ENDOMETRIAL HYPERPLASIA AND THE RISK OF CARCINOMA

Recent reports suggest that atypical endometrial hyperplasia diagnosed by biopsy or curettage is accompanied by a higher than expected risk of coexistent invasive cancer. In order to test this hypothesis we rev iewed the pathology and clinical history of all patients at our instit ution who underwent hysterectomy for endometrial hyperplasia with or w ithout cytologic atypia. We found 24 patients of 45 with a preoperativ e diagnosis of hyperplasia with cytologic atypia, and 21 with simple o r complex hyperplasia without atypia. No cancers were found at surgery in the latter group nor were any significant historical differences f ound between the two groups. Of the patients with atypia, 12/24 (50%) had an endometrial carcinoma and nine patients (37.5%) were stage IB o r greater. This is a significantly greater risk than previously report ed in the literature. Endometrial hyperplasia with cytologic atypia ma y carry a higher risk of coexistent invasive endometrial carcinoma tha n previously believed. Methods to identify those patients at highest r isk should be determined.