Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2010 May;150(1):80-3. doi: 10.1016/j.ejogrb.2010.02.002. Epub 2010 Feb 24.
To evaluate the prevalence of concurrent endometrial carcinoma in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy.
We retrospectively analyzed the medical records of 126 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 1999 to 2008. AEH was initially diagnosed by dilatation and curettage (98 cases) or endometrial biopsy with a Z-sampler (24 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy.
In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 27% with AEH and normal proliferative phases found in 54.7 and 7.9% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (13/126, 10.3%). Eleven of 13 cases were confined to the endometrium and the remaining two were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy.
Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with a risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis. Treatment modalities may differ depending on population as the rates of concurrent endometrial cancer with AEH and myometrial invasion vary by geographical location.
评估通过子宫内膜活检诊断为不典型子宫内膜增生（AEH）的女性中同时存在子宫内膜癌的患病率。
我们回顾性分析了 1999 年至 2008 年间因子宫内膜活检诊断为 AEH 而行子宫切除术的 126 例患者的病历。AEH 最初通过扩张刮宫术（98 例）或 Z 采样器进行子宫内膜活检（24 例）诊断。其余 4 例通过宫腔镜息肉切除术诊断。子宫内膜活检的结果按等级量表进行分级，并与子宫切除术中获得的病理特征进行比较。
在术前通过活检诊断为 AEH 的患者中，子宫切除标本显示伴有不典型增生的单纯或复杂子宫内膜增生的发生率为 27%，伴有 AEH 的正常增殖期发生率分别为 54.7%和 7.9%。子宫内膜癌的发生率相当高（13/126，10.3%）。13 例中有 11 例局限于子宫内膜，其余 2 例位于无子宫肌层浸润的子宫腺肌病中。所有患有子宫内膜癌的患者在子宫切除术后均显示伴有同时存在的不典型复杂增生。
活检标本显示 AEH，特别是不典型复杂增生，与同时存在子宫内膜癌的风险相关。当考虑对活检诊断为 AEH 的女性的管理策略时，临床医生应考虑到相当高的并发子宫内膜癌率以及与病理诊断的差异。治疗方式可能因人群而异，因为 AEH 伴或不伴子宫肌层浸润的并发子宫内膜癌率因地理位置而异。
