Endometrial hyperplasia natural history, complications and prognosis: Difference between revisions
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{{Endometrial hyperplasia}} | {{Endometrial hyperplasia}} | ||
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==Overview== | ==Overview== | ||
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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.
- If left untreated, 30% of patients with atypical hyperplasia may progress to develop endometrial carcinoma.[2]
Hyperplasia without atypia tends to spontaneously regress.
- whereas atypical hyperplasias are more likely to progress Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K, Okada H, Kato J, Yakushiji M, Tanizawa O, Fujimoto S, Nozawa S, Takahashi T, Hasumi K, Furuhashi N, Aono T, Sakamoto A, Furusato M (June 1997). "The behavior of endometrial hyperplasia: a prospective study. Endometrial Hyperplasia Study Group". J. Obstet. Gynaecol. Res. 23 (3): 223–30. PMID 9255033.
- 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). However, 2 recent studies have concluded that the concomitant presence of carcinoma in uteri sampled for endometrial hyperplasia is considerably higher.[4]
Complications
Malignant transformation is the most common complication of endometrial hyperpasia.[3]
Complications of untreated or poorly controlled endometrial hyperplasia can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of endometrial hyperplasia include:
Absenteeism from work or school Anemia (low red blood cell count) Cancer of the uterus Inability to participate normally in activities Infertility Menorrhagia (heavy bleeding during your menstrual period)
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. Providers must exert vigilance in identifying patients at risk and in initiating pre-emptive strategies. 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.[5] There are various forms of endometrial hyperplasia which, in terms of prognosis and therapy, can be subdivided into those having cytological atypia and those lacking this feature. The former may progress into invasive endometrial malignancy through a transitional non-invasive stage. This is a continuous process and, as a result, the distinction between an atypical hyperplasia and an intraepithelial adenocarcinoma (IEA) or an adenocarcinoma with stromal invasion is not histologically reproducible. The concept of endometrioid neoplasia, which includes the entire spectrum of the aforementioned proliferating endometrial lesions, was introduced. Adenocarcinomas arising from an atypical hyperplasia are invariably of the endometrioid cell type, whereas those developing from an atrophic endometrium may be either of the endometrioid or of the non-endometrioid cell type. Endometrioid adenocarcinomas arising through the hyperplasia-neoplasia sequence are oestrogen induced and tend to be well differentiated and less invasive of the myometrium, lack lymphatic and metastatic involvement and have an excellent prognosis. Oestrogen-induced adenocarcinomas are also endometrioid, arising from an atrophic or a rather weakly proliferating endometrium, but these neoplasms are frequently of higher histological grade and have a somewhat less favourable prognosis. Finally, endometrial carcinomas of the non-endometrioid cell type, mainly serous papillary and clear cell carcinomas, are non-oestrogen induced, non-hyperplasia associated and show adverse aggressive histological features and an extremely poor prognosis. The antigenic characteristics and the molecular events associated with the development of these forms of endometrial malignancy are distinct and allow the description of, at least, two pathogenetic types of endometrial carcinoma.[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.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ 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.