Endometrial intraepithelial neoplasia: Difference between revisions
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== Diagnosis == | == Diagnosis == | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
*The diagnosis of | *The diagnosis of endometrial intraepithelial neoplasia is made when the following diagnostic criteria are met: | ||
:* | :*Area of glands greater than stroma (volume percentage stroma less than 55%) | ||
:* | :*Cytology differs between architecturally crowded focus and background | ||
:* | :*Maximum linear dimension exceeds 1 mm | ||
:* | :*Benign conditions with overlapping criteria (ie, basalis, secretory, polyps, repair) | ||
:*Carcinoma if maze-like glands, solid areas, or appreciable cribriforming | |||
=== Symptoms === | === Symptoms === | ||
*[Disease name] is usually asymptomatic. | *[Disease name] is usually asymptomatic. | ||
Revision as of 15:00, 12 May 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Synonyms and keywords: Atypical endometrial hyperplasia
Overview
Historical Perspective
- EIN lesions have been discovered by a combination of molecular, histologic, and clinical outcome studies beginning in the 1990s which provide a multifaceted characterization of this disease. They are a subset of a larger mixed group of lesions previously called "endometrial hyperplasia[1][2]" The EIN diagnostic schema is intended to replace the previous "endometrial hyperplasia" classification as defined by the World Health Organization in 1994, which have been separated into benign (benign endometrial hyperplasia) and premalignant (EIN) classes in accordance with their behavior and clinical management.
Classification
- Endometrial intraepithelial neoplasia may be classified according to WHO94 schema classifies histology based on glandular complexity and nuclear atypia into 4 groups:
- Simple hyperplasia
- Complex hyperplasia
- Simple hyperplasia with atypia
- Complex hyperplasia with atypia
- Other variants of [disease name] include [disease subtype 1],
[disease subtype 2], and [disease subtype 3].
Pathophysiology
- Endometrial intraepithelial neoplasia, (EIN) is a premalignant lesion of the uterine lining that predisposes to endometrioid endometrial adenocarcinoma. It is composed of a collection of abnormal endometrial cells, arising from the glands that line the uterus, which have a tendency over time to progress to the most common form of uterine cancer — endometrial adenocarcinoma, endometrioid type.
- Endometrial intraepithelial carcinoma (EIC) to be the precursor of serous adenocarcinoma.
- The mutation in p53 gene has been associated with the development of endometrial intraepithelial neoplasia.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Causes
- Endometrial intraepithelial neoplasia may be caused by either estrogenic stimulation of the endometrium, unopposed by progestins.
Differentiating [disease name] from other Diseases
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
- [Differential dx1]
- [Differential dx2]
- [Differential dx3]
Epidemiology and Demographics
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be number or range] cases per 100,000 individuals in [location].
Age
- The average age at time of endometrial intraepithelial neoplasia diagnosis is approximately 52 years, compared to approximately 61 years for carcinoma.
Gender
- Females are affected with endometrial intraepithelial neoplasia.
Race
- There is no racial predilection for [disease name].
- [Disease name] usually affects individuals of the [race 1] race.
- [Race 2] individuals are less likely to develop [disease name].
Risk Factors
- Risk factors for development of EIN and the endometrioid type of endometrial carcinoma include exposure to estrogens without opposing progestins, obesity, diabetes, and rare hereditary conditions such as hereditary nonpolyposis colorectal cancer. Protective factors include use of combined oral contraceptive pills (low dose estrogen and progestin), and prior use of a contraceptive intrauterine device.
Natural History, Complications and Prognosis
- The majority of patients with [disease name] remain asymptomatic for duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation ].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
Diagnosis
Diagnostic Criteria
- The diagnosis of endometrial intraepithelial neoplasia is made when the following diagnostic criteria are met:
- Area of glands greater than stroma (volume percentage stroma less than 55%)
- Cytology differs between architecturally crowded focus and background
- Maximum linear dimension exceeds 1 mm
- Benign conditions with overlapping criteria (ie, basalis, secretory, polyps, repair)
- Carcinoma if maze-like glands, solid areas, or appreciable cribriforming
Symptoms
- [Disease name] is usually asymptomatic.
- Symptoms of [disease name] may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Imaging Findings
- There are no [imaging study] findings associated with [disease name].
- [Imaging study 1] is the imaging modality of choice for [disease name].
- On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
- [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followedup every [duration]. Followup testing includes [test 1], [test 2], and [test 3].
References
- ↑ Mutter GL, Duska L, Crum CP (2005). "Endometrial Intraepithelial Neoplasia". In Crum CP, Lee K. Diagnostic Gynecologic and Obstetric Pathology. Philadelphia PA: Saunders. pp. 493–518.
- ↑ Silverberg SG, Mutter GL, Kurman RJ, Kubik-Huch RA, Nogales F, Tavassoli FA (2003). "Tumors of the uterine corpus: epithelial tumors and related lesions". In Tavassoli FA, Stratton MR. WHO Classification of Tumors: Pathology and Genetics of Tumors of the Breast and Female Genital Organs. Lyon, France: IARC Press. pp. 221–232.