Oncologic and Reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 Adenocarcinoma: A systematic review

Korkmaz

J Turkish German Gynecol Assoc

et al. 2013

Objective: We sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia. Material and Methods:We prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success.Results: Persistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03). Conclusion:Results of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia. (J Turkish-German Gynecol Assoc 2013; 14: 19-22) Key words: Endometrial hyperplasia, medroxyprogesterone acetate, endometrial thickness, ultrasonography, atypia Received: 13 October, 2012 Accepted: 8 February, 2013 Amaç: Bu çalışma ile atipisiz endometriyal hiperplazide tedaviye cevabı öngören faktörlerin belirlenmesi amaçlandı. Gereç ve Abstract ÖzetOriginal Investigation 19

Section: Discussionmentioning

confidence: 57%

Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia

Korkmaz

J Turkish German Gynecol Assoc

et al. 2013

“…6 Response to oral progestin hormonal therapy is seen in about 77% of cases with a longterm complete response of 53%, being more prevalent in cases of atypical endometrial hyperplasia than in cases of adenocarcinoma. 9,10 More recently, local delivery by progestinimpregnated intrauterine device has also shown to be effective in some patients, even with successful pregnancies thereafter. 11 Glands with molecular alterations such as PTEN inactivation appear to be particularly sensitive to exogenous progestins, as PTEN-null glands preferentially disappear after treatment in most cases.…”

Section: Discussionmentioning

confidence: 99%

Endometrial intraepithelial neoplasia with secretory differentiation: diagnostic features and underlying mechanisms

2013

Endometrial intraepithelial neoplasia (EIN) with secretory differentiation and ordinary EIN occurring in a secretory context are rare but recognized findings. We determined how often secretory differentiation in EIN was associated with evidence of circulating progestins in the background endometrium, and studied clinical characteristics and clinical outcomes of affected patients. We selected 41 patients with secretory differentiation in either the EIN itself (n ¼ 31) and/or background endometrium (n ¼ 38). Most (90%, 28/31) secretory EINs were associated with circulating progestins. Rare exceptions were observed, suggesting that secretory EIN may occur as a hormone-independent phenomenon. Circulating progestins are not sufficient, however, to induce EIN secretory differentiation, as 26% (10/38) of EIN within a secretory background were of the ordinary (nonsecretory) type. EIN patients with secretory endometrium in the background are younger (averaging 45 years) than the aggregate group of all patients with EIN (53 years in previously published studies) and are often premenopausal with a cyclical source of endogenous progestins. Involution of EIN during follow-up was more frequent (81%, 17/21) for those with a secretory background at the time of initial EIN diagnosis compared with historical averages (25%, 36/142). These results suggest a potential role for endogenous progesterone, as well as therapeutic progestins, in modulating EIN outcomes. Modern Pathology (2013) 26, 868-873; doi:10.1038/modpathol.2012.231; published online 18 January 2013 Keywords: endometrial cancer; endometrial intraepithelial neoplasia; secretory Endometrial intraepithelial neoplasia (EIN) is a clonal proliferation of endometrial glands, considered to be a premalignant condition due to its strong association with concurrent and/or subsequent endometrioid (type I) adenocarcinoma of the endometrium. Indeed, a diagnosis of EIN is associated with a 27% likelihood of having ('concurrent') adenocarcinoma within 1 year, and carrying a 45-fold increased risk for a future (after 1 year) diagnosis of adenocarcinoma. 1 Diagnosis of EIN requires strict application of histological criteria, including size (at least 1 mm in greatest linear dimension), architecture (area of glands exceeds area of endometrial stroma) and cytology (difference in nuclear and cytoplasmic appearance between the abnormal and background endometrium). [2][3][4] Exclusion of cancer, as well as benign conditions mimicking EIN, is an important part of accurate diagnosis.Accurate and sensitive diagnosis of EIN in reproductive age women can be challenging when a secretory background is present. Secretory-phase endometrium displays changes that may morphologically overlap with EIN. 2 In normal mid-late secretory endometrium the gland to stroma ratio is increased, nuclei become enlarged and round, and large expanses of secretory superficial endometrium are offset from basal areas lacking secretory changes. Furthermore, when EIN does occur within the context of a secretory environment,...

Geburtshilfe Frauenheilkd

“…An individualised approach is necessary for patients who still wish to fall pregnant. Women must be informed that despite progesterone therapy atypia will persist in 14 % of cases and 3-7% will progress [22,23]. Ultimately a quarter of cases will recur, the most important risk factor being obesity (body mass index ≥ 35 kg/m 2 ) in which case treatment with metformin is recommended [24].…”

Section: Treatment Of Precursor Lesionsmentioning

confidence: 99%

Current Issues in the Diagnosis and Treatment of Endometrial Carcinoma

Stubert¹,

Gerber²

2016

Zielführend für die Diagnose des Endometriumkarzinoms ist in der überwiegenden Zahl der Fäl-Zusammenfassung ! Das Endometriumkarzinom ist das häufigste Karzinom des weiblichen Genitales. Führendes klinisches Zeichen ist die postmenopausale Blutung. Für die Diagnosestellung ist immer eine Endometriumbiopsie notwendig. Die Therapieentscheidung hängt von der Risikoeinschätzung des Karzinoms und der häufig vorliegenden Komorbidität ab. In Fällen mit niedrigem Risiko (Definition: pT1 a, G1/2) ist eine pelvine und paraaortale Lymphknotendissketion unnötig. Eine adjuvante Bestrahlung und eine Systemtherapie sind zumeist vermeidbar. Die Behandlung von Hochrisikopatientinnen (G3 und/oder pT1b) und von Patientinnen in palliativer Situation ist schwierig und weniger gut standardisiert. Neue, molekular definierte Subtypen könnten hier zukünftig Therapieentscheidungen erleichtern.