cardiac dysfunction, and increased morbidity and mortality. The elucidation of signaling cascades that play distinct roles in these two forms of hypertrophy will be critical for the development of more effective strategies to treat heart failure. We examined the role of the p110alpha isoform of phosphoinositide 3-kinase (PI3K) for the induction of pathological hypertrophy (pressure overload-induced) and physiological hypertrophy (exercise-induced) by using transgenic mice expressing a dominant negative (dn) PI3K(p110alpha) mutant specifically in the heart. dnPI3K transgenic mice displayed significant hypertrophy in response to pressure overload but not exercise training. dnPI3K transgenic mice also showed significant dilation and cardiac dysfunction in response to pressure overload. Thus, PI3K(p110alpha) appears to play a critical role for the induction of physiological cardiac growth but not pathological growth. PI3K(p110alpha) also appears essential for maintaining contractile function in response to pathological stimuli.

Adaptation, Physiological↗

Temporal profile of amyloid-beta (Abeta) oligomerization in an in vivo model of Alzheimer disease. A link between Abeta and tau pathology.

Accumulation of amyloid-beta (Abeta) is one of the earliest molecular events in Alzheimer disease (AD), whereas tau pathology is thought to be a later downstream event. It is now well established that Abeta exists as monomers, oligomers, and fibrils. To study the temporal profile of Abeta oligomer formation in vivo and to determine their interaction with tau pathology, we used the 3xTg-AD mice, which develop a progressive accumulation of plaques and tangles and cognitive impairments. We show that SDS-resistant Abeta oligomers accumulate in an age-dependent fashion, and we present evidence to show that oligomerization of Abeta appears to first occur intraneuronally. Finally, we show that a single intrahippocampal injection of a specific oligomeric antibody is sufficient to clear Abeta pathology, and more importantly, tau pathology. Therefore, Abeta oligomers may play a role in the induction of tau pathology, making the interference of Abeta oligomerization a valid therapeutic target.

Aging↗

Digital imaging and electronic patient records in pathology using an integrated department information system with PACS.

Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.

Computer Communication Networks↗

Coexistent thyroid pathologies and high rate of papillary cancer in patients with primary hyperparathyroidism: controversies about minimal invasive parathyroid surgery.

Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999--2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6 %) had coexistent papillary thyroid cancer. Nine patients (17.6 %) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multifocal papillary cancer. One of the two cases with thyroid adenomas was Hürthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre- and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.

Adolescent↗

High risk of cervical pathology among women with postmenopausal bleeding and endometrium <or=4.4 mm: long-term follow-up results.

BACKGROUND: To determine the risk of endometrial and cervical pathology during long-term follow-up in women with postmenopausal bleeding and thin endometrium (<or=4.4 mm), and to determine the incidence and significance of re-bleeding. METHODS: Retrospective study including all women (n=332) with postmenopausal bleeding and thin endometrium examined at the Department of Obstetrics and Gynaecology at Malmö University Hospital from 1992 until 2002. Follow-up was accomplished by searching the medical records, the local registry of cytology and pathology, and the regional cancer registry up to November 15, 2005. RESULTS: At the first visit, cervical cancer was diagnosed in 1.5% (5/332) and endometrial cancer in 0.9% (3/332) of the women. During follow-up, cervical cancer was detected in 2/313 (0.6%) of the women; no additional case of endometrial cancer was found. In the region, the expected incidence of cervical and endometrial cancer during follow-up was 0.23 (standard incidence ratio [SIR], 8.7; 95% CI 1.1-31.4) and 1.34 (SIR, 0.0; 95% CI 0.0-2.7), respectively. Thirteen percent (41/313) of the women sought medical care because of re-bleeding. Endometrial pathology was found in 16% (4/25) and cervical pathology in 11% (3/28) of these women. CONCLUSIONS: Cervical cancer was twice as common as endometrial cancer in women with postmenopausal bleeding and a thin endometrium. During follow-up, the risk of endometrial cancer was as expected, whereas the risk of cervical cancer was higher than expected. The results support that the diagnostic focus should be directed at excluding cervical pathology and that repeated diagnostic procedures be performed in cases of re-bleeding.

Aged↗