Hyperplastic processes of endometrium: what's new?
Keywords:endometrial hyperplasia, endometrial intraepithelial neoplasia
According to the extended today WHO classification (1994) there are simple and complex endometrial hyperplasia non-atypical; simple and complex atypical endometrial hyperplasia; adenocarcinoma.
In numerous studies of the last decades it has been proven that the simple and complex non-atypical endometrial hyperplasia are the result of absolute or relative hyperestrogenism, and atypical endometrial hyperplasia is a progressive monoclonal mutational damage with the independent hormonal effects of local growth. With this in mind, it has been proposed the term “endometrial intraepithelial neoplasia” (EIN), which should be viewed as precancer. Based on this approach, EIN-classification also provides a simple and complex non-atypical endometrial hyperplasia interpreted as endometrial hyperplasia (endometrial hyperplasia), which is the result of estrogenic stimulation and, therefore, lends itself well to hormone therapy.
In terms of diagnosis and treatment of endometrial hyperplastic processes the most appropriate are recommendations of the American College of Obstetrics and Gynecology (ACOG) and the Society of Gynecologic Oncology (SGO) at 2015:
• preferred fencing material at hysteroscopy, separate diagnostic curettage (suspicious areas and all endometrium must be histological exanimated);
• there are insufficient data on the efficacy of progestin therapy and monitoring the endometrial intraepithelial neoplasia;
• in the progestin treatment it is need histological control every 3–6 months, 7–10 days after withdrawal bleeding;
• supravaginal hysterectomy, morcellation, endometrial ablation are unacceptable in the case of endometrial intraepithelial neoplasia.
In Ukraine, the treatment of endometrial hyperplasia regulated by the order of the Ministry of Health of Ukraine of 31.12.2004 № 676, which includes I stage – the removal of endometrial changes, followed by a morphological study.
According to the recommendations of ACOG and SGO, the II stage of treatment of endometrial hyperplasia without atypia includes conservative therapy with progestins also permissible resectoscope endometrial ablation. Stage III involves the normalization of estrogen/progesterone ratio. The main method of treatment of endometrial hyperplasia with atypia, according to the ACOG and SGO recommendations, is total hysterectomy with/without adnexal.
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