Nagai Shimpei, Kitazawa Shoko, Shirane Terumi, Sera Asako, Fukutake Marie, Sakai Tomomi, Fujioka Yoko, Hino Makiko, Hattori Yoshihisa, Kurahashi Takashi
Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN.
Obstetrics and Gynecology, Keio University, Tokyo, JPN.
Cureus. 2025 Feb 28;17(2):e79856. doi: 10.7759/cureus.79856. eCollection 2025 Feb.
This study aimed to investigate the potential risk of a final pathological diagnosis of endometrial cancer in laparoscopic surgery for preoperatively diagnosed atypical endometrial hyperplasia (AEH), considering literature reports indicating a 40% coexistence rate of AEH with endometrial cancer.
A retrospective analysis was conducted on 17 patients with preoperative AEH undergoing laparoscopic surgery at our hospital. The median age was 50 (37-74) years, and the median body mass index (BMI) was 25.1 (16.9-44.3) kg/m. Surgical procedures included total hysterectomy and bilateral adnexectomy, accounting for the possible coexistence of endometrial cancer. Diagnostic methods comprised histological examination, dilatation and curettage, and pelvic MRI. Clinicopathological factors were thoroughly examined.
Postoperative diagnoses were AEH in 10 cases, atypical polypoid adenomyoma (APAM) in one case, and endometrial cancer in six cases. Comparison between the AEH group and the endometrial cancer group showed that the proportion of postmenopausal women was higher in the endometrial cancer group (33.3% vs. 66.7%), as was the presence of endometrial thickening on imaging (20% vs. 66.7%), although these differences were not statistically significant. However, patients in the endometrial cancer group were significantly older than those in the AEH group (median age: 59.5 vs. 47.5 years, = 0.02). All endometrial cancer cases were endometrioid carcinoma Grade 1, with five cases classified as FIGO (International Federation of Gynecology and Obstetrics) stage IA and one case as stage IB.
Despite nonsignificant differences in factors other than age, our study underscores the critical consideration of endometrial cancer during laparoscopic surgery for AEH, even with comprehensive preoperative examinations. This emphasizes the need for vigilant management strategies and heightened awareness of the surgical approach to AEH cases.
鉴于文献报道显示非典型子宫内膜增生（AEH）与子宫内膜癌的共存率为40%，本研究旨在调查术前诊断为AEH的患者在腹腔镜手术中最终病理诊断为子宫内膜癌的潜在风险。
对我院17例接受腹腔镜手术的术前AEH患者进行回顾性分析。中位年龄为50（37 - 74）岁，中位体重指数（BMI）为25.1（16.9 - 44.3）kg/m²。手术方式包括全子宫切除术和双侧附件切除术，以应对可能存在的子宫内膜癌共存情况。诊断方法包括组织学检查、刮宫术和盆腔磁共振成像（MRI）。对临床病理因素进行了全面检查。
术后诊断为AEH的有10例，非典型息肉样腺肌瘤（APAM）1例，子宫内膜癌6例。AEH组与子宫内膜癌组比较，子宫内膜癌组绝经后女性比例更高（33.3%对66.7%），影像学上子宫内膜增厚的情况也是如此（20%对66.7%），尽管这些差异无统计学意义。然而，子宫内膜癌组患者的年龄显著大于AEH组（中位年龄：59.5岁对47.5岁，P = 0.02）。所有子宫内膜癌病例均为子宫内膜样癌1级，5例为国际妇产科联盟（FIGO）IA期，1例为IB期。
尽管年龄以外的因素差异无统计学意义，但我们的研究强调，即使进行了全面的术前检查，在AEH的腹腔镜手术中仍需高度重视子宫内膜癌。这凸显了需要警惕的管理策略，并提高对AEH病例手术方法的认识。
