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419 Hysteroscopic diagnosis of endometrial cancer in premenopausal women: a descriptive retrospective study
  1. M Marti Sopeña,
  2. S Álvarez Sánchez,
  3. JM Barreiro García,
  4. JJ Delgado Espeja,
  5. JA Solano Calvo and
  6. Á Zapico Goñi
  1. Hospital Príncipe de Asturias, Ginecología y Obstetricia, Madrid, Spain


Introduction/Background*The aim of the present study was to determine the epidemiological, clinical and diagnostic features of endometrial cancers (EC) in premenopausal women diagnosed with hysteroscope.

Methodology We conducted a descriptive retrospective study in a university hospital. We involved 2367 patients who underwent office-based hysteroscopy from 1st January 2017 to 31st December 2019. Our research identified 47 patients with histological diagnosis of EC. Of these, 6 were premenopausal women.

Result(s)*Out of the 2367 office-based hysteroscopies performed, 47 cases (1,98%) of EC diagnosed by hysteroscopic exam and endometrial sampling. 6 records (12,76%) were premenopausal. These patients were referred to our gynaecological service complaining about abnormal uterine bleeding. 5 patients (83,3%), with heavy menstrual bleeding (HMB) and one case of inter-menstrual bleeding (IMB). Premenopausal patients aged 34-52 years (mean age 42,83 years).

Risk factors of endometrial cancer to highlight in our premenopausal cohort were the following. Obesity was the strongest risk factor; 4 patients (66,6%) showed a body mass index (BMI) ≥30kg/m2. The average BMI was 35kg/m2. On the other hand, two patients had normal BMI. Additionally, we found two nulliparous women (33,3%), and two patients (33,3%) carrying Mirena IUD. We did not get any interest family history.

At the ultrasound examination, endometrial pathology was identified in 5 patients (83,3%). The most frequent ultrasonographic pathological finding was endometrial polyp in 4 cases (66,6%), two of which showed myoma too. Also, one result of submucosal myoma without other lesion.

If we focus on hysteroscopic lesions, atypical polyps were found in all cases. The final histological examination showed endometrioid endometrial adenocarcinoma. There were 3 results (50%) in situ and the other three were stage IA G1.

Conclusion*This review supports that obesity is a significant modifiable risk factor for EC during premenopause. The overall rate of BMI ≥ 30kg/m2 in this study was 66%.

According to our findings, abnormal uterine bleeding is considered the guiding symptom for the diagnosis of this oncological pathology, being to one of the most frequent reasons to demand a gynecological evaluation.

Endometrial polyps are the main observed lesions in our cohort, in both ultrasound exam and hysteroscopy.

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