子宮内膜異型増殖症に対する開腹あるいは腹腔鏡下子宮全摘術施行時の問題点-子宮体癌併存のリスクと術式の工夫

抄録

Objective: Atypical endometrial hyperplasia (AEMH) is a precancerous lesion of the endometrium, which is often treated with laparoscopic hysterectomy. However, we report some cases in which a postoperative diagnosis of endometrial cancer (EMC) was made although AEMH had been diagnosed preoperatively. In the present study, we retrospectively investigated the clinical features of EMC patients diagnosed with AEMH preoperatively.

Method: We retrospectively evaluated the characteristics (age, gravidity and parity, body mass index [BMI], menstrual history, medical history of diabetes, and family history of malignancy), blood test results (preoperative serum CA125 levels), and imaging study results (measurement of endometrial thickness by ultrasonography) of patients who had been diagnosed with AEMH preoperatively by total curettage of the endometrium and had undergone abdominal or laparoscopic hysterectomy between January 2008 and April 2017. These patients were postoperatively diagnosed with EMC or AEMH on the basis of their pathological findings. We investigated whether there were any differences in the preoperative findings between the EMC and AEMH groups.

Results: A total of 20 patients diagnosed with AEMH preoperatively underwent abdominal or laparoscopic hysterectomy (abdominal; n=7, laparoscopic; n=13). The number of patients diagnosed with AEMH (AEMH group) and EMC (EMC group) postoperatively were 11 (55.0%) and 9 (45.0%), respectively. All 9 patients in the EMC group were in FIGO stage IA and were diagnosed with endometrioid carcinoma, grade 1. No significant difference was observed in the evaluated findings between the AEMH and EMC groups.

Conclusion: As it is difficult to differentiate an EMC from an AEMH diagnosed preoperatively even after total curettage of the endometrium, it is necessary to consider the possibility of malignancy when we perform surgery for patients with AEMH.