ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
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Turkish Journal of Reproductive Medicine and Surgery

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Postmenopozal Kadınlarda Histeroskopi Bulguları: Semptomatik Olmak Önemli mi?
Hysteroscopy Findings in Postmenopausal Women: Does Being Symptomatic Matters?
Received Date : 13 Jun 2019
Accepted Date : 05 Nov 2019
Available Online : 08 Jun 2020
Doi: 10.24074/tjrms.2019-70136 - Makale Dili: EN
TJRMS. 2019;3(1):1-5
ÖZET
Asemptomatik postmenopozal kadınlarda insidental olarak saptanan kalın endometriumun yönetimi tartışmalıdır. Bu çalışmanın amacı postmenapozal kanaması veya insidental olarak saptanmış kalın endometriumu olan postmenapozal kadınlarda, histeroskopi ve histopatoloji bulgularını değerlendirmektir. Gereç ve Yöntemler: Bu çalışma bir Üniversite Hastanesinin Jinekoloji Bölümünde, 2012 ve 2018 arasındaki hasta kayıtlarının retrospektif olarak taranmasıyla yapılmıştır. Toplamda tümü histeroskopi ile değerlendirilmiş; postmenapozal kanaması olan (Grup A, n=30) veya insidental olarak saptanan kalın endometriumu olan (Grup B, n=35), 65 postmenopozal hasta çalışmaya dahil edilmiştir. Tüm hastalar transvajinal ultrason ile değerlendirilmiş ve tüm hastalara sedasyon altında vajinoskopik yaklaşımla diagnostik histeroskopi yapılmıştır. İntraoperatif ve postoperatif bulgular kaydedilmiş ve 2 gruba ait bulgular değerlendirilmiştir. Bulgular: Dahil edilen vakaların ortalama yaşı 57.9±7.91’dir. A grubunda histopatolojik değerlendirme; 28 hastada benign patolojileri gösterirken, 1 hastada atipisiz endometrial hiperplazi (1/30, %3), 1 hastada (1/30, %3) ise endometrioid tipte adenokarsinoma olarak raporlanmıştır. B grubunda histopatolojik değerlendirme; 32 hastada benign patolojileri gösterirken, 1 hastada atipisiz endometrial hiperplazi (1/35, %3), 1 hastada (1/35, %3) atipili endometrial hiperplazi, 1 hastada (1/35, %3) ise endometrioid tipte adenokarsinoma olarak raporlanmıştır. Histeroskopi bulgularının doğruluğu A grubunda %70 (21/30), B grubunda %91 (32/35) olarak saptanmıştır. Sonuç: Çalışma sonuçlarının premalign ve malign lezyonlar anlamında 2 grup arasında benzer olmasından anlaşılacağı üzere postmenopozal kadınlarda insidental olarak saptanan kalın endometrium postmenopozal kanama kadar önemlidir. Risk faktörlerinin yokluğunda dahi insidental olarak saptanan kalın endometriumu olan postmenapozal kadınlarda endometrial örnekleme ve ileri değerlendirme yapılmalıdır.
ABSTRACT
Management of incidentally diagnosed thick endometrium in asymptomatic postmenopausal women is controversial. Current study aims to evaluate the hysteroscopy and histopathological findings in postmenopausal women who have either postmenopausal bleeding or incidentally found thickened endometrium. Material and Methods: The retrospective study was conducted in the Gynecology Department of an University Hospital covering medical records of women between 2012 and 2018. Totally the records of 65 postmenopausal women, all of whom were evaluated with hysteroscopy, either with postmenopausal bleeding (Group A, n=30) or incidentally found thickened endometrium (Group B, n=35) were included. All patients were evaluated with transvaginal ultrasound and hysteroscopy. Intraoperative and postoperative findings were recorded and evaluated for two groups. Results: In Group A, histopathological evaluation revealed endometrial hyperplasia without atypia in one patient (1/30, 3%) and endometrioid adenocarcinoma in one patient (1/30, 3%). In Group B, one case (1/35, 3%) was reported to have endometrial hyperplasia without atypia, one case had endometrial hyperplasia with atypia (1/35, 3%) and one woman endometrioid adenocarcinoma (1/35, 3%). Accuracy of hysteroscopic findings were 70% (21/30) in Group A and 91% (32/35) in Group B. Conclusion: As an incidental finding, thick endometrium seems to be as important as postmenopausal bleeding, as the results of this study shows similar outcomes in terms of premalignant lesions and endometrial cancer in both groups. Even in the absence of risk factors further evaluation and endometrial sampling should be considered for postmenopausal women with incidentally diagnosed thick endometrium.
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