Ayşe SERTÇELİK, Müzeyyen ASTARCI, Zişan ÖZGÜLER, B. Handan ÖZDEMİR

Endometrium adenokanseri: 50 vakanın histolojik ve histokimyasal değerlendirmesi

A.Ü. İbni Sina hastahanesinde 1988-1993 yıl¬ları arasında endometrium adeno ca tanısı alan 50 hastanın histolojik örneklen,artan yaş ile birlikte, tü¬mör grade'i, histopatolpjisi ve myometrial invazyon derinliğinin prognoza olan etkisini araştırmak amacı ile yeniden değerlendirilmiştir.Bununla birlikte küre-taj ve histerektomi materyalleri arasındaki farkı gös¬termek için 20 vakada her iki materyaldeki histo-morfoloji ve grade karşılaştırılmıştır. Hastalarda ortalama yaş 53'dür. (18-76 y) .40 yaş ve altındaki hastalar 50 hastanın %16 sini oluş¬turmaktadır. 40 yaşındaki ve altındaki hastalarda pelvik lenfnodu metastazı % 12.5 iken ,41 yaş ve üs¬tündeki lerde %43.75 dir. Elli endometrium kanserinin 12'si (%24) grade 1,15'i (%30) grade 2 ve 23 'ü (%46) grade 3 dür.Grade 1 tümörlerde myometrial ve vasküler in¬vazyon ve pelvik lenf nodu metastazı sırasıyla %12.5,%2.5 ve %10 dur.Crade 3 tümörlerde ise sı¬rasıyla %47.1,%25 ve %58.3 dür. Beş hastada (%10) tümör yaygın müsinöz diffe-ransiasyon gösterirken tüm vakaların %48inde az da olsa foka! müsin yapımı izlenmiştir.Pelvik lenfnodu metastazı müsinöz ca'da %75 ve adenoskuamöz ca da %85 dir. Uterin papiller seröz ca (UPSC) bulun¬duran kadınların %100 ünde metastaz mevcuttur. İntramukozal tümörü olan hastaların %6.6 sın-da pelvik lenf nodu metastazı izlenirken,bunun tam tersi derin myometrial invazyon gösteren vakaların %64.7 sinde metastaz izlenmiştir.Derin invazyon gösteren hastaların %85.7'ünde demonstratif vaskü¬ler invazyon mevcut iken, 1/2 den az invazyon gös¬teren vakaların sadece %14.3'ünde vasküler invaz¬yon görülmektedir. Yapılan incelemede 26/50 vakada kanser ile birlikte metaplazi mevcut değilken, 24/50 vakada kanser ve metaplazi birlikteliği saptanmıştır.Hem metaplazi hem de kanser içeren vakalar,metaplazi içermeyen hastalara oranla belirgin olarak daha genç olup,eşlik eden tümör sıklıkla daha iyi differah-siasyon göstermektedir. Sonuç olarak; grade,myometrial invazyon ,has-ta yaşı ve histopatolojik tip tümörün davranışını tah¬min etmek açısından en önemli verilerdir.

Adenocarcinoma of the endometrium: Histologic and histochemical analysis of 50 cases

Histologic specimens of 50 patients with adeno car¬cinoma of the endometrium diagnosed at A.Ü. ibni Sina Hospital department of pathology between 1988-1993 we¬re reexamined to determine the prognostic value of tumo¬ur grade, histopathology, and the depth of the myometrial invasion with the augmentation ofage.Besides ,in order to demonstrate tpe differentiation between two speci-mens,including D&C and hysterectomy materials we com¬pared the histomorphologic morphology and the grade between them in 20 cases. Mean age at diagnosis was 53 years (range 18-76 y).4O years age or younger comprised 16 % of the 50 pati-ents.The pelvic lymph node metastasis for patients 40 ye¬ars age or younger was 12.5 % and 43.75 % for those 41 years of age or older. Of 50 cases with endometrium carcinoma 12 (24 %) were grade 1 , 15 (30 %) grade 2 and 23 (46 %) grade 3. The myometrial and vascular invasion and pelvic lymph node metastasis rate for grade 1 tumour was respectively 12.5 %, 2.5 % and 10% It was 47.1 % ,25 % and 58.3 % for grade 3 tumours. Five patients (10 %) had endometrial cancer with ex¬tensive mucinous differantiation,while 48 % of all the ca¬ses showed at least some focal mucin production. The pel¬vic lymph node metastasis rate for mucinous ca was 75 % and 85 % for adenosquamous ca. Women with uterine pa¬pillary serous ca (UPSC) had a 100 % metastatic rate. Patients with intramucosal tumours had 6.6 % pelvic lymph node metastasis in-contrast with 64.7 % of the pati¬ents with deep infiltrating tumours. 85.7 % of the patients with deep infiltrating tumour had demonstrable vessel in¬vasion while patients with tumours infiltrating less than one half of the mypmetrium had 14.3 % vessel invasion. On review 26/50 cases had carcinoma without me¬taplasia and 24/50 cases had both carcinoma and metap¬lasia. Patients with both metaplasia and carcinoma were significantly younger than patients with only carcinoma and the associated carcinomas were frequently well diffe¬rentiated. Conclusion -.Grade, myometrial invasion,age andjhe histopathologic types are the most important determinants of the tumour behavior.

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