ENDOMETRIAL HYPERPLASIA: CONTROVERSIAL ISSUES OF PATHOGENESIS AND THERAPY

Yu. Yu. Tabakman; A. G. Solopova; A. Kh. Bishtavi; L. E. Idrisova

doi:10.17749/2313-7347.2016.10.2.005-010

ENDOMETRIAL HYPERPLASIA: CONTROVERSIAL ISSUES OF PATHOGENESIS AND THERAPY

Yu. Yu. Tabakman, A. G. Solopova, A. Kh. Bishtavi, L. E. Idrisova

https://doi.org/10.17749/2313-7347.2016.10.2.005-010

Full Text:

PDF (Rus)

Abstract

Traditional attitude towards the role of hyperestrogenia in endometrial hyperplasia pathogenesis can be considered cogent only in case of simple endometrial hyperplasia (SEH). In case of complex endometrial hyperplasia (CEH) and atypical endometrial hyperplasia (AEH) excessive proliferation occurs only in endometrial glands not diffusely but as pockets. The signs of atrophy are often registered outside these pockets that reflects the state of hypoestrogens. The aim. To justify a differentiated approach to treatment tactics of patients with EH. Material. Pathological changes adjacent to the lesions AEH in 274 patients have been studied. Results. The structure of the endometrium outside the foci of the CEH and the AEH represents a wide spectrum of pathological changes – SEH, proliferative and secretory endometrium, polyps, atrophic endometrium, that's not confirms the role of hyperestrogenic in the pathogenesis of the CEH and AEH. Conclusion. SEH, as a result of imbalance of estrogen and progesterone, is subject to cyclic hormone therapy with progestin for the prevention of acyclic bleeding. In the case of the absence of abnormal uterine bleeding after uterine curettage under SEH and CEH without atypia valid only observation with regular control. At AEH surgical treatment is required.

Keywords

endometrial hyperplasia, pathogenesis, treatment strategy

About the Authors

Yu. Yu. Tabakman

I.M. Sechenov First Moscow State Medical University; Cancer clinical dispensary №1 Department of Health of Moscow
Russian Federation

Tabakman Yuriy Yuryevich – MD, professor of the Department of Obstetrics and Gynecology, Faculty of Medical and Preventive Medicine First Moscow Medical Sechenov University, Honoured Doctor of the Russian Federation, radiologist of the highest qualification category, manager radioisotope laboratory diagnostics, Cancer clinical dispensary №1 Department of Health of Moscow.

Address: ul. Baumanskaya, 17/1, Moscow, Russia, 105005.

A. G. Solopova

I.M. Sechenov First Moscow State Medical University
Russian Federation

Solopova Antonina Grigorevna – MD, Professor of Department of Obstetrics and Gynecology

Address: ul. Trubetskaya, 8-1, Moscow, Russia, 119991.

A. Kh. Bishtavi

Moscow State University of Medicine and Dentistry
Russian Federation

Bishtavi Alla Khaled PhD, Assistent Professor, Department of Obstetrics and Gynecology.

Address: ul. Trubetskaya, 8-1, Moscow, Russia, 119991

L. E. Idrisova

First Moscow State Medical Sechenov University Cancer clinical dispensary №1 Department of Health of Moscow
Russian Federation
Idrisova Larisa Emievna – PhD, researcher at the Department of the Ob/Gyn Department of the Ob/Gyn Department

References

1. Agorastos Т., Vaitsi V., Pantazis K., Efstathiadis Е., Vavilis D., Bontis N. Aromatase in-hibitor anastrozole for treating endometrial hyperplasia in obese postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 2005 Feb 1; 118 (2): 239-40.

2. Ciccone M., Dancz C., Chitayat L., Ozel B. Outcomes of treatment for endometrial hy-perplasia in women yonger then age 35 years. Obstet Gynecol. 2014 May; Suppl 1: 123-4.

3. Clark T.J., Neelakantan D., Gupta J.K. The management of endometrial hyperplasia: аn evaluation of current practice. Eur J Obstet Gynecol Reprod Biol. 2006 Apr 1; 125 (2): 259-64.

4. Hasumi K., Sugiyama Y., Sakamoto K., Akiyama F. Small endometrial cfrcinoma 10 mm or less in diameter: clicopathologic and histogenetic study of 131 cases for early detection and treatment. Cancer Med. 2013 Dec; 2 (6): 827-80.

5. Horn L.C., Schnurrbusch U., Bilek K., Hentschel B., Einenkel J. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer. 2004 Mar-Apr; 14 (2): 348-53.

6. Kurman R.J., Kaminski P.F., Norris H.J. The behavior of endometrial hyperplasia. A longterm study of "untreated" hyperplasia in 170 patients. Cancer. 1985 Jul 15; 56 (2): 403-12.

7. Lacey J.V., Sherman M.E., Rush B.B. Absolute Risk of Endometrial Carcinoma During 20-Year Follow-Up Among Women With Endometrial Hyperplasia. J Clin Oncol. 2010 February 10; 28 (5): 788-792.

8. Orbo А., Baak J.P., Kleivan L. et al. Computerised morphometrical analysis in endome-trial hyperplasia for the prediction of cancer development. А long-term retrospective study from northem Norway. J Clin Pathol. 2000 Sep; 53 (9): 697-703.

9. Terakawa N., Kigawa J., Taketani Y., Yoshikawa H., Yajima A., Noda K., Okada H., Kato J., Yakushiji M., Tanizawa O., Fujimoto S., Nozawa S., Takahashi T., Hasumi K., Furuhashi N., Aono T., Sakamoto A., Furusato M. The behavior of endometrial hyper-plasia: a prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynecol Res. 1997 Jun; 23 (3): 223-30.

For citation:

Tabakman Y.Y., Solopova A.G., Bishtavi A.K., Idrisova L.E. ENDOMETRIAL HYPERPLASIA: CONTROVERSIAL ISSUES OF PATHOGENESIS AND THERAPY. Obstetrics, Gynecology and Reproduction. 2016;10(3):5-10. (In Russ.) https://doi.org/10.17749/2313-7347.2016.10.2.005-010