年轻妇女子宫内膜癌的临床与病理特点

子宫内膜癌( endometrial carcinoma)是发生于子宫内膜的一组上皮性恶性肿瘤,占女性生殖道恶性肿瘤20％～30％,平均发病年龄为53岁,高发年龄40～65岁.年轻妇女子宫内膜癌,目前国内外文献定义有年龄≤40岁,也有年龄≤45岁.考虑到与目前国内外专家探索保留生育功能治疗的指征一致,目前多数主张以年龄≤40岁的子宫内膜癌为年轻妇女子宫内膜癌.据报道,≤40岁的子宫内膜癌所占比例为1％ ～15％,近20多年来子宫内膜癌发病率在世界范围内呈上升趋势,在40岁以下妇女中发病数由2/10万上升至40～50/10万[1].     

老年妇女子宫内膜癌44例分析

探讨老年妇女子宫内膜癌的临床与病理特征。方法对１９９６年至１９９６年在我院治疗的１２８例子宫内膜癌中≥６０岁的４４例进行回顾分析,并与同时期≤５０岁的３３例子宫内膜癌做对照分析。全部手术切除术标本经病理检查确诊。     

年轻妇女子宫内膜癌的诊治进展

子宫内膜癌（endometrial carcinoma，EC）是女性生殖道常见恶性肿瘤之一，占女性生殖道恶性肿瘤的20％～30％，多见于绝经后妇女，平均年龄63．1岁，75％的患者在50岁后发病，年轻妇女患EC的比例为2％～14％。年轻妇女EC的年龄界定，目前尚无统一标准，一部分学者认为年龄≤40岁的EC患者为年轻妇女EC，另一部分学者认为年龄≤45岁者为年轻妇女EC。近年来，伴随着妇女的高龄化，EC的发病率呈上升趋势，而发病年龄趋年轻化。     

年轻妇女子宫内膜癌前病变的诊治

目前对子宫内膜癌前病变的范畴各文献报道不一,大多数观点认为世界卫生组织(WHO)对子宫内膜增生分类中仅子宫内膜不典型增生为子宫内膜癌前病变.近年来有学者不同于WHO分类基于克隆的分子基因分析,提出子宫内膜增生分为两类:多克隆增生是机体对高雌状态的生理反应,为子宫内膜增生;单克隆性增生有发展为癌的可能,被称为子宫内膜上皮内肿瘤(endometrial intraepitheliai neoplasia,EIN),是子宫内膜癌前病变.     

年轻妇女子宫内膜癌保留卵巢功能的探讨

尽管子宫内膜癌多发生于绝经后年老妇女,但随着全球范围内子宫内膜癌发病率的增加,年轻妇女子宫内膜的患病率也呈上升趋势,约15%的子宫内膜癌患者为绝经前妇女,5%的患者为40岁以下妇女。不少年轻患者渴望保留卵巢功能,年轻妇女子宫内膜癌可否保留卵巢日益成为妇科肿瘤工作者亟待解决的问题之一。目前对年轻妇女子宫内膜癌能否保留卵巢,虽尚无大规模的循证医学证据,但一些研究得出了肯定的结论。本文就年轻妇女子宫内膜癌保留卵     

138例非内膜样子宫内膜癌的临床病理分析

目的 探讨非内膜样子宫内膜癌的更合合适治疗方式。方法 收集２０年来经我院的非内膜样子宫内膜癌１３８例,比较５种量业型的肌层浸、累豚宫颈、子宫外扩散、脉管浸润及１年、３年、５年存活率情况。结果 １９例粘液腺癌及５６例角化腺癌的５年存活率均达到１００％,说明该两种病理类型具有较低的恶性生物学行为;而３８例鳞腺癌、２０例透亮细胞癌、４例浆液乳头状腺癌的５年存活率依次为７６．３１％、７２．２２％及４０．０     

子宫内膜癌1299例临床病理分析

目的分析子宫内膜癌临床病理特点及变化趋势,探讨子宫内膜癌诊治中的相关问题。方法回顾性分析1989年1月至2007年6月经四川大学华西第二医院手术治疗的1299例子宫内膜癌患者的临床病理资料,并分3时段进行对比分析(第1时段:1989-1995年,290例;第2时段:1996-2003年,499例;第3时段:2004-2007年6月,510例)。结果(1)我院3时段年均收治手术治疗子宫内膜癌患者分别为41、62、146例,呈逐年显著上升趋势。(2)3时段<45岁患者所占比例分别为5.5%、14.4%及18.6%,呈上升趋势(P<0.05)。(3)特殊病理类型(非子宫内膜样腺癌)所占比例第3时段上升至13.5%,高于第1时段的0.3%和第2时段的7.6%(P<0.05)。(4)每个时段内临床分期误差率以Ⅱ期为最高,3时段分别为80.5%、67.5%及77.8%。结论(1)子宫内膜癌发病逐年增多,且发病年龄有年轻化趋势。(2)特殊病理类型子宫内膜癌所占比例显著增加。(3)子宫内膜癌临床Ⅱ期分期误差率仍较高。     

子宫内膜癌宫体外转移相关临床病理因素分析

目的:探讨子宫内膜癌宫体外转移相关的临床病理因素。方法:回顾分析2000年1月至2006年12月我院收治经手术治疗的196例子宫内膜癌患者的临床病理资料。根据有无转移将患者分为转移组和无转移组,再根据肌层浸润情况将患者分为3组,A组:无肌层浸润组;B组:浅肌层浸润组;C组:深肌层浸润组。比较分析转移组与无转移组患者的年龄、肌层浸润、肿瘤分化、病理类型的差异。结果:196例患者中有转移68例,无转移128例,有肌层浸润、中低分化、非子宫内膜样癌明显较无肌层浸润、高分化、子宫内膜样癌易发生转移,差异有统计学意义;年龄对转移无明显影响,差异无统计学意义;30例无肌层浸润者中1例发生盆腔淋巴结转移,166例有肌层浸润者中16例宫旁组织受侵。结论:子宫内膜癌是否发生宫体外转移与其分化程度、病理类型和有无肌层浸润密切相关;与年龄无关。无肌层浸润者也可能出现盆腔淋巴结转移,应考虑淋巴结活检或切除术。肌层浸润者宫旁组织可能受侵,应适当扩大手术范围。     

年轻妇女子宫内膜癌626例临床分析

目的:探讨年轻妇女子宫内膜癌的临床特征与病理特点.方法:回顾分析广东省34家医院2000 ～2010年住院经病理检查确诊的年轻妇女子宫内膜癌(年龄≤40岁)626例的临床资料.结果:子宫内膜癌中年轻患者构成比无逐年增多的趋势,其发病平均年龄无下降趋势;93.6％为子宫内膜样腺癌,92.0％为G1和G2;87.2％无和≤1/2肌层浸润;术后手术-病理分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为71.6％,10.6％,16.1％,1.7％.术前临床误诊率为19.0％;临床分期Ⅰ、Ⅱ、Ⅲ期与手术-病理分期比较的误差率分别为18.6％,53.5％,18.9％.单因素分析显示组织学分级G3(P ＜0.01)、深肌层浸润(P＜0.01)、腹水细胞学阳性(P＜0.01)是卵巢转移的高危因素,而在多因素分析时均无统计学意义.单因素分析显示组织学分级G3(P＜0.01)、深肌层浸润(P＜0.01)、宫颈受累(P＜0.01)、腹水细胞学阳性(P＜0.05)、脉管浸润(P＜0.01)是淋巴结转移的高危因素,多因素分析时,只有宫颈受累(P＜0.05)和组织学分级G3(P ＜0.05)具有统计学意义.结论:年轻妇女子宫内膜癌患者占有一定比例,但未见有年轻化趋势.病理以子宫内膜样腺癌、G1/G2为主;手术病理分期多数为Ⅰ期.'术前临床误诊率高.宫颈受累和组织学分级G3为淋巴结转移的独立高危因素.     

Endometrial Carcinoma in Young Women

Summary: Endometrial carcinoma in young women is uncommon. The majority of cases occur in women who have been taking oestrogen-containing oral contraceptives, in those with the Stein-Leventhal syndrome, or in those with gonadal dysgenesis treated by long-term oestrogen replacement therapy. We have observed 4 women under 40 years of age with adenocarcinoma of the uterus in whom chromosomal abnormalities associated with Turner's syndrome were confirmed only after the diagnosis of carcinoma had been made. None of these had received replacement oestrogen therapy. It is postulated that chromosomal abnormalities in young women with endometrial carcinoma are more common than previously thought. As the disease in this group appears to behave in a benign fashion, a conservative approach to therapy is advocated.     

Sonohysterographic Appearances of Endometrial Carcinoma: An In Vitro Study of Uterine Specimens

Objective: To determine the sonohysterographic appearances of endometrial carcinoma by sonohysterographic examination of uterine specimens.Methods: A prospective study of sonohysterographic examination on 30 uteri obtained immediately after hysterectomy from women 30 to 86 years of age, diagnosed preoperatively with endometrial carcinoma. The transducer was applied directly on the serosal surface of the anterior uterine wall for sonographic visualization. Sonographic examination was performed initially to assess the endometrial thickness, followed by infusion of normal saline into the endometrial cavity through a Foley catheter inserted into the cervix and repeat sonographic evaluation to characterize endometrial carcinoma.Results: The mean (± SD) endometrial thickness on initial sonographic examination was 11.4 (± 6.6) mm. Sonohysterographic examination demonstrated 15 uteri to have large, irregular polyploid masses arising from the endometrium, 6 uteri to have focal endometrial thickening, 4 uteri to contain benign-appearing polyp(s), 2 uteri to contain benign-appearing polyp(s) with focal endometrial thickening, and 3 uteri to have normal endometria.Conclusion: The sonohysterographic appearance of endometrial carcinoma is variable. Although the majority of endometrial carcinomas appeared as large, irregular polyploid masses, a completely normal sonohysterographic appearance may occur.     

The Clinical Management of Endometrial Cancer in Young Women

Endometrial cancer (EC) remains the leading female genital tract malignancy in industrialized countries. Incidence rates are increasing in many Asia countries. A trend of increased fractions occurring in young women also has been observed. When fertility preservation is not a concern, standard surgical staging and tailored adjuvant therapy regardless of age should be practiced. High remission rates with subsequent pregnancies are seen in clinical stage IA without myometrial invasion and in grade 1 EC of young women using oral high-dose progestins as fertility-sparing treatment (FST), yet high recurrences and synchronous or metachronous ovarian malignancies should be cautioned. Intrauterine progestins seem efficacious but more investigations are needed. Aromatase inhibitors have limited data at present. Current selection criteria have been suboptimal for preserving uterine and/or ovary for young EC patients. Investigations on molecular profiles for selecting candidates for preserving ovary or FST and whether to do a consolidation hysterectomy are necessary.     

子宫肌瘤患者的子宫内膜病理特征分析

目的:探讨子宫肌瘤患者的子宫内膜病理特征及相关因素。方法:选取2002~2004年479例子宫肌瘤患者,分析其子宫内膜病理特征。结果:479例患者中有97例表现阴道不规则流血,单发肌瘤220例,多发肌瘤259例,子宫肌瘤变性70例,67例子宫肌瘤为富于细胞型平滑肌瘤。109例患者发生子宫内膜病变,包括子宫内膜息肉42例(8.77%)、子宫内膜单纯增生41例(8.56%)、复杂增生12例(2.51%)、非典型增生3例(0.63%)、子宫内膜癌11例(2.30%)。结论:子宫肌瘤可同时合并子宫内膜病变及子宫内膜癌,子宫肌瘤单发或多发、子宫肌瘤变性等情况与子宫内膜病变无关。不规则阴道流血、绝经与子宫内膜病变及子宫内膜癌的发生有关。     

Study of Endometrial Pathology in Abnormal Uterine Bleeding

Introduction

Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynaecology out-patient department. Endometrial sampling could be effectively used as the first diagnostic step in AUB, although at times, its interpretation could be quite challenging to the practicing pathologists. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of AUB. We also tried to observe the incidence of various pathology in different age groups presenting with abnormal uterine bleeding.

Material and Methods

This was a study done at Sri Ramachandra Medical College and Research Institute, Chennai, India on 620 patients who presented with AUB from June 2005–June 2006. Out of which 409 cases of isolated endometrial lesions diagnosed on histopathology were selected for the final analyses. A statistical analysis between age of presentation and specific endometrial causes was done using χ² test.

Results

The most common age group presenting with AUB was 41–50 years (33.5%). The commonest pattern in these patients was normal cycling endometrium (28.4%). The commonest pathology irrespective of the age group was disordered proliferative pattern (20.5%). Other causes identified were complications of pregnancy (22.7%), benign endometrial polyp (11.2%), endometrial hyperplasias (6.1%), carcinomas (4.4%) and chronic endometritis (4.2%). Endometrial causes of AUB and age pattern was statistically significant with P value <0.05.

Conclusion

There is an age specific association of endometrial lesions. In perimenopausal women AUB is most commonly dysfunctional in origin and in reproductive age group, one should first rule out complications of pregnancy. The incidence of disordered proliferative pattern was significantly high in this study, suggesting an early presentation of these patients.     

Invasive Carcinoma of the Cervix in Young Women

One hundred and seventy-six cases of cancer of the cervix in women age 35 years or less from 1959 to 1980 were compared with 65 cases occurring in the 5-year period from 1982 to 1986. The incidence of the disease in this age group changed little over this time, increasing from 9% to 11%. However, the incidence of adenocarcinoma cell types increased from 10% in the first period to 25% in the more recent cases. A change in management resulted in increased surgical emphasis in treatment; only 24% were treated surgically in the earlier group compared to 80% in the recent group. There has not been an increase in advanced cases or mortality in those young patients in recent years.     

Risk Factors for Endometrial Carcinoma in Women with Postmenopausal Bleeding

ObjectivesMost patients with postmenopausal bleeding do not have endometrial cancer. The primary objective was to evaluate risk factors for endometrial cancer among postmenopausal women with bleeding.MethodsThis was a retrospective cross-sectional study. Women with postmenopausal bleeding presenting to a gynecology clinic were included in the study. Data on potential risk factors for endometrial cancer or atypical hyperplasia were collected. Univariate and multivariate analyses were performed to assess the risk factors.ResultsAmong 212 women studied, 24 (11.3%) women had endometrial cancer. There were 38 (17.9%) with cervical cancer and 3 (1.4%) with ovarian cancer. Women 55 or older had an odds ratio of 7.5 (95% CI 2.2 to 26.2) as compared to women below 55 years (p value = 0.002). Women with 2 or more episodes of postmenopausal bleeding had an odds ratio of 4.9 (95% CI 1.1 to 23.0) and those who had either diabetes or hypertension had an odds ratio of 3.1 (95% CI 1.3 to 7.4) of endometrial cancer as compared to those who did not.ConclusionsA third of patients with postmenopausal bleeding had a gynecological cancer. Age, frequency of bleeding, diabetes and hypertension, and increased endometrial thickness were independent risk factors for endometrial cancer.     

The Utility of Pretreatment Barium Enema in Women with Endometrial Carcinoma

Objective.The objective of this study was to assess the clinical utility of a pretreatment barium enema in women with endometrial cancer.Methods.The medical records of 249 patients with endometrial cancer who underwent a pretreatment barium enema were retrospectively reviewed. The patients’ charts were abstracted for demographic information, stage, grade, histology, current disease status, and barium enema results.Results.The pretreatment barium enema was normal in 122 (49%) patients. Diverticulosis was the most common abnormality, reported in 112 (45%) patients. Apparent intraluminal abnormalities were found in 15 (6.0%) patients. Each of these patients underwent colonoscopy prior to treatment for endometrial carcinoma. During colonoscopy, benign colonic polyps were removed from 11 (4.4%) patients. Primary colonic adenocarcinoma was discovered in polypoid lesions removed from 2 (0.8%) patients. Significant luminal narrowing from extrinsic lesions was noted in 2 (0.8%) patients, one at the rectosigmoid and the other at the cecum. No patient was found to have colonic mucosal involvement by endometrial cancer.Conclusion.The results of this study do not justify routine pretreatment barium enema to assess the colonic mucosa for metastatic involvement by endometrial cancer or as a screening tool for colorectal cancer in women with endometrial cancer.