Influence of comorbid estrogen-dependent uterine pathology on morphological characteristics of endometrial carcinoma

Background. The purpose of the study was to determine special characteristics of endometrial carcinoma (EC) combined with hysteromyoma and/or uterine adenomyosis.Material and methods. We studied clinical, laboratory and morphological data of 345 patients with verified EC with comorbid benign uterine pathology.Results. Mean age of patients was 62 years. EC with hysteromyoma was noted in patients 5-7 years younger. The combination of all 3 diseases was the most frequent in patients over 62 years. EC with adenomyosis was registered mostly in women of late reproductive age, less often in peri- or deep menopause. All patients were examined and operated on in accordance with the standard of EC treatment. Surgical intervention involved panhysterectomy, pelvic lymphadenectomy. Disease stages were determined using the TNM and FIGO classifications (2009) and were updated according to the results of a postoperative morphological analysis. More than 80% of tumors were endometrioid adenocarcinoma G1-G3. The minimal spread of EC was observed in patients with comorbid hysteromyoma (T1u0430N0M0), the maximal one (T1-3N0-1M0) in EC+hysteromyoma+adenomyosis. Macroscopically, EC with hysteromyoma was represented by exophytic or polypoid tumors, EC+hysteromyoma+adenomyosis – by endophytic lesions. Diffuse infiltrative growth of EC was observed in elderly patients with adenomyosis. Aggressive and morphologically rare forms of EC with affected regional pelvic lymph nodes and uterine appendages were recorded in such cases.Conclusions. More than 50% of EC cases develop in combination with hysteromyoma and/or uterine adenomyosis. Clinically unfavorable disease course was typical of patients older than 62 years with EC in combination with two benign uterine diseases.