Hyperplastic processes of endometrium: what's new?

Authors

DOI:

https://doi.org/10.18370/2309-4117.2015.25.7-13

Keywords:

endometrial hyperplasia, endometrial intraepithelial neoplasia

Abstract

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.

Author Biographies

Т. Ф Татарчук, Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine

MD, professor, corresponding member. NAMS of Ukraine, Deputy Director for Research, Head of Endocrine Gynecology

Л. В. Калугина, Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine

MD, leading researcher of the Endocrine Gynecology Department

Т. Н. Тутченко, Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine

PhD, researcher of the Endocrine Gynecology Department

References

  1. Dubinina, V.G. Prognosis and early diagnosis of endometrial cancer. Abstract for the MD degree. Kyiv (2007).
  2. Zaporozhan, V.N., Tatarchuk, T.F., Dubinina, V.G., Kosei, N.V. “Modern diagnostics and treatment of endometrial hyperplastic processes.” Reproductive Endocrinology, 1(3) (2012): 5–12.
  3. Kartashov, S.M., Oleshko, E.M., Musayev, R.I. “Results of treatment and microsatellite instability in patients with endometrial cancer in different age groups.” Clinical Oncology, 1(9) (2013).
  4. Nelson, A.L. “Levonorgestrel-releasing intrauterine system: first line therapy for heavy menstrual bleeding.” Women's Health, 2(58) (2011): 24–32.
  5. Saprykina, L.V., Dobrokhotova, Y.E., Litvinova, N.A. “Endometrial hyperplastic processes: issues of etiology and pathogenesis, clinics, diagnosis, treatment.” Medical Business, 3(2011): 4–10.
  6. Tatarchuk, T.F., Burlaka, O.V, Korinna, K.O. “Drug therapy of endometrium hyperproliferative processes.” Medicine and Life, 1(2005): 100–101.
  7. Abushahin, N., Pang, S., Li, J. Endometrial Intraepithelial Neoplasia. In: Intraepithelial Neoplasia, ed. by Dr. Supriya Srivastava. InTech (2012): 206–240.
  8. Antonsen, S.L., Ulrich, L., Hogdall, C. “Patients with atypical hyperplasia of the endometrium should be treated in oncological centers.” Gynecol Oncol, 125(2012): 124–128.
  9. ACOG Committee Opinion No. 631. “Endometrial intraepithelial neoplasia.” Obstet Gynecol, 125(2015): 1272–1278.
  10. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2015. Toronto. Canadian Cancer Society (2015).
  11. Colombo, N., Preti, E., Landoni, F., Carinelli, S. “Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.” Annals of Oncology, 24(Suppl. 6) (2013): 33–38.
  12. Emons, G., Beckmann, M.W., Schmidt, D., Mallmann, P. “New WHO Classification of Endometrial Hyperplasias.” Geburtshilfe Frauenheilkd, 75(2) (2015): 135–136.
  13. Gallos, I.D. “Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: systematic review and metaanalysis.” Am J Obstet Gynecol, 203(6) (2010).
  14. Dallenbach-Hellweg, G., Schmidt, D., Dallenbach, F. Atlas of Endometrial Histopathology (2009): 245 p.
  15. Kandoth, C., Schultz, N., Cherniack, A.D., et al., Cancer Genome Atlas Research Network. “Integrated genomic characterization of endometrial carcinoma.” Nature, 497(2013): 67–73.
  16. Kommission Uterus der Arbeitsgemeinschaft Gynäkologische Onkologie e. V. Empfehlungen für die Diagnostik und Therapie des Endometriumkarzinoms. Aktualisierte Empfehlungen der Kommission Uterus auf Grundlage der S2k Leitlinie (Version 1.0, 01.06.2008) ohne Angabe der Evidenzlevel und Empfehlungsgrade. [http://www.ago-online. de/fileadmin/downloads/leitlinien/uterus/empfehlungen_diagnostik_therapie_EC.pdf], last accessed Nov 6, 2015.
  17. Mutter, G.L. “Histopathology of Genetically Defined Endometrial Precancers.” Int J Gynecol Pathol, 4(19) (2000): 302–308.
  18. Owings, R.A., Quick, C.M. “Endometrial intraepithelial neoplasia.” Arch Pathol Lab Med, 138(2014): 484–491.
  19. Ozdegirmenci, O., Kayikcioglu, F., Bozkurt, U., et al. “Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia.” Gynecol Obstet Invest, 72(1) (2011): 10–14.
  20. Stephan, J.M., Hansen, J., Samuelson, M., McDonald, M., et al. “Intra-operative frozen section results reliably predict final pathology in endometrial cancer.” Gynecol Oncol, 133(2014): 499–505.
  21. Siegel, R., Ma, J., Zou, Z., Jemal, A. “Cancer statistics 2014.” CA Cancer J Clin, 64(2014): 9–29.
  22. Tasci, Y., Gokcag Polat, O., Ozdogan, S., et al. “Comparison of the efficacy of micronized progesterone and lynestrenol in treatment of simple endometrial hyperplasia without atypia.” Arch Gynecol Obstet, 1(290) (2014): 83–86.
  23. Trimble, C.L., Method, M., Leitao, M., et al. “Management of endometrial precancers.” Obstet Gynecol, 120(2012): 1160–1175.
  24. Zaino, R., Carinelli, S.G., Ellenson, L.H. Tumours of the uterine Corpus: epithelial Tumours and Precursors. Lyon. WHO Press (2014): 125–126.

Downloads

Published

2015-10-25

How to Cite

Татарчук, Т. Ф., Калугина, Л. В., & Тутченко, Т. Н. (2015). Hyperplastic processes of endometrium: what’s new?. REPRODUCTIVE ENDOCRINOLOGY, (25), 7–13. https://doi.org/10.18370/2309-4117.2015.25.7-13

Issue

No. 25 (2015)

Section

Gynecology

License

Copyright (c) 2015 Т. Ф Татарчук, Л. В. Калугина, Т. Н. Тутченко

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.