子宫内膜息肉213例分析

目的　通过对 2 1 3例子宫内膜息肉的回顾性分析 ,探讨子宫内膜息肉的病因、诊断及处理。方法　回顾性分析 1 993年 1月～ 2 0 0 1年 1 2月我院通过手术病理诊断的 2 1 3例子宫内膜息肉病历。结果　患者平均年龄 4 9 1岁 (2 6～ 82岁 )。 3例 (1 4 % )有激素替代的历史 ;1 0例 (4 7% )为乳腺癌术后服用三苯氧胺。 5 6例绝经后患者中 ,2 4例 (4 2 9% )绝经后出血 ;32例 (5 7 1 % )无症状 ,仅通过超声或手术后发现。 1 5 7例未绝经患者中 ,5 7例 (36 3% )有不规则出血症状 ;5 3例 (33 8% )周期正常 ,但经量增多 ;4 7例 (2 9 9% )月经正常。经超声诊断率为 6 5 3% (1 30 1 99) ,刮宫诊断率为 30 0 % (1 8 6 0 )。病理报告 1 6 5例 (77 5 % )合并正常内膜 ;2 4例 (1 1 3% )合并存在子宫内膜单纯增生 ;6例 (2 8% )合并存在子宫内膜复合增生 ;3例 (1 4 % )并子宫内膜非典型增生 ;2例 (0 9% )合并子宫内膜癌 ;1例 (0 5 % )合并低度恶性子宫内膜间质肉瘤。结论　子宫内膜息肉是一种常见的宫腔内良性病变 ,常表现为异常出血 ,也可无症状 ,常与子宫内膜的增生或子宫内膜癌前病变合并存在。妇科阴道超声作为无创性检查 ,可提示内膜息肉的存在 ,宫腔镜是诊断内膜息肉的金标准。处理首选宫腔镜下内膜息肉     

子宫内膜增生性疾病患者内膜细胞凋亡的研究

目的 :研究凋亡在子宫内膜增生性疾病中的作用。方法 :用改良原位末端标记技术检测 15例正常月经周期的增生期、分泌期、月经期子宫内膜 ,11例增殖性子宫内膜 ,12例子宫内膜癌 ,以及术前用孕激素治疗的 13例异常增生子宫内膜中的凋亡细胞 ,并计算其凋亡指数 (AI)。结果 :分泌期、月经期子宫内膜、增殖性子宫内膜、子宫内膜癌AI均比正常增生期子宫内膜AI高 (P <0 .0 1)。增殖症患者内膜不典型增生组AI比单纯增生、复杂增生组AI高 (P <0 .0 5 ) ;内膜癌患者低分化组AI比高分化组、中分化组AI高 (P <0 .0 5 )。结论 :细胞凋亡与正常子宫内膜周期性变化有关 ,而在增殖性和癌变子宫内膜中的异常表达可能与子宫内膜的良恶性病变有关     

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     

45岁以下子宫内膜癌41例临床分析

目的探讨45岁以下子宫内膜癌的临床病理特点及诊治方法。方法对我院近10年收治的41例≤45岁的子宫内膜癌患者的临床资料进行回顾性分析。结果≤45岁者占同期内膜癌患者的17．37％，随年龄增加发病人数有增加的趋势。患者中合并原发不孕者3例（7．32％），继发不孕者2例（4．80％）。合并高血压者1例（2．44％）。合并糖尿病者3例（7．32％）。临床表现主要为不同程度的月经失调。病理类型以子宫内膜样癌为主，临床分期多为Ⅰ期，但≤35岁者和36—45岁者比较在临床分期、细胞分化、病理类型及肌层浸润深度方面差异无统计学意义（P〉0．05）。分段诊刮仍然是诊断内膜癌的有效方法。治疗以手术为主，对有高危因素者加辅助治疗。结论45岁以下子宫内膜癌患者多合并不孕、肥胖等，主要表现为月经失调，表明其发生与雌激素刺激有关。临床分期以Ⅰ期为主，尤其是≤35岁者，预后较好。对保留生育功能及保留卵巢的问题仍需进一步研究。     

cyclinD1、p16蛋白在子宫内膜癌中的表达及其临床意义

目的 :探讨cyclinD1、p16与子宫内膜癌发生与发展的关系。方法 :用免疫组化SP法检测了 50例子宫内膜癌、2 2例子宫内膜不典型增生、10例正常子宫内膜组织中cyclinD1、p16蛋白的表达情况。结果 :cyclinD1蛋白在正常子宫内膜、内膜不典型增生、子宫内膜癌中的表达率分别为 0 ( 0 /10 )、2 2 .73% ( 5/2 2 )、4 0 .0 0 % ( 2 0 /50 ) ,其中子宫内膜癌与正常内膜差异有显著性 (P <0 .0 5)。p16蛋白在内膜癌的表达率为 4 6.0 0 % ,明显低于正常内膜组织的 90 .0 0 % (P <0 .0 5)。 50例内膜癌中 ,cyclinD1蛋白在G2 、G3级及临床Ⅱ～Ⅲ期中的表达率分别高于G1级及临床Ⅰ期 (P <0 .0 5) ,复发组表达率高于未复发组 (P <0 .0 5)。p16蛋白表达与子宫内膜癌的细胞分级、临床分期及预后有关 (P <0 .0 5) ,p16蛋白表达阴性者分化差 ,分期晚 ,复发率高。相关性分析显示 ,cyclinD1与p16表达呈负相关 ,二者协同异常表达者生物学行为较差。结论 :cyclinD1、p16与子宫内膜癌的发生、发展密切相关 ,二者异常表达提示子宫内膜癌复发率高、预后差     

PTEN与cyclin E在子宫内膜腺癌中的表达及其意义

目的　探讨PTEN与cyclinE在子宫内膜腺癌发生、发展中的作用及其相互关系。方法　应用免疫组化SP法 ,检测 12例正常增生期子宫内膜、 4 1例子宫内膜增殖症包括 14例单纯型增生 (SH) ,19例复合型增生 (CH)、 8例不典型增生 (AH)和 4 5例子宫内膜腺癌组织中PTEN、cyclinE的表达 ;结果　在增生期子宫内膜、子宫内膜增殖症和子宫内膜腺癌中PTEN阳性表达率呈下降趋势 ,分别为 91 7% (11 12 )、 4 3 9% (18 4 1)和 37 8% (17 4 5 ) ,增生期子宫内膜高于子宫内膜增殖症和子宫内膜腺癌 (P <0 0 0 1) ,PTEN在SH中的阳性表达率 (78 6 % ,11 14 )高于CH、AH (分别为 2 6 3% ,5 19;2 5 0 % ,2 8) (P <0 0 5 ) ;cyclinE在增生子宫内膜、子宫内膜增殖症和子宫内膜腺癌中的阳性表达率分别为 0、 2 6 8% (11 4 1)和 73 3% (33 4 5 ) ,子宫内膜腺癌中的阳性表达率高于增生子宫内膜、子宫内膜增殖症 (P <0 0 0 1) ,在SH、CH和AH中的阳性表达率呈递增趋势 ,分别为 7 1% (1 14 )、 2 6 3% (5 19)、 6 2 5 % (5 8) ,SH与AH相比 ,差异有显著性 (P <0 0 5 ) ;4 5例子宫内膜癌中 ,所有PTEN蛋白阳性的肿瘤均为分化较好、组织学分级为G1 级的子宫内膜腺癌 ,阳性表达率为 5 6 7%(17 30 )。cyclinE表达随组织学分级的     

子宫内膜不典型增生患者的内膜癌漏诊因素分析

目的:探讨子宫内膜不典型增生患者子宫内膜癌漏诊的因素及合理治疗方案。方法:回顾分析132例子宫内膜不典型增生子宫切除前后的临床病理资料。根据术前内膜取样方式分为宫腔镜组与诊刮组,比较两种方式的诊断符合率。比较术前病理与术中冰冻病理、术后常规病理,分析其主要临床病理资料。结果:132子宫内膜不典型增生患者中,术后证实为子宫内膜癌者42例(31.82%)。诊刮组的内膜癌漏诊率为32.99%(32/97),高于宫腔镜组28.75%(10/35),但无统计学差异(P0.05)。42例内膜癌患者中,95.24%(40/42)为子宫内膜样腺癌,ⅠA期38例(90.48%),高分化癌34例(80.95%)。术中行冰冻病理检查者115例,其中11例子宫内膜癌漏诊。长期月经紊乱、未生育患者子宫内膜癌漏诊的风险增高。结论:子宫内膜病理诊断为不典型增生的患者有子宫内膜癌漏诊的风险,尤其是长期月经紊乱、未生育的女性。子宫内膜不典型增生的治疗应采取个体化治疗方案。     

子宫内膜增生并发子宫内膜癌的高危因素及预后分析

目的:研究子宫内膜增生患者并发子宫内膜癌的高危因素及其预后的分析。方法:回顾性分析2014年1月至2015年1月行全子宫切除术,且术前诊断性刮宫(诊刮)提示子宫内膜增生的74例患者的临床资料。根据全子宫切除术后的病理结果分为子宫内膜癌组(28例)和子宫内膜增生组(46例),对两组的临床特征进行比较,并分析发生子宫内膜癌的高危因素。结果:①74例患者中37.8%(28/74)并发子宫内膜癌。单因素和多因素分析结果均提示:年龄≥48岁和诊刮病理为重度子宫内膜不典型增生(重度AEH)为发生子宫内膜癌的高危因素(P0.05)。②不伴任何高危因素、伴有1个高危因素和2个高危因素的患者并发子宫内膜癌的几率分别为5.0%(1/20)、46.2%(12/26)和81.8%(9/11),差异有统计学意义(P0.05),且随着高危因素数目的增加发生子宫内膜癌的风险显著升高(OR 16.3,95%CI 1.9~140.3,P=0.011;OR 85.5,95%CI 6.8~1071.3,P=0.001)。③28例并发子宫内膜癌患者均为早期子宫内膜样癌,25例为高分化,3例为中分化。平均随诊13.3±6.3月,没有患者复发或死亡。结论:子宫内膜增生患者并发子宫内膜癌的发生率较高,特别是对于高龄(≥48岁)、诊刮病理为重度AEH的患者并发风险显著增加,但并发的子宫内膜癌多为分化较好的早期子宫内膜样癌,近期预后良好。     

环氧合酶-2在子宫内膜癌组织中的表达

目的　探讨环氧合酶COX 2与子宫内膜癌发生、发展的关系。方法　应用免疫组织化学、蛋白印迹法和逆转录聚合酶链反应 (RT PCR)技术 ,检测增生期内膜 2 5例 (增生期组 ) ,分泌期内膜2 5例 (分泌期组 ) ,内膜炎内膜 2 5例 (内膜炎组 ) ,非典型增生内膜 2 3例 (非典型增生组 ) ,子宫内膜癌34例 (内膜癌组 )组织中COX 2蛋白和mRNA的表达。结果　COX 2在增生期组、分泌期组、内膜炎组、非典型增生组、子宫内膜癌组的表达率分别为 :6 7、6 4、6 0、6 0、6 7% ,免疫组织化学染色强度分别为(5 4 6± 0 12 )、(3 2 0± 0 18)、(4 78± 0 12 )、(6 10± 0 2 5 )、(8 70± 0 93)分 ;COX 2蛋白表达水平分别为 0 75± 0 2 3、0 4 1± 0 4 5、0 5 6± 0 31、1 10± 0 5 6、1 4 6± 0 4 1;COX 2mRNA含量分别为 (93± 8)、(6 5± 11)、(79± 6 )、(2 99± 11)、(493± 30 )fpg μg。内膜癌组COX 2蛋白和mRNA表达强度明显高于其他 4组 ,差异均有极显著性 (P <0 0 0 1)。内膜癌组中高分化细胞COX 2表达高于低分化细胞 ,差异有显著性 (P <0 0 5 )。非典型增生组显著高于增生期组、分泌期组和内膜炎组 ,增生期组显著高于分泌期组 ,差异均有显著性 (P <0 0 5 )。结论　COX 2在子宫内膜癌的发生、发展中起重     

p27蛋白在子宫内膜癌组织中的表达及其临床意义

目的 :探讨p2 7在子宫内膜癌组织中的表达及其临床意义。方法 :采用免疫组化S -P法测定 16份正常子宫内膜、18份子宫内膜不典型增生及 50份子宫内膜癌组织中的p2 7蛋白表达。结果 :p2 7蛋白在子宫内膜癌、子宫内膜不典型增生及正常子宫内膜中的表达率分别为 34%、6 6 .6 7%和 93.75% ,正常子宫内膜及不典型增生组均显著高于子宫内膜癌组 ,差异有显著性 (P <0 .0 5)。p2 7蛋白表达与子宫内膜癌组织学分级、肌层浸润程度及患者预后显著相关 (P <0 .0 5) ,但与临床分期无关。结论 :p2 7蛋白表达下降或缺失可能在子宫内膜癌的发生、发展中起重要作用 ,并可能提示患者的预后     

高分化子宫内膜样癌及子宫内膜重度不典型增生患者孕激素治疗的临床分析

目的探讨35岁以下高分化子宫内膜样癌及子宫内膜重度不典型增生患者采用孕激素治疗以保留患者子宫的疗效,并随访其治疗后的生育情况.方法采用回顾性分析的方法对1991年至2005年北京协和医院收治的35岁以下、接受孕激素治疗（以醋酸甲羟孕酮为主）的25例高分化子宫内膜样癌及子宫内膜重度不典型增生患者的临床病理资料进行研究.其中,子宫内膜样癌8例（内膜癌组）,子宫内膜重度不典型增生17例（不典型增生组）.孕激素治疗前对患者进行全面的分期评估,治疗后每1～6个月诊刮以评价疗效,对有生育要求者随访其生育情况.结果内膜癌组患者孕激素治疗前经全面的分期评估,证实为早期、高分化子宫内膜样癌.除1例子宫内膜样癌患者尚未评估疗效外,内膜癌组其他7例及不典型增生组17例患者治疗后有效者分别为6例（6/7）、17例（100%）;缓解者分别为5例（5/7）、14例（82%）;缓解后复发者分别为1例（1/5）、3例（21%）,复发时间为缓解后6～30个月;随访缓解后要求生育的14例患者中,内膜癌组4例患者尚未生育,不典型增生组10例患者中4例妊娠共7次.1例自然受孕后失访;3例经促排卵治疗后受孕并足月分娩,其中1例产后人工流产3次.结论对于要求保留子宫的高分化子宫内膜样癌及子宫内膜重度不典型增生的年轻患者,孕激素治疗是一种治疗选择.孕激素治疗前应对子宫内膜样癌患者进行详细全面的分期评估,辅助生殖措施的介入有望提高治疗后的妊娠率.     

Premenopausal bleeding: When should the endometrium be investigated?—A retrospective non-comparative study of 3006 women

Objective

There is lack of consensus amongst professional organizations as regards the cut-off age for endometrial sampling of premenopausal women presenting with abnormal uterine bleeding (AUB) to exclude endometrial hyperplasia or carcinoma. Therefore we conducted this study to quantify the prevalence of hyperplasia and carcinoma in different age categories in premenopausal women with AUB to identify the appropriate cut-off age for endometrial sampling.

Study design

A retrospective review of the histopathology reports of endometrial samples taken from 3006 women presenting with AUB and aged from ≥30 to ≤50 years at Ipswich Hospital, UK, from 1 January 1998 to 31 December 2007. Women were divided into three subgroups according to age; group 1: 30 to ≤40 (n = 862), group 2: 40 to ≤45 (n = 1035) and group 3: 45 to ≤50 (n = 1109).

Results

Logistic regression revealed that the prevalence of atypical hyperplasia (OR: 3.85; 95% CI: 1.75, 8.49; p = 0.01) and carcinoma (OR: 4.03; 95% CI: 1.54, 10.5; p = 0.04) was significantly higher in women in group 3 when compared to younger women. There was no statistically significant difference as regards simple and complex hyperplasia in the different age categories. All but one of the women (n = 23) who had complex atypical hyperplasia or carcinoma under the age of 45 years, presented with irregular rather than cyclical heavy menstrual bleeding.

Conclusion

Our study, the largest in the literature, suggests using the age 45 years as a cut-off for sampling the endometrium in all women with AUB. However, irregular menstrual bleeding justifies investigating women regardless of their age.     

The diagnosis of endometrial hyperplasia on curettage: how reliable is it?

Objective  To evaluate the consistency of preoperative and postoperative histological findings in cases of endometrial hyperplasia. Materials and methods  Fifty-five patients with endometrial hyperplasia detected by surgical curettage were treated by hysterectomy. The histopathological diagnoses found on curettage specimens were compared and correlated with those found on hysterectomy. Endometrial hyperplasia was classified according to the classification scheme of the International Society of Gynecological Pathologists. Results  Fifty-five patients were diagnosed with endometrial hyperplasia on curettage specimens performed for evaluation of various bleeding abnormalities. The average age of the patients was 51.8 years (range 35–74). Thirty patients (55%) were postmenopausal. The interval between curettage and hysterectomy was 1–33 weeks. Of the patients, 26 (47%) had simple hyperplasia, 24 (44%) complex hyperplasia and 5 patients (9%) had complex atypical hyperplasia. Histopathological evaluation of hysterectomy specimens of these patients showed a total number of 35 cases (64%) with endometrial hyperplasia, 1 case of endometrial carcinoma and 19 cases with other pathological findings. The consistency rate between curettage and hysterectomy specimens was 45% (25/55 cases). Following hysterectomy, we found that none of the 26 simple hyperplasia cases and only one of the 24 complex hyperplasia cases coexisted with endometrial carcinoma. On the other hand, three of the five cases of complex atypical carcinoma coexisted with endometrial carcinoma. Conclusions  Curettage endometrial pathology tends to be more consistent with final hysterectomy pathology in simple hyperplasia. However, in cases of complex hyperplasia with atypia, curettage seems to under diagnose the real pathology.     

卵巢子宫内膜样癌同步子宫内膜病变的临床分析

目的:探讨卵巢子宫内膜样癌（OEC）同步子宫内膜病变的临床特点、治疗及预后。方法:收集1998年8月至2017年12月在北京大学人民医院接受治疗并经病理检查确诊为OEC的56例患者的临床病理资料,其中OEC同步子宫内膜病变患者13例（OEC同步内膜病变组）及单纯OEC患者43例（单一OEC组）。比较两组患者的临床特点、...     

Clinico-pathological profile of endometrial carcinoma in young women (under 40 years of age)

Twenty primary endometrial carcinomas in 40 year-old or younger women were collected from a series of 845 carcinomas and newly re-evaluated. The typical histological profile was well-differentiated adenocarcinoma (30%) or adenoacanthoma (35%); however, a case of adenosquamous carcinoma and an exceptional malignant mixed mesodermal tumor were also observed. No tendency for myometrial infiltration (M0) was displayed by 11 (55%) of the cases, while 6 were M1 and 3 were M2 infiltrating neoplasias. Adenomatous hyperplasia was associated with cancer in 53% of the 15 assessable cases. Histopathological diagnostic problems were elicited in 5 cases only. Typical Stein-Leventhal syndrome occurred in 7 patients (35%), while polycystic ovaries were observed in 15 cases (75%). Usually, the patients were obese (40%) and nulligravida (65%). All but one case were stage I disease. Prognosis seems to be excellent following surgery.     

Endometrial carcinoma in young women

Two hundred and fifty-four patients with endometrial carcinoma were diagnosed and treated from Feb. 1956 to Apr. 1987. Of these, 35 patients were below the age of 40 years at the time of diagnosis. These patients were analyzed and compared with those aged above 40. The main clinical manifestations were primary sterility and irregular menstruation. An endometrial carcinoma should be suspected in young women with menstruation disorder, sterility and follicular cyst of ovary refractory to treatment. The highly differentiated endometrial carcinoma in young women was easily confused with adenomatous hyperplasia and should be diagnosed with caution. In young patients with stage I well-differentiated disease desirous of childbirth, treatment by large dose of progestogens without hysterectomy may be the method of choice. Estimation of estrogen and progesterone receptors was very helpful in selecting therapeutic modalities and predicting prognosis. The difference of 5-year survival rates between these two groups of patients were not statistically significant.     

51例老年子宫内膜癌临床分析

目的 :分析老年子宫内膜癌的临床特点、病理类型及处理方法 ,以期进一步指导临床治疗。方法 :对 131例子宫内膜癌患者中≥ 6 0岁 5 1例 (老年组 )进行回顾性研究并与同期≤ 5 0岁的 35例 (中青年组 )做对照分析。全部手术切除的标本均经病理检查确诊。结果 :老年组与中青年组临床分期 ,Ⅱ期以上的分别为 2 9 4 %(15 / 5 1)和 11 4 %(4/ 35 ) ;组织分级G2 -G3分别为 6 8 6 %(35 / 5 1)和 45 7%(16 / 35 ) ;子宫肌层浸润深度大于 1/ 2的分别为 43 1%(2 2 / 5 1)和 2 0 0 %(7/ 35 ) (P <0 0 1) ;5年存活率分别为 6 6 6 %和 91 4 %(P <0 0 5 )。结论 :老年子宫内膜癌的预后较中青年妇女的子宫内膜癌差 ,与临床分期晚和组织分化差有关。     

Ⅰ期子宫内膜癌腹膜后淋巴结清除术的探讨

目的 探讨Ⅰ期子宫内膜癌的淋巴结转移率及行腹膜后淋巴结清除术的意义。方法 对３８例临床Ⅰ期子宫内膜癌临床、病理及随访资料呃生研究,对照分析经行腹膜后淋巴清除术后,未淋巴转移者２２例,ＦＩＧＯＩ期（Ａ组）,有淋巴结转移者６例,ＦＩＧＯ升级为ⅢＣ期（Ｂ组）及术行腹膜后淋巴清除扔１０例（Ｃ组）结果 经腹膜后淋巴清除术的患者中２１．４％有腹膜后淋巴结转移,因此期别应上升为ⅢＣ期,且腹膜后淋巴结转移与肿瘤细     

The influence of age on prognosis in carcinoma of the cervix

Of 385 new patients with invasive carcinoma of the cervix FIGO stages IB-IV treated between 1970-1984 inclusive, 11% (43 patients) were aged less than or equal to 35 years. During the period studied there was a gradual rise in the proportion of such young women from 2% for the triennium 1970-1972 to 18% for 1982-1984. In women aged less than or equal to 35 years early stage disease predominated, 72% presenting with stage IB disease, compared with 29% in the older age group. For FIGO stage IB there was no significant difference in actuarial survival between younger and older patients (P greater than 0.1), both age groups having a 5-year survival rate of 81%. Similarly for FIGO stage II there was no difference in actuarial survival (P greater than 0.1) between younger and older patients who had 5-year survival rates of 66% and 63% respectively. In our experience the incidence of invasive carcinoma of the cervix in young women is rising, but stage for stage their survival is similar to that of older women.     

The influence of age on prognosis in carcinoma of the cervix

Summary. Of 385 new patients with invasive carcinoma of the cervix FIGO stages IB—IV treated between 1970–1984 inclusive, 11% (43 patients) were aged ≤35 years. During the period studied there was a gradual rise in the proportion of such young women from 2% for the triennium 1970–1972 to 18% for 1982–1984. In women aged ≤35 years early stage disease predominated, 72% presenting with stage IB disease, compared with 29% in the older age group. For FIGO stage IB there was no significant difference in actuarial survival between younger and older patients ( P >0·1), both age groups having a 5-year survival rate of 81%. Similarly for FIGO stage II there was no difference in actuarial survival ( P >0·1) between younger and older patients who had 5-year survival rates of 66% and 63% respectively. In our experience the incidence of invasive carcinoma of the cervix in young women is rising, but stage for stage their survival is similar to that of older women.