Balloon thermoablation in a woman with complex endometrial hyperplasia with atypia - A case report

BACKGROUND: Endometrial ablation is an alternative to hysterectomy in patie nts with menorrhagia refractory to medical therapy. The histologic changes in the hyperplastic endometrium secondary to endometrial ablation are not w ell understood. CASE REPORT: A 44-year-old woman, gravida 4, para 4, had menorrhagia, was a t high risk for medical treatment and underwent thermal balloon ablation. T he dilatation and curettage specimen at the time of the procedure revealed complex hyperplasia of the endometrium with atypia. Subsequently a hysterec tomy was performed, and the pathology specimen showed scarring, fibrosis an d focal, weakly proliferative phase endometrium. There was no evidence of h yperplasia or malignancy. CONCLUSION: Endometrial ablation with a thermal balloon seems to have resul ted in resolution of endometrial hyperplasia. However, hyperplasia of the e ndometrium should still be a contraindication to such a procedure because o f the inability to accurately assess the endometrium after ablation.