508 Obstetrics and Gynecology Board Review •••
❍ What is the relative risk of development of malignancy within the various types of endometrial hyperplasia?
Simple hyperplasia without atypia—1%.
Simple hyperplasia with atypia—8%.
Complex hyperplasia without atypia—3%.
Complex hyperplasia with atypia—29%.
❍ What are the criteria to make the diagnosis of endometrial intraepithelial neoplasia?
(1) Lesion must be >1 mm
(2) The area of the glands exceeds the area of the stroma
(3) The cytology is changed relative to the background
(4) Excluded other causes that may mimic condition
❍ What is the mechanism of development of endometrial hyperplasia in obese women?
Androstenedione is converted to estrone in the adipose tissue that serves as the stimulation for development of
hyperplasia.
❍ What is the rate of concurrent endometrial cancer discovered following hysterectomy with prior tissue
diagnosis of atypical complex endometrial hyperplasia?
43% based on a prospective Gynecologic Oncology Group study.
❍ What is the nature of the endometrial carcinomas that develop in obese women secondary to peripheral
conversion to estrogens?
The tumors tend to be well-differentiated, superficially invasive, and have a very good prognosis.
❍ What are some associations with development of adenocarcinoma of the endometrium?
(1) Obesity.
(2) Diabetes mellitus.
(3) Infertility.
(4) Late menopause.
(5) Any source of continuous unopposed estrogen.
(6) Tamoxifen use.
(7) Hypertension.