In one study, 1.6% of patients diagnosed with these abnormalities eventually developed endometrial cancer. Atypical endometrial hyperplasia (simple or complex) - Simple or complex architectural changes, with worrisome (atypical) changes in gland cells, including cell stratification, tufting, loss of nuclear polarity, enlarged nuclei, and an increase in mitotic activity. These changes are similar to those seen in true cancer cells, but atypical hyperplasia does not show invasion into the connective tissues, the defining characteristic of cancer. The previously mentioned study found that 22% of patients with atypical hyperplasia eventually developed cancer. Diagnosis
Diagnosis of endometrial hyperplasia can be made by endometrial biopsy, which is done in the office setting or through curettage of the uterine cavity to obtain endometrial tissue for histopathologic analysis. A workup for endometrial disease may be prompted by abnormal uterine bleeding, or the presence of atypical glandular cells on a pap smear. Prognosis
Many studies have shown that endometrial hyperplasia can progress to cancer, particularly when there are atypical cells. Nevertheless, such studies has typically dealt with atypical hyperplasia. A review of 65 articles on estimated risk of progression to cancer concludes that none of those studies reported estimates specifically for non-atypical hyperplasia patients.
Further it states the need for population based studies including both non-atypical and atypical hyperplasia to accurately estimate the risk of progression to cancer.If untreated with hysterectomy, endometrial hyperplasia progresses to adenocarcinoma within 20 years in:

28% of cases with atypia (95% CI, 8.6% to 42.5%), and
about 5% of cases without atypia.The rates are more favorable in cases with simple rather than complex hyperplasia, but as mentioned above this terminology was phased out of the WHO classification in 2014. In patients with samples showing atypia, carcinoma is already present in over 40% of cases. Given this, the aforementioned 28% atypia progression rate may be an underestimate, and the true number may closer to the 42.5% part of the studys remarkably wide confidence interval. Treatment
Treatment of endometrial hyperplasia is individualized, and may include hormonal therapy, such as cyclic or continuous progestin therapy, or hysterectomy. See also
Endometrial intraepithelial neoplasia
Endometrial carcinoma
Hyperplasia

References


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