medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-26-46-52medalphabet-1768Research ArticleСтатьиАтипическая гиперплазия эндометрия – диагностические трудности. Есть ли они? (Клинический случай)Atypical endometrial hyperplasia: are there diagnostic difficulties? (Clinical case)СобивчакМ. С.SobivchakM. S.

врач-акушер

г. Санкт-Петербург

ПротасоваА. Э.ProtasovaA. E.

д.м.н.

г. Санкт-Петербург

РаскинГ. А.RaskinG. A.

д.м.н.

г. Санкт-Петербург

ТапильскаяН. И.TapilskayaN. I.

д.м.н. , проф.

г. Санкт-Петербург

ГлушаковР. И.GlushakovR. I.

к.м.н.

г. Санкт-Петербург

КоганИ. Ю.KoganI. Yu.

д.м.н. , проф.

г. Санкт-Петербург

ФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияSaint Petersburg State UniversityRussian FederationФГБОУ ВО «Санкт-Петербургский государственный университет»; ФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Минздрава России; ФГБУ «Национальный медицинский исследовательский центр имени В.А. Алмазова» Минздрава России; ООО «Ава-Петер»РоссияSaint Petersburg State University; North-Western State Medical University n.a. I.I. Mechnikov; National Medical Research Centre n.a. V.A. Almazov; Ava-Peter Co.Russian FederationФГБОУ ВО «Санкт-Петербургский государственный университет»; ФГБУ «Российский научный центр радиологии и хирургических технологий имени академика А.М. Гранова» Минздрава России; ФГБУ «Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии» Минздрава РоссииРоссияSaint Petersburg State University; Russian Scientific Centre of Radiology and Surgical Technologies n.a. academician A.M. Granov; Saint Petersburg State Research Institute of PhthisiopulmonologyRussian FederationФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта»РоссияScientific and Research Institute for Obstetrics and Gynecology n.a. D.O. OttRussian FederationФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны РоссииРоссияMilitary Medical Academy n.a. S.M. KirovRussian FederationФГБОУ ВО «Санкт-Петербургский государственный университет»; ФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д.О. Отта»РоссияSaint Petersburg State UniversityRussian Federation202003122020026Современная гинекология (3)4652Copyright © Собивчак М.С., Протасова А.Э., Раскин Г.А., Тапильская Н.И., Глушаков Р.И., Коган И.Ю., 20202020Собивчак М.С., Протасова А.Э., Раскин Г.А., Тапильская Н.И., Глушаков Р.И., Коган И.Ю.Sobivchak M.S., Protasova A.E., Raskin G.A., Tapilskaya N.I., Glushakov R.I., Kogan I.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1768

Дифференциальная диагностика между атипической гиперплазией эндометрия (АГЭ) и раком эндометрия (РЭ) в некоторых случаях представляет определенные трудности. Описан клинический случай местного рецидива рака эндометрия I стадии с вовлечением органов малого таза через 5 лет после выполнения радикального лечения, при этом при первичном лечении дважды морфологически выставлен диагноз атипической гиперплазии эндометрия: после диагностического выскабливания полости матки и после выполнения пангистерэктомии. При пересмотре препаратов первичной опухоли выявлена атипическая гиперплазия эндометрия с фокусами аденокарциномы с признаками dMMR / MSI-H с мозаичными реакциями на PTEN, PAX2 и негативной реакцией на ARID1А. По данным анализа гистологического материала рецидивной опухоли, установлена умеренно дифференцированная эндометриоидная аденокарцинома эндометрия с признаками dMMR/ MSI-H, позитивной реакцией на PTEN, негативной реакцией на PAX2 и ARID1A.

The aim of this clinical case is to highlight the importance of differential diagnosing between atypical endometrial hyperplasia (AEH) and endometrial cancer (EC). A 55-year-old woman with AEH had undergone panhysterectomy. Five years later, aching pains appeared in the left abdomen. MRI in the pelvis revealed a solid mass without a clear organ affiliation. The patient underwent laparotomy with removal of the pelvic tumor, resection of the bladder and left ureter and ureterocystostomy on the left. Histopathological examination found an endometrial adenocarcinoma. Immunostaining of primary and subsequent tumors showed a local recurrence of a previously undiagnosed endometrial adenocarcinoma. Primary tumor revealed AEH with foci of adenocarcinoma with signs of dMMR/MSI-H with mosaic reactions to PTEN, PAX2 and negative reaction to ARID1А. Recurrent tumor are moderately differentiated EC with signs of dMMR / MSI-H, a positive reaction to PTEN, a negative reaction to PAX2 and ARID1A was established.

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The authors declare that there are no conflicts of interest present.