25 内膜細胞診で判ること、判らないこと、 および …

1 JA 2013/07/06 60 25 1 2013/07/06 2 2013/07/06 3 (I) (II) (III) (Negative for malignancy) (Endometrium in proliferative phase) (Endometrium in secretory phase) (Menstrual phase) (Atrophic endometrium) (IUD, TAM ) (Reactive change) (Endometrial polyp) (Endometrial hyperplasia, simple) (ATEC:Atypical endometrial cells)[ ] ; (ATEC-US: Atypical endometrial cells, of undetermined significance) ; (ATEC-A: Atypical endometrial cells, cannot exclude atypical Endometrial hyperplasia or more) (Endometrial hyperplasia) (Endomertrial hyperplasia, complex) (Atypical endometrial hyperplasia) (Atypical endometrial hyperplasia) (Endometrial adenocarcinoma in situ) (Atypical polypoid adenomyoma) (Malignant tumor) G1,G2,G3,Squamous diff.

2 2012 2013/07/06 4 (Convnentional) (LBC) . 2013/07/06 5 (2012 ) Conventional *1 *2 2013/07/06 6 2012 IUD 7 50 100 10 1 2013/07/06

3 2012 2013/07/06 8 (III) / Negative for malignancy Atypical endometrial cells (ATEC) Endometrial hyperplasia Atypical endometrial hyperplasia Malignant tumor 2013/07/06 9 / Negative for malignancy Endometrium in proliferative phase Endometrium in secretory phase Endometrium in menstrual phase Atrophic endometrium Inflammatory change Reactive change due to hormonal dysfunction (IUD, TAM ) Iatrogenic change Reactive change Endometrial polyp Endometrial hyperplasia, simple 2013/07/06 10 Case 1 10 40 40 40.

4 2013/07/06 11 Case 2 10 40 40 .. N/C .. 2013/07/06 12 Case 3 40 40 .. 2013/07/06 13 Estrogen Progesterone 2013/07/06 14 Estrogen Progesterone ( ) 2013/07/06 15 Glandular and Stromal Breakdown associated with Anovulation (Sherman MT et al., Blaustein s pathology of the female genital tract, 5th ,2001:431-439) back-to-back .. Papillary syncytial metaplasia, eosinophilic change . 2013/07/06 16 Glandular and Stromal Breakdown ( 10 ) 17 2013/07/06 Case 4 Endometrial glandular and stromal breakdown(EGBD) 10 40 EGBD 40 20 40 2013/07/06 18 Case 5 EGBD 10 40 10 40 40 EGBD.

5 2013/07/06 19 Case 8 EGBD 10 EGBD 40 100 LBC (SurePath) 6 SurePath 3 EGBD .. Case 5 2013/07/06 20 Case 9 EGBD 10 20 40 LBC (SurePath) EGBD Case 4 2013/07/06 21 Glandular and Stromal Breakdown Breakdown breakdown breakdown 2013/07/06 22 (Atypical endometrial cells:ATEC ) (i) (ATEC-US) ( Atypical endometrial cells, of undetermined significance) ( ) 5% (ii).

6 (ATEC-A) (Atypical endometrial cells, cannot exclude atypical endometrial hyperplasia or more) Atypical endometrial cells 10 2013/07/06 23 Atypical endometrial cells (ATEC) Atypical endometrial cells, of undetermined significance (ATEC-US) Atypical endometrial cells, cannot exclude atypical endometrial hyperplasia or more (ATEC-A) ATEC-US 2013/07/06 24 2013/04/20,21 11th ATEC-US / 40 40 40 40 IUD TAM 25 (Endomertrial hyperplasia, complex) 2013/07/06 26 (Endomertrial hyperplasia, complex) 2013/07/06 27 (4) (Atypical endometrial hyperplasia) (i) (Atypical endometrial hyperplasia) (ii) (Endometrial carcinoma in situ) (iii) (Atypical polypoid adenomyoma) 2013/07/06 28 (Atypical endometrial hyperplasia) 2 2013/07/06 29 (5) (Malignant) 2013/07/06 30 Case 6 Grade 1 10.

7 40 100 40 G1 .. 2013/07/06 31 Case 7 20 4 . 40 100 . 2013/07/06 32 Case 10 Grade 1 10 Grade 1 20 40 LBC (SurePath) Case 6 .. 2013/07/06 33 1 2 3 4 BD SurePath 4 2013/07/06 34 2013/07/06 35 / ATEC-A 433 6 15 9 44 0 1 0 33 1 6 0 9 13 1 0 6 0 0 0 0 0 0 1 2 4 1 13 15 2 1 12 17 2 3 14 4 1 1 5 33 21 276 14 0 7391 0 0 (n=8436) 2 0 0 0 0 0 0 0 8 0 16 0 Total 77 8006 35 292 26 2013/07/06 36 Complex hyperplasia is suspected : 10 10% Atypical complex hyperplasia or carcinoma is suspected.

8 10 50% (I) * (II) (* (*maximum diameter of the cell cluster < mm) ( (morule), , , , ) 2013/07/06 37 ATEC-US (Atypical endometrial cells, of undetermined significance) (n=76) Total 14 2 0 1 3 1 0 2 6 0 15 32 76 (ATEC-US) 2013/07/06 38 / 433 6 15 9 44 0 1 0 33 1 6 0 9 13 1 0 6 0 0 0 0 0 0 1 2 4 1 13 15 2 1 12 17 3 14 4 1 5 33 276 14 0 7391 0 0 (n=8436) 2 0 0 0 0 0 0 0 8 0 16 0 Total 77 8006 35 292 26 ATEC-A 2 1 21 2013/07/06 39 ATEC.)

9 Atypical endometrial cells 52 2013/11/2 3 (Matias Jimenez-Ayala, Daisuke Aoki) " A New insight of the reporting system of endometrial cytology following the Bethesda System" Pitfalls 2013/07/06 40 The Future of the Liquid Based Cytology of the Endometrium Our experience with ThinPrep technique Petros Karakitsos Associate Professor, Director Department of Cytopathology Medical School, University of Athens, Greece University General Hospital ATTIKON ATEC(ACE-US) 2013/07/06 41 PROPOSED CYTOLOGICAL DIAGNOSTIC CATEGORY HISTOLOGICAL CATEGORY Non diagnostic or Unsatisfactory Without evidence of hyperplasia or malignancy Proliferative endometrium Secretory endometrium Atrophic endometrium Disordered endometrium ACE-US (Atypical endometrial cells of undetermined significance) ACE -L (Atypical endometrial cells with low probability for malignancy) Simple hyperplasia Complex hyperplasia Hyperplastic polyp Atypical simple hyperplasia ACE -H (Atypical endometrial cells with high probability for malignancy)

10 Atypical complex hyperplasia Well differentiated adenocarcinoma Malignant Malignant CLASSIFICATION SCHEME 2013/07/06 42 ATEC 2001 VS II 2013/07/06 43 ATEC (ATEC-US: Atypical endometrial cells, undetermined significance) Proloferative phase like endometrium 2013/07/06 44 ATEC (ATEC-US: Atypical endometrial cells, undetermined significance) Endometrial polyp 2013/07/06 45 LBC(SurePath) ATEC (ATEC-US: Atypical endometrial cells, undetermined significance) EIC . OSG 2013/07/06 46 2013/07/06 47 . 2013/07/06 48 (I) (II) (III) (Negative for malignancy) (Endometrium in proliferative phase) (Endometrium in secretory phase) (Menstrual phase) (Atrophic endometrium) (IUD, TAM ) (Reactive change) (Endometrial polyp) (Endometrial hyperplasia, simple) (ATEC:Atypical endometrial cells)[ ] ; (ATEC-US: Atypical endometrial cells, of undetermined significance).