The detection rate of endometrioid adenocarcinoma in perimenopausal patients preoperatively diagnosed with atypical endometrial hyperplasia: Clinical, morphological, and immumohistochemical studies

Objective. To study the detection rate of endometrioid adenocarcinoma (EAC) in womenpreoperatively diagnosed as having atypical endometrial hyperplasia (EH) by an immunohistochemical examination of Ki-67 and phosphatase and tensin homolog (PTEN). Subject and methods. Fifty patients who had undergone total hysterectomy with appendages for the histological diagnosis of EAC were retrospectively selected. The expression of Ki-67 and PTEN were immunohistochemically estimated. Results. Out of the 50 patients undergoing hysterectomy for endometrial cancer (EC) and complex atypical EH, 9 (18%) patients were not diagnosed as having the cancer by preoperative transvaginal ultrasonography (USG) of small pelvic organs (SPO). Preoperative SPO magnetic resonance imaging (MRI) did not diagnosed cancer in 6 (12.5%) patients. Thus, there were no great difference in the diagnostic data obtained by both SPO USG and SPO MRI. The preoperative diagnosis of atypical endometrial hyperplasia from the results of histological examination of scrapes of the endometrium revealed its cancer after total hysterectomy in 5 of the 50 cases. Moreover, EAC tissues were found in the basal endometrial layer that was absent in the endometrial scrapes (Fig. 1d). Immunohistochemical examinations of endometrial scrapes showed that it was these 5 cases that had the highest Ki-67values up to 47% and PTENloss up to 50%. Conclusion. The data of SPO USG, SPO MRI, and histological examination of endometrial scrapes are of limited value for the differential diagnosis of atypical endometrial hyperplasia and EAC. SPO USG and SPO MR did not diagnose EAC in 18 and 12.5%, respectively. Furthermore, 5 cases of endometrial cancer were detected by the preoperative diagnosis of complex atypical EH. When endometrial scraping data are used to determine treatment policy in patients diagnosed with atypical endometrial hyperplasia, it is necessary to take into account the fact that EAC may be present in the basal layer that is absent in the examined material in a number of cases. The high values of Ki-67 and partial PTEN loss in the endometrial scrapes are poor prognostic factors and may testify to the development of EAC in the deeper endometrial layers. The use of the proliferation marker Ki-67 and the PTEN tumor suppressor gene allows the timely diagnosis of the possible development of a malignant process and the substantiation of a differential approach to choosing treatment policy in patients with complex atypical EH and EAC.

PTEN, Ki67, atypical endometrial hyperplasia, low-grade endometrioid adenocarcinoma, PTEN, Ki-67