Endometrial hyperplasia: The risk of progression to carcinoma in a series of 538 cases

Citation
Lc. Horn et al., Endometrial hyperplasia: The risk of progression to carcinoma in a series of 538 cases, GEBURTSH FR, 61(7), 2001, pp. 501-506
Citations number
34
Categorie Soggetti
Reproductive Medicine
Journal title
GEBURTSHILFE UND FRAUENHEILKUNDE
ISSN journal
00165751 → ACNP
Volume
61
Issue
7
Year of publication
2001
Pages
501 - 506
Database
ISI
SICI code
0016-5751(200107)61:7<501:EHTROP>2.0.ZU;2-9
Abstract
Objective: Most endometrial carcinomas are associated with hyperestrogenism and endometrial hyperplasia. The aim of this study was to establish the ca rcinogenic potential of endometrial hyperplasia with or without progestin t herapy. Methods: We reviewed endometrial curettage specimens from 538 patients with complex or atypical endometrial hyperplasia over a 20-year period. Histolo gic features were correlated with the clinical follow-up. 215 patients rece ived progestins adjuvantly and 323 did not. There were no differences betwe en the groups in age, obesity, estrogen pretreatment or menopausal status. Results: Two thirds of the patients presented with postmenopausal bleeding and 21 were premenopausal. Overall, 23.5% of patients had a history of estr ogen replacement therapy and 86% were obese. Of the 215 patients treated wi th progestins, 128 (59.5%) showed complete regression of hyperplasia, 77 (5 9.5%) had persisting hyperplasia, 5 (2.3%) had progression to higher grade hyperplasia, and 5 (2.3%) had progression to carcinoma. Of 287 women not tr eated with progestins, 153 (53.5%) had persisting hyperplasia, 36 (12.5%)ha d progression to atypical hyperplasia, and 61 (21%) had progression to carc inoma. Overall, 8 of the 390 patients with complex hyperplasia and 58 (52%) of those with atypical hyperplasia developed carcinoma (P<0.01). Conclusion: Complex endometrial hyperplasia can safely be treated with prog estins. Atypical hyperplasia has a considerable risk of progression to carc inoma and should be treated with hysterectomy.