Endometrial intraepithelial neoplasia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD

Synonyms and Keywords: Atypical endometrial hyperplasia; Minimal uterine serous cancer (MUSC); Serous endometrial intraepithelial carcinoma (EIC); MUSC; Minimal uterine serous cancer

Overview

Endometrial intraepithelial neoplasia lesions was first described in the 1990s. Endometrial hyperplasia may be classified according to new World Health Organization (WHO2014) into two groups; hyperplasia without atypia (non-neoplastic) and atypical hyperplasia (endometrial intraepithelial neoplasm). Endometrial intraepithelial neoplasia arises from premalignant endometrial glands , which are risk of transmutatain to endometrial edometrioid carcinoma. Inactivation (mutation or deletion) of the PTEN tumor suppressor gene, inactivation of PAX2 gene, KRAS mutations, Microsatellite instability, Mutation in p53 gene are involved in the pathogenesis of endometrial intraepithelial neoplasia (EIN). Endometrial intraepithelial neoplasia may be caused by estrogenic stimulation of the endometrium that is unopposed by progestin. On microscopic histopathological analysis, individual glands are lined by a single layer of pseudostratified epithelium which is a characteristic finding of endometrial intraepithelial neoplasia. In 2002, the incidence of endometrial intraepithelial neoplasia (EIN) was estimated to be 144 cases per 100,000 individuals worldwide. The hallmark symptom of endometrial intraepithelial neoplasia is postmenopausal abnormal uterine bleeding. There are no specific laboratory findings associated with endometrial intraepithelial neoplasia. Transvaginal ultrasonography is the imaging modality of choice for endometrial intraepithelial neoplasia. Progestin therapy is recommended among patients with endometrial intraepithelial neoplasia. Hysterectomy is the mainstay of treatment for endometrial intraepithelial neoplasia to prevent endometrial carcinoma.

Historaical Perspective

Classification

Pathophysiology

Causes

Differentiating Endometrial intraepithelial neoplasia from other Diseases

  • Endometrial intraepithelial neoplasia must be differentiated from other causes of postmenopausal differentiated from:[11][14]

Epidemiology and Demographics

Prevalence and Incidence

  • In 2002, the incidence of endometrial intraepithelial neoplasia (EIN) was estimated to be 144 cases per 100,000 individuals worldwide.[15]

Age

  • The incidence of endometrial intraepithelial neoplasia (EIN) increases with age; the median age at diagnosis is 52 years.[16]

Race

  • Endometrial intraepithelial neoplasia (EIN) usually affects individuals of the African American race. Asian individuals are less likely to develop endometrial intraepithelial neoplasia.[17]

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

  • Area of glands is larger than stroma area
  • Cytology differs between architecturally crowded focus and background
  • size ≥ 1mm
  • Forbiddance of adenocarcinoma
  • Forbiddance of mimics

Symptoms

Physical Examination

Laboratory Findings

  • There are no specific laboratory findings associated with endometrial intraepithelial neoplasia.

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

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