title: Pathologic features associated with resolution of complex atypical hyperplasia and grade 1 endometrial adenocarcinoma after progestin therapy.
abstract: OBJECTIVE
  To determine the response of complex atypical hyperplasia (CAH) and well differentiated endometrioid adenocarcinoma of the uterus (WDC) to progestin therapy and whether pre-treatment estrogen and progesterone receptor status predicts outcome.
  
  
  METHODS
  We performed a retrospective review encompassing women treated with progestin therapy for CAH or WDC at two institutions. Clinicopathologic, treatment, and recurrence data were recorded. Pre/post-treatment pathologic evaluation was performed. SAS 9.2 was used for statistical analyses.
  
  
  RESULTS
  Forty-six patients were included. The median age was 35, and median BMI was 36.9. Thirty-seven percent were diagnosed with CAH and 63% had WDC. Megestrol acetate was the most commonly used agent (89%); 24% received multiple progestin therapies. Median treatment length was 6 months (range, 1-84); 36% of the patients underwent eventual hysterectomy, and 17.4% had carcinoma in their uterine specimens (8 primary endometrial, 1 primary ovarian). After a median follow-up of 35 months (range, 2-162), 65% experienced a complete response (CR), 28% had persistent or progressive disease, and 23% had a CR followed by recurrence. On univariate analysis, decreased post-treatment glandular cellularity (p = 0.0006), absence of post-treatment mitotic figures (p = 0.0008), and use of multiple progestin agents (p = 0.025) were associated with CR; however, only decreased glandular cellularity was significant on multivariate analysis (p = 0.007). Estrogen and progesterone receptor expression was not associated with treatment response.
  
  
  CONCLUSIONS
  In women with CAH or WDC, the overall response rate to progestin therapy was 65%; pre-treatment estrogen/progesterone receptor status did not predict response to treatment.
authors: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology; Oklahoma City, OK, USA. Electronic address: ccgunder@gmail.com.
authors: Camille C
authors: CC
authors: Gunderson
authors: Johns Hopkins Hospital, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology; Baltimore, MD, USA. Electronic address: sonia.dutta@gmail.com.
authors: Sonia
authors: S
authors: Dutta
authors: Johns Hopkins Medical Institutions/Greater Baltimore Medical Center, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology; Baltimore, MD, USA. Electronic address: amandanfader@gmail.com.
authors: Amanda Nickles
authors: AN
authors: Fader
authors: Johns Hopkins Hospital, Departments of Gynecology and Obstetrics, Pathology, Division of Gynecologic Pathology and Oncology; Baltimore, MD, USA. Electronic address: kpmaniar@gmail.com.
authors: Kruti P
authors: KP
authors: Maniar
authors: Johns Hopkins Hospital, Departments of Gynecology and Obstetrics, Pathology, Division of Gynecologic Pathology and Oncology; Baltimore, MD, USA. Electronic address: niloofar_nik@yahoo.com.
authors: Niloo
authors: N
authors: Nasseri-Nik
authors: University of California Irvine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology; Orange, CA, USA. Electronic address: rbristow@uci.edu.
authors: Robert E
authors: RE
authors: Bristow
authors: Johns Hopkins Hospital, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology; Baltimore, MD, USA. Electronic address: tdiazmo12@gmail.com.
authors: Teresa P
authors: TP
authors: Diaz-Montes
authors: Greater Baltimore Medical Center, Department of Pathology; Baltimore, MD, USA. Electronic address: rpalermo@gbmc.org.
authors: Robert
authors: R
authors: Palermo
authors: Johns Hopkins Hospital, Departments of Gynecology and Obstetrics, Pathology, Division of Gynecologic Pathology and Oncology; Baltimore, MD, USA. Electronic address: rkurman@jhmi.edu.
authors: Robert J
authors: RJ
authors: Kurman
mesh_terms: D000328:Adult; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000473:pathology; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011372:Progestins; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies
chemical_list: D011372:Progestins; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Complex atypical hyperplasia; Estrogen/progesterone receptor; Progestin therapy; Well differentiated endometrial adenocarcinoma