El-Sharkawy Sonia L, Abbas Naglaa F, El-Henawy Ahmed M Y, Badawi Manal A El-Megeed, Yasseen Noha N
*Pathology Department, Medical Division, National Research Centre, Giza Governorate †Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
Appl Immunohistochem Mol Morphol. 2017 Jan;25(1):32-38. doi: 10.1097/PAI.0000000000000259.
Endometrial hyperplasia is believed to increase the risk of endometrial carcinoma and represents a spectrum of morphologic and biological alterations of endometrial glands and stroma ranging from an exaggerated physiological state to carcinoma in situ. Considering the overlap between the various entities, it is not surprising that the morphologic assessment of endometrial lesions is particularly challenging. This work aimed to evaluate endometrial lesions according to their nuclear and glandular morphometric parameters, their D score, and their DNA ploidy, which help in making an accurate diagnosis. In this study, 50 endometrial biopsy specimens were stained with hematoxylin and eosin for their histopathologic and morphometric study and Feulgen stain for DNA analysis. The cases were classified into 20 cases of simple hyperplasia, 10 cases of atypical hyperplasia, and 20 cases of endometrial carcinoma. Morphometric analysis of nuclear, glandular, and stromal parameters was performed using the Leica Qwin 500 image analysis system. In the studied cases, a significant difference was found in the mean values of the morphometrical parameters of endometrial lesions, including the nuclear area and the nuclear roundness, and all glandular measurements including their complexity, area, volume percentage of stroma, and D score were significantly different. The DNA index and diploid and aneuploid values could differentiate significantly between endometrial lesions. We conclude that nuclear morphometric evaluation of the hyperplastic and carcinomatous endometrium may be used as an ancillary technique in the diagnosis of atypical changes occurring in precancerous endometrial lesions. In addition, DNA and D score assessment may be a reproducible and accurate predictor of the outcome of endometrial hyperplasia and may add some objective criteria for the correct diagnosis of difficult cases.
子宫内膜增生被认为会增加子宫内膜癌的风险，它代表了子宫内膜腺体和间质从过度的生理状态到原位癌的一系列形态学和生物学改变。考虑到不同实体之间的重叠，子宫内膜病变的形态学评估具有特别的挑战性也就不足为奇了。这项工作旨在根据子宫内膜病变的细胞核和腺体形态计量参数、D值以及DNA倍体来评估这些病变，这有助于做出准确的诊断。在本研究中，50份子宫内膜活检标本用苏木精和伊红染色用于组织病理学和形态计量学研究，并用福尔根染色进行DNA分析。这些病例被分为20例单纯性增生、10例不典型增生和20例子宫内膜癌。使用徕卡Qwin 500图像分析系统对细胞核、腺体和间质参数进行形态计量分析。在所研究的病例中，发现子宫内膜病变的形态计量参数平均值存在显著差异，包括细胞核面积和核圆度，以及所有腺体测量值，包括其复杂性、面积、间质体积百分比和D值均有显著差异。DNA指数以及二倍体和非整倍体值在子宫内膜病变之间有显著差异。我们得出结论，增生性和癌性子宫内膜的细胞核形态计量评估可作为诊断子宫内膜癌前病变中非典型变化的辅助技术。此外，DNA和D值评估可能是子宫内膜增生预后的可重复且准确的预测指标，并可为疑难病例的正确诊断增加一些客观标准。
