Hu Yang, Al-Niaimi Ahmed N, Cagaanan Alain, Sadowski Elizabeth A, Kushner David M, Weisman Paul S, McGregor Stephanie M
University of Wisconsin-Madison Medical Scientist Training Program, USA.
University of Wisconsin-Madison Department of Obstetrics and Gynecology, USA.
Gynecol Oncol Rep. 2021 Mar 16;36:100747. doi: 10.1016/j.gore.2021.100747. eCollection 2021 May.
Progestin-based therapy is common for patients with endometrial neoplasia who desire fertility preservation, but some patients ultimately require surgery. Intraoperative assessment, which can use gross lesion size, may impact the extent of surgery performed. We sought to characterize the extent to which grossly identified lesions in the setting of progestin therapy correspond to microscopic findings.
Thirteen hysterectomy specimens with progestin-treated atypical hyperplasia or endometrioid carcinoma were identified. Clinicopathologic factors were collected by chart review. Slides were assessed for the extent to which decidualized stroma (DS) comprised grossly identified lesions and comparisons were drawn with tumor size, age, and menopausal status.
Mass lesions were described in 11 cases with a median of 4.5 cm (range 1-8.2) and the 2 cases without discrete masses had diffuse thickening. Two patients had only focal residual hyperplasia despite having mass lesions (7 & 2.2 cm). DS was more prominent in premenopausal patients (median 65%, range 10-90%) than in postmenopausal patients (median 18%, range 10-40%; p = 0.06). The distribution of DS throughout mass lesions was variable.
Large mass lesions following progestin therapy may histologically consist of DS with little to no residual neoplastic disease, such that perceived tumor size does not necessarily reflect extensive residual disease, especially in pre-menopausal patients. Intraoperative gross assessment alone may lead to unnecessary lymphadenectomy and/or oophorectomy, but this can potentially be prevented by using frozen section.
对于希望保留生育功能的子宫内膜肿瘤患者，基于孕激素的治疗很常见，但有些患者最终仍需要手术。术中评估可利用大体病变大小，这可能会影响所实施手术的范围。我们试图明确在孕激素治疗背景下大体识别出的病变与显微镜下所见相符的程度。
确定了13例经孕激素治疗的非典型增生或子宫内膜样癌的子宫切除标本。通过查阅病历收集临床病理因素。评估切片中蜕膜样间质（DS）构成大体识别出病变的程度，并与肿瘤大小、年龄和绝经状态进行比较。
11例描述有肿块病变，中位数为4.5厘米（范围1 - 8.2厘米），2例无离散肿块的病例有弥漫性增厚。2例尽管有肿块病变（7厘米和2.2厘米）但仅有局灶性残留增生。DS在绝经前患者中（中位数65%，范围10% - 90%）比绝经后患者中更显著（中位数18%，范围10% - 40%；p = 0.06）。DS在整个肿块病变中的分布是可变的。
孕激素治疗后的大肿块病变在组织学上可能由DS组成，几乎没有残留肿瘤性疾病，因此所感知的肿瘤大小不一定反映广泛的残留疾病，尤其是在绝经前患者中。仅术中大体评估可能导致不必要的淋巴结切除术和/或卵巢切除术，但这有可能通过使用冰冻切片来预防。
