Ozgen ARSLAN SOLMAZA, Gülçin CİHANGİROĞLU, Nezahat YILDIRIM

Re-evaluation of Cases Diagnosed as Endometrial Hyperplasia: in 19 Years

Endometrial Hiperplazi Tanısı Almış Olguların Tekrar Gözden Geçirilmesi Amaç: Endometrial hiperplaziler prekanseröz lezyonlardır. Cerrahi patoloji içerisinde oldukça sık yanlış tanı verilen lezyonlardır. Ayırıcı tanıda kriterlerin belirlenmesi ve doğru tanıyı engelleyecek sebeplerin ortadan kaldırılması amaçlandı. Gereç Yöntem: Ocak 1995-Nisan 2014 yılları arasında kliniğimizde hiperplazi tanısı alan toplam 1000 olguyu doğru tanı ve tanıyı engelleyen nedenler yönünden tekrar değerlendirildi. Bulgular: İlk bakıda 439 basit atipisiz hiperplazi ve 61 basit atipili hiperplazi tanısı alan olgular tekrar değerlendirildiğinde olguların sadece 14'ünün basit atipili hiperplazi olduğu, 47 olgunun ise atipi içermediği görüldü. Basit atipisiz hiperplazi tanısı olan 439 olgunun %5 (n=22)'u yetersiz, % 31 (n=136)'i proliferatif endometrium, %32 (n=140)'u düzensiz proliferasyon, %0.7 (n=3)'si metaplazik değişiklikler, %6.3 (n=28)'ü endometrial polip ve %25 (n=110)'i basit atipisiz hiperplazisi olarak değerlendirildi. Kompleks atipili hiperplazi tanısı almış 33 olgu yeniden değerlendirildiğinde sadece 4 olguda kompleks atipili hiperplazi olduğu saptandı. Atipili olgular incelendiğinde invazyon bulguları saptandı ve adenokarsinom olduğuna karar verildi. Kompleks atipisiz hiperplazi tanısı olan 467 olgunun %2.1 (n=10)'i yetersiz, %37.7 (n=176)'si sekretuvar endometrium, %6.6 (n=31)'sı proliferatif endometrium, %8.6 (n=40)'sı endometrial polip, %4.9 (n=23)'u disfonksiyonel uterus kanaması, %2.4 (n=11)'ü Arias-Stella reaksiyonu, %4.5 (n=21)'i metaplazik değişiklikler, %0.2 (n=1)'si adenokarsinom ve %33 (n=154)'ü kompleks atipisiz hiperplazisi tanısı aldı. Sonuç: Yetersiz örnekleme, teknik sorunlar ve deneyim eksikliği tanı uyumsuzluklarının başlıca nedenlerini oluşturmaktadır

Endometrial HiperplaziTanısı Almış Olguların Tekrar Gözden Geçirilmesi

Aim: Endometrial hyperplasias (EH) are precancerous lesions. They are quite often misdiagnosed in surgical pathology. For the correct diagnosis of EH, the criteria for the differential diagnosis should be determined and the causes of misdiagnosis should be eliminated. For this reason, we decided to re-evaluate the cases that we had formerly diagnosed as EH. Material and Method: We re-evaluated 1000 cases who were diagnosed as endometrial hyperplasia in our clinic between January 1995 and April 2014 in terms of the correct diagnosis and factors which lead to misdiagnosis. Results: During the first examination, 439 of simple hyperplasia without atypia and 61 of simple hyperplasia with atypia were found. But when they were re-evaluated, it was found that only 14 of the cases were simple hyperplasia with atypia but 47 of cases were not containing atypia. Of the 439 cases formerly diagnosed as simple EH without atypia, %31 (n=136) were evaluated as proliferative endometrium, %32 (n=140) as irregular proliferation, %0.7 (n=3) as metaplastic changes, %6.3 (n=28) as endometrial polyp, %25 (n=110) as simple EH and %5 (n=22) as insufficient. When 33 cases which were diagnosed with complex atypical hyperplasia were re-evaluated, complex atypical hyperplasia was found only in 4 cases. When atypical cases were examined evidence of invasion have been detected and diagnosed as adenocarcinoma. Of the 467 cases formerly diagnosed as complex hyperplasia without atypia, %37.7 (n=176) were evaluated as secretory endometrium, %6.6 (n=31) as proliferative endometrium, %8.6 (n=40) as endometrial polyp, %4.9 (n=23) as dysfunctional uterine bleeding, %2.4 (n=11) as Areas-Stella reaction, %4.5 (n=21) as metaplastic changes, %0.2 (n=1) as adenocarcinoma, %33 (n=154) as complex EH and %2.1 (n=10) as insufficient. Conclusion: Inadequate sampling, technical problems and lack of experience may be assumed as the main factors causing diagnostic discordance

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