甲羟孕酮对年轻子宫内膜不典型增生患者的疗效研究

目的探讨甲羟孕酮对年轻子宫内膜不典型增生患者的疗效。方法 115例子宫内膜不典型增生患者,轻度、中度和重度不典型增生分别为63、32和20例。所有患者经诊断性刮宫病理检查确诊,应用甲羟孕酮治疗3～6个月后,行诊刮送病理检查以评价其疗效,记录有生育要求患者妊娠情况。结果 115例患者经甲羟孕酮治疗后,109例有效,总有效率达94.7%,轻度、中度和重度子宫内膜不典型增生患者有效率分别为100.0%、93.7%和70.0%,轻度和中度患者总有效率显著高于重度患者,差异有统计学意义(P<0.05)。95例有生育要求的患者治疗后64例达临床妊娠,其中轻度患者42例,中度患者15例,重度患者7例,轻度、中度和重度患者妊娠率分别为73.6%、60.0%和53.8%,三组妊娠率比较无统计学差异(P>0.05)。结论对有生育要求的年轻子宫内膜不典型增生患者,采用甲羟孕酮保守治疗的效果好,不仅能够有效治疗疾病,而且能够提高患者生活质量,达到生育目的,但要注意密切随访预防复发。     

高分化子宫内膜癌或非典型子宫内膜增生患者保守治疗后妊娠结局影响因素分析

目的 探讨对于高分化子宫内膜癌(EC)或非典型子宫内膜增生(AEH)患者醋酸甲羟孕酮(MPA)保守治疗后妊娠建立的影响因素。方法 回顾性研究65例EC/AEH患者,分为妊娠组(34例)和非妊娠组(31例),统计学分析妊娠建立的影响因素。结果 妊娠组和非妊娠组相比临床基本特征均无统计学差异(P＞0.05);妊娠组的MPA治疗的持续时间、病变消失时间、妊娠允许年龄、复发、行刮宫术次数和排卵期间子宫内膜厚度与非妊娠组相比存在统计学差异(P＜0.05);Logistic回归分析显示复发(OR=2.323,P=0.015)、排卵期间子宫内膜厚度(OR=0.283,P＜0.001)和允许妊娠年龄(OR=2.524,P=0.039)是影响妊娠结局的显著性因素。结论 复发、排卵期子宫内膜厚度和怀孕时年龄是MPA保守治疗后妊娠建立的影响因素;MPA治疗肿瘤消失后即采用辅助生殖技术(ART)保育治疗可能有助于肿瘤复发、薄型子宫内膜或高妊娠年龄的患者保留生育力。     

子宫内膜非典型增生65例诊疗分析

子宫内膜非典型增生是一个组织病理学名称，属子宫内膜增生的一种类型．是激素依赖型子宫内膜癌的癌前病变，临床上多发生于比较年轻的女性。我们治疗子宫内膜非典型增生65例，结果总结报道如下。     

年轻早期高分化子宫内膜样腺癌或子宫内膜不典型增生保留生育功能的Ⅱ期临床研究

背景与目的:早期子宫内膜癌保留生育功能的治疗是妇瘤科医生面临的一个挑战。本研究旨在评估醋酸甲地孕酮治疗早期高分化子宫内膜样腺癌和(或)子宫内膜复杂性不典型增生过长的可行性、安全性。方法:本研究为一项单臂、开放性、前瞻性研究。研究对象为40岁以下高分化子宫内膜样腺癌和(或)子宫内膜不典型增生过长且有强烈保留生育功能愿望的初治患者。治疗前清除子宫内膜全部病灶并排除子宫外转移;所有患者激素受体阳性表达。口服醋酸甲地孕酮160 mg/d,每12周进行1次疗效评估;无效者改行手术治疗,完全缓解者巩固1个疗程后进入随访阶段。结果:2006年至今共20例患者纳入本研究,其中14例为子宫内膜癌,6例为子宫内膜不典型增生;治疗24周(2个疗程)后共计17例(85.0%)患者完全缓解,无严重不良事件发生。初次治疗结束后中位随访26个月(9～60个月),所有患者均存活。4例患者在治疗结束后10～24个月复发,1例患者再次行孕激素治疗后缓解,另外3例患者接受手术治疗。6例计划妊娠的患者中2例自然受孕,其中1例患者已经顺产一健康女婴。结论:醋酸甲地孕酮治疗早期高分化子宫内膜样腺癌和(或)子宫内膜不典型增生安全、可行、有效;但是治疗后复发率较高,所有保守治疗者需要密切随访。     

代谢因素与子宫内膜不典型增生及子宫内膜癌的相关性列线图模型

[目的]探讨代谢因素与子宫内膜不典型增生及子宫内膜癌的相关性,并建立列线图(Nomogram)预测子宫内膜恶性增生的发病风险.[方法]收集2010年1月1日至2015年12月31日首都医科大学附属北京妇产医院妇瘤科收治的子宫内膜不典型增生102例及子宫内膜癌103例共205例患者为病例组,选取同期子宫内膜单纯性增生或息...     

子宫内膜非典型增生65例诊疗分析

子宫内膜非典型增生是一个组织病理学名称,属子宫内膜增生的一种类型,是激素依赖型子宫内膜癌的癌前病变,临床上多发生于比较年轻的女性。我们治疗子宫内膜非典型增生65例,结果总结报道如下。1　对象与方法1.1　病例选择及一般资料我院1998年1月1日~2001年12月31日共收治不规则阴道流血患者378例,经诊断性刮宫病理报告为子宫内膜非典型增生65例,患者要求保守治疗,自愿接收药物治疗。65例患者年龄35~54岁,中位年龄40 2岁。流血时间为2周~1 年,平均84 d。按1987年国际妇科病理协会(ISGP)的子宫内膜非典型增生分级标准进行分级,子宫内膜…     

筋膜外全子宫切除术治疗无生育要求的子宫内膜不典型增生临床观察

目的 探讨不同筋膜外全子宫切除术治疗无生育要求的子宫内膜不典型增生的临床效果,指导其手术方式选择。方法 回顾性分析2018年1月至2021年12月尉氏县人民医院收治的经术后病理学确诊的89例无生育要求的子宫内膜不典型增生患者,其中75例子宫较小者行腹腔镜辅助下筋膜外全子宫切除术(腹腔镜组),余14例行开腹筋膜外全子宫切除术(开腹组),术中所有患者均切除双侧输卵管,部分切除输卵管,必要时给予淋巴结清扫,比较观察2组患者手术时间、术中出血量、肛门首次排气时间、住院时间、并发症等。结果 腹腔镜组75例子宫内膜不典型增生患者的手术时间、术中出血量、肛门首次排气时间、住院时间分别为(90.56±10.49)min、(107.23±19.81)mL、(25.95±3.10)h、(5.11±1.06)d,均明显少于开腹组的(123.29±7.27)min、(226.93±33.22)mL、(39.79±4.37)h、(6.36±1.01)d(t=11.155,P<0.001;t=13.058,P<0.001;t=14.299,P<0.001;t=4.081,P<0.001)。...     

乳腺癌患者应用三苯氧胺导致子宫及子宫内膜病变的早期诊断及治疗

目的观察乳腺癌患者长期服用三苯氧胺对子宫及子宫内膜的影响，并探讨子宫内膜增生的诊断和治疗。方法41例服用三苯氧胺的绝经后女性乳腺癌患者入组，定期行阴道B超。发现子宫内膜厚度≥8mm者行子宫内膜病理检查，并应用不同剂量的甲羟孕酮来治疗子宫内膜增生，甲羟孕酮10mg，每日1次，共10天，或倍恩片0．25g每日1次，共10天。结果应用阴道超声发现子宫内膜厚度≥8mm者共15例，8例行诊断性刮宫，子宫内膜增生6例。应用甲羟孕酮后增生的子宫内膜脱落，不同剂量的甲羟孕酮疗效无差异。本组发现子宫肌瘤6例，其中3例TAM治疗前存在子宫肌瘤，TAM治疗后使子宫肌瘤迅速增大和个数增多，另3例在TAM治疗后出现子宫肌瘤。结论长期服用三苯氧胺可使子宫内膜增生，应采用阴道超声定期检测。甲羟孕酮可使增生的子宫内膜脱落。     

子宫内膜复杂性不典型增生及早期子宫内膜癌患者保留生育功能的预后研究

摘 要：［目的］ 探讨子宫内膜复杂性不典型增生及早期子宫内膜癌患者保留治疗的完全缓解率、复发率和妊娠情况。［方法］ 回顾性分析2015年1月至2018年10月我院妇产科收治106例子宫内膜复杂性不典型增生或早期子宫内膜癌患者保守治疗情况,分析其治疗疗效、复发和妊娠情况,并分析影响子宫内膜复杂性不典型增生及早期子宫内膜癌患者保守生育功能治疗后完全缓解、复发和妊娠的因素。［结果］ 经保守治疗后完全缓解率为83.96%（89/106）,完全缓解后复发率为23.60%（21/89）,妊娠率为35.96%（32/89）。BMI≥30kg/m2是影响完全缓解(OR=2.031,95%CI：1.163~6.032）和完全缓解后复发(OR=1.325,95%CI：1.033~4.251)］、完全缓解后妊娠（OR=1.625,95%CI：1.235~5.621）的独立因素。BMI＜30kg/m2(OR=1.705,95%CI：1.511~4.981)、采用辅助生殖技术 （OR=2.009,95%CI：1.735~6.235）可提高完全缓解后妊娠率。［结论］ 子宫内膜复杂性不典型增生及早期子宫内膜癌患者采用保守治疗可获得满意疗效。肥胖是影响保守治疗疗效、复发的主要因素,积极控制肥胖,采取辅助生殖技术可提高妊娠率,降低复发。     

Study on the long-term follow-up of endometrial hyperplasia

Background A follow-up study of patients with endometrial hyperplasias was performed in order to clarify whether or not hyperplasias were precursor lesions of endometrial carcinoma in a Japanese population. Methods One hundred and seventy-one patients with various endometrial hyperplasias; 88 with simple, 57 with complex, 12 with simple atypical, and 14 with complex atypical hyperplasias were followed up to evaluate the fate of the lesions as well as their clinical features. The follow-up period ranged from 12 to 195 months (mean, 46). Results The patient ages at the time of the initial diagnosis ranged from 27 to 55 years (mean, 44.5) with simple, 16 to 60 (mean, 43.8) with complex, 33 to 53 (mean, 44.8) with simple atypical, and 29 to 50 (mean, 39.7) with complex atypical hyperplasias. More than 85% of the patients complained of metrorrhagia. Menstrual cycles were irregular in 40% of the cases. Cyclic ovulatory phases measured with basal body temperature were observed in 33.9% of patients with simple, 25.6% with complex, and 22.2% with simple atypical, whereas these were only seen in 8.3% of the cases with complex atyical hyperplasia. Ovulatory disturbances were found in more than 65% of the patients with increasing frequency, depending on the severity of hyperplasia. Only 1 (1.1%) of 88 simple, 1 (3.5%) of 57 complex, and 1 (8.1%) of 12 simple atypical cases progressed to endometrial carcinoma, whereas 3 (21.4%) complex atypical cases progressed to endometrial carcinoma. The incidence of complex atypical is significantly higher than in the former two (P<0.001,P<0.05). The 7 patients who progressed to carcinoma had been followed for 16 to 73 months (mean, 38). Their histological type was either G1, G2 or adenoacanthoma and their FIGO surgical stage was l in all cases. The progression rates of the patients treated with or without cyclic medroxyprogesterone acetate (MPA) were 3.7% and 4.4% respectively, showing no significant differences. The regression rates of each hyperplasia to normal endometrium were 69.4% with simple, 68.4% with complex, 75.0% with simple atypical, and 57.2% with complex atyical hyperplasias. Conclusion Endometrial hyperplasias, especially complex atypical are the precursors to endometrial carcinoma. The strict follow-up of patients with endometrial hyperplasia is mandatory.     

Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia

Objective

To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH).

Methods

This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy.

Results

Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed.

Conclusion

Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.     

Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia

Objective: The purpose of this study was to correlate the histological diagnosis made during intraoperativefrozen section (FS) examination of hysterectomy samples with complex atypical endometrial hyperplasia (CAEH)diagnosed with definitive paraffin block histology. Methods: FS pathology results of 125 patients with a preoperativebiopsy showing CAEH were compared retrospectively with paraffin block pathology findings. Results:Paraffin block results were consistent with FS in 78 of 125 patients (62.4%). The FS sensitivity and specificityof detecting cancer were 81.1% and 97.9%, with negative and positive predictive values of 76.7%, and 98.4%,respectively. Paraffin block results were reported as endometrial cancer in 77 of 125 (61.6%) patients. Finalpathology was endometrial cancer in 45.3% patients diagnosed at our center and 76.9% for patients who hadtheir diagnosis at other clinics (p=0.018). Paraffin block results were consistent with FS in 62.4% of all casesConsistence was 98.4% in patients who had endometrial cancer in FS. Conclusion: FS does not exclude thepossibility of endometrial cancer in patients with the preoperative diagnosis of CAEH. In addition, sufficientendometrial sampling is important for an accurate diagnosis     

Magnitude and laterality of breast cancer risk according to histologic type of atypical hyperplasia: results from the Nurses' Health Study

BACKGROUND: Atypical hyperplasia (AH) in a benign breast biopsy is associated with an increased breast cancer risk. However, the influence of the histologic type of AH on the magnitude and laterality of breast cancer risk is poorly defined. METHODS: The authors conducted a case-control study of benign breast disease and breast cancer risk nested within the Nurses' Health Study (395 cases, 1610 controls). Benign breast biopsy slides were reviewed and categorized as showing nonproliferative lesions, proliferative lesions without atypia, or AH. Slides that showed AH were categorized further as atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH). RESULTS: The odds ratio (OR) for breast cancer among all women with AH was 4.1 (95% confidence interval [95% CI], 2.9-5.8). However, among premenopausal women, breast cancer risk was higher for women with ALH (OR, 7.3; 95% CI, 3.8-14.2) than for women with ADH (OR, 3.1; 95% CI, 2.0-4.8). Overall, 58.9% of invasive breast cancers that developed in women with AH were in the ipsilateral breast, and the frequency of ipsilateral breast cancer was similar for women with ALH (61.3%) and women with ADH (55.9%; P = .66). CONCLUSIONS: Women with AH in a benign breast biopsy were at a substantially increased risk for the development of breast cancer. Among premenopausal women, the risk appeared to be greater for those with ALH than those with ADH. Because only approximately 60% of cancers that develop in women with AH occur in the ipsilateral breast, for the purposes of clinical management, these lesions are viewed best as markers of a generalized (bilateral) increase in breast cancer risk.     

Detection of chromosomal anomalies in endometrial atypical hyperplasia and carcinoma by using fluorescence in situ hybridization

BACKGROUND:

Endometrial cancer is the most common pelvic gynecological malignancy. The diagnosis of well‐differentiated endometrial adenocarcinoma, atypical hyperplasia, and hyperplasia is often challenging. The authors sought to investigate the utility of chromosomal anomalies for the detection of endometrial hyperplasia and carcinoma using multitarget fluorescence in situ hybridization (FISH).

METHODS:

Samples were collected by endometrial Tao brush and processed by liquid‐based cytological preparation protocol from consecutive cases to include 50 benign, 50 hyperplasia without atypia, 47 atypical hyperplasia, and 53 endometrial cancers. Each was hybridized using fluorescence‐labeled DNA probes to chromosomes 1, 8, and 10. The FISH signals were enumerated in 100 cells per case, and the chromosomal anomalies were correlated with pathologic findings, including histologic diagnoses on matched endometrial tissue samples.

RESULTS:

Numeric chromosomal anomalies were found in 0% (0 of 50) of benign, 20% (10 of 50) of hyperplasia, 74% (35 of 47) of atypical hyperplasia, and 87% (46 of 53) of carcinoma specimens. The mean percentage of cells with chromosomal changes was 55% in cancer specimens, which was significantly higher than that in hyperplasia without atypia (13%, P < .0001) and atypical hyperplasia (32%, P = .003). The most frequent chromosomal anomaly was gain of chromosome 1. FISH anomalies had an overall sensitivity of 81% and specificity of 90% for the detection of atypical hyperplasia and/or endometrial carcinoma. There was no association with grade of endometrial carcinoma.

CONCLUSIONS:

Multitarget FISH appears to be useful for the differential diagnosis of hyperplasia, atypical hyperplasia, and endometrial adenocarcinoma, with a high level of sensitivity and specificity. It is also a potential tool for the early detection of neoplastic cells in endometrial cytology specimens. Endometrial hyperplasia with FISH‐detected chromosomal anomalies may represent a clinically significant subset of cases that warrant close clinical follow‐up. Cancer (Cancer Cytopathol) 2010. © 2010 American Cancer Society.     

上皮型钙粘附蛋白在子宫内膜癌中的表达及意义

目的　探讨上皮型钙粘附蛋白 (E -cad)在正常子宫内膜、子宫内膜不典型增生、子宫内膜癌中的表达 ,及其与临床参数间的关系。方法　应用免疫组化S -P法检测 14例正常子宫内膜、10例子宫内膜不典型增生及 5 0例子宫内膜癌中E -cad表达情况。结果　在正常子宫内膜、子宫内膜不典型增生及子宫内膜癌中 ,E -cad阳性表达率分别为 10 0 %、80 0 %、42 0 %,各组差异具有显著性 (P <0 .0 5 )。在G1、G2 、G3 子宫内膜癌中 ,E -cad阳性表达率分别为 72 2 %、30 0 %、16 7%(P <0 .0 5 )。在限于内膜组、浸润浅肌层及浸润深肌层组 ,E -cad阳性表达率分别为 6 8 4 %、35 3%、14 3%(P <0 .0 5 ) ,在临床Ⅰ、Ⅱ、Ⅲ期 ,E -cad阳性表达率分别为 6 0 9%、31 3%、18 2 %(P <0 .0 5 )。结论　E -cad异常表达与子宫内膜癌的发生发展密切相关。     

Pulmonary Atypical Adenomatous Hyperplasia And Bronchioloalveolar Carcinoma

Objective To study the relationship between atypical adenomatous hyperplasia (AAH) and bronchioloalveolar carcinoma (BAC). Methods Morphometric, immunohistochemical and ultrastructural analyses were performed in 4 patients with low grade AAH, 5 with high grade AAH and 7 with BAC. Results The mean nuclear areas of high grade AAH and BAC were greater than those of low grade AAH (P<0.05); p53 protein expression was negative in 4 cases of low grade AAH,while the positive rates in high grade AAH and BAC were 40% (2/5) and 57% (4/7), respectively. Conclusiion The development of BAC is stepwise. AAH appears to be a lesion closely related with BAC, probably as its genuine precursor.