Атипическая гиперплазия эндометрия и ранние стадии рака эндометрия: спорные аспекты терминологии, классифицирования, диагностики и лечения

Подзолкова Н.М., Карпов А.А., Лебедев С.С., Кузнецов Р.Э., Денисова Ю.В., Алимов В.А., Данилов А.М., Чижиков Н.П., Закурдаев Е.И., Созаева Л.Г., Глазкова О.Л., Карпова А.Е., Шабалова И.П., Касоян К.Т. Атипическая гиперплазия эндометрия и ранние стадии рака эндометрия: спорные аспекты терминологии, классифицирования, диагностики и лечения. Гинекология. 2025;27(4):272–280. DOI: 10.26442/20795696.2025.4.203511

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Podzolkova NM, Karpov AA, Lebedev SS, Kuznetsov RE, Denisova YuV, Alimov VA, Danilov AM, Chizhikov NP, Zakurdaev EI, Sozaeva LG, Glazkova OL, Karpova AE, Shabalova IP, Kasoyan KT. Atypical hyperplasia and early endometrial cancer: controversial aspects of terminology, classification, diagnosis and treatment. A review. Gynecology. 2025;27(4):272–280. DOI: 10.26442/20795696.2025.4.203511

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Аннотация

Ежегодно отмечается неуклонный рост показателей заболеваемости атипической гиперплазией (АГЭ) и раком эндометрия (РЭ), что ассоциировано с увеличением распространенности их факторов риска, в первую очередь «нестероидной триады»: ожирения, сахарного диабета, метаболического синдрома. В условиях демографического кризиса и откладывания репродуктивных планов в угоду самореализации вопрос сохранения фертильности при благоприятном прогнозе у пациенток молодого возраста с АГЭ и ранними стадиями РЭ группы низкого риска становится особенно актуальным. Значительное усовершенствование подходов к классифицированию с выделением молекулярных подтипов РЭ, определяющих прогноз, и диагностике с разработкой новой методики жидкостного цитологического исследования в сочетании с ультразвуковым исследованием позволяет четко стратифицировать пациенток на амбулаторном этапе с выделением когорты, подходящей для проведения органосохраняющей терапии. Обзор результатов систематических обзоров и метаанализов доказывает, что на сегодняшний день пероральный прием прогестинов или агонистов гонадотропин-рилизинг-гормона, установка левоноргестрелсодержащей внутриматочной системы изолированно или в различных комбинациях – оправданная альтернатива радикальному хирургическому лечению у пациенток с предраком и РЭ с минимальной инвазией в миометрий по данным ультразвукового исследования экспертного уровня или магнитно-резонансной томографии при условии достижения полного лекарственного патоморфоза очагов со скорейшей реализацией репродуктивных планов под чутким контролем акушера-гинеколога и репродуктолога.

Ключевые слова: атипическая гиперплазия эндометрия, рак эндометрия, фертильность, гормонотерапия

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The incidence of endometrial atypical hyperplasia (EAH) and cancer (EC) shows a steady increase every year, which is associated with an increase in the prevalence of their risk factors, primarily the “nonsteroidal triad”: obesity, diabetes mellitus, and metabolic syndrome. In the context of the demographic crisis and the postponement of reproductive plans for the sake of self-realization, the issue of fertility preservation with a favorable prognosis in young patients with EAH and early stages of EC of the low-risk group becomes especially relevant. Significant advancements in classification approaches, with the isolation of EC molecular subtypes that determine prognosis, and in diagnostics, with the development of a new method of liquid-based cytology combined with ultrasound examination, help clearly stratify patients at the outpatient stage into a cohort suitable for organ-preserving therapy. A review of the results of systematic reviews and meta-analyses proves that to date, oral progestins or gonadotropin-releasing hormone agonists, the installation of a levonorgestrel-containing intrauterine system alone or in various combinations are justified alternatives to radical surgical treatment in patients with precancer and EC with minimal invasion of the myometrium according to expert-level ultrasound or magnetic resonance imaging, provided that complete drug pathomorphosis of foci is achieved with the prompt implementation of reproductive plans with the thorough monitoring by an obstetrician-gynecologist and a reproductive specialist.

Keywords: atypical endometrial hyperplasia, endometrial cancer, fertility, hormone therapy

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29. Sozaeva LG, Shabalova IP, Karpova AYe. Endometrial pathology: the possibilities of cytological studies in diagnosis. Effective Pharmacotherapy. 2024;20(45):6-10 (in Russian). DOI:10.33978/2307-3586-2024-20-45-6-10
30. Karpova AE, Shabalova IP, Kasoyan KT. Evaluation of exfoliative cytology in endometrial pathology. Medicinskij Alfavit. 2022;19:29-32 (in Russian). DOI:10.33667/2078-5631-2022-19-28-32
31. Devic A, Vasiljevic M, Devic A. Endometrial intraepithelial neoplasia (EIN) in an endometrial polyp. Serbian Journal of Experimental and Clinical Research. 2015;16(4):343-6. DOI:10.1515/sjecr-2015-0042
32. Hawez T, Bollino M, Lönnerfors C, Persson J. Endometrial Intraepithelial Neoplasia, Concurrent Endometrial Cancer and Risk for Pelvic Sentinel Node Metastases. Cancers (Basel). 2024;16(24):4215. DOI:10.3390/cancers16244215
33. Georgescu TA, Cirstoiu M, Costache M, et al. Histopathological, immunohistochemical and therapeutical assessment of premalignant endometrial lesions in a hospital based series of cases. Maedica (Bucur). 2016;11(2):115-21.
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Авторы

Н.М. Подзолкова^1,2, А.А. Карпов^1,2, С.С. Лебедев^1,2, Р.Э. Кузнецов^1,2, Ю.В. Денисова*^1,2, В.А. Алимов^1,2, А.М. Данилов¹, Н.П. Чижиков¹, Е.И. Закурдаев¹, Л.Г. Созаева², О.Л. Глазкова², А.Е. Карпова², И.П. Шабалова², К.Т. Касоян²

¹ГБУЗ «Московский многопрофильный научно-клинический центр им. С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Российская Федерация
²ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Российская Федерация
*Yulia.sheveleva.97@mail.ru

________________________________________________

Natalia M. Podzolkova^1,2, Alexey A. Karpov^1,2, Sergey S. Lebedev^1,2, Roman E. Kuznetsov^1,2, Yulia V. Denisova*^1,2, Vladimir A. Alimov^1,2, Andrey M. Danilov¹, Nikita P. Chizhikov¹, Evgenij I. Zakurdaev¹, Larisa G. Sozaeva², Olga L. Glazkova², Asel E. Karpova², Irina P. Shabalova², Karine T. Kasoyan²

¹Botkin City Clinical Hospital, Moscow, Russian Federation
²Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
*Yulia.sheveleva.97@mail.ru

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