Assessment of Endometrial Carcinoma Markers and Hormone Receptors Profile before and after Bariatric Surgery: A Clinico-Pathological-Immunohistochemical Study ()
Affiliation(s)
1Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
2Department of Pathology, Faculty of Medicine (Rabigh Branch), King Abdul Aziz University, Jeddah, KSA.
3Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
4Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
5Department of Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
6Department of Community, Environmental & Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
ABSTRACT
Background: Obesity is a major risk factor for endometrial carcinoma, and we aim to
assess markers of carcinogenesis including PTEN and Ki-67 and hormone receptors
profile including ER, PR and AR before and after bariatric surgery to find out
its effects in reducing endometrial carcinoma risk in morbid obese females. Patients
and methods: The study included 80 females with morbid obesity (BMI > 40
Kg/m2) who underwent bariatric surgery. All were sampled by Pipelle
biopsy at baseline and 12 months after operation and examined
histopathologically and immunohistochemically for Ki-67, PTEN, ER, PR and AR. Results: Sixty two out of 80 (62/80) females showed no pathological abnormalities; 4 had
polyps; 7 had simple endometrial hyperplasia; 4 had atypical endometrial
hyperplasia and 3 had endometrial carcinoma. In total, 34 females underwent
gastric bypass operation (42.5%) and 46 underwent a sleeve gastrectomy
operation (57.5%). There was a statistically significant difference between
baseline weight and BMI before and after surgery (p < 0.001). Of the 7 women
with simple hyperplasia, resolution occurred in 5 within 7 months of surgery.
Three of 4 females with atypical hyperplasia (AH) showed resolution after 9
months. Mean Ki-67 score was lower at 12 months (p < 0.001) after surgery.
43/77 (55.8%) baseline biopsies were glandular PTEN null, including 9/15 of the
women with baseline endometrial abnormalities, of whom 5/15 regained glandular
PTEN expression as their endometrial abnormalities resolved. There was a
significant reduction in ER score after surgery (p < 0.001). PR H-scores
were not significantly different post-operatively (p = 0.193). AR H-scores were
higher significantly in pre-operative biopsies than post-operative ones (p <
0.001). Conclusion: Females with morbid obesity have a higher risk of
harboring endometrial abnormalities even if asymptomatic. However, the
endometrial pathology and the high ER and PR expression can be normalized
within one year without medical treatment, signifying the role of bariatric
surgery-induced weight loss in reducing the risk of endometrial neoplasia
development. Also, the marked weight loss occurring after bariatric surgery
induces highly significant endometrial change as resolution of atypical
hyperplasia, and molecular changes as reduction of Ki-67 and restoration of
PTEN that are associated with transition of endometrium from high to low risk.
Share and Cite:
Elnagar, W. , Elbasateeny, S. , Abdelwahab, M. , Yassin, M. , Baiomy, T. , Amin, M. and El-Shafei, D. (2019) Assessment of Endometrial Carcinoma Markers and Hormone Receptors Profile before and after Bariatric Surgery: A Clinico-Pathological-Immunohistochemical Study.
Open Journal of Obstetrics and Gynecology,
9, 1019-1031. doi:
10.4236/ojog.2019.97099.
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