Study on the long-term follow-up of endometrial hyperplasia
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A follow-up study of patients with endometrial hyperplasias was performed in order to clarify whether or not hyperplasias were precursor lesions of endometrial carcinoma in a Japanese population.
One hundred and seventy-one patients with various endometrial hyperplasias; 88 with simple, 57 with complex, 12 with simple atypical, and 14 with complex atypical hyperplasias were followed up to evaluate the fate of the lesions as well as their clinical features. The follow-up period ranged from 12 to 195 months (mean, 46).
The patient ages at the time of the initial diagnosis ranged from 27 to 55 years (mean, 44.5) with simple, 16 to 60 (mean, 43.8) with complex, 33 to 53 (mean, 44.8) with simple atypical, and 29 to 50 (mean, 39.7) with complex atypical hyperplasias. More than 85% of the patients complained of metrorrhagia. Menstrual cycles were irregular in 40% of the cases. Cyclic ovulatory phases measured with basal body temperature were observed in 33.9% of patients with simple, 25.6% with complex, and 22.2% with simple atypical, whereas these were only seen in 8.3% of the cases with complex atyical hyperplasia. Ovulatory disturbances were found in more than 65% of the patients with increasing frequency, depending on the severity of hyperplasia. Only 1 (1.1%) of 88 simple, 1 (3.5%) of 57 complex, and 1 (8.1%) of 12 simple atypical cases progressed to endometrial carcinoma, whereas 3 (21.4%) complex atypical cases progressed to endometrial carcinoma. The incidence of complex atypical is significantly higher than in the former two (P<0.001,P<0.05). The 7 patients who progressed to carcinoma had been followed for 16 to 73 months (mean, 38). Their histological type was either G1, G2 or adenoacanthoma and their FIGO surgical stage was l in all cases. The progression rates of the patients treated with or without cyclic medroxyprogesterone acetate (MPA) were 3.7% and 4.4% respectively, showing no significant differences. The regression rates of each hyperplasia to normal endometrium were 69.4% with simple, 68.4% with complex, 75.0% with simple atypical, and 57.2% with complex atyical hyperplasias.
Endometrial hyperplasias, especially complex atypical are the precursors to endometrial carcinoma. The strict follow-up of patients with endometrial hyperplasia is mandatory.
Key wordsendometrial hyperplasia follow-up malignant progression endometrial carcinoma medroxyprogesterone acetate
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