ENDOMETRİAL HİPERPLAZİLİ HASTALARDA EŞ ZAMANLI ENDOMETRİAL KANSER GÖRÜLMESİNİN DEGERLENDİRİLMESİ;ÜÇÜNCÜ BASAMAK HASTANE OLARAK 10 YILLIK DENEYİMİMİZ
Abstract
ÖZET
Amaç: Cerrahi tedavi uygulanan endometrial hiperplazili hastalarda eş
zamanlı endometrial kanser insidansını belirlemeyi amaçladık.
Gereç ve yöntem: Çalışmamız retrospektif olarak dizayn edildi. 2007 - 2017
yılları arasında Eskişehir Osmangazi Üniversitesi (ESOGÜ) jinekolojik Onkoloji
bölümünde endometrial biyopsi ile endometrial hiperplazi (EH) tanısı alan ve
cerrahi tedavi uygulanan hastaların tıbbi kayıtları incelenerek çalışma
oluşturuldu. Endometrial örnekleme sonucu endometrial hiperplazili 522 hastanın
verileri değerlendirildi. 187 hasta medikal tedavi uygulandığı için, 35 hasta
tıbbi kayıtları yetersiz olduğu için ve
15 hasta endometrial kanser şüphesi olduğu için çalışma dışı bırakıldı.
Çalışmaya endometrial hiperplazili 285 hasta dahil edildi.
Bulgular: Çalışmaya alınan 285 hastanın 64'ü (% 22.4) basit hiperplazi, 31'i (%
10.8) basit atipili hiperplazi, 72'si (% 25.2) kompleks hiperplazi ve 118'i (%
41.4) kompleks atipili hiperplazi idi. Histerektomi spesmenlerinin
incelenmesiyle 84 (% 29.4) hastada endometrial patoloji izlenmezken , 36
hastada (% 12.6) endometrial kanser, 165 hastada (% 57.8) endometrial
hiperplazi bulduk. Basit hiperplazide 1 (% 1,5) hastada endometrial kanser
bulduk.Basit atipili hiperplazide 1 (% 3,2) hastada endometrial kanser tespit
edildi. Kompleks hiperplazide 6 hastada
(% 8.3) endometrial kanser vardı. Kopleks atipili hiperplazide 28 (% 23,7) hastada endometrial kanser tespit edildi. 2014 Dünya
Sağlık Örgütü sınıflandırma sistemine göre, eş zamanlı endometrial kanser
oranları atipili endometrial hiperplazide
% 19.4, atipi olmayan endometrial hiperplazide % 5.1 olarak tespit
edildi.
Sonuç: Basit hiperplazide eşzamanlı
endometrial kanser oranı% 5.1, bu oran kompleks hiperplazide % 8,3 olarak
bulundu. Atipi olmayan endometrial hiperplazili hastaların tedavisinde medikal tedavi seçilecekse bu oranlar göz önünde bulundurulmalıdır.Endometrial
hiperplazi yönetiminde endometrial
kanser için tüm risk faktörlerinin detaylı değerlendirilmesi önerilir.
References
- 1. Lacey JV Jr, Sherman ME, Rush BB, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28:788.2. Emons G, Beckmann MW, Schmidt D, et al. New WHO Classification of Endometrial Hyperplasias. Geburtshilfe Frauenheilkd 2015; 75:135.3. R.E.Scully,T.A. Bonfiglio,Kurman,et al.,Uterine corpus,Histological Typing of Female Genital Tract Tumors, second ed, Springer-verlag,NewYork,1994,p.134. C.L. Trimble, J. Kauderer, R. Zaino, S. Silverberg, P.C. Lim, J.J. Burke 2nd, et al., Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study, Cancer 106 (2006) 812–819.5. Kurman RJ, Norris HJ. Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. Cancer 1982;49:2547–59.6. Widra EA, Dunton CJ, McHugh M, Palazzo JP. Endometrial hyperplasia and the risk of carcinoma. Int J Gynecol Cancer 1995;5:233–5. 7. Antonsen SL,Ulrich L and Hogdall C: Patients with atypical hyperplasia of endometrium should be treated in oncolojical centers.Gynecol Oncol 125:124-128,20128. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87.9. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66:7.10. http://seer.cancer.gov/statfacts/html/corp.html (Accessed on June 06, 2016).11. Elshaikh MA, Munkarah AR, Robbins JR, et al. The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma. Gynecol Oncol 2013; 128:171.12. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10.13. Hedrick Ellenson L, Ronnett BM, Kurman RJ. Precursor Lesions of Endometrial Carcinoma. In: Blaustein's Pathology of the Female Genital Tract, 6th ed, Kurman RJ, Hedrick Ellenson L, Ronnett, BM (Eds), Springer, New York 2010. p.360-361.14. Cyrıl Touboul, Bruno Pıel, Martın Koskas et al: Factors Predictive of Endometrial Carcinoma in Patients with Atypical Endometrial Hyperplasia on Preoperative Histology: Antıcanser Research 34: 5671-5676 (2014)15. Filip Kisielewski, Małgorzata Ewa Gajewska, Maja Janina Marczewska et all. Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer.Ginekologia Polska 2016; 87, 7: 488–49216. Baki Erdema, Osman Aşıcıoğlua, Niyazi Alper Seyhana et all. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? International Journal of Surgery 53 (2018) 350–35317. Koji Matsuo a,f, Amin A. Ramzana, Marc R. Gualtieri b et all. Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasiaGynecologic Oncology 139 (2015) 261–26718. Y.L. Chen, W.F. Cheng, M.C. Lin, C.Y. Huang, C.Y. Hsieh, C.A. Chen Concurrent endometrial carcinoma in patients with a curettage diagnosis of endometrial hyperplasiab J Formos Med Assoc, 108 (6) (Jun 2009), pp. 502-50719. Allison KH, Reed SD, Voigt LF, et al. Diagnosing endometrial hyperplasia: why is it so difficult to agree? Am J Surg Pathol 2008; 32:691.20. Mutter GL, Kauderer J, Baak JP, Alberts D; Gynecologic Oncology Group. Biopsy histomorphometry predicts uterine myoinvasion by endometrial carcinoma: a Gynecologic Oncology Group study. Hum. Pathol. 2008; 39; 866–874.21. Pavlakis K, Messini I, Vrekoussis T et al. PTEN-loss and nuclear atypia of EIN in endometrial biopsies can predict the existence of a concurrent endometrial carcinoma. Gynecol. Oncol. 2010; 119; 516–519.22. Salman MC, Usubutun A, Boynukalin K, Yuce K. Comparison of WHO and endometrial intraepithelial neoplasia classifications in predicting the presence of coexistent malignancy in endometrial hyperplasia. J. Gynecol. Oncol. 2010; 21; 97–101.23. Chen YL, Wang KL, Chen MY et al. Risk factor analysis of coexisting endometrial carcinoma in patients with endometrial hyperplasia: a retrospective observational study of Taiwanese Gynecologic Oncology Group. J. Gynecol. Oncol. 2013; 24; 14–20.24. Dolanbay M, Kutuk MS, Uludag S et al. Concurrent endometrial carcinoma in hysterectomy specimens in patients with histopathological diagnosis of endometrial hyperplasia in curettage specimens. Ginekol. Pol. 2015; 86; 753–758.25. Kadirogullari P, Atalay CR, Ozdemir O, Sari ME. Prevalence of co-existing endometrial carcinoma in patients with preoperative diagnosis of endometrial hyperplasia. J. Clin. Diagn. Res. 2015; 9; QC10–QC14.26. Boyraz G, Bas_aran D, Salman MC, €Ozg€ul N, Y€uce K. Does preoperative diagnosis of endometrial hyperplasia necessitate intraoperative frozen section consultation? Balkan Med. J. 2016; 33; 657–661.27. Yang YF, Liao YY, Peng NF, Li LQ, Xie SR, Wang RB. Prediction of coexistent carcinomas risks by subjective EIN diagnosis and comparison with WHO classification in endometrial hyperplasias. Pathol. Res. Pract. 2012; 208; 708–712.28. Hikmet Hassa, H. Mete. Tanir ,Tanser senses et all. Related factors in bone mineral density of lumbal and femur in natural postmenopausal women. Archives of Gynecology and Obstetrics December 2005, Volume 273, Issue 2, pp 86–8929. Reed SD, Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009; 200:678.e1.30. Jın-sung yuk.the incidence rates of endometrial hyperplasia and endometrial cancer:a four-year population-based study.Peerj4:e2374;doi 10.771731. Ørbo A, Moe BT, Arnes M et al. Prognostic markers for detection of coexistent carcinoma in high-risk endometrial hyperplasia. Anticancer Res. 2010; 30; 4649–4655.
EVALUATION OF CONCURRENT ENDOMETRİAL CANCSER İN PATİENTS WİTH ENDOMETRIAL HYPERPLASIA; 10 YEARS EXPERIENCE AS A TERTİARY CENTER
Abstract
ABSTRACT
Objective: we aimed to determine the incidence of simultaneous endometrial cancer
in patients with endometrial hyperplasia who underwent surgical treatment.
Material
and method: Our study
was designed retrospectively.The medical data of patients who was
diagnosed endometrial hyperplasia(EH) by
the endometrial biopsy and accepted surgical treatment were examined and collected between 2007 -
2017 at the gynecologic oncology depertmant of Eskişehir Osmangazi University(ESOGÜ).
The data of 522 patients with endometrial hyperplasia as a result of endometrial
sampling were evaluated. Due to 187 patients received medical
treatment, 35 patients lacked medical data and 15 patients suspected endometrial CA were excluded from the study.
A
total of 285 patients with endometrial hyperplasia were included in the study.
Result:
Of the 285 patients included in the study, 64 (22.4%) were simple hyperplasia,
31 (10.8%) were simple atypia hyperplasia, 72 (25.2%) were complex hyperplasia
and 118 (41.4%) were complex atypia hyperplasia. Endometrial
hyperplasia could not be detected in 84 (29.4%) patients after a final
pathology. We found endometrial cancer in 36 (12.6%) patients
and endometrial hyperplasia in 165 (57.8%) patients. We found 1 (1.5%) patient
EC in simple hyperplasia. EC was detected in 1 (3.2%) patient in SAH. 6
patients (8.3%) had EC in CH. 28 (23.7%) EC’s were detected in patients with
CAH. According to the 2014 WHO classification system
,Concurrent endometrial cancer rates were determined as AEH 19.4% and EH without atypia was 5.1%.
Conclusion: Concurrent EC ratio in simple hyperplasia was
5.1% this rate was found to be 8.3 % in
CH. Management of patients with endometrial
hyperplasia without atypia If medical treatment is to be chosen, these rates
should be considered and it is recommended to consider all risk factors for EC.
References
- 1. Lacey JV Jr, Sherman ME, Rush BB, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28:788.2. Emons G, Beckmann MW, Schmidt D, et al. New WHO Classification of Endometrial Hyperplasias. Geburtshilfe Frauenheilkd 2015; 75:135.3. R.E.Scully,T.A. Bonfiglio,Kurman,et al.,Uterine corpus,Histological Typing of Female Genital Tract Tumors, second ed, Springer-verlag,NewYork,1994,p.134. C.L. Trimble, J. Kauderer, R. Zaino, S. Silverberg, P.C. Lim, J.J. Burke 2nd, et al., Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study, Cancer 106 (2006) 812–819.5. Kurman RJ, Norris HJ. Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. Cancer 1982;49:2547–59.6. Widra EA, Dunton CJ, McHugh M, Palazzo JP. Endometrial hyperplasia and the risk of carcinoma. Int J Gynecol Cancer 1995;5:233–5. 7. Antonsen SL,Ulrich L and Hogdall C: Patients with atypical hyperplasia of endometrium should be treated in oncolojical centers.Gynecol Oncol 125:124-128,20128. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87.9. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66:7.10. http://seer.cancer.gov/statfacts/html/corp.html (Accessed on June 06, 2016).11. Elshaikh MA, Munkarah AR, Robbins JR, et al. The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma. Gynecol Oncol 2013; 128:171.12. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10.13. Hedrick Ellenson L, Ronnett BM, Kurman RJ. Precursor Lesions of Endometrial Carcinoma. In: Blaustein's Pathology of the Female Genital Tract, 6th ed, Kurman RJ, Hedrick Ellenson L, Ronnett, BM (Eds), Springer, New York 2010. p.360-361.14. Cyrıl Touboul, Bruno Pıel, Martın Koskas et al: Factors Predictive of Endometrial Carcinoma in Patients with Atypical Endometrial Hyperplasia on Preoperative Histology: Antıcanser Research 34: 5671-5676 (2014)15. Filip Kisielewski, Małgorzata Ewa Gajewska, Maja Janina Marczewska et all. Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer.Ginekologia Polska 2016; 87, 7: 488–49216. Baki Erdema, Osman Aşıcıoğlua, Niyazi Alper Seyhana et all. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? International Journal of Surgery 53 (2018) 350–35317. Koji Matsuo a,f, Amin A. Ramzana, Marc R. Gualtieri b et all. Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasiaGynecologic Oncology 139 (2015) 261–26718. Y.L. Chen, W.F. Cheng, M.C. Lin, C.Y. Huang, C.Y. Hsieh, C.A. Chen Concurrent endometrial carcinoma in patients with a curettage diagnosis of endometrial hyperplasiab J Formos Med Assoc, 108 (6) (Jun 2009), pp. 502-50719. Allison KH, Reed SD, Voigt LF, et al. Diagnosing endometrial hyperplasia: why is it so difficult to agree? Am J Surg Pathol 2008; 32:691.20. Mutter GL, Kauderer J, Baak JP, Alberts D; Gynecologic Oncology Group. Biopsy histomorphometry predicts uterine myoinvasion by endometrial carcinoma: a Gynecologic Oncology Group study. Hum. Pathol. 2008; 39; 866–874.21. Pavlakis K, Messini I, Vrekoussis T et al. PTEN-loss and nuclear atypia of EIN in endometrial biopsies can predict the existence of a concurrent endometrial carcinoma. Gynecol. Oncol. 2010; 119; 516–519.22. Salman MC, Usubutun A, Boynukalin K, Yuce K. Comparison of WHO and endometrial intraepithelial neoplasia classifications in predicting the presence of coexistent malignancy in endometrial hyperplasia. J. Gynecol. Oncol. 2010; 21; 97–101.23. Chen YL, Wang KL, Chen MY et al. Risk factor analysis of coexisting endometrial carcinoma in patients with endometrial hyperplasia: a retrospective observational study of Taiwanese Gynecologic Oncology Group. J. Gynecol. Oncol. 2013; 24; 14–20.24. Dolanbay M, Kutuk MS, Uludag S et al. Concurrent endometrial carcinoma in hysterectomy specimens in patients with histopathological diagnosis of endometrial hyperplasia in curettage specimens. Ginekol. Pol. 2015; 86; 753–758.25. Kadirogullari P, Atalay CR, Ozdemir O, Sari ME. Prevalence of co-existing endometrial carcinoma in patients with preoperative diagnosis of endometrial hyperplasia. J. Clin. Diagn. Res. 2015; 9; QC10–QC14.26. Boyraz G, Bas_aran D, Salman MC, €Ozg€ul N, Y€uce K. Does preoperative diagnosis of endometrial hyperplasia necessitate intraoperative frozen section consultation? Balkan Med. J. 2016; 33; 657–661.27. Yang YF, Liao YY, Peng NF, Li LQ, Xie SR, Wang RB. Prediction of coexistent carcinomas risks by subjective EIN diagnosis and comparison with WHO classification in endometrial hyperplasias. Pathol. Res. Pract. 2012; 208; 708–712.28. Hikmet Hassa, H. Mete. Tanir ,Tanser senses et all. Related factors in bone mineral density of lumbal and femur in natural postmenopausal women. Archives of Gynecology and Obstetrics December 2005, Volume 273, Issue 2, pp 86–8929. Reed SD, Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009; 200:678.e1.30. Jın-sung yuk.the incidence rates of endometrial hyperplasia and endometrial cancer:a four-year population-based study.Peerj4:e2374;doi 10.771731. Ørbo A, Moe BT, Arnes M et al. Prognostic markers for detection of coexistent carcinoma in high-risk endometrial hyperplasia. Anticancer Res. 2010; 30; 4649–4655.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | December 15, 2019 |
| Published in Issue | Year 2019 Volume: 50 Issue: 4 |
