Ring Kari L, Mills Anne M, Modesitt Susan C
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, and the Department of Pathology, University of Virginia Health System, Charlottesville, Virginia; and the Gynecologic Oncology Division, Gynecology and Obstetrics Department, Emory University, Atlanta, Georgia.
Obstet Gynecol. 2022 Dec 1;140(6):1061-1075. doi: 10.1097/AOG.0000000000004989. Epub 2022 Nov 2.
The objectives of this Clinical Expert Series on endometrial hyperplasia are to review the etiology and risk factors, histologic classification and subtypes, malignant progression risks, prevention options, and to outline both surgical and nonsurgical treatment options. Abnormal uterine and postmenopausal bleeding remain the hallmark of endometrial pathology, and up to 10-20% of postmenopausal bleeding will be either hyperplasia or cancer; thus, immediate evaluation of any abnormal bleeding with either tissue procurement for pathology or imaging should be undertaken. Although anyone with a uterus may develop atypical hyperplasia, also known as endometrial intraepithelial neoplasia (EIN), genetic predispositions (eg, Lynch syndrome), obesity, chronic anovulation, and polycystic ovarian syndrome all markedly increase these risks, whereas use of oral contraceptive pills or progesterone-containing intrauterine devices will decrease the risk. An EIN diagnosis carries a high risk of concomitant endometrial cancer or eventual progression to cancer in the absence of treatment. The definitive and curative treatment for EIN remains hysterectomy; however, the obesity epidemic, the potential desire for fertility-sparing treatments, the recognition of varying rates of malignant transformation, medical comorbidities, and an aging population all may factor into decisions to employ nonsurgical treatment modalities.
本子宫内膜增生临床专家系列的目标是回顾其病因和危险因素、组织学分类及亚型、恶性进展风险、预防方法，并概述手术和非手术治疗方案。子宫异常出血和绝经后出血仍然是子宫内膜病变的标志，高达10%-20%的绝经后出血将是增生或癌症；因此，应立即通过获取病理组织或影像学检查对任何异常出血进行评估。虽然任何有子宫的人都可能发生非典型增生，也称为子宫内膜上皮内瘤变（EIN），但遗传易感性（如林奇综合征）、肥胖、慢性无排卵和多囊卵巢综合征都会显著增加这些风险，而使用口服避孕药或含孕激素的宫内节育器会降低风险。未经治疗的EIN诊断伴有子宫内膜癌或最终进展为癌症的高风险。EIN的确定性和根治性治疗仍然是子宫切除术；然而，肥胖流行、保留生育功能治疗的潜在需求、对不同恶性转化率的认识、内科合并症以及人口老龄化都可能影响采用非手术治疗方式的决策。
