Osamu Sugimoto (Sugimoto, O. (1975). Hysteroscopic diagnosis of endometrial carcinoma A report of fifty-three cases examined at the Women’s Clinic of Kyoto University Hospital, American Journal of Obstetrics and Gynecology, 121 (1), 105- 113) highlighted the role of hysteroscopy in the diagnosis of endometrial carcinoma as well as in the assessment of extension and cervical involvement.
Sugimoto defined four hysteroscopic patterns of endometrial adenocarcinoma
1-Polypoid: With polypoid and histologically well differentiated growth. The surface has few atypical blood vessels and is usually whitish-grayish.
2-Nodular: Solid appearance with very marked atypical vascularization and the existence of atypical vessels in zigzag on the surface of the tumor.
3-Papillomatosis: is the most commonly pattern present in more than 50% of patients with endometrial carcinoma. Although of a nodular appearance, the detailed examination reveals a surface covered with numerous tentacle-like projections. Each projection is composed of a blood vessel covered with cancerous tissue.
4-Diffuse Carcinoma: When the entire endometrial cavity is affected. Usually, this pattern is associated with poorly differentiated carcinoma. Cases of metastatic carcinoma usually present this pattern.
Another important factor to consider in the hysteroscopic assessment of endometrial carcinoma is the determination of the existence of cervical involvement. The hysteroscopy allows to easily identify the internal cervical os, which offers a great precision in the assessment of the extension towards the cervical canal.
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Hysteroscopy is the only way to see and catch some samples where suspicious lesions are identified. When cancer is not diffused, blinded methods of sampling can miss cancerous tissue and fail the diagnosis.