Lenci Marco Antonio, Nascimento Vanessa Alessandra Lui do, Grandini Ana Beatriz, Fahmy Walid Makin, Depes Daniella de Batista, Baracat Fausto Farah, Lopes Reginaldo Guedes Coelho
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Universidade Cidade de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2014 Jan-Mar;12(1):16-21. doi: 10.1590/s1679-45082014ao2764.
To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy.
The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm.
Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal.
Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.
评估接受宫腔镜息肉切除术患者子宫内膜息肉中癌前病变和癌症的发生率。
分析了1020例接受宫腔镜息肉切除术患者的病理检查结果，以及他们的诊断性和手术性宫腔镜检查结果。就月经状况而言，295例（28.9%）患者处于青春期。其中，193例（65.4%）出现异常子宫出血，102例（34.6%）无症状，但经阴道超声显示子宫内膜回声改变。在725例（71.1%）绝经后患者中，171例（23.6%）有症状（异常子宫出血），554例（76.4%）无症状，但子宫内膜回声>5.0mm。
21例（2.0%）患者息肉中存在癌前病变，13例为单纯性腺体增生，其中5例无异型性，8例有异型性。8个息肉出现复杂性增生灶：4例有异型性，4例无病变。5个（0.5%）息肉诊断为癌症。在21个存在癌前病变的息肉中，12个在诊断性和手术性宫腔镜检查中被判定为良性。在患有癌症的息肉中，4个在宫腔镜检查中也被判定为正常。
青春期有症状的息肉以及所有绝经后妇女的息肉均应切除并进行组织病理学检查，因为即使息肉存在细胞异型性区域或癌症，其外观可能仍为良性。
