Endometrial hyperplasia natural history, complications and prognosis: Difference between revisions
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{{Endometrial hyperplasia}} | {{Endometrial hyperplasia}} | ||
{{CMG}}{{AE}} {{ | {{CMG}}{{AE}} {{Swathi}} | ||
==Overview== | ==Overview== | ||
The majority of cases of endometrial hyperplasia (except complex atypical hyperplasia) resolve spontaneously with time | The majority of cases of [[endometrial]] [[hyperplasia]] (except complex atypical [[hyperplasia]]) resolve spontaneously with time. | ||
==Natural History== | ==Natural History== | ||
*The majority of cases of endometrial | *The majority of cases of [[endometrial]] [[hyperplasia]] (except complex atypical [[hyperplasia]]) resolve spontaneously with time.<ref name="pmid9255033">{{cite journal| author=Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K et al.| title=The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. | journal=J Obstet Gynaecol Res | year= 1997 | volume= 23 | issue= 3 | pages= 223-30 | pmid=9255033 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9255033 }} </ref><ref name="pmid9255033">{{cite journal| author=Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K et al.| title=The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group. | journal=J Obstet Gynaecol Res | year= 1997 | volume= 23 | issue= 3 | pages= 223-30 | pmid=9255033 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9255033 }} </ref> | ||
*If left untreated, 30% of patients with atypical hyperplasia may progress to develop [[endometrial carcinoma]].<ref name="pmid19285814">{{cite journal| author=Lacey JV, Chia VM| title=Endometrial hyperplasia and the risk of progression to carcinoma. | journal=Maturitas | year= 2009 | volume= 63 | issue= 1 | pages= 39-44 | pmid=19285814 | doi=10.1016/j.maturitas.2009.02.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19285814 }} </ref> | *If left untreated, 30% of patients with atypical hyperplasia may progress to develop [[endometrial carcinoma]].<ref name="pmid19285814">{{cite journal| author=Lacey JV, Chia VM| title=Endometrial hyperplasia and the risk of progression to carcinoma. | journal=Maturitas | year= 2009 | volume= 63 | issue= 1 | pages= 39-44 | pmid=19285814 | doi=10.1016/j.maturitas.2009.02.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19285814 }} </ref> | ||
*[[Malignant]] [[transformation]] into [[endometrial cancer]] is the most common [[Complication (medicine)|complication]] of [[Endometrial hyperplasia|endometrial hyperpasia]].<ref name="rc">Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 16, 2016</ref> | |||
*[[Prognosis]] is generally good with treatment. | |||
*[[Hyperplasia]] without [[atypia]] tends to spontaneously [[Regression|regress]]. | |||
*[[Atypia|Atypical]] [[Hyperplasia|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 [[Diagnose|diagnosed]] as [[Atypia|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 [[Uterus|uteri]] sampled for [[endometrial]] [[hyperplasia]] is considerably higher.<ref name="WidraDunton1995">{{cite journal|last1=Widra|first1=E.A.|last2=Dunton|first2=C.J.|last3=McHugh|first3=M.|last4=Palazzo|first4=J.P.|title=Endometrial hyperplasia and the risk of carcinoma|journal=International Journal of Gynecological Cancer|volume=5|issue=3|year=1995|pages=233–235|issn=1048-891X|doi=10.1046/j.1525-1438.1995.05030233.x}}</ref> | |||
*[[Adenocarcinomas]] arising from an [[Atypia|atypical]] [[hyperplasia]] are of the [[Endometrium|endometrioid]] [[Cell (biology)|cell]] type, whereas those developing from an [[atrophic]] [[endometrium]] may be either [[Endometrium|endometrioid]] or non-[[Endometrium|endometrioid]] [[Cell (biology)|cell]] type. | |||
**[[Endometrioid Endometrial cancer|Endometrioid]] [[adenocarcinomas]] arising through the [[hyperplasia]]-[[neoplasia]] sequence are [[Estrogen|oestrogen]] induced. | |||
***Well [[Differentiate|differentiated]] | |||
***Less [[Invasive (medical)|invasive]] of the [[myometrium]] | |||
***Lack [[lymphatic]] and [[Metastasis|metastatic]] involvement | |||
***Excellent [[prognosis]]. | |||
**[[Estrogen|Oestrogen]]-induced [[adenocarcinomas]] are also [[Endometrium|endometrioid]], arising from an [[atrophic]] or a rather weakly [[Proliferate|proliferating]] [[endometrium]]. | |||
***Frequently of higher [[histological]] grade | |||
***Less favourable [[prognosis]]. | |||
**Finally, [[endometrial]] [[Carcinoma|carcinomas]] of the non-[[Endometrium|endometrioid]] [[Cell (biology)|cell]] type, mainly [[serous]] [[papillary]] and [[Clear cell tumor|clear cell carcinomas]], are non-[[Estrogen|oestrogen]] induced and non-[[hyperplasia]] associated. | |||
***Adverse aggressive [[histological]] features | |||
***Extremely poor [[prognosis]].<ref name="pmid23073327">{{cite journal |vauthors=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 |title=Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature |journal=Am. J. Surg. Pathol. |volume=36 |issue=11 |pages=1683–90 |date=November 2012 |pmid=23073327 |doi=10.1097/PAS.0b013e31825dd4ff |url=}}</ref> | |||
==Complications== | ==Complications== | ||
[[Malignant]] transformation is the most common complication of endometrial hyperpasia.<ref name=rc>Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 16, 2016</ref> | *[[Malignant]] [[transformation]] is the most common [[Complication (medicine)|complication]] of [[Endometrial hyperplasia|endometrial hyperpasia]].<ref name="rc">Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 16, 2016</ref> | ||
*[[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]]. | |||
*[[Complication (medicine)|Complications]] of [[endometrial hyperplasia]] include: | |||
**Absenteeism from work or school | |||
**[[Anemia]] | |||
**[[Cancer]] of the [[uterus]] | |||
**Inability to participate normally in [[Activities of daily living|activities]] | |||
**[[Infertility]] | |||
**[[Menorrhagia]] | |||
==Prognosis== | ==Prognosis== | ||
Prognosis is generally good with treatment for endometrial hyperplasias without atypia. | *[[Prognosis]] is generally good with treatment for [[Endometrial hyperplasia|endometrial hyperplasias]] without [[atypia]]. | ||
*[[Chronic (medical)|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 for Improving Care|strategies]] is highly important. This includes; risk [[reduction]] with [[lifestyle]] [[Modifications (genetics)|modification]], [[weight loss]], and [[glycemic]] [[control]] can improve [[regression]] and overall [[health]]. | |||
*[[Fertility]] [[Outcome|outcomes]] for these [[patients]] are promising, especially with [[Assisted Reproductive Technology|assisted]] [[reproductive]] technology.<ref name="GresselParkash2015">{{cite journal|last1=Gressel|first1=Gregory M.|last2=Parkash|first2=Vinita|last3=Pal|first3=Lubna|title=Management options and fertility-preserving therapy for premenopausal endometrial hyperplasia and early-stage endometrial cancer|journal=International Journal of Gynecology & Obstetrics|volume=131|issue=3|year=2015|pages=234–239|issn=00207292|doi=10.1016/j.ijgo.2015.06.031}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 14:52, 8 May 2019
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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.