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首页> 外文期刊>European journal of gynaecological oncology >Well differentiated endometrioid adenocarcinoma of the uterus: a cancer unit or centre case?
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Well differentiated endometrioid adenocarcinoma of the uterus: a cancer unit or centre case?

机译：子宫高分化子宫内膜样腺癌：癌症单位还是中心病例？

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OBJECTIVE: The purpose of this study was to investigate what proportion of cases showing a well differentiated endometrioid endometrial adenocarcinoma in the hysterectomy specimen removed at two UK cancer centres had adverse pathological features or advanced stage disease at the time of presentation. STUDY DESIGN: Ninety-eight patients who were operated on at either the South East London Cancer Centre, London or the Kent Oncology Centre, Maidstone had a histological diagnosis of well differentiated (grade 1) endometrioid adenocarcinoma in their hysterectomy specimen. These were identified using the multidisciplinary meeting database as well as the respective pathology department databases. The histology reports for these patients were examined and analysed for the purpose of this study. RESULTS: Of the initial 98 cases, 65 patients (66.3%) were referred with a preoperative curettage showing a well differentiated endometrioid adenocarcinoma, 25 cases (25.5%) were referred with atypical endometrial hyperplasia, seven patients (7.1%) were referred with a moderately differentiated endometrioid adenocarcinoma, and one case (1.0%) was referred with a possible malignant mixed Mullerian tumour. Subsequent histological examination of the hysterectomy specimens revealed that all of these cases had a well differentiated endometrioid adenocarcinoma. In 20 of the 98 cases (20.4%) there was no myometrial invasion, 56 cases (57.1%) showed invasion of the inner half of the myometrium and 22 cases (22.4%) showed outer half involvement. There was no cervical involvement in 78 cases (79.6%), endocervical gland involvement in eight patients (8.2%) and cervical stromal involvement in 12 patients (12.2%). The total percentage of cases with cervical involvement was 20.4%. Thirty-eight cases (out of the 98) underwent a bilateral pelvic lymphadenectomy. Of these 38 cases, four cases had locoregional nodal metastases (10.5% of the patients who underwent lymphadenectomy). There were ovarian metastases in one case and metastasisto one fallopian tube in another. From our study, 33.6% of cases with a well differentiated endometrioid adenocarcinoma of the uterus were Stage Ic or more at the time of presentation; 12.2% were at least FIGO Stage Ic, eight patients (8.2%) were FIGO Stage IIa, seven patients (7.1%) were Stage IIb and six patients (6.1%) were Stage III. In these patients a full surgical staging operation with a pelvic lymphadenectomy was indicated according to FIGO recommendation. CONCLUSION: A significant proportion (33.6%) of well differentiated tumours in a hysterectomy were found to have Stage Ic disease or more at the time of presentation, and thus full surgical staging including a lymphadenectomy should have been carried out in these cases. Cases with a preoperative biopsy showing atypical hyperplasia or well differentiated adenocarcinoma should have a preoperative MRI scan or preferably an intraoperative frozen section examination to identify those cases with adverse pathological features which need to be fully stagedwith pelvic and paraaortic lymphadenectomy.
机译：目的：本研究的目的是调查在英国的两个癌症中心切除的子宫切除标本中显示出高分化子宫内膜样子宫内膜腺癌的病例中有多少比例具有不良病理特征或晚期疾病。研究设计：在伦敦东南伦敦癌症中心或梅德斯通肯特肿瘤学中心接受手术的98例患者，其子宫切除标本经组织学诊断为高分化（1级）子宫内膜样腺癌。这些是使用多学科会议数据库以及各个病理科数据库来确定的。为了研究的目的，对这些患者的组织学报告进行了检查和分析。结果：在最初的98例患者中，有65例（66.3％）进行了术前刮除术，显示出高分化子宫内膜样腺癌; 25例（25.5％）发生了非典型子宫内膜增生; 7例（7.1％）发生了刮宫中度分化的子宫内膜样腺癌，其中1例（1.0％）可能患有恶性混合穆勒氏肿瘤。子宫切除标本的随后组织学检查显示，所有这些病例均具有高分化子宫内膜样腺癌。 98例中有20例（20.4％）没有子宫肌层浸润，56例（57.1％）表现为子宫肌层内半部浸润，22例（22.4％）表现为子宫内膜受累。 78例（79.6％）无颈椎受累，8例（8.2％）无宫颈内膜受累，12例（12.2％）无宫颈间质受累。宫颈受累病例总数为20.4％。 98例中有38例接受了双侧盆腔淋巴结清扫术。在这38例病例中，有4例发生了局部淋巴结转移（占接受淋巴结清扫术的患者的10.5％）。一例发生卵巢转移，另一例发生转移至一根输卵管。根据我们的研究，在就诊时33.6％的子宫内膜样腺癌高分化患者为Ic期或更高。至少FIGO Ic期为12.2％，FIGO IIa期为8名患者（8.2％），IIb期为7名患者（7.1％），III期为6名患者（6.1％）。在这些患者中，根据FIGO的建议进行了盆腔淋巴结清扫术的完整手术分期手术。结论：在出现子宫时，子宫切除术中分化良好的肿瘤中有相当大比例（33.6％）被发现患有Ic期疾病或更多，因此，在这些情况下，应进行包括淋巴结清扫术在内的完整手术分期。术前活检显示非典型增生或分化良好的腺癌的病例应进行术前MRI扫描或术中冰冻切片检查，以识别那些病理不良的病例，需要对其进行盆腔和主动脉旁淋巴结清扫术的完整分期。

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