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Atypical endometrial hyperplasia

MedGen UID:
138105
•Concept ID:
C0349579
•
Disease or Syndrome
Synonyms: Atypical Endometrial Hyperplasia; Atypical Endometrial Hyperplasias; Endometrial Hyperplasia, Atypical; Endometrial Hyperplasias, Atypical; Hyperplasia, Atypical Endometrial; Hyperplasias, Atypical Endometrial
SNOMED CT: Atypical endometrial hyperplasia (277158007)
 
Monarch Initiative: MONDO:0006096

Definition

An endometrial hyperplasia characterized by cytologic and architectural changes which may lead to endometrial carcinoma. Despite the atypical features and possible course, there is debate on whether to consider this a neoplasm. The relationship with endometrial intraepithelial neoplasia is also unclear. [from MONDO]

Professional guidelines

PubMed

Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5.
Obstet Gynecol 2023 Sep 1;142(3):735-744. doi: 10.1097/AOG.0000000000005297. PMID: 37590985
Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women.
Uccella S, Zorzato PC, Dababou S, Bosco M, Torella M, Braga A, Frigerio M, Gardella B, Cianci S, Laganà AS, Franchi MP, Garzon S
Medicina (Kaunas) 2022 Sep 11;58(9) doi: 10.3390/medicina58091256. PMID: 36143933Free PMC Article
Guideline No. 390-Classification and Management of Endometrial Hyperplasia.
Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A
J Obstet Gynaecol Can 2019 Dec;41(12):1789-1800. doi: 10.1016/j.jogc.2019.03.025. PMID: 31785798

Recent clinical studies

Etiology

Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5.
Obstet Gynecol 2023 Sep 1;142(3):735-744. doi: 10.1097/AOG.0000000000005297. PMID: 37590985
Risk of endometrial cancer in asymptomatic postmenopausal women in relation to ultrasonographic endometrial thickness: systematic review and diagnostic test accuracy meta-analysis.
Vitale SG, Riemma G, Haimovich S, Carugno J, Alonso Pacheco L, Perez-Medina T, Parry JP, Török P, Tesarik J, Della Corte L, Cobellis L, Di Spiezio Sardo A, De Franciscis P
Am J Obstet Gynecol 2023 Jan;228(1):22-35.e2. Epub 2022 Aug 4 doi: 10.1016/j.ajog.2022.07.043. PMID: 35932873
Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women.
Uccella S, Zorzato PC, Dababou S, Bosco M, Torella M, Braga A, Frigerio M, Gardella B, Cianci S, Laganà AS, Franchi MP, Garzon S
Medicina (Kaunas) 2022 Sep 11;58(9) doi: 10.3390/medicina58091256. PMID: 36143933Free PMC Article
Endometrial hyperplasia as a risk factor of endometrial cancer.
Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, Wallwiener M
Arch Gynecol Obstet 2022 Aug;306(2):407-421. Epub 2022 Jan 10 doi: 10.1007/s00404-021-06380-5. PMID: 35001185Free PMC Article
Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding.
Van Den Bosch T, Verbakel JY, Valentin L, Wynants L, De Cock B, Pascual MA, Leone FPG, Sladkevicius P, Alcazar JL, Votino A, Fruscio R, Lanzani C, Van Holsbeke C, Rossi A, Jokubkiene L, Kudla M, Jakab A, Domali E, Epstein E, Van Pachterbeke C, Bourne T, Van Calster B, Timmerman D
Ultrasound Obstet Gynecol 2021 Jan;57(1):164-172. doi: 10.1002/uog.22109. PMID: 32484286

Diagnosis

Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5.
Obstet Gynecol 2023 Sep 1;142(3):735-744. doi: 10.1097/AOG.0000000000005297. PMID: 37590985
Single-cell transcriptomic analysis highlights origin and pathological process of human endometrioid endometrial carcinoma.
Ren X, Liang J, Zhang Y, Jiang N, Xu Y, Qiu M, Wang Y, Zhao B, Chen X
Nat Commun 2022 Oct 22;13(1):6300. doi: 10.1038/s41467-022-33982-7. PMID: 36273006Free PMC Article
Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women.
Uccella S, Zorzato PC, Dababou S, Bosco M, Torella M, Braga A, Frigerio M, Gardella B, Cianci S, Laganà AS, Franchi MP, Garzon S
Medicina (Kaunas) 2022 Sep 11;58(9) doi: 10.3390/medicina58091256. PMID: 36143933Free PMC Article
Fertility-Sparing Approaches in Atypical Endometrial Hyperplasia and Endometrial Cancer Patients: Current Evidence and Future Directions.
Contreras NA, Sabadell J, Verdaguer P, Julià C, Fernández-Montolí ME
Int J Mol Sci 2022 Feb 25;23(5) doi: 10.3390/ijms23052531. PMID: 35269674Free PMC Article
Guideline No. 390-Classification and Management of Endometrial Hyperplasia.
Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A
J Obstet Gynaecol Can 2019 Dec;41(12):1789-1800. doi: 10.1016/j.jogc.2019.03.025. PMID: 31785798

Therapy

Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women.
Uccella S, Zorzato PC, Dababou S, Bosco M, Torella M, Braga A, Frigerio M, Gardella B, Cianci S, Laganà AS, Franchi MP, Garzon S
Medicina (Kaunas) 2022 Sep 11;58(9) doi: 10.3390/medicina58091256. PMID: 36143933Free PMC Article
Fertility-Sparing Approaches in Atypical Endometrial Hyperplasia and Endometrial Cancer Patients: Current Evidence and Future Directions.
Contreras NA, Sabadell J, Verdaguer P, Julià C, Fernández-Montolí ME
Int J Mol Sci 2022 Feb 25;23(5) doi: 10.3390/ijms23052531. PMID: 35269674Free PMC Article
Endometrial hyperplasia as a risk factor of endometrial cancer.
Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, Wallwiener M
Arch Gynecol Obstet 2022 Aug;306(2):407-421. Epub 2022 Jan 10 doi: 10.1007/s00404-021-06380-5. PMID: 35001185Free PMC Article
Guideline No. 390-Classification and Management of Endometrial Hyperplasia.
Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A
J Obstet Gynaecol Can 2019 Dec;41(12):1789-1800. doi: 10.1016/j.jogc.2019.03.025. PMID: 31785798
Oral and intrauterine progestogens for atypical endometrial hyperplasia.
Luo L, Luo B, Zheng Y, Zhang H, Li J, Sidell N
Cochrane Database Syst Rev 2018 Dec 4;12(12):CD009458. doi: 10.1002/14651858.CD009458.pub3. PMID: 30521671Free PMC Article

Prognosis

Uterine-Conserving Treatment Options for Atypical Endometrial Hyperplasia and Early Endometrial Cancer.
Adjei NN, Bowen MB, Wilke RN, Yates MS, Westin SN
Curr Oncol Rep 2024 Nov;26(11):1367-1379. Epub 2024 Oct 3 doi: 10.1007/s11912-024-01603-9. PMID: 39361076Free PMC Article
Conservative Management of Atypical Endometrial Hyperplasia and Early Endometrial Cancer in Childbearing Age Women.
Uccella S, Zorzato PC, Dababou S, Bosco M, Torella M, Braga A, Frigerio M, Gardella B, Cianci S, Laganà AS, Franchi MP, Garzon S
Medicina (Kaunas) 2022 Sep 11;58(9) doi: 10.3390/medicina58091256. PMID: 36143933Free PMC Article
Atypical Endometrial Hyperplasia, Low-grade: "Much ADO About Nothing".
D'Angelo E, Espinosa I, Cipriani V, Szafranska J, Barbareschi M, Prat J
Am J Surg Pathol 2021 Jul 1;45(7):988-996. doi: 10.1097/PAS.0000000000001705. PMID: 34105519
Management of endometrial precancers.
Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, Higgins R, Zaino R, Mutter GL; Society of Gynecologic Oncology Clinical Practice Committee
Obstet Gynecol 2012 Nov;120(5):1160-75. doi: 10.1097/aog.0b013e31826bb121. PMID: 23090535Free PMC Article
Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma.
Jadoul P, Donnez J
Fertil Steril 2003 Dec;80(6):1315-24. doi: 10.1016/s0015-0282(03)01183-x. PMID: 14667859

Clinical prediction guides

Atypical Endometrial Hyperplasia, Low-grade: "Much ADO About Nothing".
D'Angelo E, Espinosa I, Cipriani V, Szafranska J, Barbareschi M, Prat J
Am J Surg Pathol 2021 Jul 1;45(7):988-996. doi: 10.1097/PAS.0000000000001705. PMID: 34105519
Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding.
Van Den Bosch T, Verbakel JY, Valentin L, Wynants L, De Cock B, Pascual MA, Leone FPG, Sladkevicius P, Alcazar JL, Votino A, Fruscio R, Lanzani C, Van Holsbeke C, Rossi A, Jokubkiene L, Kudla M, Jakab A, Domali E, Epstein E, Van Pachterbeke C, Bourne T, Van Calster B, Timmerman D
Ultrasound Obstet Gynecol 2021 Jan;57(1):164-172. doi: 10.1002/uog.22109. PMID: 32484286
Guideline No. 390-Classification and Management of Endometrial Hyperplasia.
Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A
J Obstet Gynaecol Can 2019 Dec;41(12):1789-1800. doi: 10.1016/j.jogc.2019.03.025. PMID: 31785798
Management of endometrial precancers.
Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, Higgins R, Zaino R, Mutter GL; Society of Gynecologic Oncology Clinical Practice Committee
Obstet Gynecol 2012 Nov;120(5):1160-75. doi: 10.1097/aog.0b013e31826bb121. PMID: 23090535Free PMC Article
Menopause: evidence-based practice.
Blake J
Best Pract Res Clin Obstet Gynaecol 2006 Dec;20(6):799-839. Epub 2006 Nov 2 doi: 10.1016/j.bpobgyn.2006.07.001. PMID: 17084674

Recent systematic reviews

Metformin and progestins in women with atypical hyperplasia or endometrial cancer: systematic review and meta-analysis.
Adamyan L, Pivazyan L, Isaeva S, Shapovalenko R, Zakaryan A
Arch Gynecol Obstet 2024 Jun;309(6):2289-2305. Epub 2024 Mar 19 doi: 10.1007/s00404-024-07416-2. PMID: 38503850
Risk of endometrial cancer in asymptomatic postmenopausal women in relation to ultrasonographic endometrial thickness: systematic review and diagnostic test accuracy meta-analysis.
Vitale SG, Riemma G, Haimovich S, Carugno J, Alonso Pacheco L, Perez-Medina T, Parry JP, Török P, Tesarik J, Della Corte L, Cobellis L, Di Spiezio Sardo A, De Franciscis P
Am J Obstet Gynecol 2023 Jan;228(1):22-35.e2. Epub 2022 Aug 4 doi: 10.1016/j.ajog.2022.07.043. PMID: 35932873
Endometrial hyperplasia as a risk factor of endometrial cancer.
Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, Wallwiener M
Arch Gynecol Obstet 2022 Aug;306(2):407-421. Epub 2022 Jan 10 doi: 10.1007/s00404-021-06380-5. PMID: 35001185Free PMC Article
Oral and intrauterine progestogens for atypical endometrial hyperplasia.
Luo L, Luo B, Zheng Y, Zhang H, Li J, Sidell N
Cochrane Database Syst Rev 2018 Dec 4;12(12):CD009458. doi: 10.1002/14651858.CD009458.pub3. PMID: 30521671Free PMC Article
Atypical Endometrial Polyps and Concurrent Endometrial Cancer: A Systematic Review.
de Rijk SR, Steenbergen ME, Nieboer TE, Coppus SF
Obstet Gynecol 2016 Sep;128(3):519-525. doi: 10.1097/AOG.0000000000001566. PMID: 27500332

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