Atypical endometrial hyperplasia

Atypical endometrial hyperplasia is the term used to describe hypertrophic changes in the adenomatous nature occurring in the endometrium, in combination with atypia.

With this disease, pathological spread of the mucous membrane of the uterus occurs, and in such malignancies, glands prevail, which underwent a number of changes and differ from those tissues from which their regeneration began. In this case, there may be the presence of atypical cells, that is, those that differ in their appearance and characteristics are not characteristic of those cells that have become the starting material for their development.

Similar changes in the uterine mucosa may indicate the onset of the conversion of endometrial hyperplasia into a malignant disease - endometrial adenocarcinoma.

Atypical hyperplasia of the endometrium has certain manifestations, by which it can be distinguished from the initial stages of oncology development. So one of the characteristic properties is the appearance of atypical changes mainly in the functional layer of the uterine mucosa, from which the pathological growth occurs. In the event that the appearance of atypical cells in the basal layer, stroma, is detected, this is one of the signs of cancer beginning in the endometrium.

[1], [2], [3]

Causes of the atypical endometrial hyperplasia

The causes of atypical hyperplasia of the endometrium are closely related to the disruption of the hypothalamus, the cortex, responsible for the functioning of the endocrine system. This causes adverse changes in the hormonal background during menstruation. On the other hand, failures in the functioning of the pituitary gland, which is the main gland of internal secretion, affect the normal activity of the ovaries.

As a result of such disorders, changes in the optimal balance of endocrine and metabolic processes occur with a tendency to increase the amount of estrogens needed in the first half of the monthly cycle, and in the second half, to which the necessary hormonal background is provided by progesterone, this female sex hormone is not produced enough.

The causes of atypical hyperplasia of the endometrium are also due to the fact that hypertrophied endometrium leads to the lack of a phase of secretion, in which the mucous uterus is prepared to assume the embryo. In this case, when the phase of secretion does not occur, and the proliferation of the mucous membrane continues, after a decrease in the level of estrogens, its gradual rejection occurs. This is accompanied by prolonged and profuse menstrual bleeding, which can also occur during the intermenstrual period.

As the pathological changes progress, the properties of the uterine mucosa become different, which now largely contribute to the appearance of atypical cells, which can become a sign of the development of a malignant disease.

[4]

Symptoms of the atypical endometrial hyperplasia

Symptoms of atypical hyperplasia of the endometrium occur in the form of certain manifestations inherent in each specific character and type of development of the pathological process.

So with the glandular form of the disease, which is inherently benign, proliferation of the stroma and endometriosis glands occurs. There is a thickening of the mucous membrane, and the glands in the stroma are located in the wrong way.

The severity of the processes of glandular hyperplasia causes its differentiation into the active, acute stage of the disease and is in a state of rest, its chronic form.

The active form is characterized by a large number of cellular mitoses in the stroma and epithelium of the glands, which is manifested as a consequence of a prolonged excessively high level of estrogens. At the stage of chronic disease, mitoses are rare, which causes insufficient hormonal stimulation due to the small amount of estrogens.

Symptoms of atypical hyperplasia of the endometrium of the glandular-cystic type are similar to manifestations of glandular hyperplasia, with the only difference being that they have a somewhat higher degree of severity. One of the characteristic features is the cystic enlargement of the glands.

[5], [6], [7]

Forms

[8], [9], [10], [11]

Atypical glandular hyperplasia of the endometrium

Atypical glandular hyperplasia of the endometrium is a process of proliferation of glands, characterized by a high intensity and a significant pathological transformation at the structural level.

Endometrioid cells, in addition to activating the processes of their growth and reproduction, are subject to changes in the structure of the nuclei, which, with a certain set of factors, may serve as a sign of malignant processes that begin.

Foci of appearance can be either a functional or basal layer of the uterus's mucous membrane, and both can be involved in the development of pathology. In the case of destruction of both these layers, the probability of acquiring neoplastic properties and qualities of an oncological character seems particularly high.

Atypical glandular hyperplasia of the endometrium can occur not only as a result of the hyperplastic endometrioid layer, but also in the case of its thinning and atrophic changes.

There are two types of this disease - cell and structural hyperplasia of the endometrium.

In the first case, pathological processes occur in epithelial cells and in the stroma, while the second kind causes changes in the location and shape of the glands.

[12], [13], [14]

Complex atypical endometrial hyperplasia

Complex atypical endometrial hyperplasia is characterized by a large consolidation of the location of the endometrial glands or their separate foci.

This lesion of the endometrium of the uterus is marked by a significant degree of manifestation of glandular proliferation. In the glands affected by this process, pathological changes in structure and form are noted. There is a violation of the optimal ratio in the proliferation of glands and stroma. There is also a phenomenon of pronounced multinucleation of the epithelium. Atypicality in the change of nuclei in this disease is not observed.

Complex atypical endometrial hyperplasia is one of the most dangerous forms of endometroiodic lesions in women. It can be transformed to a high degree of risk in the oncology of the uterus. The probability of such a degeneration into a malignant neoplasm is 22-57% of cases.

Distinctive features are the presence of pronounced proliferation of the epithelium with the appearance of atypia in cells and tissues.

With the development of this pathology in the mucous membrane of the uterus glands acquire irregular shapes and in size can differ significantly from each other, and the polymorphic nuclei are elongated or rounded.

[15]

Focal atypical endometrial hyperplasia

Focal atypical endometrial hyperplasia can develop according to one of the following scenarios.

In many cases, the cause of focal escalation lies in fragments for some reason not torn away tissues of the uterine mucosa. Often this is due to all sorts of endocrine disorders and an imbalance in the hormonal background.

Under normal conditions, the layer of the endometrium of the uterus thickens during the menstrual cycle and, if fertilization does not occur, then it comes out in parts along with menstrual blood. Undivided remains of the endometrioid layer become the causes of intermenstrual uterine bleeding, and may subsequently cause the focal extension of the endometrium and provoke polyp in the inner cavity of the uterus.

Another mechanism of the emergence of foci of endometriosis lesions is triggered by the insufficient amount produced in the body of estrogen. Due to this, the maturation of the egg does not occur, which leads to a prolonged irregular production of this female hormone. Ultimately, an unripened egg can not leave the ovary, and menstrual bleeding continues for a long time. In this case, rejection of the mucous uterus occurs gradually, and some of its particles can linger inside.

Such fragments remaining in the uterus cavity become the reason for the appearance of focal atypical endometrial hyperplasia on their basis.

The emergence of foci of endometriotic neoplasms can be triggered by the consequences of the transferred inflammatory diseases of the uterus, traumatic factors, severe labor, abortion, disruption of the endocrine system, stress, problems with overweight, etc.

[16]

Simple atypical endometrial hyperplasia

Simple atypical endometrial hyperplasia has a number of specific characteristics.

Among them is the presence of an insignificant predominance of structures of glandular and stromal type over normal ones.

There is an increase in the endometrium in the volume, as well as a change in its structure, which is manifested in the following. Stroma and glands are active, the location of the glands is uneven, some of them are susceptible to cystic enlargement.

As for the stroma, then it should be noted the uniform arrangement of the vessels in it.

Simple atypical endometrial hyperplasia also has a disruption in the normal ordering of cells, which differ in their unusual, in many cases round, form. This disease is also characterized by significant polymorphism of the cell nuclei, without a tendency to atypia.

In addition, the features are the presence of cellular dyspolarity, anacytosis, hyperchromatism and an increase in nuclei in size. From the number of cellular changes, phenomena of expansion of vacuoles and cytoplasmic eosinophilia are also observed.

The degree of risk of degeneration into a malignant neoplasm is determined with a probability of 8 to 20 cases out of 100.

Diagnostics of the atypical endometrial hyperplasia

Diagnosis of atypical hyperplasia of the endometrium involves a number of appropriate measures aimed at identifying the characteristic changes and signs indicative of the onset of development or the presence of a certain stage of the disease in the woman's body.

The initial diagnostic action is the passage of a gynecological examination, as a result of which, in case of suspicion, a specialist can prescribe additional examinations using various methods of techniques.

Examining pelvic organs with ultrasound diagnostics with intravaginal injection, it is possible to detect an increase in the thickness of the endometrium, or in the formations of the corresponding form, to determine the presence of polyps in the uterine cavity.

The method of hysteroscopy is that the uterine cavity is examined using a special optical device and separate diagnostic scraping is performed for histological analysis to determine the type of hyperplasia.

This method of diagnosis belongs to the most expedient, since it ensures high accuracy of diagnosis.

Diagnosis of atypical endometrial hyperplasia is also performed by aspiration biopsy, when a fragment of endometrial tissue is separated for histological examination.

Help in determining the disease and making a clear diagnosis can and research levels of estrogen and progesterone, and in some cases also hormones of the adrenal and thyroid gland.

[17], [18], [19], [20]

Treatment of the atypical endometrial hyperplasia

Treatment of atypical hyperplasia of the endometrium can now occur through surgical intervention and treatment with the use of hormonal drugs.

Surgical treatment in one of its ways is reduced to the procedure of scraping the inner cavity of the uterus. This treatment and diagnostic operation, carried out both independently and accompanied by hysteroscopy, is aimed at removing from the uterus of all possible endometrium of susceptible hyperplasia. In this case, the data collected by hysteroscopy make it possible to give an accurate definition of the type of hyperplasia.

Another method of treatment is the use of electric current or a laser beam in hysteroscopy.

An extremely radical method is the extirpation of the uterus, which consists in the complete removal of this female organ. Indications for its use in strictly individual order can only become inefficiency of all other types of treatment, atypical nature of hyperplasia, relapse of the disease.

Treatment of atypical hyperplasia of the endometrium may be less radical than surgery.

The course of treatment with hormones is prescribed in addition to surgical treatment based on the results obtained with a histological examination.

Hormonal treatment involves the use of preparations of the group of gestagens, the introduction of an intrauterine levonorgestrel-containing spiral, as well as combined oral contraceptives - for the regulation of the menstrual cycle, which helps normalize the processes of cyclic build-up of endometrium rejection.

Prevention

Prevention of atypical hyperplasia of the endometrium as well as measures aimed at preventing the emergence of most of the female diseases, comes mainly to regular visits to the gynecologist's doctor.

There is no need to remind once again of such a significant factor that influences the healthy and vital tone of the whole organism, as the need to maintain a healthy lifestyle.

Sports activities and regular physical activity significantly reduce the likelihood of being at risk of developing this disease.

It is also important to adhere to the correct diet and control the maintenance of the body mass index within its individual optimum.

The factor of reception of the combined oral contraceptives is actual also.

Prevention of atypical hyperplasia of the endometrium is also in the timely detection of failures in the onset of ovulation with immediate start of treatment.

Methods of contraception with the use of hormonal drugs, which prevents proliferation, that is, excessive increase in the endometrium due to the active process of cell division, is also a preventive measure.

[21], [22], [23],

Forecast

The prognosis of atypical hyperplasia of the endometrium is mainly based on the fact that it is necessary to give special attention to the degree of probability of its transition into the category of oncological diseases.

For young women, the issue of choice of treatment combining the highest possible efficacy with the unconditional possibility of preserving reproductive function is becoming topical. In this case, the most appropriate is the conduct of a course of conservative therapy with progestins.

However, if cell atypia is detected, which implies the possibility of persistent processes, progression and the occurrence of relapses, more attention should be paid to such cases.

For older women who entered the menopause, in most cases, a practically unambiguous prescription is hysterectomy. Especially if atypical hyperplasia occurs.

Thus, the prognosis of atypical hyperplasia of the endometrium in the absence of atypia of cells using conservative methods of treatment under the supervision of competent specialists in the field of gynecology is favorable, since it presupposes the preservation of fertility in young women.

[24], [25], [26], [27], [28]