Endometrial hyperplasia natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Swathi Venkatesan, M.B.B.S.[2]
Overview
The majority of cases of endometrial hyperplasia (except complex atypical hyperplasia) resolve spontaneously with time.
Natural History
- The majority of cases of endometrial hyperplasia (except complex atypical hyperplasia) resolve spontaneously with time.[1][1]
- If left untreated, 30% of patients with atypical hyperplasia may progress to develop endometrial carcinoma.[2]
- Malignant transformation into endometrial cancer is the most common complication of endometrial hyperpasia.[3]
- Prognosis is generally good with treatment.
- Hyperplasia without atypia tends to spontaneously regress.
- Atypical hyperplasias are more likely to progress
- Endometrial carcinoma with concomitant hyperplasia is associated with less aggressive disease.
- When an endometrial biopsy or curettage specimen is diagnosed as atypical hyperplasia, the risk of concomitant carcinoma in the same uterus has been reported as 17% to 25% (35–37).
- On the contrary, 2 recent studies have concluded that the concomitant presence of carcinoma in uteri sampled for endometrial hyperplasia is considerably higher.[4]
- Adenocarcinomas arising from an atypical hyperplasia are of the endometrioid cell type, whereas those developing from an atrophic endometrium may be either endometrioid or non-endometrioid cell type.
- Endometrioid adenocarcinomas arising through the hyperplasia-neoplasia sequence are oestrogen induced.
- Well differentiated
- Less invasive of the myometrium
- Lack lymphatic and metastatic involvement
- Excellent prognosis.
- Oestrogen-induced adenocarcinomas are also endometrioid, arising from an atrophic or a rather weakly proliferating endometrium.
- Frequently of higher histological grade
- Less favourable prognosis.
- Finally, endometrial carcinomas of the non-endometrioid cell type, mainly serous papillary and clear cell carcinomas, are non-oestrogen induced and non-hyperplasia associated.
- Adverse aggressive histological features
- Extremely poor prognosis.[5]
- Endometrioid adenocarcinomas arising through the hyperplasia-neoplasia sequence are oestrogen induced.
Complications
- Malignant transformation is the most common complication of endometrial hyperpasia.[3]
- Complications of untreated or poorly controlled endometrial hyperplasia can be serious.
- To minimize risk of serious complications follow the treatment plan provided by health care professional designed specifically for patient.
- Complications of endometrial hyperplasia include:
- Absenteeism from work or school
- Anemia
- Cancer of the uterus
- Inability to participate normally in activities
- Infertility
- Menorrhagia
Prognosis
- Prognosis is generally good with treatment for endometrial hyperplasias without atypia.
- Chronic anovulation, obesity, polycystic ovarian syndrome, metabolic syndrome, insulin resistance, and type 2 diabetes mellitus must be appreciated as risk factors for endometrial pathology.
- Initiating pre-emptive strategies is highly important. This includes; risk reduction with lifestyle modification, weight loss, and glycemic control can improve regression and overall health.
- Fertility outcomes for these patients are promising, especially with assisted reproductive technology.[6]
References
- ↑ 1.0 1.1 Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K; et al. (1997). "The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group". J Obstet Gynaecol Res. 23 (3): 223–30. PMID 9255033.
- ↑ Lacey JV, Chia VM (2009). "Endometrial hyperplasia and the risk of progression to carcinoma". Maturitas. 63 (1): 39–44. doi:10.1016/j.maturitas.2009.02.005. PMID 19285814.
- ↑ 3.0 3.1 Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 16, 2016
- ↑ Widra, E.A.; Dunton, C.J.; McHugh, M.; Palazzo, J.P. (1995). "Endometrial hyperplasia and the risk of carcinoma". International Journal of Gynecological Cancer. 5 (3): 233–235. doi:10.1046/j.1525-1438.1995.05030233.x. ISSN 1048-891X.
- ↑ Rakha E, Wong SC, Soomro I, Chaudry Z, Sharma A, Deen S, Chan S, Abu J, Nunns D, Williamson K, McGregor A, Hammond R, Brown L (November 2012). "Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature". Am. J. Surg. Pathol. 36 (11): 1683–90. doi:10.1097/PAS.0b013e31825dd4ff. PMID 23073327.
- ↑ Gressel, Gregory M.; Parkash, Vinita; Pal, Lubna (2015). "Management options and fertility-preserving therapy for premenopausal endometrial hyperplasia and early-stage endometrial cancer". International Journal of Gynecology & Obstetrics. 131 (3): 234–239. doi:10.1016/j.ijgo.2015.06.031. ISSN 0020-7292.