Taşkın Salih, Kan Özgür, Dai Ömer, Taşkın Elif A, Koyuncu Kazibe, Alkılıç Ayşegül, Güngör Mete, Ortaç Fırat
Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
Department of Obstetrics and Gynecology, Losante Hospital, Ankara, Turkey.
J Turk Ger Gynecol Assoc. 2017 Sep 1;18(3):127-132. doi: 10.4274/jtgga.2017.0043.
The rate of concomitant endometrial carcinoma in patients with atypical endometrial hyperplasia is high. We aimed to investigate the role of lymphadenectomy in deciding adjuvant treatment in patients with concomitant atypical endometrial hyperplasia and endometrial carcinoma.
Women with atypical endometrial hyperplasia were enrolled in this retrospective study. Lymph node dissection was performed in only some patients who gave informed consent if their surgeon elected to do so, or if the intraoperative findings necessitated. The final histopathologic evaluations of surgical specimens were compared with endometrial biopsy results.
Eighty eligible patients were evaluated. Seventy-two (90%) patients had complex hyperplasia with atypia, and 8 (10%) patients had simple hyperplasia with atypia. Hysterectomy and bilateral salpingo-oophorectomy were performed to all patients; 37 also underwent lymph node dissection. Lymph node dissection was extended to the paraaortic region in 9 of 37 patients. The concomitant endometrial carcinoma rate was 50%. Two patients had lymph node metastasis. Among 40 cases of carcinoma, 17 had deep myometrial invasion and/or cervical or ovarian involvement or grade 2 tumors with superficial myometrial invasion on hysterectomy specimens; 27.5% of all carcinomas were stage Ib or higher.
The concomitant endometrial carcinoma rate was high in patients with atypical endometrial hyperplasia. Nearly half of these patients had risk factors for extrauterine spread. Lymph node dissection might be helpful to decide adjuvant treatment.
非典型子宫内膜增生患者中子宫内膜癌的并发率较高。我们旨在研究淋巴结切除术在伴有非典型子宫内膜增生和子宫内膜癌患者辅助治疗决策中的作用。
本回顾性研究纳入了患有非典型子宫内膜增生的女性。仅在部分获得知情同意的患者中进行淋巴结清扫，这些患者由其外科医生决定是否进行清扫，或者术中发现有必要时进行清扫。将手术标本的最终组织病理学评估结果与子宫内膜活检结果进行比较。
对80例符合条件的患者进行了评估。72例（90%）患者为复杂性不典型增生，8例（10%）患者为单纯性不典型增生。所有患者均接受了子宫切除术和双侧输卵管卵巢切除术；37例还进行了淋巴结清扫。37例患者中有9例将淋巴结清扫范围扩大至腹主动脉旁区域。子宫内膜癌并发率为50%。2例患者有淋巴结转移。在40例癌症病例中，17例在子宫切除标本上有肌层深部浸润和/或宫颈或卵巢受累，或为浅表肌层浸润的2级肿瘤；所有癌症中有27.5%为Ib期或更高分期。
非典型子宫内膜增生患者中子宫内膜癌并发率较高。这些患者中近一半有子宫外扩散的危险因素。淋巴结清扫可能有助于决定辅助治疗。
