Endometrial hyperplasia Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2016;38(10):506-511
To evaluate the accuracy of transvaginal ultrasonography, hysteroscopy and uterine curettage in the diagnosis of endometrial polyp, submucous myoma and endometrial hyperplasia, using as gold standard the histopathological analysis of biopsy samples obtained during hysteroscopy or uterine curettage.
Cross-sectional study performed at the Hospital Universitário de Brasília (HUB). Data were obtained from the charts of patients submitted to hysteroscopy or uterine curettage in the period from July 2007 to July 2012.
One-hundred and ninety-one patients were evaluated, 134 of whom underwent hysteroscopy, and 57, uterine curettage. Hysteroscopy revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps, 78.1% for myoma and 63.2% for endometrial hyperplasia. Within the 57 patients submitted to uterine curettage, there was an accuracy of 56% for polyps and 54.6% for endometrial hyperplasia.
Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management.
Summary
Rev Bras Ginecol Obstet. 2016;38(10):506-511
To evaluate the accuracy of transvaginal ultrasonography, hysteroscopy and uterine curettage in the diagnosis of endometrial polyp, submucous myoma and endometrial hyperplasia, using as gold standard the histopathological analysis of biopsy samples obtained during hysteroscopy or uterine curettage.
Cross-sectional study performed at the Hospital Universitário de Brasília (HUB). Data were obtained from the charts of patients submitted to hysteroscopy or uterine curettage in the period from July 2007 to July 2012.
One-hundred and ninety-one patients were evaluated, 134 of whom underwent hysteroscopy, and 57, uterine curettage. Hysteroscopy revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps, 78.1% for myoma and 63.2% for endometrial hyperplasia. Within the 57 patients submitted to uterine curettage, there was an accuracy of 56% for polyps and 54.6% for endometrial hyperplasia.
Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):18-23
DOI 10.1590/S0100-72032006000100004
PURPOSE: to characterize postmenopausal endometrial polyps and to determine risk for concomitant premalignant and malignant pathology. METHODS: a retrospective study including 82 postmenopausal women with a histological diagnosis of endometrial polyps who underwent hysteroscopic polypectomy, after a diagnosis of endometrial thickening made by transvaginal ultrasound, was performed. Medical reports provided clinical and gynecological history, data related to the operative hysteroscopy and definitive histological findings. RESULTS: among the 82 patients who underwent hysteroscopic polypectomy, 10.9% were receiving some type of hormonal therapy. Twenty-eight women (34.1%) reported abnormal vaginal bleeding. Single polyp was encountered in 56 women (68.3%), two polyps were found in 19 cases (23.2%) and in 7 cases (3.6%), three or more polyps were found. The definitive histopathologic analysis revealed 63 (76.8%) benign polyps, 17 (20.8%) hyperplastic polyps (10 cases 12.2% - of simple endometrial hyperplasia without cytologic atypia and 7 cases 8.6% - of complex endometrial hyperplasia without cytologic atypia). Two polyps (2.4%) were diagnosed as harboring neoplasia. For the statistical analysis we employed chi2 test improved by Yates. The authors correlated the polyps' histology with the occurrence of abnormal vaginal bleeding (p=0.0056), number of endometrial polyps (p=0.921) and time after menopause (p=0.720). CONCLUSIONS: endometrial polyps are commonly found entities in postmenopausal women, related with low frequency to endometrial hyperplasia or carcinomas and only histological evaluation seems to allow the exclusion of premalignant and malignant pathology.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):18-23
DOI 10.1590/S0100-72032006000100004
PURPOSE: to characterize postmenopausal endometrial polyps and to determine risk for concomitant premalignant and malignant pathology. METHODS: a retrospective study including 82 postmenopausal women with a histological diagnosis of endometrial polyps who underwent hysteroscopic polypectomy, after a diagnosis of endometrial thickening made by transvaginal ultrasound, was performed. Medical reports provided clinical and gynecological history, data related to the operative hysteroscopy and definitive histological findings. RESULTS: among the 82 patients who underwent hysteroscopic polypectomy, 10.9% were receiving some type of hormonal therapy. Twenty-eight women (34.1%) reported abnormal vaginal bleeding. Single polyp was encountered in 56 women (68.3%), two polyps were found in 19 cases (23.2%) and in 7 cases (3.6%), three or more polyps were found. The definitive histopathologic analysis revealed 63 (76.8%) benign polyps, 17 (20.8%) hyperplastic polyps (10 cases 12.2% - of simple endometrial hyperplasia without cytologic atypia and 7 cases 8.6% - of complex endometrial hyperplasia without cytologic atypia). Two polyps (2.4%) were diagnosed as harboring neoplasia. For the statistical analysis we employed chi2 test improved by Yates. The authors correlated the polyps' histology with the occurrence of abnormal vaginal bleeding (p=0.0056), number of endometrial polyps (p=0.921) and time after menopause (p=0.720). CONCLUSIONS: endometrial polyps are commonly found entities in postmenopausal women, related with low frequency to endometrial hyperplasia or carcinomas and only histological evaluation seems to allow the exclusion of premalignant and malignant pathology.
Summary
Rev Bras Ginecol Obstet. 2005;27(5):289-292
DOI 10.1590/S0100-72032005000500010
Endometrial polyps are benign lesions, with a low potential of malignancy. In the reproductive period their diagnosis is established in symptomatic patients with abnormal uterine bleeding or infertility. Postmenopausal women are mostly asymptomatic but in approximately one third of the cases there is an association with abnormal bleeding. They are more frequent after the menopause and risk factors of cancer of the endometrium have not been associated in the same way as risk for endometrial polyps, although they are hormone-dependent as in patients in use of tamoxifen, for instance. Their definitive diagnosis is established by hysteroscopy-guided biopsy and their most effective treatment is hysteroscopic resection. Polyps may recur after treatment. Polypectomy is highly satisfactory after the menopause, is less successful in symptomatic women in the reproductive period and improves fertility rates in infertile women.
Summary
Rev Bras Ginecol Obstet. 2005;27(5):289-292
DOI 10.1590/S0100-72032005000500010
Endometrial polyps are benign lesions, with a low potential of malignancy. In the reproductive period their diagnosis is established in symptomatic patients with abnormal uterine bleeding or infertility. Postmenopausal women are mostly asymptomatic but in approximately one third of the cases there is an association with abnormal bleeding. They are more frequent after the menopause and risk factors of cancer of the endometrium have not been associated in the same way as risk for endometrial polyps, although they are hormone-dependent as in patients in use of tamoxifen, for instance. Their definitive diagnosis is established by hysteroscopy-guided biopsy and their most effective treatment is hysteroscopic resection. Polyps may recur after treatment. Polypectomy is highly satisfactory after the menopause, is less successful in symptomatic women in the reproductive period and improves fertility rates in infertile women.
Summary
Rev Bras Ginecol Obstet. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Rev Bras Ginecol Obstet. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):169-173
DOI 10.1590/S0100-72032001000300006
Purpose: the aim of the present study was to evaluate the role of hysteroscopic endometrial ablation in the treatment of menorrhagia. Methods: two hundred patients were submitted to hysteroscopic endometrial ablation between April 1991 and April 1999. The surgery was performed in a private hospital under spinal anesthesia. In the first four years we used 1.5% glycine as a distension medium and in the last four years we used mannitol 3%. The follow-up ranged from 8 months to 8 years. Results: relief of the symptomatology was achieved in 180 (90%) patients. One episode of uterine perfuration, two cases of moderate liquid overload and five of hematometra were recorded. The histologic evaluation of the resected endometrium showed proliferative activity in 104 patients (52%) and secretory activity in 34 (17%). Endometrial hyperplasia was found in 20 patients (10%). The patients submitted to resection showed a smaller uterine cavity and fibrous synechia, whereas in patients submitted to endometrial destruction the uterine cavity was small but without synechia. Two patients had moderade hypervolemia during the procedure, for which clinical treatment was successful. Conclusions: Hysteroscopic endometrial ablation showed to be a safe and effective procedure as treatment of menorrhagia.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):169-173
DOI 10.1590/S0100-72032001000300006
Purpose: the aim of the present study was to evaluate the role of hysteroscopic endometrial ablation in the treatment of menorrhagia. Methods: two hundred patients were submitted to hysteroscopic endometrial ablation between April 1991 and April 1999. The surgery was performed in a private hospital under spinal anesthesia. In the first four years we used 1.5% glycine as a distension medium and in the last four years we used mannitol 3%. The follow-up ranged from 8 months to 8 years. Results: relief of the symptomatology was achieved in 180 (90%) patients. One episode of uterine perfuration, two cases of moderate liquid overload and five of hematometra were recorded. The histologic evaluation of the resected endometrium showed proliferative activity in 104 patients (52%) and secretory activity in 34 (17%). Endometrial hyperplasia was found in 20 patients (10%). The patients submitted to resection showed a smaller uterine cavity and fibrous synechia, whereas in patients submitted to endometrial destruction the uterine cavity was small but without synechia. Two patients had moderade hypervolemia during the procedure, for which clinical treatment was successful. Conclusions: Hysteroscopic endometrial ablation showed to be a safe and effective procedure as treatment of menorrhagia.
Summary
Rev Bras Ginecol Obstet. 2002;24(9):625-628
DOI 10.1590/S0100-72032002000900009
Brenner's tumor is small, unilateral and benign. Its diagnosis can only be confirmed by the anatomomicopathological examination, that on microscopy presents nests or columns of transition epithelial cells in a fibromatous matrix. The epithelial cells present a characteristic longitudinal "coffee bean" furrow and can undergo carcinomatous transformation. We present a case of a menopausal patient with vaginal bleeding, and a palpable abdominal mass. She was submitted to surgical treatment (total hysterectomy, bilateral oophorectomy and omentectomy) with the histopathological diagnosis of Brenner's bilateral tumor, being malignant on one side and benign on the other. After surgical treatment she is now alive for three years and free of disease.
Summary
Rev Bras Ginecol Obstet. 2002;24(9):625-628
DOI 10.1590/S0100-72032002000900009
Brenner's tumor is small, unilateral and benign. Its diagnosis can only be confirmed by the anatomomicopathological examination, that on microscopy presents nests or columns of transition epithelial cells in a fibromatous matrix. The epithelial cells present a characteristic longitudinal "coffee bean" furrow and can undergo carcinomatous transformation. We present a case of a menopausal patient with vaginal bleeding, and a palpable abdominal mass. She was submitted to surgical treatment (total hysterectomy, bilateral oophorectomy and omentectomy) with the histopathological diagnosis of Brenner's bilateral tumor, being malignant on one side and benign on the other. After surgical treatment she is now alive for three years and free of disease.
