Karamursel B S, Guven S, Tulunay G, Kucukali T, Ayhan A
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Hacettepe, Ankara, Turkey.
Int J Gynecol Cancer. 2005 Jan-Feb;15(1):127-31. doi: 10.1111/j.1048-891X.2005.15013.x.
To determine the occult coexistence of endometrial carcinoma in patients with atypical endometrial hyperplasia and to compare histological prognostic factors according to lymph node status in occult endometrial carcinoma.
Two hundred and four patients from two referral centers (during the period 1990-2003) who were operated on within 1 month of endometrial biopsy for symptomatic endometrial hyperplasia without receiving any medical treatment were included retrospectively. Patients having preoperative endometrial biopsy results of concomitant endometrial hyperplasia and carcinoma were excluded from the study. Fifty-six patients having atypia in preoperative biopsy (group I) were compared with 148 patients without atypia (group II). Chi-square and Mann-Whitney U-tests were used for statistical analyses.
No significant difference was observed between the two groups according to age or menopausal status. Patients in group II had significantly higher parity than patients in group I. In group I, 62.5% of the patients had endometrial carcinoma, 21.4% had endometrial hyperplasia, and 16.1% had normal endometrium in hysterectomy specimens. In group II, the percentages were 5.4, 38.5, and 56.1%, respectively. Complete surgical staging was performed in 20 patients. Four patients had metastatic lymph nodes. All of them had grade 2 tumors with lymphovascular space involvement. Three of them had nonendometrioid tumors.
Careful intraoperative and preoperative evaluation of the endometrium must be the sine qua non for patients with atypical endometrial hyperplasia. It is reasonable to do frozen section at the time of hysterectomy for atypical endometrial hyperplasia, and if grade 2/3 of nonendometrioid cancer with lymphovascular space involvement is found, complete surgical staging should be performed.
确定非典型子宫内膜增生患者中子宫内膜癌的隐匿共存情况，并根据隐匿性子宫内膜癌的淋巴结状态比较组织学预后因素。
回顾性纳入了来自两个转诊中心（1990年至2003年期间）的204例患者，这些患者因有症状的子宫内膜增生在子宫内膜活检后1个月内接受手术，且未接受任何治疗。术前子宫内膜活检结果为合并子宫内膜增生和癌的患者被排除在研究之外。将术前活检有非典型增生的56例患者（I组）与148例无非典型增生的患者（II组）进行比较。采用卡方检验和曼-惠特尼U检验进行统计学分析。
两组在年龄或绝经状态方面未观察到显著差异。II组患者的产次显著高于I组患者。在I组中，子宫切除标本中62.5%的患者患有子宫内膜癌，21.4%患有子宫内膜增生，16.1%子宫内膜正常。在II组中，这些百分比分别为5.4%、38.5%和56.1%。对20例患者进行了完整的手术分期。4例患者有转移性淋巴结。他们均患有2级肿瘤且伴有淋巴管间隙受累。其中3例为非子宫内膜样肿瘤。
对于非典型子宫内膜增生患者，术中及术前对子宫内膜进行仔细评估必不可少。对非典型子宫内膜增生患者进行子宫切除时进行冰冻切片检查是合理的，如果发现2/3级非子宫内膜样癌伴有淋巴管间隙受累，应进行完整的手术分期。
