Endometrial assessment for fertility-sparing treatment of young women with early-stage endometrial carcinoma: adaptation of a standardized synoptic reporting.

IF 3.4 3区医学 Q1 PATHOLOGY

Virchows Archiv Pub Date : 2025-06-24 DOI:10.1007/s00428-025-04148-9

Zitong Zhao, Joella Xiaohong Ang, Ravichandran Nadarajah, Shing Lih Wong

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引用次数: 0

Abstract

Recent guidelines emphasize regular endometrial assessment for fertility-sparing treatment (FST) in endometrial carcinoma (EC), but no consensus exists on histological reporting. We reviewed 14 patients under 40 years old with early-stage, low-grade endometrial endometrioid carcinoma (EEC) treated with FST. Our patients received oral therapy (28.6%) or combined oral therapy with intrauterine device (71.4%), and were followed for 11-76 months (median, 31.5 months). Using a classification proposed by Wheeler et al., treatment outcomes included resolution (50%), persistence (14.3%), progression (14.3%), and recurrence (21.4%). Resolution occurred within 4-15 months. Two patients achieved successful pregnancies. Three underwent hysterectomy, including one with progression and distant metastasis. We find that young women with EEC often extend FST beyond recommended durations due to strong fertility desires, increasing progression risk. Standardized synoptic reporting with routine reviews of prior biopsies, obtaining deeper tissue sections, and seeking second opinions can improve endometrial assessment and guide treatment.

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早期子宫内膜癌年轻女性保留生育能力治疗的子宫内膜评估：标准化天气报告的适应。

最近的指南强调子宫内膜癌（EC）保留生育治疗（FST）的定期子宫内膜评估，但在组织学报告方面尚无共识。我们回顾了14例40岁以下的早期，低级别子宫内膜样癌（EEC）经FST治疗的患者。患者接受口服治疗（28.6%）或口服联合宫内节育器（71.4%），随访11-76个月（中位31.5个月）。根据Wheeler等人提出的分类，治疗结果包括缓解（50%）、持续（14.3%）、进展（14.3%）和复发（21.4%）。在4-15个月内得到解决。两名患者成功怀孕。其中3人接受了子宫切除术，其中1人有进展和远处转移。我们发现，由于强烈的生育欲望，患有EEC的年轻女性经常延长FST超过推荐的持续时间，增加了进展风险。标准化的概要报告，常规回顾既往活检，获得更深的组织切片，并寻求第二意见可以改善子宫内膜评估和指导治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Virchows Archiv 医学-病理学

CiteScore

7.40

自引率

2.90%

发文量

204

审稿时长

4-8 weeks

期刊介绍： Manuscripts of original studies reinforcing the evidence base of modern diagnostic pathology, using immunocytochemical, molecular and ultrastructural techniques, will be welcomed. In addition, papers on critical evaluation of diagnostic criteria but also broadsheets and guidelines with a solid evidence base will be considered. Consideration will also be given to reports of work in other fields relevant to the understanding of human pathology as well as manuscripts on the application of new methods and techniques in pathology. Submission of purely experimental articles is discouraged but manuscripts on experimental work applicable to diagnostic pathology are welcomed. Biomarker studies are welcomed but need to abide by strict rules (e.g. REMARK) of adequate sample size and relevant marker choice. Single marker studies on limited patient series without validated application will as a rule not be considered. Case reports will only be considered when they provide substantial new information with an impact on understanding disease or diagnostic practice.