Hysteroscopic picture of recurrent endometrial hyperplasia without atypia in women of reproductive age

• Victor E. Radzinsky
• Mekan R. Orazov
• Lyudmila M. Mikhaleva
• Marina B. Khamoshina
• Irina A. Mullina
• Yulia S. Artemenko

Abstract

The aim of the study was to establish the most informative hysteroscopic signs of recurrent endometrial hyperplasia without atypia in women of reproductive age.

Material and methods. A prospective analysis of 89 patients of reproductive age was performed on the basis of the Department of Obstetrics and Gynecology with a course of perinatology at the Russian Peoples’ Friendship University named after Patrice Lumumba. In the course of the study two cohorts of patients were formed depending on the course of endometrial hyperplasia: the main cohort (n=45) was represented by patients with morphologically verified recurrent endometrial hyperplasia without atypia (1 and more than 2 episodes of recurrence within a year), and the comparison cohort (n=44) was represented by patients with first detected endometrial hyperplasia without atypia. The mean age of the patients in the study cohort was 44±3.0 years (comparison group – 42±2.0 years).

Design: the comparative prospective study.

Results. The study found a significantly high incidence of diffuse endometrial hyperplasia in the patients of the study cohort 82.2% vs 63.6% (p<0.05) (OR, 2.6; 95% CI 0.991–7.045). 40% of patients with recurrent endometrial hyperplasia had hysteroscopic signs of chronic endometritis: multiple micropolyps less than 10 mm in diameter, micro- and macrohemorrhages in the uterine cavity with increased vascularity, stromal edema, and diffuse/focal endometrial hyperemia (OR 3.0; 95% CI 1.136–7.921, p<0.05).

Conclusion. The most informative hysteroscopic signs of recurrent endometrial hyperplasia are the presence of multiple micropolyps less than 10 mm in diameter and micro and macrohemorrhages in the uterine cavity (RR 3.0; 95% CI 1.136–7.921) against the background of increased vascular pattern, stromal edema and diffuse/focal hyperemia and irregular endometrial thickening within 10-15 mm with visualization of gland ducts. Active introduction of office hysteroscopy with multifocal targeted biopsy of endometrium to replace blind curettage into the routine practice of obstetrician-gynecologist will increase diagnostic informativeness, value and accuracy of endometrial hyperplasia.

Keywords:hysteroscopy; proliferative diseases of the endometrium; endometrial cancer; endometrial hyperplasia

REFERENCES

1. MacLean J.A. II, Hayashi K. Progesterone actions and resistance in gynecological disorders. Cells. 2022; 11: 647. DOI: https://doi.org/10.3390/cells11040647

2. Vitale S.G., Riemma G., Carugno J., Chiofalo B., Vilos G.A., Cianci S., et al. Hysteroscopy in the management of endometrial hyperplasia and cancer in reproductive aged women: new developments and current perspectives. Transl Cancer Res. 2020; 9 (12): 7767–77.

3. Palmer J.E., Perunovic B., Tidy J.A. Endometrial hyperplasia. Obstetrician Gynaecologist. 2008; 10 (4): 211–6.

4. Hannemann M.M., Alexander H.M., Cope N.J. Endometrial hyperplasia: a clinician’s review. Obstet Gynaecol Reprod Med. 2010; 20 (4): 116–20.

5. ACOG Technology Assessment No. 13: Hysteroscopy. Obstet Gynecol. 2018; 131 (5): 151–6. DOI: https://doi.org/10.1097/AOG.0000000000002634 PMID: 29683912.

6. Centini G., Troia L., Lazzeri L., Petraglia F., Luisi S. Modern operative hysteroscopy. Minerva Ginecol. 2016; 68 (2): 126–32. Epub 2016 Mar 1. PMID: 26930389.

7. Sulima A.N., Kolesnikova I.O., Davydova A.A., Kriventsov M.A. Hysteroscopic and morphological assessment of intrauterine pathology in different age periods. Zhurnal akusherstva i zhenskikh bolezney [Journal of Obstetrics and Women’s Diseases]. 2020; 69 (2): 51–8. DOI: https://doi.org/10.17816/JOWD69251-58 (in Russian)

8. Ring K.L., Mills A.M., Modesitt S.C. Endometrial hyperplasia. Obstet Gynecol. 2022; 140 (6): 1061–75. DOI: https://doi.org/10.1097/AOG.0000000000004989 Epub 2022 Nov 2. PMID: 36357974.

9. Long-term effect of pregnancy-related factors on the development of endometrial neoplasia: a nationwide retrospective cohort study. PLoS One. 2019; 14 (3): e0214600. DOI: https://doi.org/10.1371/journal.pone.0214600

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)