akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347.2016.10.2.032-036akusherstvo-287Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИENDOMETRIAL PRECANCER: DEFINITION OF CONCEPTS, TACTICSПРЕДРАК ЭНДОМЕТРИЯ: ОПРЕДЕЛЕНИЕ ПОНЯТИЯ, ТАКТИКАТабакманЮ. Ю.TabakmanIu. Iu.

д.м.н., профессор кафедры акушерства и гинекологии медико-профилактического факультета Первого МГМУ им. И.М. Сеченова,

заслуженный врач РФ, врач-радиолог высшей квалификационной категории, зав. лабораторией радиоизотопной диагностики 

ул. Бауманская, д. 17/1, Москва, 105005

MD, professor of the Department of Obstetrics and Gynecology, Faculty of Medical and Preventive Medicine First Moscow Medical Sechenov University,

Honoured Doctor of the Russian Federation, radiologist of the highest qualification category, manager radioisotope laboratory diagnostics, 

ul. Baumanskaya, 17/1, Moscow, 105005

tabakman37@mail.ruСолоповаА. Г.SolopovaA. G.

д.м.н., профессор кафедры акушерства и гинекологии медико-профилактического факультета,

ул. Трубецкая, дом 8, стр. 1, 119991, Москва

MD, Professor of Department of Obstetrics and Gynecology,

Trubetskaya str., 8, p. 1, Moscow, 119991

antoninasolopova@yandex.ruБиштавиА. Х.BishtaviA. Kh.

к.м.н., ассистент кафедры акушерства и гинекологии,

ул. Делегатская. 20, стр. 1, Москва, 127473

PhD, Assistent Professor, Department of Obstetrics and Gynecology, 

ul. Delegatskaia, 20/1, Moscow, 127473

haled72@mail.ruИдрисоваЛ. Э.IdrisovaL. E.

к.м.н., научный сотрудник кафедры акушерства и гинекологии медико-профилактического факультета,

ул. Земляной Вал, 62, стр. 1, Москва, 109004

PhD, researcher at the Department of the Ob/Gyn Department,

ul. Zemlyanoi Val, 62-1, Moscow, 109004

gemostasis@mail.ruГБУЗ «Онкологический клинический диспансер №1 Департамента здравоохранения города Москвы»РоссияClinical Oncology Dispensary number 1 Department of Health in MoscowRussian FederationГБОУ ВПО «Первый МГМУ имени И.М. Сеченова» Минздрава РоссииРоссияFirst Moscow State Medical Sechenov University of the Ministry of Health Russian FederationRussian FederationГБОУ ВПО «МГМСУ имени А.И. Евдокимова» Минздрава РоссииРоссияMoscow state University of Medical and Dentistry named after Evdokimov of the Ministry of Health Russian FederationRussian Federation2016020920161023236Copyright © Tabakman I.I., Solopova A.G., Bishtavi A.K., Idrisova L.E., 20162016Табакман Ю.Ю., Солопова А.Г., Биштави А.Х., Идрисова Л.Э.Tabakman I.I., Solopova A.G., Bishtavi A.K., Idrisova L.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/287Objective

Objective. To substantiate indications for a differential approach in the treatment of patients with atypical endometrial hyperplasia.

Materials and Methods

Materials and Methods.The results of surgical treatment in 132 patients with atypical endometrial hyperplasia have been studied.

Results

Results. Post-operative diagnosis was:endometrial cancer – in 19%, atypical hyperplasia – in 35%, simple and complex hyperplasia – in 33%, only atrophic endometrial changes – in 13% of patients. The tumor was within the endometrium in 5 patients, the superficial invasion of the myometrium (1-2 mm) were in 8 patients, invasion to half of the myometrium – in 9 patients, invasion of more than half of the myometrium – in 3 patients.

Conclusion

Conclusion. The guestions of tactics of treatment of atypical endometrial hyperplasia is under discussion.

Цель – обосновать показания к дифференцированному подходу при лечении больных с атипической гиперплазией эндометрия (АГЭ).

Материал и методы

Материал и методы. Изучены результаты хирургического лечения 132 больных с предоперационным диагнозом АГЭ.

Результаты

Результаты. При патоморфологическом исследовании операционного материала у 25 (19%) больных обнаружен рак эндометрия (РЭ), у 46 (35%) – АГЭ, у 43 (33%) – простая гиперплазия эндометрия (ПГЭ) и сложная гиперплазия эндометрия (СГЭ) без атипии, у 18 (13%) больных – только атрофические изменения эндометрия. Из 25 больных РЭ шесть были в возрасте до 50 лет, пять – от 51 до 55 лет, 14 больных – старше 55 лет. У пяти больных РЭ опухоль была в пределах эндометрия, у восьми имелась инвазия миометрия на 1-2 мм, у девяти – до половины толщины миометрия, у трех – более половины.

Заключение

Заключение. Обсуждаются вопросы тактики ведения больных.

предрак эндометрияатипическая гиперплазия эндометриятактика леченияatypical endometrial hyperplasiaendometrial precancertactics of treatmentReferencesПерельмутер В.М. Морфологические изменения эндометрия при гиперплазии и эндометриальной интраэпителиальной неоплазии. Сибирский онкологический журнал. 2008; 5 (29): 5-10.Perel'muter V.M. Sibirskii onkologicheskii zhurnal. 2008; 5 (29): 5-10.Allison K.H., Reed S.D., Voigt L.F., Jordan C.D., Newton K.M., Garcia R.L. Diagnosing endometrial hyperplasia: why is it so difficult to agree? Am О Surg Pathol. 2008 May; 32 (5): 691-8.Allison K.H., Reed S.D., Voigt L.F., Jordan C.D., Newton K.M., Garcia R.L. Diagnosing endometrial hyperplasia: why is it so difficult to agree? Am O Surg Pathol. 2008 May; 32 (5): 691-8.Horn L.C., Schnurrbusch U., Bilek K., Hentschel B., Einenkel J. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer. 2004 Mar-Apr; 14 (2): 348-53.Horn L.C., Schnurrbusch U., Bilek K., Hentschel B., Einenkel J. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer. 2004 Mar-Apr; 14 (2): 348-53.Kimura T., Kamiura S., Komoto T., Seino H., Tenma K., Ohta Y., Yamamoto T., Saji F. Clinical over- and under-estimation in patients who underwent hysterectomy for atypical endometrial hyperplasia diagnosed by endometrial biopsy: the predictive value of clinical parameters and diagnostic imaging. Eur J Obstet Gynecol Reprod Biol. 2003 Jun 10; 108 (2): 213-6.Kimura T., Kamiura S., Komoto T., Seino H., Tenma K., Ohta Y., Yamamoto T., Saji F. Clinical over- and under-estimation in patients who underwent hysterectomy for atypical endometrial hyperplasia diagnosed by endometrial biopsy: the predictive value of clinical parameters and diagnostic imaging. Eur J Obstet Gynecol Reprod Biol. 2003 Jun 10; 108 (2): 213-6.Kurman R.J., Kaminski P.F., Norris H.J. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer 1985 Jul 15; 56 (2): 403-12.Kurman R.J., Kaminski P.F., Norris H.J. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer. 1985 Jul 15; 56 (2): 403-12.Lacey J.V., Sherman M.E., Rush B.B. Absolute Risk of Endometrial Carcinoma During 20-Year Follow-Up Among Women With Endometrial Hyperplasia. J Clin Oncol. 2010 February 10; 28 (5): 788-792.Lacey J.V., Sherman M.E., Rush B.B. Absolute Risk of Endometrial Carcinoma During 20-Year Follow-Up Among Women With Endometrial Hyperplasia. J Clin Oncol. 2010 February 10; 28 (5): 788-792.Masur M.T. Endometrial hyperplasia / adenocarcinoma, a conventional ahhroch. Ann Diagn Pathol. 2005 Jun; 9 (3): 174-81.Masur M.T. Endometrial hyperplasia / adenocarcinoma, a conventional ahhroch. Ann Diagn Pathol. 2005 Jun; 9 (3): 174-81.Mittal K., Da Costa D. Endometrial hyperplasia and carcinoma in endometrial polyps: clinicopathologic and follow-up findigs. Int J Gynecol Pathol. 2008 Jan; 27 (1): 45-8.Mittal K., Da Costa D. Endometrial hyperplasia and carcinoma in endometrial polyps: clinicopathologic and follow-up findigs. Int J Gynecol Pathol. 2008 Jan; 27 (1): 45-8.Rakha E., Wong S.C., Soomro I., Chaudry Z., Sharma A., Deen S., Chan S., Abu J., Nunns D., Williamson K., McGregor A., Hammond R., Brown L. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol. 2012 Nov; 36 (11): 1683-90.Rakha E., Wong S.C., Soomro I., Chaudry Z., Sharma A., Deen S., Chan S., Abu J., Nunns D., Williamson K., McGregor A., Hammond R., Brown L. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol. 2012 Nov; 36 (11): 1683-90.Silverberg S.C. Problems in the differential diagnosis of endometrial hyperplasia and carcinoma. Mod Pathol. 2000 Mar; 13 (3): 309-27.Silverberg S.C. Problems in the differential diagnosis of endometrial hyperplasia and carcinoma. Mod Pathol. 2000 Mar; 13 (3): 309-27.Suh-Burgmann E., Hung Yu., Armstrong M. Complex Atypical Endometrial Hyperplasia. The Risk of Unrecognized Adenokarcinoma and Value of Preoperative Dilatation and Curettage. J Obstet Gynaecol. 2009; 114: 523-9.Suh-Burgmann E., Hung Yu., Armstrong M. Complex Atypical Endometrial Hyperplasia. The Risk of Unrecognized Adenokarcinoma and Value of Preoperative Dilatation and Curettage. J Obstet Gynaecol. 2 009; 114: 523-9.Terakawa N., Kigawa J., Taketani Y., Yoshikawa H., Yajima A., Noda K., Okada H., Kato J., Yakushiji M., Tanizawa O., Fujimoto S., Nozawa S., Takahashi T., Hasumi K., Furuhashi N., Aono T., Sakamoto A., Furusato M. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynecol Res. 1997 Jun; 23 (3): 223-30.Terakawa N., Kigawa J., Taketani Y., Yoshikawa H., Yajima A., Noda K., Okada H., Kato J., Yakushiji M., Tanizawa O., Fujimoto S., Nozawa S., Takahashi T., Hasumi K.,Furuhashi N., Aono T., Sakamoto A., Furusato M. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynecol Res. 1997 Jun; 23 (3): 223-30.Furuhashi N., Aono T., Sakamoto A., Furusato M. The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynecol Res. 1997 Jun; 23 (3): 223-30.

The authors declare that there are no conflicts of interest present.