Honda Michiko, Tsuchiya Akira, Isono Wataru, Takahashi Mikiko, Fujimoto Akihisa, Kawamoto Masashi, Nishii Osamu
Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan.
Department of Pathology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Japan.
Case Rep Oncol. 2018 May 29;11(2):311-317. doi: 10.1159/000489084. eCollection 2018 May-Aug.
In order to diagnose endometrial cancer preoperatively, outpatient endometrial biopsy with a curette is frequently performed owing to its convenience. However, in some cases, gynecologists fail to diagnose endometrial cancer via outpatient endometrial biopsy because of the cancer's distribution in the uterus and its consistency. A 57-year-old Japanese woman (gravida 4 para 4) presented with a 6-month history of light but intermittent postmenopausal vaginal bleeding. A malignant uterine tumor was strongly suspected after imaging using ultrasound examination and magnetic resonance imaging; however, a precise pathological diagnosis was not achieved despite multiple outpatient endometrial biopsies with the aid of office hysteroscopy. Based on an endometrial biopsy obtained using a cutting loop electrode on an 8.3-mm operative resectoscope, we reached a diagnosis of endophytic-type endometrial cancer, which is in accordance with the final pathological diagnosis after abdominal hysterectomy. Three months after her first visit to our hospital, total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic/para-aortic lymph node dissection were performed. Macroscopically, the endometrium was atrophic, and there was no obvious mass in the uterine cavity; however, microscopically, the cancer cells mainly existed in the deep myometrium and the final diagnosis was International Federation of Gynecology and Obstetrics (FIGO) stage IB endometrial cancer. Operative biopsy of the uterine endometrium and deep myometrium using hysteroscopy confirmed an accurate preoperative diagnosis of uterine endometrial cancer specifically of the endophytic type.
为了术前诊断子宫内膜癌，由于其操作方便，门诊常采用刮宫术进行子宫内膜活检。然而，在某些情况下，由于癌症在子宫内的分布及其质地，妇科医生无法通过门诊子宫内膜活检诊断出子宫内膜癌。一名57岁的日本女性（孕4产4）出现绝经后阴道少量但间歇性出血6个月。经超声检查和磁共振成像检查后，强烈怀疑存在恶性子宫肿瘤；然而，尽管在门诊宫腔镜辅助下进行了多次子宫内膜活检，仍未获得精确的病理诊断。基于在8.3毫米手术切除镜上使用切割环电极获取的子宫内膜活检结果，我们诊断为内生型子宫内膜癌，这与腹式子宫切除术后的最终病理诊断一致。在她首次就诊我院三个月后，进行了全腹子宫切除术、双侧输卵管卵巢切除术及盆腔/腹主动脉旁淋巴结清扫术。肉眼可见，子宫内膜萎缩，宫腔内无明显肿物；然而，显微镜下可见癌细胞主要存在于肌层深部，最终诊断为国际妇产科联盟（FIGO）ⅠB期子宫内膜癌。使用宫腔镜对子宫内膜和肌层深部进行手术活检证实了术前对子宫子宫内膜癌尤其是内生型的准确诊断。
