Abstract：
BACKGROUND: Interpretation of changes and premalignant lesions in endometrial polyps can be challenging. We evaluated the clinical course of patients with focal gland crowdings in endometrial polyps via repeat biopsies and searched for possible morphological findings in the initial biopsy that may foresee a premalignant course.
METHODS: Specimens diagnosed as endometrial polyp and focal gland crowding in patients who had a repeat biopsy in a 1-year period were reexamined. Morphological findings in the initial biopsies were recorded. The group whose repeat biopsies were \"premalignant or malignant\" (Group 1), and the group with \"benign\" repeat biopsies (Group 2) were compared.
RESULTS: \"Endometrial polyp and gland crowdings\" was diagnosed in 115 specimens of which 38 patients had repeat biopsies. Among these 8 (21%) were diagnosed as \"endometrial intraepithelial neoplasia (EIN)\" (Group 1) and 30 (79%) as \"benign\" (Group 2). Morphological features in the initial biopsies were evaluated; PAX2 loss was 6 of 8 (75%) for Group 1 and 7 of 30 (23%) for Group 2 (P = .020), and altered epithelial cytological features were present in 5 of 8 (62%) versus 4 of 30 (13%) (P = .015), both significantly higher in Group 1. Dark intraluminal secretion, intraluminal histiocytes, intraglandular epithelial proliferation, and mean diameter of crowded gland areas were not statistically different between the 2 groups.
CONCLUSIONS: \"Focal gland crowdings\" in endometrial polyps do carry a risk of EIN in subsequent biopsies. We suggest that the loss/decrease of PAX2 and altered epithelial cytological features in these areas in the initial biopsy are indicative of a premalignant course.
METHODS: Specimens diagnosed as endometrial polyp and focal gland crowding in patients who had a repeat biopsy in a 1-year period were reexamined. Morphological findings in the initial biopsies were recorded. The group whose repeat biopsies were \"premalignant or malignant\" (Group 1), and the group with \"benign\" repeat biopsies (Group 2) were compared.
RESULTS: \"Endometrial polyp and gland crowdings\" was diagnosed in 115 specimens of which 38 patients had repeat biopsies. Among these 8 (21%) were diagnosed as \"endometrial intraepithelial neoplasia (EIN)\" (Group 1) and 30 (79%) as \"benign\" (Group 2). Morphological features in the initial biopsies were evaluated; PAX2 loss was 6 of 8 (75%) for Group 1 and 7 of 30 (23%) for Group 2 (P = .020), and altered epithelial cytological features were present in 5 of 8 (62%) versus 4 of 30 (13%) (P = .015), both significantly higher in Group 1. Dark intraluminal secretion, intraluminal histiocytes, intraglandular epithelial proliferation, and mean diameter of crowded gland areas were not statistically different between the 2 groups.
CONCLUSIONS: \"Focal gland crowdings\" in endometrial polyps do carry a risk of EIN in subsequent biopsies. We suggest that the loss/decrease of PAX2 and altered epithelial cytological features in these areas in the initial biopsy are indicative of a premalignant course.
摘要：
背景：解释子宫内膜息肉的改变和癌前病变可能具有挑战性。我们通过重复活检评估了子宫内膜息肉局灶性腺体拥挤患者的临床过程，并在最初的活检中寻找可能的形态学发现，这可能预示着癌前病变。
方法：在1年内重复活检的患者中，对诊断为子宫内膜息肉和局灶性腺体拥挤的标本进行了重新检查。记录初始活检中的形态学发现。重复活检为“癌前或恶性”的组（第1组），和“良性”重复活检组（第2组）进行比较。
结果：在115个标本中诊断出“子宫内膜息肉和腺体拥挤”，其中38例患者进行了重复活检。其中8例(21%)被诊断为“子宫内膜上皮内瘤变(EIN)”(第1组)，30例(79%)被诊断为“良性”(第2组)。评估了初始活检的形态特征；第1组的PAX2丢失为8个中的6个（75％），第2组的PAX2丢失为30个中的7个（23％）（P=0.020）。8人中有5人（62%）与30人中有4人（13%）（P=0.015），两组均明显较高。黑暗的腔内分泌物，管腔内组织细胞，腺内上皮增殖，两组之间拥挤的腺体区域的平均直径没有统计学差异。
结论：子宫内膜息肉中的“局灶性腺体拥挤”在随后的活检中确实存在EIN的风险。我们建议，在最初的活检中，这些区域中PAX2的丢失/减少和上皮细胞学特征的改变表明癌前病变。
方法：在1年内重复活检的患者中，对诊断为子宫内膜息肉和局灶性腺体拥挤的标本进行了重新检查。记录初始活检中的形态学发现。重复活检为“癌前或恶性”的组（第1组），和“良性”重复活检组（第2组）进行比较。
结果：在115个标本中诊断出“子宫内膜息肉和腺体拥挤”，其中38例患者进行了重复活检。其中8例(21%)被诊断为“子宫内膜上皮内瘤变(EIN)”(第1组)，30例(79%)被诊断为“良性”(第2组)。评估了初始活检的形态特征；第1组的PAX2丢失为8个中的6个（75％），第2组的PAX2丢失为30个中的7个（23％）（P=0.020）。8人中有5人（62%）与30人中有4人（13%）（P=0.015），两组均明显较高。黑暗的腔内分泌物，管腔内组织细胞，腺内上皮增殖，两组之间拥挤的腺体区域的平均直径没有统计学差异。
结论：子宫内膜息肉中的“局灶性腺体拥挤”在随后的活检中确实存在EIN的风险。我们建议，在最初的活检中，这些区域中PAX2的丢失/减少和上皮细胞学特征的改变表明癌前病变。
