Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy

Objective: To evaluate the patients diagnosed with atypical endometrial hyperplasia preoperatively, and compare preoperative and postoperative results. Materials and method: We investigated the files of 58 patients diagnosed with atypical endometrial hyperplasia who were treated surgically after clinical evaluation. We compared sociodemographic diagnosis, preoperative and postoperative diagnosis. Results: Mean-age of patients was 51.7. Obesity, diabetes mellitus, hypertension and infertility were seen, respectively, in eight cases (13.7%), 12 cases (20.6%), 19 cases (32.7%) and four cases (6.8%). While endometrial cancer was not found postoperatively in patients preoperatively diagnosed with simple atypical endometrial hyperplasia, we determined well differentiated endometrial adenocarcinoma in 44.7% of the patients. Conclusion: In the literature the probability of developing well differentiated endometrial cancer from complex atypical endometrial hyperplasia is 40-50%. All patients diagnosed with complex atypical hyperplasia should be evaluated preoperatively for well differentiated adenocarcinoma and undergo an appropriate surgical technique and staging.

Atypia; Biopsy; Consensus diagnosis; Endometrial hyperplasia; Endometrioid adenocarcinoma; Hysterectomy

[1] Gültekin M., Dursun P., Yüce K., Ayhan A.: “Endometrial hyperplazi yönetiminde güncel yaklas¸ım”. Türk Jinekolojik Onkoloji Dergisi, 2007, 10, 1 (in Turkish).

[2] Demir B., Kılınç N., Güven E.S.D., Güven S., Gül T.: “Endometrial hyperplazi olgularının de erlendirilmesi”. Türk Jinekolojik Onkoloji Dergisi, 2006, 9, 14 (in Turkish).

[3] Karamursel B.S., Guven S., Tulunay G., Kucukali T., Ayhan A.: “Whic surgical procedure for patients with atypical endometrial hyperplasia?”. Int. J. Gynecol. Cancer, 2005, 15, 127.

[4] Kurman R.J., Kamiski P.F., Norris H.J.: “The behavior of endometrial hyperplasia. A long term study of “untreated’’ hyperplasia in 170 patients”. Cancer, 1985, 56, 403.

[5] Clark T.J., Neelakantan D., Gupta J.K.: “The managemnet of endometrial hyperplasia: an evaluation of current practice”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2006, 125, 259.

[6] Ünlü Y., Özardalı I., Orha R.T., Behzatog˘lu K.: “Endometrial hyperplazi ve adenokarsinomlar östrojen reseptörlerinin durumu”. Genel. Tıp Dergisi, 1997, 7, 143.

[7] Trimble C.L., Kauderer J., Zaino R., Silverberg S., Lim P.C., Burke J.J. 2nd et al.: “Concurrent endometrial carcinoma in women with a biopsy diagnosis of atipcal endometrial hyperplasia: a Gynecologic Oncology Group study”. Cancer, 2006, 106, 812.

[8] Win A.K., Dowty J.G., Antill Y.C., English D.R., Baron J.A., Young J.P. et al.: “Body mass index in early adulthood and endometrial cancer risk for mismatch repair gene mutation carriers”. Obstet. Gynecol., 2011, 114, 899.

[9] S¸enda F., Akman L., Bilgin O., Öztekin K.: “Postmenopzal uterin kanma veya endometrial kalınla ması olan kadınlarda histereskopik de erlendirme”. J. Turk. Soc. Obstet. Gynecol., 2007, 4, 144.

[10] Timmermans A., Doorn L.C., Opmeer B.C., Kroeks M.V.A.M., Duk M.J. et al.: “Follow-up women after a first episode of postmenopausal bleeding and endometrial thickness greater than 4 milimeters”. Obstet. Gynecol., 2008, 111, 137.

[11] Mazur M.T.: “Endometrial hyperplasia/adenocarcinoma. a conventional approach”. Ann. Diagn. Pathol., 2005, 174.

[12] Leitao M.M., Barakat R.R.: “Clinical approach to diagnosis and management of endometrial hyperplasia and carcinoma”. Surg. Pathol. Clin., 2011, 4, 113.

[13] Burgmann E.S., Hung Y.Y., Armstrong M.A.: “Complex atypical endometrial hyperplasia”. Obstet. Gynecol., 2009, 114, 523.

[14] Merisio C., Bertta R., De Ioris A., Pultrone D.C., Rolla M., Giordano G. et al.: “Endometrial cancer in patients with preoperative diagnosisis of atypical endometrial hyperplasia”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2005, 122, 107.

[15] Dijkhuizen F.P., Mol B.W., Brölmann H.A., Heintz A.P.: “The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis”. Cancer, 2000, 89, 1765.

[16] Attard Montalto S., Coutts M., Devaja O., Summers J., Jyothirmayi R., Papadopoulos A.: “Accuracy of frozen section diagnosis at surgery in pre- malignant and malignant lesions of the endometrium”. Eur. J. Gynaecol. Oncol., 2008, 29, 435.

[17] Salman M.C., Usubutun A., Dogan N.U., Yuce K.: “The accuracy of frozen section analysis at hysterectomy in patients with atypical endometrial hyperplasia”. Clin. Exp. Obstet. Gynecol., 2009, 36, 31.

[18] Indermaur M.D., Shoup B., Tebes S., Lancaster J.M.: “The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy”. Am. J. Obstet. Gynecol., 2007, 196, e40.

[19] Case A.S., Rocconi R.P., Straughn J.M. Jr., Conner M., Novak L., Wang W., Huh W.K.: “A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer”. Obstet. Gynecol., 2006, 108, 1375.

[20] Amant T., Moerman P., Neven P., Timmerman D., Limbergen E.V., Vergote I.: “Treatment Modalities in endometrial cancer”. Curr. Opin. Oncol., 2007, 19, 479.

[21] Tas¸kın S., Güngör M., Ortaç F., Öztuna D.: “Does postoperative radiotherapy provide any survival advantage over observation in Stage IC endometrial cancer after comprehensive surgical staging?”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2010, 154, 200.