Which surgical procedure for patients with atypical endometrial hyperplasia?

OBJECTIVE: To determine the occult coexistence of endometrial carcinoma in patients with atypical endometrial hyperplasia and to compare histological prognostic factors according to lymph node status in occult endometrial carcinoma. MATERIALS AND METHODS: Two hundred and four patients from two referral centers (during the period 1990-2003) who were operated on within 1 month of endometrial biopsy for symptomatic endometrial hyperplasia without receiving any medical treatment were included retrospectively. Patients having preoperative endometrial biopsy results of concomitant endometrial hyperplasia and carcinoma were excluded from the study. Fifty-six patients having atypia in preoperative biopsy (group I) were compared with 148 patients without atypia (group II). Chi-square and Mann-Whitney U-tests were used for statistical analyses. RESULTS: No significant difference was observed between the two groups according to age or menopausal status. Patients in group II had significantly higher parity than patients in group I. In group I, 62.5% of the patients had endometrial carcinoma, 21.4% had endometrial hyperplasia, and 16.1% had normal endometrium in hysterectomy specimens. In group II, the percentages were 5.4, 38.5, and 56.1%, respectively. Complete surgical staging was performed in 20 patients. Four patients had metastatic lymph nodes. All of them had grade 2 tumors with lymphovascular space involvement. Three of them had nonendometrioid tumors. CONCLUSION: Careful intraoperative and preoperative evaluation of the endometrium must be the sine qua non for patients with atypical endometrial hyperplasia. It is reasonable to do frozen section at the time of hysterectomy for atypical endometrial hyperplasia, and if grade 2/3 of nonendometrioid cancer with lymphovascular space involvement is found, complete surgical staging should be performed.     

两种类型子宫内膜癌的血管生成研究

目的 :研究两种类型 (伴有内膜过度增生和不伴有内膜过度增生 )内膜癌血管生成的差别。方法 :诊刮或子宫切除内膜癌标本 94份 ,用LSAB免疫组化法以CD34标记血管内皮细胞计数微血管密度 (MVD) ,检测并比较碱性成纤维细胞生长因子 (FGF - 2 )在两种不同类型内膜癌中的表达。结果 :37份 (39.4 % )在内膜癌邻近部位有内膜过度增生。在有过度增生型内膜癌中 ,MVD低 (≤ 6 0 / 2 0 0倍光镜 )的例数所占比例 (70 .3% )多于无过度增生型 (42 .1% ) (P <0 .0 1)。FGF - 2阳性率在有过度增生的内膜癌组 (43.2 % )低于无过度增生组 (6 4 .9% ) (P <0 .0 5 )。FGF - 2阳性组的平均MVD(6 1.2 9± 6 .38)高于FGF - 2阴性组 (5 8.6 4± 5 .17) (P <0 .0 5 )。结论 :无子宫内膜过度增生的内膜癌患者血管生成增加 ,而FGF - 2有促进内膜癌血管生成的作用     

Normal endometrial cells in Papanicolaou smears: prevalence in women with and without endometrial disease

OBJECTIVE: To determine whether the prevalence of normal endometrial cells in Papanicolaou smears of women with and those without endometrial carcinoma or hyperplasia differs significantly. METHODS: Papanicolaou smears of women with biopsy-proved endometrial hyperplasia or carcinoma diagnosed between 1990 and 1998 were reviewed for the presence of normal endometrial cells. Chi-square and a power analysis were used to compare these smears with results of smears from women older than 35 years of age with tissue diagnoses other than hyperplasia or carcinoma. All Papanicolaou smears obtained within the 5 years before endometrial sampling were reviewed. Each patient had at least one smear done within the previous 12 months. Clinical information was available for all patients. RESULTS: Of the 201 women in whom endometrial hyperplasia (n = 103) or carcinoma (n = 98) was diagnosed, 4 (2%) had normal endometrial cells in otherwise negative Papanicolaou smears. Of the 289 women in the comparison group, 15 (5%) had normal endometrial cells in their Papanicolaou smears. The prevalence of normal endometrial cells did not differ significantly between the two groups (P =.071). The study had 80% power to detect a 5% or greater difference between groups. CONCLUSION: The prevalence of normal endometrial cells in Papanicolaou smears of women with endometrial carcinoma or hyperplasia does not significantly differ from that in women without these conditions. Reporting normal endometrial cells in Papanicolaou smears according to the recommendations of the Bethesda System may lead to unnecessary procedures and patient anxiety.     

45岁以下子宫内膜癌患者的临床分析

目的　总结 45岁以下子宫内膜癌患者的临床特点。方法　回顾性分析北京协和医院52例 45岁以下子宫内膜癌患者的临床资料 ,并将其分为≤ 3 5岁年龄组 (A组 ,17例 )与 3 5～ 45岁年龄组 (B组 ,3 5例 )进行比较分析。结果　 45岁以下内膜癌患者占内膜癌总数的 12 7% ,随年龄的增加 ,发病人数有增加的趋势 ,约 50 %的患者合并未产、不育、月经失调、子宫内膜增生 ,2 9%合并肥胖 ,2 3 %合并多囊卵巢 ,其中A组合并多囊卵巢的比例为 53 % ,合并内膜不典型增生的比例为 59% ,较B组明显增高 (分别为 9%、2 6% ) ,差异有显著性 (P <0 0 5)。按国际妇产科联盟 (FIGO)标准手术病理分期Ⅰ期占 82 % ,其中A组均为Ⅰ期子宫内膜样腺癌 ;B组有高危因素的患者比例占 2 6% ,但除了分期有升高的趋势 (P <0 0 5)外 ,其余差异均无显著性 (P >0 0 5)。治疗以手术为主 ,另有 2例患者采用孕激素治疗保留生育功能 ,获得缓解。 2例复发。结论　 45岁以下子宫内膜癌患者多合并不育、月经失调、内膜增生、肥胖、多囊卵巢 ,表明其发生与雌激素有关 ;期别以Ⅰ期为主 ,尤其是≤ 3 5岁者 ,高危因素少 ,预后较好。对于早期 (Ⅰa期 ) 45岁以下内膜癌患者可考虑保留生育功能或卵巢     

子宫内膜癌患者血清uPA和PAI-1的含量变化及临床意义

目的:探讨子宫内膜癌患者血清尿激酶型纤溶酶原激活物(uPA)及纤溶酶原激活物抑制物-1(PAI-1)含量的变化及其临床意义。方法:用ELISA法测定35例子宫内膜癌(内膜癌组)、18例子宫内膜增生(内膜增生组)和16例正常子宫内膜患者(正常对照组)血清uPA和PAI-1含量及计算两者的比值。结果:内膜癌组患者血清uPA和PAI-1含量及uPA/PAI-1值均显著高于内膜增生组及正常对照组,差异有极显著性(P均<0.01)。内膜增生组及正常对照组,差异无统计学意义(P>0.05)。内膜癌组Ⅲ~Ⅳ期患者血清uPA和PAI-1含量与Ⅰ期相比差异有极显著性(P<0.01),Ⅲ~Ⅳ期患者血清uPA和PAI-1含量高于Ⅱ期(P<0.05),Ⅱ期患者血清uPA、PAI-1含量高于Ⅰ期(P<0.05)。内膜癌组患者血清uPA、PAI-1含量及uPA/PAI-1值随着手术病理分期及组织学分级的增高、肌层浸润深度的增加及淋巴结的转移而升高,差异有显著性(P均<0.05),而与患者病理类型无关(P>0.05)。结论:子宫内膜癌患者血清uPA和PAI-1含量及uPA/PAI-1值明显升高,并与其手术病理分期、浸润转移有关,提示其可能在内膜癌的发生、发展及浸润过程中起重要作用。     

Pathological findings in early-stage endometrial cancer

OBJECTIVE: The aim of this study was to assess the pathological characteristics of early-stage endometrial cancer, with regard to endometrioid versus serous papillary adenocarcinoma. METHODS: Sixty-six cases of early-stage endometrial carcinoma were classified into two groups: group I--36 cases of endometrioid endometrial cancer, staged IA-IB and graded G1-G2; group II--30 cases of Stage I serous papillary endometrial cancer. The pathological characteristics compared between the two groups included features such as tumor location in the uterine cavity, tumor focality, lymphovascular invasion, as well as the status of the uninvolved endometrium, adjacent to the tumor. Patient clinical characteristics were obtained from the medical records. RESULTS: Significantly more patients with endometrioid endometrial cancer were premenopausal (p < 0.0001), obese (p < 0.02), had hypertension (p < 0.00001) and familial cancer (p < 0.0001). On the other hand, significantly more patients with serous papillary cancer had another primary malignancy (p < 0.001). Considering the pathological characteristics, 75% of endometrioid as compared with 6.7% of serous papillary cancer cases were found in the upper uterine segment only (p < 0.0001). Multifocality was observed in 16.7% of endometrioid as compared with 100% of serous papillary cancer cases (p < 0.0001). Lymphovascular space invasion was absent in all cases of endometrioid cancer, while present in 90% of serous papillary cancer cases (p < 0.0001). Seventy-five percent of endometrioid and 100% of serous papillary cancer cases were associated with an atrophic endometrium. CONCLUSION: The clinical and pathological features of early-stage endometrial cancer differ according to the histological type of the cancer. The majority of endometrioid cancers are probably associated with an atrophic or normally cycling endometrium, and not with endometrial hyperplasia.     

Endometrial metaplasia associated with endometrial adenocarcinoma

Endometrial metaplasia is a complex group of epithelial proliferations. The relationship of metaplasia, other than squamous metaplasia, to endometrial adenocarcinoma has not been clearly established. Between 1969 and 1979, 183 patients diagnosed as having Stage I endometrial adenocarcinoma (according to International Federation of Gynecology and Obstetrics) were treated at the University of Virginia Medical Center. Sixty of the patients were treated with hysterectomy without preoperative irradiation. A histopathologic review was performed without knowledge of the clinical outcome and subsequent clinicopathologic correlations were analyzed. On review, 32/60 had carcinoma without metaplasia and 15/60 had both carcinoma and metaplasia. Thirteen of the 60 patients were judged not to have cancer: 12 had both hyperplasia and metaplasia and one had hyperplasia without metaplasia. None of the 12 patients reclassified as having metaplasia had a recurrence or died of endometrial carcinoma. Patients with both metaplasia and carcinoma were significantly younger than patients with only carcinoma and the associated carcinomas were more frequently well differentiated.     

The value of curettage in diagnosis of endometrial hyperplasia.

OBJECTIVES: The aim of this study was to assess the value of diagnosis of endometrial hyperplasia by curettage and to determine the results of proliferating cell nuclear antigen (PCNA) immunostaining in differentiating endometrial carcinoma from endometrial hyperplasia. METHODS: According to Kurman's criteria, we treated 150 patients with endometrial hyperplasia detected by curettage and compared retrospectively the diagnosis by curettage with that by hysterectomy. PCNA expression was examined using immunohistochemostaining on 60 patients with complex atypical hyperplasia detected by curettage. RESULTS: Simple hyperplasia was found by curettage in 53 patients, complex hyperplasia in 11, simple atypical hyperplasia in 26, and complex atypical hyperplasia in 60. All patients were rediagnosed after hysterectomy. As a result, 65 were found to have simple hyperplasia, 7 complex hyperplasia, 15 simple atypical hyperplasia, 29 complex atypical hyperplasia, and 34 endometrial carcinoma. The accuracy of histological diagnosis by curettage was 76.7-92.0% and was dependent on different types of hyperplasia. Simple atypical hyperplasia and complex atypical hyperplasia were more likely to coexist with endometrial carcinoma than both simple hyperplasia and complex hyperplasia (chi2 = 26.3, P < 0.001), and complex atypical hyperplasia was more likely to coexist with endometrial carcinoma than simple atypical hyperplasia (chi2 = 9.78, P < 0.005). In complex atypical hyperplasia patients, coexistence with endometrial carcinoma was more common after menopause than before menopause (chi2 = 3.93, P < 0.05). In complex atypical hyperplasia patients, the expression of PCNA in cases associated with endometrial carcinoma was higher or stronger than in cases associated without endometrial carcinoma (chi2 = 7.68, P < 0.01, or U = 252.00, P < 0.01). Conclusions. Curettage tends to be more highly accurate in diagnosing simple hyperplasia than complex atypical hyperplasia, which is often found by hysterectomy to be associated with endometrial carcinoma. The expression of PCNA may be helpful in differentiating complex atypical hyperplasia from endometrial carcinoma.     

Molecular analysis of endometrial hyperplasia in HNPCC-suspicious patients may predict progression to endometrial carcinoma.

Women predisposed to hereditary nonpolyposis colorectal cancer are at high risk of developing endometrial carcinoma at a young age. Hereditary nonpolyposis colorectal cancer-associated endometrial carcinomas are of the endometrioid type, usually arise from complex atypical hyperplasia, and often show microsatellite instability. To identify occult hereditary nonpolyposis colorectal cancer individuals among endometrial carcinoma patients, we examined complex atypical hyperplasias and endometrial carcinomas of 60 women < or =50 years of age (mean age: 35.7 years) using microsatellite instability, immunohistochemistry, and DNA sequence analysis. Three patient groups were recruited: group 1, patients with complex atypical hyperplasia exclusively (n = 27); group 2, patients with complex atypical hyperplasia and synchronous or metachronous endometrial carcinoma (n = 15); group 3, patients with endometrial carcinoma only (n = 18). Overall, 13 of 33 endometrial carcinomas (39%) displayed high-level microsatellite instability. None of the complex atypical hyperplasias in group 1 had high-level microsatellite instability or loss of hMLH1/hMSH2 protein expression. In group 2 patients, 33% of complex atypical hyperplasias and 53% of endometrial carcinomas had high-level microsatellite instability. Loss of hMSH2 protein expression was found in six endometrial carcinoma patients, five of them with verified hMSH2 germline mutations, including four patients with high-level microsatellite instability in complex atypical hyperplasia. Among group 3 patients, 28% of endometrial carcinomas displayed high-level microsatellite instability; three of those five endometrial carcinomas were from patients with multiple extrauterine hereditary nonpolyposis colorectal cancer-associated tumors. We conclude that young women (< or =50 years of age) with concurrent complex atypical hyperplasia and multiple hereditary nonpolyposis colorectal cancer-associated carcinomas are at risk of developing high-level microsatellite instability endometrial carcinoma. Combined microsatellite instability and immunohistochemistry analysis allows the identification of a high proportion of hereditary nonpolyposis colorectal cancer patients among young women with endometrial carcinoma and complex atypical hyperplasia. All complex atypical hyperplasias with high-level microsatellite instability progressed to endometrial carcinoma. Only one third of the complex atypical hyperplasias with microsatellite stability progressed to high-level microsatellite instability endometrial carcinoma, while seven complex atypical hyperplasias progressed to microsatellite stability endometrial carcinoma. Microsatellite analysis of complex atypical hyperplasia in young patients may therefore be a useful prognostic marker for predicting possible progression to high-level microsatellite instability endometrial carcinomas.     

Postmenopausal endometrial pathologies with tamoxifen treatment: comparison between hysteroscopic and hysterectomy findings.

Histological findings of endometrial specimens collected by hysteroscopy from 261 postmenopausal breast cancer patients with tamoxifen treatment (group I) and from endometrial specimens obtained following hysterectomy from 40 similar patients (group II) were compared. This comparison was performed in order to assess whether endometrial pathologies are more frequently diagnosed in specimens collected by hysterectomy than by those collected during hysteroscopy in such patients. Overall positive endometrial histological findings were significantly more common in group II patients than in group I patients (82.5 and 24.5%, respectively; p < 0.0001). Atrophic endometrium was significantly more common in group I patients than in group II patients (75.5 and 15.0%, respectively; p < 0.0001). All other different endometrial pathologies, except for proliferative endometrium, were significantly more common in group II patients than in group I patients (endometrial hyperplasia = 17.5 and 4.2%, respectively; p < 0.0003; endometrial polyps = 30.0 and 11. 5%, respectively; p < 0.006; endometrial polyps with hyperplasia = 17.5 and 4.2%, respectively; p < 0.0003; endometrial carcinoma = 15. 0 and 0.4%, respectively; p < 0.0001). These findings suggest that in postmenopausal breast cancer patients treated with tamoxifen, the frequency of various endometrial histological findings and of overall positive endometrial histological findings were significantly higher in specimens collected by hysterectomy than in specimens obtained by hysteroscopy.     

子宫内膜癌组织中垂体肿瘤转化基因PTTG的表达及其意义

目的 检测子宫内膜癌组织中垂体肿瘤转化基因PTTG的表达,并分析其与碱性成纤维细胞生长因子(bFGF)蛋白表达和微血管密度(MVD)计数的相关性,探讨其在子宫内膜癌发生、发展中的作用。方法 采用RT-PCR技术,检测50例子宫内膜癌组织中PTTG mRNA的表达,并进行半定量分析;应用免疫组化链霉菌抗生物素蛋白-过氧化酶连接(SP)法,检测PTTG和bFGF蛋白的表达,CD34标记血管内皮细胞并计数肿瘤间质MVD;结合临床病理特征、bFGF蛋白及MVD计数进行分析。另选择15例增生性子宫内膜和12例正常子宫内膜组织作为对照。结果 子宫内膜癌组织中PTTG基因呈过度表达,内膜癌组织中PTTG mRNA的阳性表达率及平均表达水平(分别为96％,0.84±0.08)显著高于增生性子宫内膜(分别为60％,0.78±0.06)及正常子宫内膜组织(分别为33％,0.48±0.12),3组间分别比较,差异均有极显著性(P<0.01);内膜癌组织中PTTG蛋白的阳性表达率(70％)明显高于增生性子宫内膜(40％)及正常子宫内膜组织(17％),3组间分别比较,差异也均有极显著性(P<0.01);PTTG基因的表达与手术病理分期、淋巴结转移及肌层浸润有明显相关性(P<0.05),且其在子宫内膜样腺癌组织中的表达显著高于其他类型的内膜癌组织(P<0.05);PTTG基因的表达与年龄及病理分级无关(P>0.05)。子宫内膜癌组织     

Three-dimensional endometrial volume and 3-dimensional power Doppler analysis in predicting endometrial carcinoma and hyperplasia

OBJECTIVE: To evaluate the accuracy of endometrial volume measurement and 3-dimensional power Doppler analysis (3D-PDA) in the diagnosis of endometrial carcinoma and endometrial hyperplasia in women with post- and peri-menopausal bleeding. METHODS: 56 women with post-menopausal and 89 with peri-menopausal bleeding were enrolled. All were scheduled for hysteroscopy, dilatation and curettage, endometrial sampling or hysterectomy, and the ultrasound was performed within 24 h before the procedure. Endometrial thickness, endometrial volume, vascularity index (VI), flow index (FI) and vascularity flow index (VFI) were measured. These parameters were compared between the group of women with normal histology (including endometrial polyps) and the pathologic group (carcinoma and hyperplasia with or without atypia). RESULTS: Ninety women (62%) had normal histology, 26 (17.9%) had an endometrial polyp, 18 (12.5%) hyperplasia and 11 (7.6%) had endometrial carcinoma. Mean endometrial thickness was 11 mm and 15.5 mm in the normal and pathologic groups respectively (p<0.005). The mean endometrial volume was 6.87 cc and 15.5 cc in the two groups respectively (p<0.001). The VI was 2.27% and 2.95% in the two groups respectively (p=0.022). The FI was 18.6 and 23.6 in the two groups respectively (p=0.014). The VFI was 0.68 and 0.89 in the two groups respectively (p=0.018). Using ROC the area under the curve was 0.698, 0.728, 0.621, 0.631, and 0.625 for endometrial thickness, endometrial volume, VI, FI and VFI respectively. The best predictor of endometrial carcinoma was an endometrial volume of 3.56 cc or more (sensitivity 93.1%, specificity 36.2%). CONCLUSIONS: Endometrial volume and 3D-PDA are good diagnostic tools in predicting endometrial carcinoma and hyperplasia in women with post- and peri-menopausal bleeding.     

基质金属蛋白酶-2及孕激素受体在子宫内膜癌组织中的表达及其意义

目的检测基质金属蛋白酶-2（MMP-2）和孕激素受体（PR）在子宫内膜癌组织中的表达，分析其在子宫内膜癌中表达的相关性以及与临床病理特征的关系，探讨MMP-2在子宫内膜癌发生、发展中的作用。方法采用免疫组化SP法检测45例子宫内膜癌和12例增生子宫内膜中MMP-2、PR的表达，以20例正常子宫内膜作为对照。结果MMP-2蛋白在正常子宫内膜、增生子宫内膜中的阳性表达率比较，差异无显著性（P〉0．05）。子宫内膜癌组织中MMP-2阳性表达率（62．2％）高于对照组（15．6％）（P〈0．05）。MMP-2在中、低分化子宫内膜癌组织中的阳性表达率（82．6％）高于高分化子宫内膜癌组织（40．9％）（P〈0．01），有肌层浸润标本中的阳性表达率（71．1％）高于无肌层浸润者（14．3％）（P〈0．05）；绝经者（65．5％）与未绝经者（56．3％）、手术病理为Ⅰ期者（52．0％）与Ⅱ～Ⅳ者（75．0％）以及有淋巴结转移者（63．6％）与无淋巴结转移者（61．8％）相比，MMP-2的阳性表达率差异无显著性。子宫内膜癌中PR的阳性表达率（55．6％）明显低于对照组（84．4％）（P〈0．05）。MMP-2与PR在子宫内膜癌中的表达呈负相关（P=0．0048，r=-0．42）。结论MMP-2在子宫内膜癌中呈高表达，可能在其进展中有重要作用，PR表达降低可能是MMP-2表达升高的原因；检测MMP-2在子宫内膜癌中的表达，有助于子宫内膜癌预后的判断。     

细胞凋亡与Fas、Fas配体表达在子宫内膜癌中的意义

目的：研究子宫内膜癌的细胞凋亡Fａｓ、Fａｓ配体（ＦａｓＬ）表达其意义。方法：光镜下观察３５例子宫内膜癌及１５例子宫内膜增生ＨＥ染色石蜡切片中的凋亡细胞和凋亡小体，计算细胞凋亡指数（ＡＩ）。应用免疫组化ＳＡＢＣ法检测组织中Ｆａｓ及ＦａｓＬ的表达。结果：子宫内膜癌中细胞ＡＩ显著高于子宫内膜增生。在子宫内膜癌中高ＡＩ与高组织学分级、肌层浸润大于１／２及有淋巴结转移，患者生存率低有关。Ｆａｓ表达阳性率在子宫内膜癌中明显低于子宫内膜增生。ＦａｓＬ表达阳性率在子宫内膜癌中明显高于子宫内膜增生。结论：细胞凋亡异常在子宫内膜癌发病中起重要作用。ＡＩ对判断患者预后具有一定的价值。Ｆａｓ、ＦａｓＬ表达异常可导致子宫内膜癌发生、发展。     

CYP17 genetic polymorphism in patients with endometrial hyperplasia and cancer

Abstract.   Aban M, Arslan M, Tok E, Tekes S, Budak T, Altintas A. CYP17 genetic polymorphism in patients with endometrial hyperplasia and cancer. Int J Gynecol Cancer 2006; 16(Suppl. 1): 448–451.
We investigated the association of CYP17 gene polymorphism with the risk of having endometrial cancer and a well-known precursor of it, endometrial hyperplasia. Group A (control group) consisted of 35 patients who had histologically proven normal endometrium. Group B and C consisted of 18 and 30 patients who had endometrial hyperplasia with and without atypia, respectively. Group D consisted of 57 patients who had endometrial cancer. Venous blood samples were collected from patients in groups, and polymerase chain reaction was performed to determine the CYP17 gene polymorphism. Significant increase of A1/A1 and a decrease of A1/A2 genotype frequencies have been determined in patients with endometrial cancer and with atypical endometrial hyperplasia. No significant differences were found between groups in the frequency of A2/A2 genotype. There was no significant difference between the groups in the meaning of allele distributions. CYP17 polymorphism had correlation with endometrial atypia and cancer. Related effects of different types of CYP17 gene variants on the progression of hyperplastic endometrial cells into carcinoma should be evaluated in further studies. Progress in this area would help us modulate preventive treatments used in those actual high–risk group patients.     

间皮素mRNA在子宫内膜癌的表达及意义

目的:研究间皮素mRNA表达与子宫内膜癌发生、发展的关系。方法:采用半定量RT-PCR技术检测41例子宫内膜癌组织和14例正常子宫内膜组织中间皮素mR-NA的表达。结果:间皮素mRNA在子宫内膜癌和正常子宫内膜组织中的表达率分别为82.9%(34/41)与78.6%(11/14),相对含量分别为74.95±22.34、54.45±9.01。子宫内膜癌组间皮素mRNA相对含量高于正常内膜组(P=0.005)。手术病理分期Ⅲ~Ⅳ期、有淋巴结转移、深肌层浸润及低分化组的子宫内膜癌间皮素mRNA相对含量分别高于手术病理分期Ⅰ~Ⅱ期、无淋巴结转移、浅肌层浸润及高、中分化组(P分别为0.000、0.014、0.01和0.034),而与病理类型无关(P=0.219)。结论:间皮素mRNA过表达与子宫内膜癌的浸润、转移有相关性,检测其表达有助于判断子宫内膜癌的恶性程度和评估预后。     

Ⅰ期子宫内膜癌不同术式疗效的研究

目的　对Ⅰ期子宫内膜癌不同术式的疗效及其术后并发症进行比较分析。方法　回顾性分析 1986年 1月至 1997年 12月手术治疗的 2 11例Ⅰ期子宫内膜癌 ,根据术式不同分为两组 ,61例采用全子宫加双侧附件切除术 (组 1) ,150例采用广泛性全子宫切除术 (组 2 )。对两组的疗效及术后并发症进行比较分析。结果　组 1和组 2总的 5年生存率分别为 96 0 %、93 5% ,两组比较 ,差异无显著性 (P >0 0 5) ;复发率分别为 6 6%、10 7% ,两组比较 ,差异无显著性 (P >0 0 5) ;术后并发症分别为 11 5%、2 4 7% ,两组比较 ,差异有显著性 (P <0 0 5)。结论　Ⅰ期子宫内膜癌患者可以采用全子宫加双侧附件切除术     

The risk of premalignant and malignant pathology in endometrial polyps

OBJECTIVE: To evaluate the risk of premalignant and malignant pathology among endometrial polyps. DESIGN: Prospective cohort study. SETTING: Minimal Access Surgical Training (MAST) center in a large teaching hospital. METHODS: Among 248 patients seen in outpatient hysteroscopy clinic (1996-97), 62 had endometrial polyps. All patients had endometrial sampling for histological assessment. To determine the magnitude of malignant potential among polyps, we compared the pathological findings in polyps (cases) with non-polypoidal specimens (controls). RESULTS: Out of 62 polyps, histologically 53 (85.5%) were benign, seven (11.3%) had hyperplasia, and two (3.2%) were associated with malignancy. Hyperplasia was more frequent in endometrial specimens with polyps than in those without (11.3% vs 4.3%, p=0.04), but the incidence of carcinoma in the two groups was the same (3.2% vs 3.2%, p= 1.0). CONCLUSION: In abnormal uterine bleeding, hyperplasia was, but cancer was not, more common in women with endometrial polyps compared to those without polyps.     

The effect of long-term use of progesterone therapy on proliferation and apoptosis in simple endometrial hyperplasia without atypia

The aim of this study was to evaluate the effect of long-term use of progesterone treatment on proliferation and apoptosis in simple endometrial hyperplasia without atypia. In this prospective control study, endometrial tissue samples of 19 patients with simple endometrial hyperplasia without atypia (group 1), posttreatment biopsy materials of the patients after 3 months of cyclic progesterone treatment with noretisterone for 10 days (group 2), and 18 endometrial biopsy materials of the control group (group 3) were examined for proliferative and apoptotic activities. There was a statistically significant difference between the median values of the proliferative index of the three groups (P = 0.000). The proliferative index was significantly higher in the endometrial hyperplasia group than in posttreatment group (P = 0.000). But there was no significant difference between posttreatment group and control group. The median value of apoptotic activity was significantly different between three groups (P = 0.000). Apoptotic index was highest in hyperplasia group. A significant decrease in apoptosis was observed after the progesterone treatment (P = 0.002). The lowest apoptotic activity was detected in the control group. In conclusion, 3 months of cyclic progesterone treatment reduces both proliferative and apoptotic activities in endometrial tissue with simple hyperplasia.