Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
Department of Obstetrics and Gynaecology, University of Manchester and St. Mary's Hospital, Manchester M13 9WL, UK.
Medicina (Kaunas). 2019 Aug 28;55(9):543. doi: 10.3390/medicina55090543.
Endometrial polyps in asymptomatic postmenopausal women are often incidentally found, yet only 1.51% of them are malignant. Their potential for malignant transformation has not been adequately addressed. The aim of this study was to investigate the proliferation within endometrial polyps as one of the indicators of their malignization potential in asymptomatic postmenopausal women. Immunohistochemical studies of Ki-67 were performed. Cases included 52 benign postmenopausal polyps, 19 endometrioid carcinoma with coexisting benign polyps, 12 polyps with foci of carcinoma and 4 cases of polyps, which later developed carcinoma. The control group included 31 atrophic endometria and 32 benign premenopausal polyps. Ki-67 was scored in either 10 or 20 "hot spot" fields, as percentage of positively stained cells. Results: The median epithelial Ki-67 score in postmenopausal benign polyps (4.7%) was significantly higher than in atrophic endometria (2.41%, < 0.0001) and significantly lower than in premenopausal benign polyps (11.4%, = 0.003) and endometrial cancer (8.3%, < 0.0001). Where endometrial polyps were found in association with endometrial carcinoma, Ki-67 was significantly higher in cancer ( < 0.0001). No significant difference was found between Ki-67 scores of cancer focus and of the polyps tissue itself, respectively 2.8% and 4.55%, = 0.37. Ki-67 expression, where polyps were resected and women later developed cancer, was not significantly different ( = 0.199). Conclusion: Polyps from asymptomatic postmenopausal women showed significantly more proliferation in both epithelial and stromal components than inactive atrophic endometria but less than premenopausal benign polyps and/or endometrial cancer. Benign postmenopausal endometrial polyps exhibit low proliferative activity, suggesting low malignant potential and may not require resection in asymptomatic women.
无症状绝经后妇女的子宫内膜息肉常为偶然发现，但其中仅有 1.51%为恶性。它们恶变的潜在风险尚未得到充分重视。本研究旨在探讨无症状绝经后妇女子宫内膜息肉中的增殖情况，作为其恶变潜能的指标之一。进行了 Ki-67 的免疫组织化学研究。病例包括 52 例良性绝经后息肉、19 例伴良性息肉的子宫内膜样癌、12 例有癌灶的息肉和 4 例息肉后发展为癌的病例。对照组包括 31 例萎缩性子宫内膜和 32 例良性绝经前息肉。Ki-67 以阳性染色细胞的百分比在 10 或 20 个“热点”视野中评分。结果：绝经后良性息肉的上皮 Ki-67 评分中位数（4.7%）明显高于萎缩性子宫内膜（2.41%，<0.0001），明显低于绝经前良性息肉（11.4%，=0.003）和子宫内膜癌（8.3%，<0.0001）。在子宫内膜息肉与子宫内膜癌并存的情况下，癌症中的 Ki-67 明显更高（<0.0001）。癌症组织中的 Ki-67 评分（2.8%）与息肉组织本身的 Ki-67 评分（4.55%）之间无显著差异（=0.37）。切除息肉后妇女后来发生癌症的 Ki-67 表达无显著差异（=0.199）。结论：无症状绝经后妇女的息肉上皮和间质成分的增殖均明显高于无活性的萎缩性子宫内膜，但低于绝经前良性息肉和/或子宫内膜癌。良性绝经后子宫内膜息肉增殖活性低，提示恶变潜能低，在无症状妇女中可能无需切除。
