Endometrial hyperplasia and the risk of progression to carcinoma

Earlier studies have shown that morphometric analysis of nuclear size and shape features and stereologic analysis of gland architecture in endometrial hyperplasia are useful to predict the risk of progression to cancer. A multivariate discriminatory D-score using these features has a higher sensitivity than qualitative microscopic characteristics (nuclear atypicality and glandular complexity) when an appropriate threshold is chosen. In the present study, the (additional) prognostic value of morphometric features related to the arrangement of nuclei in glands (distance of nuclear centroids to basal membrane, angle of longest nuclear axis with basal membrane) and DNA-ploidy (determined by flow cytometry) has been analyzed in 39 cases of endometrial hyperplasia, seven (18%) of which have progressed to cancer. Variation in stratification of nuclei has prognostic value, in contrast to DNA-ploidy. Multivariate analysis selects the outer surface density of the glands, mean distance, volume percentage of lumen and the coefficient of variation of nuclear axes as having separate and additional value. A multivariate rule called HYPER-score results from these features. With this score a high-risk (score value ≥0.20, nine cases, 78% progressed) and a low-risk group (score value <0.20, 30 cases, none progressed) can be discerned. The prognostic value, sensitivity and specificity of the hyper-score greatly exceeds that of any of the previously described prognostic factors in endometrial hyperplasias. An additional clinical advantage is that with the HYPER-score two groups (instead of four groups as with Kurman's method(1)) with a high sensitivity and specificity can be discerned. The morphometric and stereologic features agree well with the usual qualitative predictors but have much stronger prognostic value.

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Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment

International Journal of Gynecological Cancer ◽

10.1111/j.1048-891x.2004.014220.x ◽

2004 ◽

Vol 14 (2) ◽

pp. 348-353 ◽

Cited By ~ 74

Author(s):

L.-C. Horn ◽

U. Schnurrbusch ◽

K. Bilek ◽

B. Hentschel ◽

J. Einenkel

Keyword(s):

Endometrial Hyperplasia ◽

Atypical Endometrial Hyperplasia ◽

Risk Of Progression

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COMPARISON OF ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA & WHO CLASSIFIED ENDOMETRIAL HYPERPLASIA IN PREDICTING THE RISK OF PROGRESSION TO ENDOMETRIAL CARCINOMA

10.36106/ijar/7902341 ◽

2021 ◽

pp. 59-61

Author(s):

Bansi Kavar ◽

Neeru Dave

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Intraepithelial Neoplasia ◽

Atypical Hyperplasia ◽

Cytological Atypia ◽

Endometrial Intraepithelial Neoplasia ◽

Risk Of Progression ◽

Classi Cation ◽

Cation System ◽

Sampling Procedures

Background: Endometrial hyperplasia is the precursor lesion of most endometrial cancers of endometrioid type. The most commonly used classication system for endometrial hyperplasia is WHO 1994 classication system in which architecture disruption and cytological atypia are used to identify four types of endometrial hyperplasia including simple or complex hyperplasia with or without atypia. Newer EIN diagnosis by cytological atypia is of great consideration for the progression to endometrial cancer. Material And Methods: The study consists of 100 cases of WHO classied endometrial hyperplasia for period of 4 yrs from 2015 to 2019. Type of sampling procedures- dilation & curettage, endometrial biopsy and fractional curettage. Objective: 1. To discuss revised criteria for recognition of endometrial intraepithelial neoplasia (EIN). 2. To nd out the sensitivity of endometrial intraepithelial neoplasia (EIN) classication in predicting the risk of malignancy. Results: This study consists of 100 cases of endometrial hyperplasia. Patients were mostly postmenopausal & presented with abnormal vaginal bleeding. From WHO classied endometrial lesions, 2 out of 35 cases of simple typical hyperplasia, 10 out of 14 cases of complex typical hyperplasia,12 out of 20 cases of simple atypical hyperplasia and 20 out of 21 cases of complex atypical hyperplasia were reclassied as EI N. Conclusion: To estimate the risk of progression to carcinoma and guide clinical management, the histo-pathologic diagnosis of endometrial hyperplastic lesion is very important, specially the diagnosis of EIN lesions. EIN carries a much greater risk of progression to endometrial cancer than other WHO classied endometrial hyperplasia.

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Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200403000-00023 ◽

2004 ◽

Vol 14 (2) ◽

pp. 348-353 ◽

Cited By ~ 21

Author(s):

L.-C. Horn ◽

U. Schnurrbusch ◽

K. Bilek ◽

B. Hentschel ◽

J. Einenkel

Keyword(s):

Vaginal Bleeding ◽

Endometrial Hyperplasia ◽

Hormonal Treatment ◽

Atypical Hyperplasia ◽

Endometrioid Adenocarcinoma ◽

Endometrioid Carcinoma ◽

Total Hysterectomy ◽

Atypical Endometrial Hyperplasia ◽

Risk Of Progression ◽

Leading Symptom

In most cases, the endometrioid adenocarcinoma of the endometrium is preceded by hyperplasia with different risk of progression into carcinoma. The original histologic slides from 560 consecutive cases with complex and atypical hyperplasia were re-examined to assess the interobserver-correlation. The hyperplasias were analyzed separately for their likelihood of progression to carcinoma in patients with and without progestogen hormonal therapy. In all cases, a fractional re-curreting was performed to establish the state of the disease.The leading symptom was vaginal bleeding in 65.5% of the cases in the postmenopausal period. Eighty-six percent of the patients presented with obesity (BMI > 30 kg/m2), 23% had had an exogeneous use of estrogens. Twenty-two cases were reclassified as simple hyperplasia and excluded from further analysis. The interobserver-correlation was 91% for complex, 92% for atypical hyperplasia, and 89% for endometrioid carcinoma, representing an overall correlation of 90%. Two percent of the cases with complex hyperplasia (8/390) progressed into carcinoma and 10.5% into atypical hyperplasia. Fifty-two percent of the atypical hyperplasias (58/112) progressed into carcinomas. In the case of progestogen treatment (n = 208; P < 0.0001) 61.5% showed remission confirmed by re-curetting, compared with 20.3% of the cases without hormonal treatment (n = 182; P < 0.0001).Endometrial hyperplasia without atypia is likely to respond to hormonal treatment. Especially in postmenopausal situation, atypical hyperplasia should be treated with total hysterectomy.

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MicroRNAs as predictors of future endometrial malignancies in endometrial hyperplasia without atypia.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17563 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17563-e17563

Author(s):

Chyong-Huey Lai ◽

Chiao-Yun Lin ◽

Ren-Chin Wu ◽

Lan-Yan Yang ◽

Hsiao-Jung Tseng ◽

...

Keyword(s):

Medical Records ◽

Endometrial Hyperplasia ◽

Area Under The Curve ◽

Mirna Array ◽

Histological Criteria ◽

Rate Of Progression ◽

Cumulative Rate ◽

Risk Of Progression ◽

Polymerase Chain ◽

Independent Cohort

e17563 Background: The histological criteria of predicting risk of progression of endometrial hyperplasia (EH) to endometrial cancer (EC) is based on the degree of architectural crowding and nuclear atypia. We aim to investigate the cumulative rate of progression to EC in simple or complex hyperplasia without atypia (SH/CH-nonA) and the molecular biomarkers for risk of developing EC in women with SH/CH-nonA. Methods: EH tissues of EC patients with preceding SH/CH-nonA (case) were compared to SH/CH-nonA patients without progression to EC (control) using miRNA array, followed by reverse transcription and quantitative real-time polymerase chain reaction (RT-qPCR), and verified in an independent cohort. Results: The 10-year and 15-year cumulative rates were 8% and 10%, respectively by the hospital medical records. The median time from EH to EC was 8.71 years (range, 0.55-19.84). Twenty miRNAs (p < 0.05, fold change > 4) were significantly different in SH/CH-nonA cases (n = 6) compared to SH/CH-nonA controls (n = 12) by miRNA array. Multiplex RT-qPCR validation (51 SH/CH-nonA controls and 19 SH/CH-nonA cases) selected miR30a-3p, miR141, miR200a, and miR200b. Area under the curve values for tissue miR30a-3p (p = 0.043), miR141(p = 0.003), miR-200a (p < 0.001), and miR200b (p = 0.004) in discriminating cases from controls were 0.658, 0.734, 0.811, and 0.710, and the sensitivity and specificity rates were 56.9% and 76.5%, 73.7% and 74.5%, and 68.4% and 100%, 47.4% and 100%, respectively. Conclusions: MiR30a-3p, miR141, miR-200a, and miR200b are useful tissue biomarkers for predicting future risk of developing EC for patients with SH/CH-nonA.

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