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Original Research

Open Access

Atypical endometrial lesions: hysteroscopic resection as an alternative to hysterectomy

  • P. Litta1,*,
  • C. Bartolucci1
  • C. Saccardi1
  • A. Codroma1
  • A. Fabris1
  • S. Borgato1
  • L. Conte1

1Department of Health of the Woman and Child, Obstetrics and Gynecology Clinic, University of Padua (Italy)

DOI: 10.12892/ejgo340109 Vol.34,Issue 1,January 2013 pp.51-53

Published: 10 January 2013

*Corresponding Author(s): P. Litta E-mail:


Background: Endometrial hyperplasia is a precursor to endometrial carcinoma: the risk of progression to invasive endometrial cancer is increased in postmenopausal women and much more in cases of atypical endometrial hyperplasia (25%-30%). In addition, in 12.7% to 42.6% of cases according to various studies, endometrial cancer coexists in patients with diagnosis of atypical endometrial hyperplasia. The aim of this study was to evaluate the correlation between radical hysteroscopic resection of atypical endometrial lesions and the histopathological examination of the uterus. Materials and Methods: The authors collected 25 patients referring to the Department of Woman and Child Health, in the University of Padua (Italy) from January 2008 to June 2012, undergoing hysteroscopic resection for atypical polyps and focal atypical endometrial hyperplasia, and following hysterectomy within 30 days. Average age, menopausal status, hormone replacement therapy, body mass index (BMI), presence of hypertension and diabetes, and taking tamoxifen were reported. Results: After hysteroscopic resection in all patients atypical polyps and focal endometrial hyperplasia were confirmed. The hystopathologic evaluation of the uterus reported: in only two (8%) cases, the persistence of atypical endometrial lesion, whereas in 23 (92%) cases the endometrial tissue was negative for atypia or malignancy. Conclusions: Radical endometrial resection by hysteroscopy may serve as an alternative to hysterectomy in selected patients with atypical focal endometrial lesions, not only in fertile women, but also in patients who refuse hysterectomy or present high anesthesiologic and surgical risks, regardless of the risk of recurrence, and with the necessity of undergoing hysteroscopic close follow-up.


Resectoscope; Atypical endometrial hyperplasia; Atypical endometrial polyps; Conservative management.

Cite and Share

P. Litta,C. Bartolucci,C. Saccardi,A. Codroma,A. Fabris,S. Borgato,L. Conte. Atypical endometrial lesions: hysteroscopic resection as an alternative to hysterectomy. European Journal of Gynaecological Oncology. 2013. 34(1);51-53.


[1] Wheeler D.T., Bristow R.E., Kurman R.J.: “Histologic alterations in endometrial hyperplasia and well-differentiated carcinoma treated with progestins”. Am. J. Surg. Pathol., 2007, 31, 988.

[2] Terakawa N., Kigawa J., Taketani J., Yoshikawa H., Yajima A., Noda K. et al.: “The behavior of endometrial hyperplasia: a prospective study. Endometrial hyperplasia Study Group”. J. Obstet. Gynaecol. Res., 1997, 23, 223.

[3] Montgomery B.E., Daum G.S., Dunton C.J.: “Endometrial hyperplasia: a review”. Obstet. Gynecol. Surv., 2004, 59, 368.

[4] Kurman R.J., Kaminski 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] Hahn H.S., Chun Y.K., Kwon Y.I., Kim T.J., Lee K.H., Shim J.U. et al.: “Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2010, 150, 80.

[6] Ferrazzi E., Zupi E., Leone F.P., Savelli L., Omodei U., Moscarini M. et al.: “How often are endometrial polyps malignant in asymptomatic postmenopausal womed? A mulcicenter study”. Am. J. Obstet. Gynecol., 2009, 200, 235.

[7] Giusa-Chiferi M.G., Goncalves W.J., Baracat E.C., De Albuquerque Neto L.C., Bortoletto C.C., De Lima G.R.: “Transvaginal ultrasound, uterine biopsy and hysteroscopy for postmenopausal bleeding”. Int. J. Gynecol. Obstet., 1996, 55, 39.

[8] Epstein E., Ramirez A., Skoog L., Valentin L.: “Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm”. Ultrasound Obstet. Gynecol., 2001, 18, 157.

[9] Gimpelson R.J., Rappold H.O.: “A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage”. Am. J. Obstet. Gynecol., 1988, 158, 489.

[10] Marchetti M., Litta P., Lanza P., Lauri F., Pozzan C.: “The role of hysteroscopy in early diagnosis of endometrial cancer”. Eur. J. Gynaecol. Oncol., 2002, 23, 151.

[11] Litta P., Merlin F., Saccardi C., Pozzan C., Sacco G., Fracas M. et al.: “Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding”. Maturitas., 2005, 50, 117.

[12] Litta P., Cosmi E., Saccardi C., Esposito C., Rui R., Ambrosini G.: “Outpatient operative polypectomy using a 5 mm-hysteroscope without anaesthesia and/or analgesia: advantages and limits”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2008, 139, 210.

[13] Litta P., Fracas M., Pozzan C., Merlin F., Saccardi C., Sacco G. et al.: “Laparoscopic management of early stage endometrial cancer”. Eur. J. Gynaecol. Oncol., 2003, 24, 41.

[14] Horn L.C., Schnurrbusch U., Bilek K., Hentschel B., Einenkel J.: “Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment”. Int. J. Gynecol. Cancer, 2004, 14, 348.

[15] Scrimin F., Mangino F.P., Wiesenfeld U., Candiotto A., Guaschino S.: “Is resectoscopic treatment of atypical endometrial polyps a safe option?”. Am. J. Obstet. Gynecol., 2006, 195, 1328.

[16] Scrimin F., Wiesenfeld U., Candiotto A., Inglese S., Ronfani L., Guaschino S.: “Resectoscopic treatment of atypical endometrial polyps in fertile women”. Am. J. Obstet. Gynecol., 2008, 199, 365.

[17] Mazzon I., Corrado G., Masciullo V., Morricone D., Ferrandina G., Scambia G.: “Conservative surgical management of Stage IA endometrial carcinoma for fertility preservation”. Fertil. Steril., 2010, 93, 1286.

[18] Niwa K., Tagami K., Lian Z., Onogi K., Mori H., Tamaya T.: “Outcome of fertility-preserving treatment in young women with endometrial carcinomas”. BJOG, 2005, 112, 317.

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