Endometrial hyperplasia
- Definition. abnormal endometrial glandular proliferation.
- Etiology. prolonged unopposed estrogenic stimulation due to endogenous (obesity) or exogenous (unopposed estrogen) sources.
- Classification:
1 Hyperplasia with cytologic atypia exhibits an increased nuclear/cytoplasmic ratio, hyperchromasia, and loss of cell polarity. More than 40% of patients with this biopsy result will already have an early endometrial adenocarcinoma.
2 Hyperplasia without cytologic atypia is clinically benign, but accurate diagnosis is dependent on the sampling.
- Diagnosis. Patients typically present with abnormal uterine bleeding or a Pap smear having atypical glandular cells. An office endometrial biopsy (see Chapter 4) makes the diagnosis.
- Treatment. Fertility sparing treatment involves oral contraceptives, progestins, or insertion of a progesterone intrauterine device (IUD; see Chapter 12), followed by a repeat endometrial biopsy in 3–6 months to confirm resolution. Hysterectomy is recommended for most women with cytologic atypia.
Endometrial cancer (>95%)
Epidemiology and risk factors
- Incidence (annual). The USA: 47,000 new cases and 8,000 deaths; the UK: 7,700 new cases and 2,000 deaths – lifetime risk is 2% in the general population.
- Median age. Sixty years.
- Etiology. Exposure to unopposed estrogen increases the risk of endometrial cancer. Protective factors include high parity, pregnancy, and smoking.
- Hereditary factors. Women with a hereditary non-polyposis colorectal cancer (HNPCC) gene mutation (MLH1, MSH2) have a 40–60% lifetime risk of developing endometrial cancer.
Prevention and diagnosis
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