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VOLUME 8 , ISSUE 1 ( January-June, 2020 ) > List of Articles

Original Article

Concurrent Endometrial Carcinoma in Endometrial Hyperplasia with Atypia

Sandhana Manoharan, Marianallur Ganesan Dhanalakshmi

Keywords : Abnormal uterine bleeding, Carcinoma endometrium, Endometrial biopsy, Endometrial cancer, Endometrial thickness, Malignancy, Posmenopausal bleeding, Trans vaginal sonogram

Citation Information : Manoharan S, Dhanalakshmi MG. Concurrent Endometrial Carcinoma in Endometrial Hyperplasia with Atypia. J South Asian Feder Menopause Soc 2020; 8 (1):34-36.

DOI: 10.5005/jp-journals-10032-1203

License: CC BY-NC 4.0

Published Online: 18-00-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Endometrium that lies within the uterus may develop hyperplasia, due to various causes, of which unopposed estrogen exposure is the most common one. Endometrial hyperplasia may well mask an underlying malignancy and should be followed upon by further procedures to rule out underlying malignancy. Materials and methods: This is a prospective observational study, from June 2017 to June 2019, at a tertiary care level teaching institution. Seventy patients who underwent hysterectomy following a diagnosis of endometrial hyperplasia with atypia were included. Results: 95.7% were in multiparous group, 67.14 % were in perimenopausal, 30% in postmenopausal and 2.85% in reproductive age groups, 52.8% presented with abnormal uterine bleeding, 34.28% with postmenopausal bleeding and 12.85% were asymptomatic, 35.41% had diabetes mellitus, 22.91% had hypertension and 30.20% had obesity as comorbid factors. Positive family history for malignancy was noted in 3.1%. MRI findings suggested endometrial carcinoma in 27.2%. In cases in which MRI suggested non malignancy, 82.4% turned out to be malignant in the final histopathology report. Of the 70 patients, 40% had endometrial carcinoma (not otherwise specified), 30% had adenocarcinoma, 10% had serous carcinoma, 5.7% had papillary serous carcinoma and carcinosarcoma in 1.4%. 12.9% were declared to be nonmalignant by final histopathology reports. Except for two patients, all others had grade 1 well differentiated carcinomas. Conclusion: This study demonstrates that endometrial carcinoma may be coexisting with endometrial hyperplasia with atypia, in majority of cases and available imaging modalities are not foolproof to rule out malignancy. Hence where appropriate hysterectomy may be suggested as the treatment option.


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  1. Lacey Jr JV, Mutter GL, Nucci MR, et al. Risk of subsequent endometrial carcinoma associated with endometrial intraepithelial neoplasia classification of endometrial biopsies. Cancer 2008;113(8):2073–2081. DOI: 10.1002/cncr.23808.
  2. Baak JP, Mutter GL, Robboy S, et al. The molecular genetics and morphometry-based endometrial intraepithelial neoplasia classification system predicts disease progression in endometrial hyperplasia more accurately than the 1994 World Health Organization classification system. Cancer 2005;103(11):2304–2312. DOI: 10.1002/cncr.21058.
  3. Trimble CL, Kauderer J, Zaino R, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a gynecologic oncology group study. Cancer 2006;106(4):812–819. DOI: 10.1002/cncr.21650.
  4. Lax SF. Molecular genetic pathways in various types of endometrial carcinoma: from a phenotypical to a molecular-based classification. Virchows Arch 2004;444(3):213–223. DOI: 10.1007/s00428-003-0947-3.
  5. MacMahon B. Risk factors for endometrial cancer. Gynecol Oncol 1974;2(2-3):122–129. DOI: 10.1016/0090-8258(74)90003-1.
  6. Fisher B, Costantino JP, Redmond CK, et al. Endometrial cancer in tamoxifen-treated breast cancer patients; findings from the national surgical adjuvant breast and bowel project B-14. J Natl Cancer Inst 1994;86(7):527–537. DOI: 10.1093/jnci/86.7.527.
  7. Jenabi E, Pooralajal J. The effect of body mass index on endometrial cancer: a meta analysis. Public Health 2015;129(7):872–880. DOI: 10.1016/j.puhe.2015.04.017.
  8. Luo J, Beresford S, Chen C, et al. Association between diabetes, diabetes treatment and risk of developing endometrial cancer. Br J Cancer 2014;111(7):1432–1439. DOI: 10.1038/bjc.2014.407.
  9. Kazerouni N, Schairer C, Friedman HB, et al. Family history of breast cancer as a determinant of the risk of developing endometrial cancer: a nationwide cohort study. J Med Genet 2002;39(11):826–832. DOI: 10.1136/jmg.39.11.826.
  10. American Gastroenterological Association. American Gastroenterological Association medical position statement: hereditary colorectal cancer and genetic testing. Gastroenterology 2001;121(1):195–197. DOI: 10.1053/gast.2001.25580.
  11. Rakha E, Wong SC, Soomro I, et al. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol 2012;36(11):1683–1690. DOI: 10.1097/PAS.0b013e31825dd4ff.
  12. Bergeron C, Nogales FF, Masseroli M, et al. A multicentric european study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy for curettage specimens. Am J Surg Pathol 1999;22(9):1012–1019. DOI: 10.1097/00000478-199909000-0 0014.
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