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Гиперплазии эндометрия: без атипии и с атипией
Гиперплазии эндометрия: без атипии и с атипией
Сабанцев М.А., Шрамко С.В., Левченко В.Г. и др. Гиперплазии эндометрия: без атипии и с атипией. Гинекология. 2021; 23 (1): 18–24. DOI: 10.26442/20795696.2021.1.200666
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Аннотация
В статье представлен анализ данных за последние 70 лет, вошедших в базу данных PubMed, о гиперплазии эндометрия (ГПЭ), которая занимает ведущие позиции в структуре гинекологических заболеваний и является основным фактором риска злокачественного новообразования эндометрия – рака эндометрия (РЭ). Отражена хроника классификации ГПЭ с акцентом на изменении в динамике обозначения и актуальности аденоматозной ГПЭ. Показано, как действующая классификация ГПЭ, благодаря тому что спектр синонимов ограничен двумя вариантами, позволяет максимально повысить воспроизводимость диагноза, улучшить взаимодействие акушера-гинеколога с патологоанатомом и снизить долю неэффективного лечения. Результаты последних исследований о распространенности и факторах риска ГПЭ и РЭ отличаются от ранее принятых и разрушают «триаду Бохмана», конкретизированы риски развития ГПЭ при приеме тамоксифена и нюансах менопаузальной гормональной терапии. Обозначены результаты исследований, направленных на диагностику ГПЭ и РЭ. Представленные в обзоре различия в этиопатогенезе, распространенности, диагностике, факторах риска развития и прогрессирования в злокачественный процесс представляют 2 вида ГПЭ (без атипии и с атипией) как абсолютно разные заболевания эндометрия, объединенные в одну классификацию.
Ключевые слова: аденоматоз, воспроизводимость диагноза, гиперплазия эндометрия, гистероскопия, железистая интраэпителиальная неоплазия, предикторы рака эндометрия, рак эндометрия, тамоксифен
Keywords: adenomatosis, endometrial cancer, endometrial hyperplasia, glandular intraepithelial neoplasia, hysteroscopy, predictors of endometrial cancer, reproducibility of the diagnosis, tamoxifen
Ключевые слова: аденоматоз, воспроизводимость диагноза, гиперплазия эндометрия, гистероскопия, железистая интраэпителиальная неоплазия, предикторы рака эндометрия, рак эндометрия, тамоксифен
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Keywords: adenomatosis, endometrial cancer, endometrial hyperplasia, glandular intraepithelial neoplasia, hysteroscopy, predictors of endometrial cancer, reproducibility of the diagnosis, tamoxifen
Полный текст
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23. Sherman ME, Ronnett BM, Ioffe OB, et al. Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification. Int J Gynecol Pathol 200; 27 (3): 318–25. DOI: 10.1097/PGP.0b013e3181659167
24. Mutter GL, Zaino RJ, Baak JP, et al. Benign endometrial hyperplasia sequence and endometrial intraepithelial neoplasia. Int J Gynecol Pathol 2007; 26 (2): 103–14. DOI: 10.1097/PGP.0b013e31802e4696
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26. Ordi J, Bergeron C, Hardisson D, et al. Reproducibility of current classifications of endometrial endometrioid glandular proliferations: further evidence supporting a simplified classification. Histopathology 2014; 64 (2): 284–92. DOI: 10.1111/his.12249
27. Reed SD, Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009; 200 (6): 678.e1-6. DOI: 10.1016/j.ajog.2009.02.032
28. Yuk JS. The incidence rates of endometrial hyperplasia and endometrial cancer: a four-year population-based study. PeerJ 2016; 4: e2374. DOI: 10.7717/peerj.2374
29. Sabantsev M.A., Bazhenova L.G., Shramko S.V., et al. Informativnost' standartnykh metodov diagnostiki proliferativnykh zabolevanii endometriia. Rossiiskii vestnik akushera-ginekologa. 2017; 17 (1): 62–6 (In Russian) DOI: 10.17116/rosakush201717162-66
30. Göl K, Saraçoğlu F, Ekici A, Sahin I. Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women. Gynecol Endocrinol 2001; 15 (1): 63–7.
31. Park JC, Lim SY, Jang TK, et al. Endometrial histology and predictable clinical factors for endometrial disease in women with polycystic ovary syndrome. Clin Exp Reprod Med 2011; 38 (1): 42–6. DOI: 10.5653/cerm.2011.38.1.42
32. Armstrong AJ, Hurd WW, Elguero S, et al. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol 2012; 19 (5): 562–71. DOI: 10.1016/j.jmig.2012.05.009
33. Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol 2001; 15 (3): 393–405.
34. Gallos ID, Devey J, Ganesan R, Gupta JK. Predictive ability of estrogen receptor (ER), progesterone receptor (PR), COX-2, Mlh1, and Bcl-2 expressions for regression and relapse of endometrial hyperplasia treated with LNG-IUS: a prospective cohort study. Gynecol Oncol 2013; 130 (1): 58–63. DOI: 10.1016/j.ygyno.2013.04.016
35. Cullen TS. Cancer of the uterus: its pathology, symptomatology, diagnosis and treatment: also the pathology of diseases of the endometrium. New York: D. Appleton&Co, 1900.
36. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol 1989; 160 (1): 126–31.
DOI: 10.1016/0002-9378(89)90103-8
37. Horn LC, Schnurrbusch U, Bilek K, et al. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14 (2): 348–53. DOI: 10.1111/j.1048-891x.2004.014220.x
38. Lacey JV Jr, Sherman ME, Rush BB, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28 (5): 788–92. DOI: 10.1200/JCO.2009.24.1315
39. Lacey JV Jr, Ioffe OB, Ronnett BM, et al. Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan. Br J Cancer 2008; 98 (1): 45–53. DOI: 10.1038/sj.bjc.6604102
40. Epplein M, Reed SD, Voigt LF, et al. Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history. Am J Epidemiol 2008; 168 (6): 563–70. DOI: 10.1093/aje/kwn168
41. Rotkina I.E. Hyperplastic processes and endometrial precancer. Novokuzneck, 1993 (In Russian)
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43. Lacey JV Jr, Chia VM. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas 2009; 63 (1): 39–44. DOI: 10.1016/j.maturitas.2009.02.005
44. Furness S, Roberts H, Marjoribanks J, et al. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev 2009; 2: CD000402. DOI: 10.1002/14651858.CD000402.pub3
45. Sheshukova N.A. Giperplasticheskie processy endometriya: kliniko-morfologicheskie aspekty, prognosticheskie kriterii razvitiya, differencirovannyj podhod k lecheniyu. Avtoref. dis. … d-ra med. nauk. Moscow, 2012 (in Russian)
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48. Kaye SA, Folsom AR, Soler JT, et al. Associations of body mass and fat distribution with sex hormone concentrations in postmenopausal women. Int J Epidemiol 1991; 20 (1): 151–6. DOI: 10.1093/ije/20.1.151
49. Rizkallah TH, Tovell HM, Kelly WG. Production of estrone and fractional conversion of circulating androstenedione to estrone in women with endometrial carcinoma. J Clin Endocrinol Metab 1975; 40 (6): 1045–56. DOI: 10.1210/jcem-40-6-1045
50. Ricci E, Moroni S, Parazzini F, et al. Risk factors for endometrial hyperplasia: results from a case-control study. Int J Gynecol Cancer 2002; 12 (3): 257–60.
DOI: 10.1046/j.1525-1438.2002.01105.x
51. Lindor NM, Petersen GM, Hadley DW, et al. Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review. JAMA 200; 296 (12): 1507–17. DOI: 10.1001/jama.296.12.1507
52. Vasen HF, Blanco I, Aktan-Collan, K et al. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts. Gut 2013; 62 (6): 812–23. DOI: 10.1136/gutjnl-2012-304356
53. Shokouhi B. Role of transvaginal ultrasonography in diagnosing endometrial hyperplasia in pre- and post-menopause women. Niger Med J 2015; 56 (5): 353–6.
DOI: 10.4103/0300-1652.170390
54. Endometrial Hyperplasia, Management of (Green-top Guideline No. 67). RCOG/BSGE Joint Guideline, 2016. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hy.... Accessed: February 2016.
55. Ghoubara A, Emovon E, Sundar S, Ewies A. Thickened endometrium in asymptomatic postmenopausal women – determining an optimum threshold for prediction of atypical hyperplasia and cancer. J Obstet Gynaecol 2018; 38 (8): 1146–9. DOI: 10.1080/01443615.2018.1458081
56. Kaprin A.D., Starinskii V.V., Petrova G.V. Malignant neoplasms in Russia in 2018 (morbidity and mortality). Moscow: Moscow Scientific Research Oncological Institute named after P.A. Herzen, 2019 (In Russian)
57. van Hanegem N, Prins MM, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2016; 197: 147–55. DOI: 10.1016/j.ejogrb.2015.12.008
58. Gkrozou F, Dimakopoulos G, Vrekoussis T, et al. Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies. Arch Gynecol Obstet 2015; 291 (6): 1347–54. DOI: 10.1007/s00404-014-3585-x
59. Saso S, Chatterjee J, Georgiou E, et al. Endometrial cancer. BMJ 2011; 343: d3954. DOI: 10.1136/bmj.d3954
60. Bourdel N, Chauvet P, Tognazza E, et al. Sampling in Atypical Endometrial Hyperplasia: Which Method Results in the Lowest Underestimation of Endometrial Cancer? A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2016; 23 (5): 692–701. DOI: 10.1016/j.jmig.2016.03.017
61. de Rijk SR, Steenbergen ME, Nieboer TE, Coppus SF. Atypical Endometrial Polyps and Concurrent Endometrial Cancer: A Systematic Review. Obstet Gynecol 2016; 128 (3): 519–25. DOI: 10.1097/AOG.0000000000001566
62. Savel'eva G.M., Breusenko V.G., Kareva E.N., et al. Izuchenie roli ekspressii genov retseptorov estrogenov i progesterona v vozniknovenii proliferativnykh protsessov v endometrii dlia resheniia voprosa o taktike vedeniia bol'nykh s ukazannymi patologicheskimi izmeneniiami endometriia. Ros. vest. akushera-ginekologa. 2018; 18 (6): 17–24 (in Russian) DOI: 10.17116/rosakush20181806117
63. Auclair MH, Yong PJ, Salvador S, et al. Guideline No. 392-Classification and Management of Endometrial Hyperplasia. J Obstet Gynaecol Can 2019; 41 (12): 1789–800. DOI: 10.1016/j.jogc.2019.03.025
2. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer 1985; 56 (2): 403–12. DOI: 10.1002/1097-0142(19850715)56:2<403::aid-cncr2820560233>3.0.co;2-x
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30. Göl K, Saraçoğlu F, Ekici A, Sahin I. Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women. Gynecol Endocrinol 2001; 15 (1): 63–7.
31. Park JC, Lim SY, Jang TK, et al. Endometrial histology and predictable clinical factors for endometrial disease in women with polycystic ovary syndrome. Clin Exp Reprod Med 2011; 38 (1): 42–6. DOI: 10.5653/cerm.2011.38.1.42
32. Armstrong AJ, Hurd WW, Elguero S, et al. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol 2012; 19 (5): 562–71.
DOI: 10.1016/j.jmig.2012.05.009
33. Marsden DE, Hacker NF. Optimal management of endometrial hyperplasia. Best Pract Res Clin Obstet Gynaecol 2001; 15 (3): 393–405.
34. Gallos ID, Devey J, Ganesan R, Gupta JK. Predictive ability of estrogen receptor (ER), progesterone receptor (PR), COX-2, Mlh1, and Bcl-2 expressions for regression and relapse of endometrial hyperplasia treated with LNG-IUS: a prospective cohort study. Gynecol Oncol 2013; 130 (1): 58–63. DOI: 10.1016/j.ygyno.2013.04.016
35. Cullen TS. Cancer of the uterus: its pathology, symptomatology, diagnosis and treatment: also the pathology of diseases of the endometrium. New York: D. Appleton&Co, 1900.
36. Ferenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol 1989; 160 (1): 126–31.
DOI: 10.1016/0002-9378(89)90103-8
37. Horn LC, Schnurrbusch U, Bilek K, et al. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14 (2): 348–53. DOI: 10.1111/j.1048-891x.2004.014220.x
38. Lacey JV Jr, Sherman ME, Rush BB, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28 (5): 788–92. DOI: 10.1200/JCO.2009.24.1315
39. Lacey JV Jr, Ioffe OB, Ronnett BM, et al. Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan. Br J Cancer 2008; 98 (1): 45–53. DOI: 10.1038/sj.bjc.6604102
40. Epplein M, Reed SD, Voigt LF, et al. Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history. Am J Epidemiol 2008; 168 (6): 563–70. DOI: 10.1093/aje/kwn168
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43. Lacey JV Jr, Chia VM. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas 2009; 63 (1): 39–44. DOI: 10.1016/j.maturitas.2009.02.005
44. Furness S, Roberts H, Marjoribanks J, et al. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev 2009; 2: CD000402. DOI: 10.1002/14651858.CD000402.pub3
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47. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005; 97 (22): 1652–62. DOI: 10.1093/jnci/dji372
48. Kaye SA, Folsom AR, Soler JT, et al. Associations of body mass and fat distribution with sex hormone concentrations in postmenopausal women. Int J Epidemiol 1991; 20 (1): 151–6. DOI: 10.1093/ije/20.1.151
49. Rizkallah TH, Tovell HM, Kelly WG. Production of estrone and fractional conversion of circulating androstenedione to estrone in women with endometrial carcinoma. J Clin Endocrinol Metab 1975; 40 (6): 1045–56. DOI: 10.1210/jcem-40-6-1045
50. Ricci E, Moroni S, Parazzini F, et al. Risk factors for endometrial hyperplasia: results from a case-control study. Int J Gynecol Cancer 2002; 12 (3): 257–60.
DOI: 10.1046/j.1525-1438.2002.01105.x
51. Lindor NM, Petersen GM, Hadley DW, et al. Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review. JAMA 200; 296 (12): 1507–17. DOI: 10.1001/jama.296.12.1507
52. Vasen HF, Blanco I, Aktan-Collan, K et al. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts. Gut 2013; 62 (6): 812–23. DOI: 10.1136/gutjnl-2012-304356
53. Shokouhi B. Role of transvaginal ultrasonography in diagnosing endometrial hyperplasia in pre- and post-menopause women. Niger Med J 2015; 56 (5): 353–6.
DOI: 10.4103/0300-1652.170390
54. Endometrial Hyperplasia, Management of (Green-top Guideline No. 67). RCOG/BSGE Joint Guideline, 2016. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hy.... Accessed: February 2016.
55. Ghoubara A, Emovon E, Sundar S, Ewies A. Thickened endometrium in asymptomatic postmenopausal women – determining an optimum threshold for prediction of atypical hyperplasia and cancer. J Obstet Gynaecol 2018; 38 (8): 1146–9. DOI: 10.1080/01443615.2018.1458081
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58. Gkrozou F, Dimakopoulos G, Vrekoussis T, et al. Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies. Arch Gynecol Obstet 2015; 291 (6): 1347–54. DOI: 10.1007/s00404-014-3585-x
59. Saso S, Chatterjee J, Georgiou E, et al. Endometrial cancer. BMJ 2011; 343: d3954. DOI: 10.1136/bmj.d3954
60. Bourdel N, Chauvet P, Tognazza E, et al. Sampling in Atypical Endometrial Hyperplasia: Which Method Results in the Lowest Underestimation of Endometrial Cancer? A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2016; 23 (5): 692–701. DOI: 10.1016/j.jmig.2016.03.017
61. de Rijk SR, Steenbergen ME, Nieboer TE, Coppus SF. Atypical Endometrial Polyps and Concurrent Endometrial Cancer: A Systematic Review. Obstet Gynecol 2016; 128 (3): 519–25. DOI: 10.1097/AOG.0000000000001566
62. Савельева Г.М., Бреусенко В.Г., Карева Е.Н. и др. Изучение роли экспрессии генов рецепторов эстрогенов и прогестерона в возникновении пролиферативных процессов в эндометрии для решения вопроса о тактике ведения больных с указанными патологическими изменениями эндометрия. Рос. вестн. акушера-гинеколога. 2018; 18 (6): 17–24 [Savel'eva G.M., Breusenko V.G., Kareva E.N., et al. Izuchenie roli ekspressii genov retseptorov estrogenov i progesterona v vozniknovenii proliferativnykh protsessov v endometrii dlia resheniia voprosa o taktike vedeniia bol'nykh s ukazannymi patologicheskimi izmeneniiami endometriia. Ros. vest. akushera-ginekologa. 2018; 18 (6): 17–24 (in Russian)]. DOI: 10.17116/rosakush20181806117
63. Auclair MH, Yong PJ, Salvador S, et al. Guideline No. 392-Classification and Management of Endometrial Hyperplasia. J Obstet Gynaecol Can 2019; 41 (12): 1789–800. DOI: 10.1016/j.jogc.2019.03.025
________________________________________________
2. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer 1985; 56 (2): 403–12. DOI: 10.1002/1097-0142(19850715)56:2<403::aid-cncr2820560233>3.0.co;2-x
3. Markovina I.Yu., Ulumbekov E.G. English-Russian Medical Dictionary. Moscow: GEOTAR-Media; 2013 (in Russian)
4. Khmel'nitskaia N.M., Neishtadt E.L., Khalimdzhanov Z.K. Trudnosti i oshibki diagnostiki atipichnoi giperplazii endometriia. Arkhiv patologii. 2006; 68 (6): 39–42 (in Russian)
5. Gusberg SB. Precursors of corpus carcinoma estrogens and adenomatous hyperplasia. Am J Obstet Gynecol 1947; 54 (6): 905–27. DOI: 10.1016/s0002-9378(16)39706-x
6. International Classification of Diseases 10th Revision, World Health Organization; 2010. Available at: https://icd.who.int/browse10/2016/en#/N80-N98. Accessed: 01.06.2018.
7. Hertig AT, Sommers SC. Genesis of endometrial carcinoma; study of prior biopsies. Cancer 1949; 2 (6): 946–56. DOI: 10.1002/1097-0142(194911)2:6<946::aid-cncr2820020603>3.0.co;2-d
8. Campbell PE, Barter RA. The significance of a typical endometrial hyperplasia. J Obstet Gynaecol Br Commonw 1961; 68: 668–72. DOI: 10.1111/j.1471-0528.1961.tb02789.x
9. Gusberg SB, Kaplan AL. Precursors of corpus cancer. IV. Adenomatous hyperplasia as stage o carcinoma of the endometrium. Am J Obstet Gynecol 1963; 87: 662–78. DOI: 10.1016/0002-9378(63)90060-7
10. Gore H, Hertig AT. Carcinoma in situ of the endometrium. Am J Obstet Gynecol 1966; 94 (1): 134–55.
11. Vellios F. Endometrial hyperplasias, precursors of endometrial carcinoma. Pathol Annu 1972; 7: 201–29.
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Авторы
М.А. Сабанцев*1, С.В. Шрамко2, В.Г. Левченко2, О.А. Волков1, Т.В. Третьякова2
1 ГАУЗ «Новокузнецкая городская клиническая больница №1» Минздрава России, Новокузнецк, Россия;
2 Новокузнецкий государственный институт усовершенствования врачей –
филиал ФГБОУ ВПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Новокузнецк, Россия
*Dr.Sabantsev@ya.ru
1 Novokuznetsk City Clinical Hospital №1, Novokuznetsk, Russia;
2 Novokuznetsk State Institute for Further Training of Physicians – branch campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia
*Dr.Sabantsev@ya.ru
1 ГАУЗ «Новокузнецкая городская клиническая больница №1» Минздрава России, Новокузнецк, Россия;
2 Новокузнецкий государственный институт усовершенствования врачей –
филиал ФГБОУ ВПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Новокузнецк, Россия
*Dr.Sabantsev@ya.ru
________________________________________________
1 Novokuznetsk City Clinical Hospital №1, Novokuznetsk, Russia;
2 Novokuznetsk State Institute for Further Training of Physicians – branch campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia
*Dr.Sabantsev@ya.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.