Sone Kenbun, Eguchi Satoko, Asada Kayo, Inoue Futaba, Miyamoto Yuichiro, Tanikawa Michihiro, Tsuruga Tetsushi, Mori-Uchino Mayuyo, Matsumoto Yoko, Hiraike-Wada Osamu, Oda Katsutoshi, Osuga Yutaka, Fujii Tomoyuki
Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
Mol Clin Oncol. 2020 Aug;13(2):141-145. doi: 10.3892/mco.2020.2053. Epub 2020 May 27.
A diagnostic biopsy for endometrial cancer is performed via dilation and curettage (D&C). However, D&C may miss endometrial cancer lesions due to of its 'blind' approach. Hysteroscopy is a useful method that can be used to detect endometrial cancer lesions. In addition, office hysteroscopy is easy to be scheduled and does not require anesthesia. The patient was a 40-year-old woman with suspected endometrial cancer; however, it could not be diagnosed by D&C and biopsy using hysteroscopy during hospitalization. Office hysteroscopy during the proliferative phase indicated that the suspicious endometrial cancerous lesion was minimal at the isthmus of the uterus with atypical vessels and a white spot, for which biopsy was performed. Pathological diagnosis was endometrioid carcinoma with squamous differentiation, G1. Therefore, total laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were performed. In this case, it was difficult to detect minimal lesion in the secretory phase because the endometrial thickness hid the endometrial cancer. It is easy to perform office hysteroscopy in the proliferative phase. This case indicated that office hysteroscopy is a useful method to diagnose and perform biopsy for minimal lesions.
子宫内膜癌的诊断性活检通过刮宫术（D&C）进行。然而，由于其“盲目”操作方式，刮宫术可能会遗漏子宫内膜癌病变。宫腔镜检查是一种可用于检测子宫内膜癌病变的有用方法。此外，门诊宫腔镜检查易于安排，且无需麻醉。该患者为一名40岁疑似子宫内膜癌的女性；然而，住院期间通过刮宫术和宫腔镜活检均无法确诊。增殖期门诊宫腔镜检查显示，可疑的子宫内膜癌病变位于子宫峡部，表现为非典型血管和一个白色斑点，面积很小，遂在此处进行活检。病理诊断为伴有鳞状分化的子宫内膜样癌，G1级。因此，实施了全腹腔镜子宫切除术、双侧输卵管卵巢切除术和盆腔淋巴结清扫术。在这种情况下，由于子宫内膜厚度掩盖了子宫内膜癌，在分泌期很难检测到微小病变。在增殖期进行门诊宫腔镜检查很容易。该病例表明，门诊宫腔镜检查是诊断微小病变并进行活检的一种有用方法。
