子宫内膜厚度在绝经前妇女子宫内膜疾病中的诊断价值

[目的]评价子宫内膜厚度在绝经前妇女子宫内膜疾病中的诊断价值。[方法]对1211例子宫内膜病变患者行超声检查,分析超声图像下子宫内膜厚度和内膜的均匀程度。[结果]子宫内膜癌者的子宫内膜平均厚度为10.16±4.28mm,显著性大于子宫内膜炎（5.64±2.64mm）、子宫内膜增生（7.18±2.32mm）、不典型增生（8.46±4.18mm）和正常子宫（5.77±3.05mm）的内膜厚度,差异均有统计学意义（P〈0.05）。子宫内膜癌者内膜均匀的比例与其他内膜性疾病者比较差异无统计学意义（30.43%vs40.06%,χ2=0.873,P=0.351）。[结论]子宫内膜厚度有助于鉴别绝经前阴道流血妇女内膜疾病的良恶性质。     

经阴道超声诊断绝经后子宫内膜病变应用价值

目的：探讨经阴道彩色多普勒超声对绝经后妇女子宫内膜病变的诊断价值。方法：对125例绝经后出现阴道出血症状患者的子宫内膜声像图及彩色多普勒血流显像进行回顾性分析。所有病灶以子宫内膜活检或刮宫病理证实。结果：经阴道彩色多普勒超声子宫内膜息肉诊断符合率为86.57％（58/67）,子宫内膜增生过长诊断符合率为90.00％（27/30）,子宫内膜癌诊断符合率为82.35％（14/17）,病灶内RI值平均为0.42     

肥胖、糖尿病和高血压与子宫内膜癌前病变和癌的相关性分析

[目的]分析绝经前妇女子宫内膜发生恶变的相关危险因素。[方法]回顾性分析630例因阴道出血就诊并经病理证实绝经前子宫内膜病变患者的临床资料,比较分析良性病变组（595例）和恶性病变组（35例）患者的临床特征以及子宫内膜恶变的相关危险因素。恶性病变相关高危因素分析采用Logistic多元回归分析。[结果]调整年龄、子宫内膜厚度因素后,肥胖（RK=2．938,95％CI：1．060～8．142）、糖尿病（RR=9．945,95％CI：3．297—29．997）患子宫内膜癌前病变,癌恶性病变的风险增加。且有统计学差异：高血压患子宫内膜癌前病变／癌恶性病变的风险是无高血压患者的1．752倍（95％CI：0．903～7．831）,无统计学差异。[结论]肥胖、糖尿病与子宫内膜癌密切相关。因此,若能尽早改变生活方式,如合理饮食、增加活动量则有可能在很大程度上预防子宫内膜癌的发生。     

绝经后阴道流血患者的临床特征及子宫内膜癌发生的影响因素分析

目的 探讨绝经后阴道流血患者的临床特征及子宫内膜癌发生的影响因素。方法 选取126例绝经后阴道流血患者,病理检查结果显示,子宫内膜癌28例、子宫良性病变98例,比较子宫内膜癌和子宫良性病变患者的临床特征;绝经后阴道流血患者子宫内膜癌发生的影响因素采用多因素Logistic回归分析。结果 子宫内膜癌患者糖尿病发生率、反复阴道流血发生率、雌激素受体（ER）阳性表达率、孕激素受体（PR）阳性表达率、子宫内膜异常回声发生率均高于子宫良性病变患者,阴道流血程度重于子宫良性病变患者,子宫内膜厚度大于子宫良性病变患者,差异均有统计学意义（P﹤0.05）。多因素Logistic回归分析结果显示,糖尿病、重度阴道流血、子宫内膜厚度≥10.3 mm、反复阴道流血均是绝经后阴道流血患者发生子宫内膜癌的独立危险因素（P﹤0.05）。结论 糖尿病、重度阴道流血、子宫内膜厚度≥10.3 mm、反复阴道流血均是绝经后阴道流血患者发生子宫内膜癌的危险因素,早期采取积极有效的治疗措施,可能会改善患者的预后。     

淋巴管密度在子宫内膜癌淋巴结转移中的作用

[目的] 检测月经周期正常子宫内膜层和肌层以及子宫内膜癌组织中淋巴管密度(LVD),分析其与子宫内膜癌淋巴结转移的相关性.[方法] 收集正常子宫全层标本30例(15例增殖期,15例分泌期),子宫内膜癌标本40例(20例Ⅰa期,20例Ⅲc期),应用 D2-40 抗体进行免疫组化染色,显微镜下计数 LVD.[结果] 在正常月经周期的子宫内膜层和肌层均有D2-40 阳性染色的淋巴管,淋巴管与螺旋小动脉伴行.正常肌层 LVD 显著高于内膜层(10.70±1.16/mm2 vs 4.98±0.84/mm2; P＜0.01);癌灶内部 LVD(Ⅰa期3.49±0.94/mm2,Ⅲc期2.43±1.08/mm2)较正常内膜层和肌层均有所降低,差异显著(P＜0.01).而癌灶周边 LVD 升高,高于正常内膜但是低于正常肌层(P＜0.05).有淋巴结转移组癌灶周边 LVD (8.63±2.88/mm2)较未转移组显著增高(7.09±1.22/mm2,P=0.012).[结论] 癌灶周边淋巴管与子宫内膜癌的淋巴结转移发生有关.     

分化相关基因1在Ⅰ型子宫内膜癌中的表达

[目的]检测NDRG1基因在正常子宫内膜和Ⅰ型子宫内膜癌中的表达，探讨其在Ⅰ型子宫内膜癌发生中的作用机制。[方法]应用免疫组化、原位杂交及RT—PCR技术检测NDRG1基因在正常子宫内膜与Ⅰ型子宫内膜癌中的表达。[结果]免疫组化结果显示，NDRG1蛋自在正常子宫内膜和Ⅰ型子宫内膜癌中的表达率分别为12．5％和83．5％，有显著性差异（P=0．000）；原位杂交结果显示．NDRG1 mRNA在10例正常子宫内膜中只有2例表达．而在30例Ⅰ型子宫内膜癌中有22例表达，有显著性差异（P=0.007）；RT-PCR结果显示，NDRG1mRNA在Ⅰ型子宫内膜癌中的表达比正常内膜增高3倍（P=0.000）。[结论]NDRG1在子宫内膜癌中在蛋白水平和mRNA水平与正常子宫内膜相比都明显升高。它可能是一种肿瘤相关基因，其异常表达可能参与了Ⅰ型子宫内膜癌的发病机制。     

KAI1/CD82和E-cadherin在子宫内膜癌的表达

[目的]研究KAI1/CD82与E-cadherin在子宫内膜癌组织中的表达及其与临床病理参数的关系。[方法]采用免疫组织化学EnVision二步法检测76例子宫内膜癌,15例非典型增生子宫内膜和20例正常增生期子宫内膜组织中KAI1/CD82、E-cadherin的表达。[结果]KAI1/CD82在正常增生期子宫内膜、非典型增生内膜、子宫内膜癌的阳性表达率分别为95%、93.3%和60.5%;E-cadherin在正常增生期子宫内膜、非典型增生内膜、子宫内膜癌的异常表达率分别为0、6.67%和55.26%。KAI1/CD82在子宫内膜癌的表达与组织学分级、肌层浸润程度呈负相关(P=0.000,P=0.01)。E-cadherin在子宫内膜癌的表达与组织学分级及组织学类型有关。KAI1/CD82与E-cadherin在子宫内膜癌中的表达呈显著性相关(P<0.01)。[结论]KAI1/CD82表达下调和E-cadherin异常表达增高与子宫内膜癌的进展有关。     

三苯氧胺对围绝经期乳腺癌患者子宫内膜影响及宫腔镜的诊断价值

摘 要:［目的］ 分析围绝经期乳腺癌患者服用三苯氧胺(TAM)对子宫内膜的影响,并评价宫腔镜对子宫内膜病变的诊断价值。［方法］ 回顾性分析104例服用TAM的围绝经期乳腺癌患者资料。所有患者行病理组织活检、阴道超声及宫腔镜检查。［结果］ 病理结果显示正常子宫内膜21例,子宫内膜增生22例,子宫内膜息肉39例,子宫肌瘤/腺肌瘤17例,子宫内膜不典型增生2例,子宫内膜癌3例。宫腔镜检查诊断正常子宫内膜21例,子宫内膜增生21例,子宫内膜息肉40例,子宫肌瘤20例,子宫内膜癌2例,各病理类型宫腔镜检查与病理诊断符合率分别为100%、95.5%、97.5%、85.0%、66.7%。阴道超声检测显示,服用TAM ≤12个月、12～24个月、24～36个月、36～48个月、48～60个月和＞60个月患者的子宫内膜厚度分别为8.35mm、8.80mm、9.99mm、10.14mm、11.12mm和11.33mm,与用药＜2年患者相比,≥2年者内膜厚度明显增加（P＜0.05）。［结论］ 围绝经期乳腺癌患者长期服用TAM可能可引起子宫内膜病变。宫腔镜在子宫内膜病变诊断中有重要价值。     

雌激素受体亚型在子宫内膜癌发生中的作用

[目的]比较雌激素受体两种亚型α和β及Ki67在子宫内膜癌患者中的表达,探讨雌激素受体亚型在子宫内膜癌发生和发展中的作用。[方法]应用免疫组化技术及医学图像分析仪检测子宫内膜单纯性增生(56例)、复杂性增生(37例)、不典型增生(86例)及子宫内膜癌(68例)组织中ERα、ERβ及Ki67的阳性细胞百分率及灰度值,分析相应抗体的表达量。[结果]①与子宫内膜单纯性增生患者比较,复杂性增生、不典型增生及子宫内膜癌患者ERα阳性率及灰度值无明显性改变(P>0.05);②子宫内膜复杂性增生患者的ERβ的阳性率(62.16%)高于轻、中度不典型增生患者(54.9%)(P=0.031),而后者又高于早期内膜癌患者(32.0%)(P=0.049),ERβ的灰度值在复杂性增生患者中(69.49±112.52)也高于轻、中度不典型增生(67.23±124.07)及早期内膜癌患者(33.26±96.56)(P=0.025,P=0.001);③重度不典型增生周围组织(62.86%)及Ⅰ～Ⅱ期和Ⅲ～Ⅳ期内膜癌癌旁组织(48.0%,50.0%)中ERβ的阳性率表达水平高于相应病变组织(48.57%,32.0%,38.89%)(P=0.023,P=0.001,P=0.001);④Ki67的表达水平与ERβ的表达呈负相关(rs=-0.458,P=0.001),与ERα表达无关(rs=-0.043,P=0.506)。[结论]提示在子宫内膜癌发生的不同病理阶段ERβ表达量的是逐渐降低的,推测ERβ的表达降低与子宫内膜癌的发生有关。     

分化相关基因1在Ⅰ型子宫内膜癌中的表达

[目的]检测NDRG1基因在正常子宫内膜和Ⅰ型子宫内膜癌中的表达，探讨其在Ⅰ型子宫内膜癌发生中的作用机制。[方法]应用免疫组化、原位杂交及RT—PCR技术检测NDRG1基因在正常子宫内膜与Ⅰ型子宫内膜癌中的表达。[结果]免疫组化结果显示，NDRG1蛋自在正常子宫内膜和Ⅰ型子宫内膜癌中的表达率分别为12．5％和83．5％，有显著性差异（P=0．000）；原位杂交结果显示．NDRG1 mRNA在10例正常子宫内膜中只有2例表达．而在30例Ⅰ型子宫内膜癌中有22例表达，有显著性差异（P=0.007）；RT-PCR结果显示，NDRG1mRNA在Ⅰ型子宫内膜癌中的表达比正常内膜增高3倍（P=0.000）。[结论]NDRG1在子宫内膜癌中在蛋白水平和mRNA水平与正常子宫内膜相比都明显升高。它可能是一种肿瘤相关基因，其异常表达可能参与了Ⅰ型子宫内膜癌的发病机制。     

Endometrial carcinoma

Opinion statement Endometrial cancer is a common tumor of the female genital tract. The majority of women diagnosed with endometrial cancer present with early-stage disease. Although the optimal treatment for these patients requires hysterectomy, the use of lymphadenectomy is controversial. Growing scientific data support the use of lymphadenectomy in all patients diagnosed with endometrial cancer. When performed by an experienced surgeon, pelvic and para-aortic lymphadenectomy is a safe and potentially therapeutic procedure that provides prognostic information to the patient and physician. This information allows appropriate, cost-effective treatment strategies to be created for all women with endometrial cancer.     

Endometrial cancer

The current treatment of choice for endometrial cancer is reported to be primary surgery including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytologic sampling, and exploration, palpation, and biopsy of any suspicious lymph nodes or lesions. This allows determination of the extent of the disease, the stage of malignancy and the risk of recurrence. Adjuvant radiation therapy is administered to the pelvis for intermediate-risk patients, and a systemic chemotherapy is considered for high-risk ones, while no treatment is added for low-risk patients. But for patients with the malignancy, many Japanese gynecologists have performed extended hysterectomy instead of total hysterectomy to reduce the incidence of vaginal recurrence, achieved the pelvic and para-aortic lymphadenectomy as a substitute for biopsy sampling to avoid recurrence in lymph nodes, and given cytotoxic chemotherapy in place of irradiation to prevent radiation morbidity and recurrence at a distant site. Although differences in treatments for advanced disease have disappeared, further efforts are recommended to find useful prognostic factors for distinguishing patients with poorer prognoses, and to establish a standard treatment for endometrial cancer all over the world.     

Endometrial cancer

Radical surgery including complete pelvic and para-arortic lymph node dissection (LND) is both the main therapeutic effort and the decisive staging procedure in patients with invasive endometrial cancer (EC) and should be performed in specialized institutions. Vaginal cuff brachytherapy holds little serious side effects and may be beneficial in preventing vaginal recurrences. External irradiation treatment no longer has a routine indication in primary therapy. The omission of retroperitoneal staging (LND) at primary surgery does not indicate adjuvant radiotherapy but rather second-effort surgery removing pelvic and para-aortic lymph-nodes. External radiotherapy should be reserved for fully staged patients with residual non-resectable tumor manifestation and/or nodal involvement in relation to the extent of tumor involvement and surgical intervention. Hormonal and cytotoxic therapy is experimental in the adjuvant setting. The first step in palliative systemic treatment should be the administration of endocrine therapy when the tumor expresses progesterone receptors and tumor manifestations are not acutely life-threatening. In other cases or when endocrine treatment fails chemotherapy may be considered, which is often limited due to its toxicity. Preferably, palliative hormonal and/or chemotherapy should be administered in controlled clinical trials.     

Endometrial cancer

Carcinoma of the uterine corpus (endometrialcancer) remains the gynecologic malignant disease with the highest annual prevalence in the United States. The most common histologic type is adenocarcinoma, although more aggressive variants (e.g., papillary serous carcinoma and clear cell carcinoma) have been identified. Risk factors that are strongly associated with the development of endometrial cancer include tamoxifen therapy, obesity, and stimulation from unopposed estrogen (from exogenous sources or endogenously secreting ovarian tumors). The current staging system of the International Federation of Gynecology and Obstetrics is based on surgical-pathologic findings. Survival has been directly correlated with tumor stage in this staging system. The cornerstone of therapy is total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pelvic and para-aortic lymphadenectomy may provide additional prognostic information but probably does not confer a therapeutic advantage. Moreover, such nodal dissections predispose to the development of complications, especially in women who subsequently receive pelvic irradiation. Other than surgical treatment, irradiation is the single most active therapy for endometrial carcinoma. In fact, some women who are not candidates for hysterectomy because of medical contra-indications can be cured with radiation alone. Adjuvant therapy following hysterectomy is based on patient- and tumor-related features that provided prognostic information for incidence and pattern of recurrence. Adjuvant treatment usually includes pelvic irradiation for selected patients. Current investigational strategies are directed at the role of whole-abdomen irradiation, extended-field irradiation, and systemic chemotherapy. The most active systemic agents include cisplatin, doxorubicin, paclitaxel, and progestins.     

Endometrial cancer.

Endometrial cancer is the most common gynecologic malignancy in the United States, with 37,400 new cases and 6400 deaths estimated to occur in 1999. The epidemiology of endometrial cancer has been widely characterized; nevertheless, efforts continue to more precisely define risk factors for the disease. Accurate epidemiologic risk factor profiles or focused screening efforts may ultimately facilitate the primary prevention of endometrial cancer. Currently, standard management of women with endometrial cancer includes surgical exploration with total hysterectomy and bilateral salpingo-oophorectomy. Uterine histopathologic characteristics and intraoperative findings continue to provide the primary indications for surgical staging in endometrial cancer. The addition of serum CA125 and selected imaging techniques (eg, transvaginal sonography with color Doppler and MR imaging) to the preoperative assessment may ultimately improve the sensitivity and specificity with which patients are selected for pathologic nodal evaluation. Various clinicopathologic factors have been evaluated as predictors of the clinical course of endometrial cancer and as selection criteria for patients most likely to benefit from adjuvant therapy. Histologic measurement of the tumor microvessel density is a promising technique for identifying patients at high risk for recurrence. Although uterine papillary serous carcinoma of the endometrium represents only 3% to 4% of endometrial cancer cases, it is of particular interest because of the aggressive clinical course and poor prognosis associated with this disease.     

联合宫腔刷及宫腔吸管采集子宫内膜在子宫内膜癌筛查中的应用

目的 探讨联合应用宫腔刷及宫腔吸管采集子宫内膜的组织学诊断在子宫内膜癌筛查中的应用价值.方法 选取具有宫腔镜活检指征的患者,先采用宫腔刷刷取子宫内膜,再用宫腔吸管将脱落于宫腔的子宫内膜吸出,对两者获取的子宫内膜"有形成份"经石蜡包埋后进行组织学诊断,同时行宫腔镜活检进行组织学诊断.以宫腔镜活检的组织学诊断作为诊断"金标准",分析联合采样中子宫内膜"有形成份"的检出率以及对子宫内膜癌及癌前病变的诊断符合率、灵敏度及特异度.结果 150例患者中,联合采样获取子宫内膜"有形成份"92例,检出率为61.33%.经宫腔镜活检确诊癌前病变11例及子宫内膜癌15例.15例子宫内膜癌中,联合采样"有形成份"组织学诊断14例,诊断符合率为93.33%、灵敏度为100.00%、特异度为99.26%.结论 联合应用宫腔刷及宫腔吸管可提高样本检出率,有利于子宫内膜癌的筛查;宫腔刷取子宫内膜"有形成份"有利于子宫内膜癌的组织学诊断.     

Endometrial cancer imaging

Endometrial cancer is staged according to the International Federation of Gynecology and Obstetrics surgical system. Clinical estimation of stage, however, can be inaccurate in more than 20%, and therefore, preoperative imaging of the disease may assist in planning the optimal course of treatment. Magnetic resonance imaging (MRI) may detect gross myometrial extension or extension of tumor to the cervical stroma, which can alter management and therefore help in preoperative surgical planning. This issue is increasingly relevant as less invasive surgical techniques, such as laparoscopic surgeries, are becoming more commonplace for lower stage cancers. Currently, MRI is the most widely used modality for preoperative planning.     

Endometrial Stromal Sarcoma

Uterine sarcomas comprise 2–3% of all uterine malignancies. Tumors in this category are, in order of decreasing incidence, carcinosarcoma, leiomyosarcoma, endometrial stromal sarcoma, and adenosarcoma. Endometrial stromal sarcomas are divided into low- and high-grade according to tumor cell morphology and mitotic rate. Low-grade tumors are characterized by a slow growth pattern, presence of estrogen and/or progesterone receptors, and an indolent clinical course with late recurrences. Despite this indolent course, 37–60% of patients with early-stage disease experience recurrent disease. High-grade stromal sarcomas, on the other hand, exhibit more aggressive biological behavior and poor outcome. The standard treatment for localized endometrial stromal sarcomas is total abdominal hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiation therapy appears to reduce locoregional failure, although its benefit in terms of overall survival is unknown. Progestogens have been considered first-line therapy in recurrent low-grade tumors, with durable response rates of approximately 50%. Some authors also favor their use in the adjuvant setting, although no clear data exist to support this indication as a standard approach. Other hormonal approaches such as aromatase inhibitors may provide an alternative to progestogens in light of a more favorable toxicity profile and similar antitumor activity. Chemotherapy, including anthracyclines, is generally reserved for recurrent low-grade tumors that progress on hormonal therapies and for high-grade lesions that usually lack hormone receptors. The combination of chemotherapy and hormones may be considered in highly symptomatic patients or in those with high-volume, life-threatening disease. In summary, endometrial stromal sarcoma of the uterus is a rare disease that should be treated with radical surgery. Prognostic factors according to tumor stage, mitotic count, and tumor grade can, to some extent, predict biologic tumor behavior and prognosis. The role of postoperative radiation therapy and adjuvant progestogens, particularly for low-grade disease, remains to be defined. Recurrent or metastatic disease should be treated with systemic therapy, and the choice between hormonal therapy and chemotherapy should be based on histologic characteristics including mitotic count, cell morphology, and estrogen and progesterone receptor status. Salvage surgery and/or radiation have been associated with some long-term remissions, and can be considered as part of the multimodality approach in selected cases. New prognostic markers and specific therapeutic targets are clearly needed in this rare disease.     

Relations of Platelet Indices with Endometrial Hyperplasia and Endometrial Cancer

Background: Platelets are blood elements thought to play a role in the immune system and therefore tumordevelopment and metastasis. Platelet activation parameters such as mean platelet volume (MPV), plateletdistribution width (PDW), and plateletcrit (PCT) can be easily evaluated with the whole blood count and havebeen studied as markers of systemic inflammatory responses in various cancer types. Our aim in this study wasto evaluate the correlation between endometrial pathologies and MPV, PDW and PCT. Materials and Methods:A total of 194 patients who presented to our clinic with abnormal vaginal bleeding were included in our study.The patients were divided into 3 groups (endometrial hyperplasia, endometrial cancer, control) according to theirpathology results. The groups were compared for MPV, PDW, and PCT values obtained from the blood samplestaken on endometrial biopsy day. Results: The endometrial cancer patients were the oldest group (p=0.04).There was no significant difference between the three groups in terms of white blood cell count (WBC), plateletcount (PC), and hemoglobin (Hb) level. The highest MPV (p<0.001), PDW (p=0.002), and PCT (p<0.001) levelswere in the endometrial cancer group, and the lowest levels were in the control group. Conclusions: The easyevaluation of platelet parameters in patients who are suspected of having endometrial pathology is a significantadvantage. We found MPV, PDW, and PCT to be correlated with the severity of endometrial pathology with thehighest values in endometrial cancer. Studies to be conducted together with different laboratory parameters willfurther help evaluate the diagnosis and severity of endometrial cancer and precursor lesions.