الفهرس 
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Abstract
Endometrial carcinoma is the most common malignant gynecologic neoplasm that develops mostly on top of atypical endometrial hyperplasia. The role of ghrelin in the development of carcinomas in different organs is poorly understood. Some studies believed that ghrelin has antiproliferative effects while in other studies, proliferative actions of ghrelin were observed. Evidence is emerging that ghrelin plays an autocrine/paracrine role in cancer and could serve as diagnostic or prognostic tool or as therapeutic target.
This study was based on 86 cases of endometrial biopsies that include normal endometrium, hyperplastic endometrium and endometrioid adenocarcinoma. We use both WHO and EIN classification systems for diagnosis of hyperplastic endometrial lesions.
There was no significant relationship between age of the studied malignant cases and the tumor grade, stage, myometrial invasion or lymphovascular invasion.
There was significant relationship between ghrelin expression in normal endometrium, simple endometrial hyperplasia without atypia, atypical endometrial hyperplasia and endometrial carcinoma cases.
A statistically significant relationship was observed between ghrelin expression in normal endometrium, endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN) and endometrial carcinoma cases.
There was no relationship between ghrelin expression in normal endometrium and hyperplastic endometrium without or with atypia.
There was significant relationship between ghrelin expression in atypical endometrial hyperplasia and endometrial carcinoma. Also, a significant relationship between ghrelin expression in endometrial hyperplasia with atypia and well differentiated endometrial carcinoma was found.
Summary
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No relationship between ghrelin expression in normal endometrium and EH or between EH and EIN was found .
There was a significant relationship between ghrelin expression in EIN and endometrial carcinoma. Also, significant relationship between ghrelin expression in EIN and well differentiated endometrial carcinoma was found.
Calculating sensitivity and specifity for ghrelin immunostaining in different categories of the cases regarding to cutoff point method showed that ghrelin can be considered as sensitive but not specific diagnostic marker for endometrial samples.
There was a significant relationship between positive ghrelin expression and low grade tumors. However, there was no relationship between the positive ghrelin immunostaining and the age, stage, lymphovascular invasion, myometrial invasion, mitotic index or apoptotic index in malignant cases.
There was no relationship between ghrelin immunostaining assessed by H-score method in malignant cases and their age, grade, stage, lymphovascular invasion, myometrial invasion, mitotic index or apoptotic index.
There was a significant relationship between stromal ghrelin expression in malignant and nonmalignant cases. There was no relationship between stromal immunostaining of ghrelin and patient`s age, tumor stage, myometrial invasion, lymphovascular invasion, mitotic index or apoptotic index.
There was no statistically significant correlation between ghrelin expression in endometrial glands and stroma in nonmalignant cases. But a statistically significant correlation was found between epithelial and stromal ghrelin immunoreactivity in malignant cases.