A novel hysteroscopic pattern of microvascular architecture in uterine endometrioid adenocarcinoma: Initial clinical experience

Abstract

Objective: To establish a specific hysteroscopic pattern–the “glomerular pattern”–to diagnose high-grade endometrial cancer and evaluate the accuracy rate of the pattern, based on final histology. Materials and methods: From 2008 to 2011, 30 patients for whom pathology indicated endometrial cancer, based on the office hysteroscopy study, were included in the study. We reviewed the hysteroscopic pictures to determine the specific hysteroscopic pattern in high-grade endometrial cancer. Results: Thirty patients who had endometrial cancer under hysteroscopy were included to the study. The study population had a mean age of 49.9 years. All patients had abnormal uterine bleeding. Office hysteroscopy was completed in all patients without anesthesia. The findings of the office hysteroscopy suggested endometrial cancer in 30 patients. Fifteen patients had the specific hysteroscopic pattern, called the “glomerular pattern.” All 15 patients had grade 2 or grade 3 disease. Among patients who had a glomerular pattern, 53.3% (8/15) of patients had grade 2 endometrioid adenocarcinoma and 46.7% (7/15) patients had grade 3 endometrioid adenocarcinoma. Among the nonglomerular pattern group patients, 66.7% (10/15) patients had grade 1 endometrioid adenocarcinoma, 26.7% (4/15) patients had grade 2 endometrioid adenocarcinoma and 6.7% (1/15) patients had grade 3 endometrioid adenocarcinoma. Conclusion: Our conclusion is that patients with the glomerular pattern have a high percentage of moderate or high-grade endometrioid adenocarcinoma. The glomerular sign may provide information on preoperative pathohistology and decrease the possibility of histology upgrade after hysterectomy. However, large series, prospective, and comparison studies are still needed.

Keywords

• endometrial cancer
• glomerular pattern
• hysteroscopy
• vascular pattern