Risk for Advanced-Stage Endometrial Cancer in Surgical Specimens from Patients with Complex Endometrial Hyperplasia with Atypia

Abstract

Objectives: To determine the incidence of endometrial cancer in patients undergoing hysterectomy for atypical complex endometrial hyperplasia and to study the risk of advanced endometrial cancer that may be associated with extra-uterine disease. Methods: A retrospective chart review was performed of the records of all women who underwent hysterectomy for a preoperative diagnosis of complex hyperplasia with atypia from two teaching hospitals between 1999 and 2006. Demographic and clinical variables were collected and analyzed for the 80 patients identified by the initial screening methods. Results: After screening and exclusions, 66 women with a preoperative diagnosis of atypical complex hyperplasia who subsequently underwent a hysterectomy were identified. Eleven of the 66 patients with atypical complex hyperplasia had a diagnosis of endometrial carcinoma in the hysterectomy specimens (17%). No endometrial cancer patient was staged greater than stage 1B or had greater than grade 2 disease. The patients with endometrial cancer were older (p < 0.05). Evidence of myometrial invasion was found in 63% (7/11) of the cancer cases, but all were less than 50% of the myometrium. Conclusion: Endometrial cancer found at the time of hysterectomy for complex hyperplasia with atypia may be associated with less advanced disease.

Prevalence of Co-existing Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia

“…Eddib et al, found out that; the incidence of endometrial cancer in patients undergone hysterectomy after being diagnosed with atypical endometrial hyperplasia was 17% and none of them was observed to have advanced tumour of more than grade 2 or stage 1B [17]. In similar study done by Rakha et al, suggested that patients who undergone hysterectomy due atypical endometrial hyperplasia and diagnosed with endometrial cancer; their tumours are endometrioid in morphology, early staged, low-graded and show good prognosis [18].…”

A Novel Preoperative Scoring System for Predicting Endometrial Cancer in Patients with Complex Atypical Endometrial Hyperplasia and Accuracy of Frozen Section Pathological Examination in This Context: A Multicenter Study

“…ACH is a well-known precursor of EC [6,14,15,16], being associated with progression to EC in 29% of all cases [4]. The usual surgical treatment for ACH is simple hysterectomy with or without BSO.…”

Gene Promoter Methylation in Endometrial Carcinogenesis

“…The presence of a coexistent carcinoma may alter the surgical treatment approach. In addition, 20% of patients with these type I tumours, that develop out of endometrial hyperplasia, with, a presumed good outcome, present with recurrent disease [ 8 , 9 , 14 ]. Understanding of the progression from AH to EC might contribute to improved selection for hormonal treatment for fertility preservation for young patients, as well as for patients that are not suitable for surgery due to comorbidity.…”