Endometrial Hyperplasia

Excerpt

Endometrial hyperplasia, in atypical forms, is the precursor lesion for endometrioid adenocarcinoma of the endometrium, representing the most common gynecologic malignancy in industrialized countries. Defined as the disordered proliferation of endometrial glands, endometrial hyperplasia results from estrogenic stimulation of the endometrial tissue with a relative deficiency of progesterone's counterbalancing effects, often referred to in clinical practice as "unopposed." This imbalance results may occur in patients with obesity, chronic anovulation, early menarche, late menopause, and estrogen-secreting tumors.

This disordered growth of the endometrium results in an abnormal gland-to-stroma ratio involving varying degrees of histopathological complexity and atypical features in the cells and nuclei. Endometrial hyperplasia, if untreated, has the propensity to develop into endometrial cancer. Strategies for clinical management range from surveillance or progestin therapy to hysterectomy, depending on the risk of progression to or concomitant endometrial cancer and the patient's desire to preserve fertility.