Endometrial hyperplasia natural history, complications and prognosis: Difference between revisions

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{{Endometrial hyperplasia}}
{{Endometrial hyperplasia}}
{{CMG}}{{AE}} {{STM}}
{{CMG}}{{AE}} {{Swathi}}


==Overview==
==Overview==
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> 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 of 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.
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 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>
*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


Complications

Prognosis

References

  1. 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.
  2. 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. 3.0 3.1 Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 16, 2016
  4. 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.
  5. 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.
  6. 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.

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