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

2004 ◽  
Vol 14 (2) ◽  
pp. 348-353 ◽  
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.

scholarly journals Immunohistochemical Expression of “HE4” in Endometrial Hyperplasia versus Endometrial Endometrioid Carcinoma

2021 ◽  
Vol 9 (A) ◽  
pp. 669-675
Author(s):  
Amany Talaat Abd El-Hamed ◽  
Samira Abd-Allah Mahmoud ◽  
Ahmed A. Soliman ◽  
Dina F. El-Yasergy
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Prognostic Significance ◽  
Atypical Hyperplasia ◽  
Cancer Tissue ◽  
Endometrioid Carcinoma ◽  
Immunohistochemical Expression ◽  
Atypical Endometrial Hyperplasia ◽  
Strong Expression

Aim Endometrial cancer is the most common cancer of the female genital tract. No effective biomarkers currently exist to allow for an efficient risk classification of endometrial carcinoma. Human epididymis protein 4 (HE4) overexpression is first observed in ovarian cancer tissue and subsequent research has shown that the HE4 overexpression has also been observed in patients with endometrial carcinoma. To our knowledge, this marker was evaluated in small number of research studies in cases of endometrial carcinoma versus hyperplasia. This has inspired us to test for immunohistochemical expression of HE4 in endometrial endometrioid carcinoma and hyperplastic endometria and to correlate HE4 expression with various prognostic pathological parameters including International Federation of Gynecology and Obstetrics (FIGO) grading and staging. Methods Immunohistochemical staining for HE4 was performed on paraffin-embedded sections of forty cases of endometrial endometrioid carcinoma and thirty cases of endometrial hyperplasia: including 15 cases of non-atypical hyperplasia and 15 cases of atypical hyperplasia. A histochemical score was used to evaluate HE4 expression by the tumor cells. Results In this study, HE4 overexpression level was significantly higher in endometrial endometrioid carcinoma than endometrial hyperplasia and significantly higher than non-atypical endometrial hyperplasia (P<0.05). HE4 strong expression was detected in 20% of atypical endometrial hyperplasia, but no statistical significance was detected between atypical hyperplasia and endometrial carcinoma. HE4 overexpression showed statistically significant positive correlation with FIGO grading, FIGO staging, and depth of myometrial invasion. Conclusion: During interpretation of endometrial biopsies of atypical hyperplasia, HE4 strong expression might raise the possibility of the presence of coexisting adenocarcinoma not biopsied or even warning of a near future malignant transformation. Also, strong expression of HE4 by tissue biopsy of adenocarcinoma should be reported as this might predict higher grade and stage of the tumor, a point that should be considered by surgeons while performing hysterectomy. These results should be further confirmed by extending the study on a large scale, correlation of HE4 expression with the molecular classification of Tumor Cancer Genome Atlas and long term follow up are required to establish the prognostic significance of HE4 expression in endometrial carcinoma and atypical hyperplasia. Keywords: Endometrial carcinoma, Endometrial hyperplasia, HE4, Immunohistochemistry.

New Variant Of Hormonal Treatment For Atypical Endometrial Hyperplasia And An Early Endometrial Cancer With Fertility Preservation

2019 ◽  
pp. 36-45
Author(s):  
Olga V. Novikova ◽  
Cholpon A. Avasova ◽  
Elena G. Novikova ◽  
Ksenia V. Krasnopolskaya ◽  
Yulia A. Lozovaya ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Fertility Preservation ◽  
Endometrial Hyperplasia ◽  
Hormonal Treatment ◽  
Atypical Endometrial Hyperplasia ◽  
New Variant

Mutational profile of endometrial hyperplasia and risk of progression to endometrioid adenocarcinoma

Cancer ◽  
2020 ◽  
Vol 126 (12) ◽  
pp. 2775-2783 ◽  
Author(s):  
Mariano Russo ◽  
Jordan M. Newell ◽  
Laura Budurlean ◽  
Kenneth R. Houser ◽  
Kathryn Sheldon ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Endometrioid Adenocarcinoma ◽  
Risk Of Progression

Risk of occult atypical hyperplasia or cancer in women with non-atypical endometrial hyperplasia

2020 ◽  
Vol 159 ◽  
pp. 217
Author(s):  
N. Lee ◽  
K.B. Lee ◽  
K. Kim ◽  
J.H. Hong ◽  
G.W. Yim ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Atypical Hyperplasia ◽  
Atypical Endometrial Hyperplasia

Ezrin, a membrane-cytoskeletal linking protein, is highly expressed in atypical endometrial hyperplasia and uterine endometrioid adenocarcinoma

2002 ◽  
Vol 179 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Kaori Ohtani ◽  
Hideki Sakamoto ◽  
Thomas Rutherford ◽  
Zhaocong Chen ◽  
Atushi Kikuchi ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Endometrioid Adenocarcinoma ◽  
Atypical Endometrial Hyperplasia

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

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.

Young Nulliparous Female with Continous Vaginal Bleeding: A Case of Atypical Endometrial Hyperplasia

2018 ◽  
Vol 3 (6) ◽  
Keyword(s):  
Endometrial Carcinoma ◽  
Vaginal Bleeding ◽  
Endometrial Hyperplasia ◽  
Definitive Treatment ◽  
Atypical Endometrial Hyperplasia ◽  
Dilatation And Curettage ◽  
One Year ◽  
Nulliparous Female ◽  
Secretory Endometrium ◽  
Continuous Bleeding

Mrs. XYZ 32 years of age, nulliparous presented in the OPD with complaint of continuous vaginal bleeding for 1 month. She had had Dx D & C twice previously for the same complaint one year ago. The two H/P reports showed Adenocarcinoma of the Uterus and repeat D & C one month later showed Secretory endometrium. Dilatation and curettage was done again on19. 03 2018 which showed Atypical Endometrial Hyperplasia (AEH). The couple was counseled and they opted for definitive treatment. TAH & BSO was done on 03.04 2018. Cut section showed thickened endometrium with no myometrium invasion. Conclusion: In patients with irregular or continuous bleeding P/V should be evaluated for AEH or Endometrial carcinoma.

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