Endometrial hyperplasia

Endometrial hyperplasia

Infobox_Disease
Name = Endometrial hyperplasia


Caption = Velvety polyps of "endometrial hyperplasia" in a hysterectomy specimen
DiseasesDB = 4263
ICD10 = N85.0
ICD9 = ICD9|621.3
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = med
eMedicineTopic = 3334
eMedicine_mult =
MeshID =

Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus. Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily counteract estrogen's proliferative effects on this tissue. This may occur in a number of settings, including polycystic ovary syndrome and certain formulations of estrogen replacement therapy. Endometrial hyperplasia is a significant risk factor for the development of endometrial cancer so careful monitoring and treatment of women with this disorder is essential.

Classification

Like other hyperplastic disorders, endometrial hyperplasia initially represents a physiological response of endometrial tissue to the growth-promoting actions of estrogen. However, the gland-forming cells of a hyperplastic endometrium may also undergo changes over time which predispose them to cancerous transformation. Several histopathology subtypes of endometrial hyperplasia are recognisable to the pathologist, with different therapeutic and prognostic implications.cite book |author=Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor) |title=Modern Surgical Pathology (2 Volume Set) |publisher=W B Saunders |location=London |year= |pages= |isbn=0-7216-7253-1 |oclc= |doi=]

*Endometrial hyperplasia (simple or complex) - Irregularity and cystic expansion of glands (simple) or crowding and budding of glands (complex) without worrisome changes in the appearance of individual gland cells. In one study, 1.6% of patients diagnosed with these abnormalities eventually developed endometrial cancer.cite journal |author=Kurman RJ, Kaminski PF, Norris HJ |title=The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients |journal=Cancer |volume=56 |issue=2 |pages=403–12 |year=1985 |pmid=4005805 |doi=]

*Atypical endometrial hyperplasia (simple or complex) - Simple or complex architectural changes, with worrisome ("atypical") changes in gland cells, including cell stratification, tufting, loss of nuclear polarity, enlarged nuclei, and an increase in mitotic activity. These changes are similar to those seen in true cancer cells, but atypical hyperplasia does not show invasion into the connective tissues, the defining characteristic of cancer. The previously mentioned study found that 22% of patients with atypical hyperplasia eventually developed cancer.cite journal |author=Kurman RJ, Kaminski PF, Norris HJ |title=The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients |journal=Cancer |volume=56 |issue=2 |pages=403–12 |year=1985 |pmid=4005805 |doi=]

Diagnosis

Diagnosis of endometrial hyperplasia is typically performed though curettage of the uterine cavity to obtain endometrial tissue for histopathologic analysis. A workup for endometrial disease may be prompted by abnormal uterine bleeding, or the presence of atypical glandular cells on a pap smear. [http://www.uptodateonline.com/utd/content/topic.do?topicKey=gen_gyne/13384&type=A&selectedTitle=1~22] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)]

Treatment

Treatment of endometrial hyperplasia is individualized, and may include hormonal therapy, such as cyclic or continuous progestin therapy, or hysterectomy. [http://www.uptodateonline.com/utd/content/topic.do?topicKey=gen_gyne/13384&type=A&selectedTitle=1~22] Howard A Zacur, Robert L Giuntoli, II, Marcus Jurema, "Endometrial Hyperplasia" from UpToDate Online (accessed 5-26-07)]

References


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