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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(01): 035-040
DOI: 10.1055/s-0040-1719145
Original Article
Gynecological Endoscopy/Oncology

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps

Doença residual após histeroscopia cirúrgica em pacientes com câncer de endométrio endometrioide associado a pólipo endometrial
Marcelo Simonsen 
1   Department of Gynecologic Oncology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
Henrique Mantoan 
2   Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
,
Carlos Chaves Faloppa 
2   Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
,
Lillian Yuri Kumagai 
2   Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
,
Levon Badiglian Filho 
2   Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
,
Andrea Guerreiro Machado 
1   Department of Gynecologic Oncology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
Najla Mohamed Tayfour 
1   Department of Gynecologic Oncology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
,
Glauco Baiocchi 
2   Department of Gynecologic Oncology, Hospital AC Camargo, São Paulo, SP, Brazil
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Abstract

Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC).

Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records.

Results In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp.

Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Resumo

Objetivo Avaliar a presença de doença residual no exame anatomopatológico definitivo de pacientes com câncer de endométrio endometrioide após polipectomia ou biópsia de pólipo histeroscópica.

Métodos Analisamos 104 pacientes (92 casos do Hospital AC Camargo e 12 casos do Hospital do Servidor Público Estadual de São Paulo) com pólipos diagnosticados durante histeroscopia e cuja biópsia histeroscópica ou exame patológico final do útero acusaram câncer de endométrio endometrioide. As pacientes foram submetidas a cirurgia para câncer de endométrio de janeiro de 2002 a janeiro de 2017. Os dados clínicos e anatomopatológicos de cada paciente foram retirados dos prontuários médicos

Resultados Em 78 casos (75%), o pólipo continha a neoplasia, e em 40 (38.5%), ela estava restrita ao tecido do pólipo, sem envolvimento endometrial adjacente. O estadio final foi IA em 96 casos (92.3%) e em 90 (86.5%) tratava-se de grau 1 ou 2. Em 18 casos (17.3%), não havia doença residual no espécime uterino, mas em apenas 9 deles a histeroscopia sugeriu doença restrita ao pólipo. Em 5 casos (4.8%), não havia doença aparente extrapólipo na histeroscopia, mas havia invasão miometrial, sugerindo extravasamento do tumor pela base do pólipo.

Conclusão Pacientes com câncer de endométrio associado a pólipos podem ter o tumor completamente removido durante a histeroscopia, mas, com as variáveis avaliadas, é difícil predizer com segurança qual paciente ficará sem tumor residual.

Keywords

endometrial neoplasm - hysteroscopy - endometrial polyp

Palavras-chave

câncer de endométrio - histeroscopia - pólipo endometrial

Contributions

Study concepts: Simonsen M. and Baiocchi Neto G. Study design: Simonsen M. and Baiocchi Neto G. Data acquisition: Simonsen M., Mantoan H., Faloppa C. C., Kumagai L. Y., Badiglian-Filho L., Machado A. G., Tayfour N. M., Baiocchi Neto G. Quality control of data and algorithms: Mantoan H., Faloppa C. C., Kumagai L. Y., Badiglian-Filho L., Machado A. G., Tayfour N. M. Data analysis and interpretation: Simonsen M. and Baiocchi Neto G. Statistical analysis: Simonsen M. and Baiocchi Neto G. Manuscript preparation: Simonsen M. and Baiocchi Neto G. Manuscript editing: Simonsen M. and Baiocchi Neto G. Manuscript review: Simonsen M., Mantoan H., Faloppa C. C., Kumagai L. Y., Badiglian-Filho L., Machado A. G., Tayfour N. M., Baiocchi Neto G.




Publication History

Received: 26 February 2020

Accepted: 14 September 2020

Article published online:
29 January 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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