••• Chapter 44^ Endometrial Hyperplasia and Carcinoma^443
❍ What are the earliest signs of cytologic atypia?
- Enlarged round nuclei.
- Fine and evenly dispersed chromatin.
❍ What differentiates complex atypical hyperplasia from well-differentiated adenocarcinoma?
The presence of stromal invasion defined as a desmoplastic stromal response or a complex proliferation exceeding
half of a low power microscopic field, approximately 2.1 mm.
❍ In what type of hyperplasia there is back-to-back glandular crowding without cytologic atypia?
This is the definition of complex hyperplasia.
❍ What is the value of mitotic activity in the diagnosis and prognosis of endometrial hyperplasia?
It has none.
❍ Is there any difference between the biologic behavior between simple and complex hyperplasia?
No. Neither has cytologic atypia and both have a low incidence of progression to cancer.
❍ What characterizes the endometrial hyperplasia that is most likely to progress to endometrial carcinoma?
A complex architectural pattern and a moderate degree of cytologic atypia.
❍ What factors influence the treatment of endometrial hyperplasia?
- Age.
- Amount and duration of vaginal bleeding.
- Associated anemia.
- Desire for future childbearing.
- The presence or absence of cytologic atypia.
- The degree of cytologic atypia.
❍ What medical therapeutic options exist for treating endometrial hyperplasia in women who do not desire
pregnancy at this time?
- Progesterone.
- Oral contraceptive pills (OCPs).
- Gonadotropin-releasing hormone (GnRH) analogs.
- A progesterone-containing IUD.
❍ What surgical options are currently available for the treatment of endometrial hyperplasia?
- Curettage for acute bleeding.
- Hysteroscopy to exclude polyps and carcinoma.
- Hysterectomy, particularly if cytologic atypia is present.
❍ What nonmedical, nonsurgical lifestyle changes are important in counseling the woman with endometrial
hyperplasia?
Dietary counseling and weight loss, screening for diabetes mellitus, and discontinuing exogenous unopposed
estrogen.