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

Abstract

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/m(2)), 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.

Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan

“…Therefore, the experience of women diagnosed with SH or CH in our study is likely representative of the general population of women with nonatypical EH. Our study design represents an improvement over previous studies that lacked control groups (Kurman et al, 1985;Lindahl and Willen, 1994;Terakawa et al, 1997;Tabata et al, 2001;Horn et al, 2004;Baak et al, 2005), included few women with EH who developed carcinoma (Kurman et al, 1985;Feldman et al, 1994;Lindahl and Willen, 1994;Horn et al, 2004;Baak et al, 2005) or relied on short follow-up (Terakawa et al, 1997;Tabata et al, 2001). Previous studies expressed risk as crude percentages -e.g., 20% of patients with non-atypical AH (Ferenczy and Gelfand, 1989) or 29% of patients with AH (Kurman et al, 1985) progress to cancerrather than population-based rate ratios.…”

“…Approximately 20 200 women in the United States who undergo hysterectomy receive a primary hospital discharge diagnosis of EH each year (Keshavarz et al, 2002), but progression risks for EH have not been accurately characterised in rigorous populationbased studies (Silverberg, 2000). Current management of EH relies on largely historical data from studies that lacked adequate control groups (Kurman et al, 1985;Feldman et al, 1995;Terakawa et al, 1997;Tabata et al, 2001;Horn et al, 2004;Baak et al, 2005) and were limited by sample size (Feldman et al, 1995;Tabata et al, 2001), short follow-up (Feldman et al, 1995;Terakawa et al, 1997;Tabata et al, 2001), suboptimal statistical methods (Kurman et al, 1985;Pettersson et al, 1985;Feldman et al, 1995;Terakawa et al, 1997;Tabata et al, 2001;Horn et al, 2004), and minimal clinical and treatment information (Kurman et al, 1985;Pettersson et al, 1985;Terakawa et al, 1997;Tabata et al, 2001;Horn et al, 2004). Endometrial hyperplasia diagnoses can misclassify disease severity because of biopsy sampling errors (Zaino, 2000;Trimble et al, 2006;Zaino et al, 2006) or the community pathologists' reported tendency to overestimate lesion severity (Silverberg, 2000).…”

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

“…In that study, females with CH without atypia were treated with norethisterone acetate and MPA (10-20 mg/day) for 3-5 months, and a second biopsy was performed. Regression was evident in 61.5% of the patients (Horn et al, 2004). Approximately 60-70% of cases of CH have been reported to respond to progestin treatment (Wang et al, 2003).…”

“…The median duration of follow up was 95.1 months. According to previous studies, the risk of progression or persistence is 0-60% for CH and 10-100% for AH following progestin therapy (Ferenczy et al, 1989;Randall et al, 1997;Horn et al, 2004).…”

Hiperplasia Endometrial: Análisis De Serie De Casos Diagnosticados en Biopsia Endometrial

“…La simple (también conocida como hiperplasia quística o leve) es una lesión proliferativa que se caracteriza por cambios arquitectónicos en las glándulas de diversos tamaños, con mínimos cambios en la complejidad y densidad glandular y abundante estroma entre las mismas. El epitelio superficial es pseudoestratificado con ocasionales figuras mitóticas y ausencia de atipia nuclear (4)(5)(6)(7)(8)(9). La hiperplasia endometrial compleja es también una lesión proliferativa, en la cual se exhibe un incremento en el número y tamaño de las glándulas endometriales, que lucen apiñadas de forma irregular y con mínimo estroma interpuesto adoptando una morfología característica conocida como patrón de "espalda contra espalda" (4,6,9,10,11) (Figura 1).…”