Clinicopathologic survey of Endometrial Intraepithelial Neoplasia with and without concurrent Endometrial Cancer

Abstract

Although old age, menopause, obesity, diabetes, AUB, and atypical hyperplasia are known as predictors of endometrial cancer, the risk factors that indicate the accompanying concurrence of endometrial cancer with EIN have not been identified. Since young women with EIN and simultaneous presence of endometrial cancer who want to preserve fertility may suffer from the conservative hormonal treatment, this study was conducted to compare some clinicopathological characteristics of patients with endometrial intra-epithelial neoplasia with and without endometrial cancer. Materials and Methods: This cross-sectional analytical study was performed on patients who have undergone pipelle biopsy or D&C or hysteroscopy and D&C and have been admitted at Al-Zahra teaching hospital for abdominal hysterectomy with the diagnosis of EIN (Endometrial Intraepithelial Neoplasia). Patients of any age or with any symptoms were included in the study. Patients who had received hormonal therapy for at least three months before hospitalization were excluded from the study. Hysterectomy was performed with or without oophorectomy and, if necessary, frozen section and surgical staging. Based on the pathological results of hysterectomy samples, patients were divided into two groups with or without concurrent endometrial cancer: the first group of patients with concurrent endometrial cancer and the second group of patients without concurrent endometrial cancer. The clinical characteristics obtained from all patients and the pathology results obtained from hysterectomies were recorded and compared in the prepared information form. Results: A total of 1438 hysterectomy cases were included in the study, of which 85 cases (5.91%) were performed due to atypical hyperplasia (EIN), and finally 59 cases were diagnosed with endometrial cancer (69.4%). Furthermore, 26 control people (30.6%) without endometrial cancer participated in this study. Among the 59 patients with cancer, histologically, most cases (94.9%) were of endometrioid type. Almost 95% of the patients were in stage I, and more than 64% were in grade I. Myometrium and lymph node involvement were 8.5% in both groups; cervix and ovary involvement was only one case, and tubal involvement was not reported. Also, the tumor did not metastasize in any of the patients at the time of the study. Based on multiple logistic regression, after adjusting and keeping other variables constant, Increasing age significantly increased the chance of endometrial cancer, and increasing age increased the risk of developing cancer by 1.1 times (CI: 1.03- 1.16). Having bleeding before menopause also increased the risk of endometrial cancer by 4.4 times, but this relationship did not reach a statistically significant level (CI: 0.52 - 37.17).