title: Assessing endometrial hyperplasia and carcinoma treated with progestin therapy.
abstract: The effects of increased amounts of progesterone on the endometrium, including such features as eosinophilic cytoplasmic metaplasia, glandular atrophy, and decidualized stroma, are well-known among surgical pathologists. These changes are typically seen as secondary effects of pregnancy or exogenous hormone therapy for birth control purposes or abnormal bleeding. Treatment with progesterone has become a viable alternative to hysterectomy in some patients with complex atypical hyperplasia (CAH) and well-differentiated endometrial carcinoma (WDC), especially those who are poor surgical candidates or those wishing to preserve fertility. To date, only 1 study has specifically examined the effects of progestin therapy on patients with a previous diagnosis of CAH or WDC. That study proposed a classification scheme for the assessment of treated CAH and WDC. The authors concluded that after 6 months of treatment, endometrial biopsy findings of persistent cytologic atypia and architectural abnormalities were associated with treatment failure. This current study aims to assess the previously proposed criteria in a cohort of 30 patients (18 with a diagnosis of CAH and 12 with a diagnosis of WDC), and determine the usefulness of these criteria in clinical practice. Our study confirms that cytologic atypia after 6 months of therapy is strongly associated with treatment failure, and should be an indication to pursue definitive surgical treatment in these patients.
authors.affiliation: Department of Pathology, University of Virginia Health Systems, Charlottesville, VA, USA. mjm7vw@virginia.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mentrikoski
authors.forename: Akeesha A
authors.initials: AA
authors.lastname: Shah
authors.forename: Krisztina Z
authors.initials: KZ
authors.lastname: Hanley
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Atkins
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D015331:Cohort Studies; D004714:Endometrial Hyperplasia / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D016889:Endometrial Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D004717:Endometrium / Q000187:drug effects / Q000473:pathology; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000627:therapeutic use*; D019290:Megestrol Acetate / Q000627:therapeutic use*; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D011379:Prognosis; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D016912:Levonorgestrel; D019290:Megestrol Acetate