Tesadüfen Tanı Konulan Endometrium Kanserinin Yönetimi: Tek Merkez Bir Deneyimi

Öz

Amaç: Bu çalışma, benign nedenlerle histerektomi uygulanan hastalarda tesadüfi olarak tanı alan en-dometrium kanserli olguların klinik özelliklerini ve tedavi yöntemlerini değerlendirmeyi amaçlamaktadır. Materyal ve Metod: Bu retrospektif çalışmada, 15 Ekim 2023 – 15 Ekim 2024 tarihleri arasında benign endikasyonlarla histerektomi sonrası tesadüfen endometrium kanseri tanısı alarak jinekolojik onkoloji kliniğimize yönlendirilen hastaların verileri incelenmiştir. Klinik, patolojik ve cerrahi veriler hastane kayıtlarından elde edilmiş; tanımlayıcı istatistikler ile karşılaştırmalı analizler SPSS 29 programı kullanılarak gerçekleştirilmiştir. Bulgular: Çalışmaya toplam 57 hasta dâhil edildi. Ortalama yaş 53,9 ± 8,2 yıl olup, hastaların %57,9’u postmenopozal dönemdeydi. En sık rastlanan histolojik alt tip %94,7 oranıyla endometrioid tip idi ve olguların %86,0’ında yüzeyel myometriyal invazyon mevcuttu. Preoperatif endometrial örnekleme hastaların %28,1’inde yapılmamıştı. Hastaların %28,1’ine tamamlayıcı cerrahi müdahale planlanırken, %71,9’u konservatif olarak yakın takip ile yönetildi. Patoloji blok revizyonu, jinekolojik onkoloji alanın-da deneyimi olmayan merkezlerde değerlendirilen 15 hastada, tanısal doğruluğu sağlamak amacıyla gerçekleştirilmiştir. Uzman patoloji incelemesi sonucunda bu hastaların 8’inde (%53,3) tanıda değişiklik saptanmıştır. Grade 2–3 tümörlerde derin invazyon, lenvovasküler alan invazyonu ve cerrahi gereksini-mi anlamlı olarak daha yüksek bulundu (p<0,05). Sonuç: Tesadüfen tanı konulan endometrium kanseri olgularında multidisipliner ve risk temelli bir yaklaşım gereklidir. Bu çalışma, özellikle jinekolojik onkoloji deneyimi olmayan merkezlerde raporlanan olgular için yapılan patoloji blok revizyonunun, tedavi kararlarını yönlendirmede önemli katkı sağladığı-nı göstermektedir. Düşük riskli hastalarda konservatif takip güvenli bir seçenek olabilirken, yüksek riskli olgularda zamanında tamamlayıcı cerrahi ve adjuvan tedavi uygulamaları hayati önemdedir.

Anahtar Kelimeler

• Histerektomi
• Endometrial Kanser
• İnsidental
• Takip
• Yönetim

Management of Incidentally Diagnosed Endometrial Cancer: A Single-Center Experience

Öz

Background: The objective of this study is to evaluate the clinical features and management strategies of patients diagnosed with endometrial cancer incidentally following hysterectomy performed for benign indications. Materials and Methods: This retrospective cohort study collected data from patients referred to our gynecologic oncology clinic between 15 October 2023 and 15 October 2024, following an incidental diagnosis of endometrial cancer. It should be noted that all patients had previously undergone hysterectomy for non-malignant indications. Clinical, pathological, and surgical data were retrieved from institutional records. Descriptive statistics and comparative analyses were performed using SPSS version 29. Results: The study population comprised a total of 57 patients. The mean age was 53.9 ± 8.2 years, and 57.9% were postmenopausal. The most prevalent histological subtype was endometrioid (94.7%), and 86.0% of tumours exhibited superficial myometrial invasion. Preoperative endometrial sampling was absent in 28.1% of cases. Frozen section analysis was not requested intraoperatively in 26.3% of cases. Surgical re-intervention was planned in 28.1% of patients, while 71.9% were managed conservatively with close follow-up. Block revision of pathology slides resulted in changes to diagnoses in over half of the reviewed cases. Furthermore, a statistically significant association was identified between Grade 2–3 tumours and higher rates of deep invasion, LVSI, and the necessity for further surgery (p < 0.05). Conclusion: Incidentally diagnosed endometrial cancer poses significant clinical challenges, particularly in determining optimal staging and adjuvant treatment. A multidisciplinary and individualised approach is crucial. The revision of pathology reports by an expert pathologist in the field of gynecology, in conjunction with risk-based decision-making processes, is of paramount importance in the enhancement of outcomes. The primary objective of management should be to avoid overtreatment in low-risk patients and to provide adequate intervention in high-risk cases.

Anahtar Kelimeler

• Hysterectomy
• Endometrial Cancer
• Incidental
• Follow-Up
• Management

Kaynakça

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