Obstetrics and Gynecology, Shinshu University Graduate School of Medicine School of Medicine, Matsumoto, Nagano, Japan.
Obstetrics and Gynecology, Shinshu University Graduate School of Medicine School of Medicine, Matsumoto, Nagano, Japan
Int J Gynecol Cancer. 2020 Oct;30(10):1480-1487. doi: 10.1136/ijgc-2020-001612. Epub 2020 Sep 3.
Although lobular endocervical glandular hyperplasia is a benign disorder of the uterine cervix, its potential as a precursor of minimal deviation adenocarcinoma has been reported. However, the natural history of the disease and the frequency of malignant change are not fully understood. We evaluated the frequency of malignant change of clinical lobular endocervical glandular hyperplasia and explored useful parameters indicating malignant change.
The clinical courses of 175 patients with cervical multi-cystic lesions who visited Shinshu University Hospital between June 1995 and June 2019 were retrospectively analyzed. We examined the results of follow-up and outcomes of the patients diagnosed with lobular endocervical glandular hyperplasia and investigated the frequency of malignant transformation.
Of the 175 patients, 15, 84, and 76 were clinically diagnosed with suspected malignancy, suspected lobular endocervical glandular hyperplasia, and suspected nabothian cyst, respectively. Of these patients, 69 patients with suspected lobular endocervical glandular hyperplasia were followed, and 12 underwent hysterectomy after a mean follow-up of 57.1 (range: 3-154) months due to lesion enlargement (increase in tumor diameter of >20%) and/or worsening cytology. Of these 12 patients, two had lobular endocervical glandular hyperplasia with atypia and one had minimal deviation adenocarcinoma. Of 69 patients, the rate of malignant change was 1.4% (1/69). The growth rates of the lesions for these three patients during follow-up were significantly higher than those of nine patients who underwent surgery with lobular endocervical glandular hyperplasia without atypia and 48 follow-up cases of suspected lobular endocervical glandular hyperplasia. The cut-off value of the growth rate suggesting malignant transformation was 38.1% (84.6% sensitivity and 100% specificity). Tumor size and cytology did not change in the remaining 57 cases continuing follow-up.
An increase in tumor size and worsening cytology are important parameters for detecting malignant transformation of lobular endocervical glandular hyperplasia during follow-up. However, the frequency of malignant change of this disease may be limited. These results suggest that conservative management may be an option for clinical lobular endocervical glandular hyperplasia.
虽然宫颈管腺样增生是一种良性的宫颈病变，但已有报道称其具有发展为低度恶性腺癌的潜能。然而，其疾病的自然史和恶变的频率尚不完全清楚。我们评估了宫颈多房性病变患者中临床宫颈管腺样增生的恶变频率，并探讨了有助于提示恶变的有用参数。
回顾性分析了 1995 年 6 月至 2019 年 6 月期间在信州大学医院就诊的 175 例宫颈多房性病变患者的临床病程。我们检查了这些患者的随访结果和结局，并对诊断为宫颈管腺样增生的患者进行了恶变频率的调查。
175 例患者中，分别有 15 例、84 例和 76 例被临床诊断为疑似恶性肿瘤、疑似宫颈管腺样增生和疑似纳博特囊肿。在这些患者中，对 69 例疑似宫颈管腺样增生的患者进行了随访，其中 12 例因病变增大（肿瘤直径增加>20%）和/或细胞学恶化，在平均随访 57.1 个月（范围：3-154 个月）后接受了子宫切除术。这 12 例患者中，2 例为宫颈管腺样增生伴不典型增生，1 例为低度恶性腺癌。在 69 例患者中，恶变率为 1.4%（1/69）。这 3 例患者在随访过程中的病变生长速度明显高于 9 例手术切除伴不典型增生的宫颈管腺样增生患者和 48 例疑似宫颈管腺样增生的随访病例。提示恶变的生长速度截断值为 38.1%（84.6%的敏感性和 100%的特异性）。其余 57 例继续随访的患者肿瘤大小和细胞学均无变化。
肿瘤大小增加和细胞学恶化是随访中检测宫颈管腺样增生恶变的重要参数。然而，该疾病的恶变频率可能有限。这些结果表明，对于临床宫颈管腺样增生，保守治疗可能是一种选择。
