• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.5935-5939
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• 2013

Our study is to determine the presence of endometrial intraepithelial neoplasia (EIN) in endometrial biopsy specimens classified by the 1994 World Health Organization (WHO) criteria for endometrial hyperplasia. Endometrial biopsy specimens that were stained with hematoxylin and eosin (HE) were examined and categorized by the WHO 1994 criteria and for the presence of EIN as defined by the International Endometrial Collaborative Group. ${\beta}$-catenin expression was examined by immunohistochemistry. A total of 474 cases of HE stained endometrial biopsy tissues were reviewed. There were 379 cases of simple endometrial hyperplasia, 16 with simple atypical endometrial hyperplasia, 48 with complex endometrial hyperplasia, and 31 with complex atypical endometrial hyperplasia. Among the 474 endometrial hyperplasia cases, there were 46 (9.7%) that were classified as EIN. Of these 46 cases, 11(2.9%) were classified as simple endometrial hyperplasia, 1 (6.3%) as simple atypical endometrial hyperplasia, 6 (12.5%) as complex endometrial hyperplasia, and 28 (90.3%) as complex atypical endometrial hyperplasia. EIN was associated with a higher rate of ${\beta}$-catenin positivity than endometrium classified as benign hyperplasia (72% vs. 22.5%, respectively, P<0.001), but a lower rate than endometrial adenocarcinoma (72% vs. 96.2%, respectively, P<0.001). In benign endometrial hyperplasia, high ${\beta}$-catenin expression was noted in the cell membranes, whereas in EIN and endometrial adenocarcinoma high expression was noted in the cytoplasm. In conclusion, EIN is more accurate than the WHO classification for the diagnosis of precancerous lesions of the endometrium.

• Clinical and Experimental Reproductive Medicine
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• v.38 no.1
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• pp.42-46
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• 2011

Objective: This study was aimed to investigate endometrial histology and to find predictable clinical factors for endometrial disease (hyperplasia or cancer) in women with polycystic ovary syndrome (PCOS). Methods: We investigated the endometrial histology and analyzed the relationship between endometrial histology and clinical parameters, such as LH, FSH, estradiol, testosterone, fasting and 2 hours postprandial glucose and insulin, insulin resistance, body mass index, endometrial thickness, menstrual status from 117 women with PCOS. Statistical analysis was performed with chi square and t-test, p-value<0.05 was considered as statistically significant. And receiver operating characteristic curve was used to find predictable clinical factors for endometrial disease and to decide the cuff off values. Results: In 117 women with PCOS, endometrial histologic profiles are as follows: proliferative phase in 90 women (76.9%), endometrial hyperplasia in 25 women (21.4%), and endometrial cancer in 2 women (1.7%). Of 25 women with endometrial hyperplasia, simple hyperplasia without atypia, complex hyperplasia without atypia and complex hyperplasia with atypia were diagnosed in 15 (12.8%), 6 (5.1%), 4 (3.4%) women, respectively. Age and endometrial thickness were significantly related with endometrial disease, p=0.013 and p=0.001, respectively. At the cut off level of 25.5 years in age, sensitivity and specificity predicting for endometrial disease were 70.4% and 55.6%, respectively (p=0.023). At the cut off level of 8.5 mm in endometrial thickness, sensitivity and specificity were 77.8% and 56.7%, respectively (p=0.000). Conclusion: In women with PCOS, the incidence of endometrial hyperplasia and cancer were 21.4% and 1.7%. The age and endometrial thickness may be used as clinical determining factors for endometrial biopsy.

• The Korean Journal of Cytopathology
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• v.11 no.1
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• pp.1-10
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• 2000

The purpose of this study is to describe the cellular characteristics of endometrial hyperplasia without/with atypia in cervical smears. These cellular features were compared with those of normal endometrium and endometrial carcinoma. We reviewed 265 cervical smears : 64 normal proliferative endometrium, 118 endometrial hyperplasia without atypia, 21 endometrial hyperplasia with atypia, and 62 endometrial adenocarcinoma. Of these smears, 72(27.2%) smears which had diagnostic endometrial epithelial cells were selected for this study. The cytologic abnormalities about cellularity, background, changes in cellular architecture, alterations in nuclear size, anisokaryosis, chromatin pattern, nucleoli, cytoplasmic vacuoles, and mitosis were observed. Nuclear enlargement(1.6 to 2 times of the nucleus in the intermediate squamous cell) and anisokaryosis(${\geq}$2 fold in size variation) were highly suggestive of endometrial hyperplasia without/with atypia. The nuclei from endometrial hyperplasia with atypia were more coarsely granular in chromatin patterns than hyperplasia without atypia(33.3% vs 3.4%). Micronucleoli were observed in all endometrial conditions, but the presence of macronucleoli were more suggestive of hyperplasia with atypia(22.2%) and adenocarcinoma(55%). The changes in cellular architecture(loss of polarity, uneven internuclear distance, overlapping and loose arrangement) were seen in hyperplasia with atypia and adenocarcinoma. Characteristically, bloody background was seen in endometrial hyperpiasia, and cellular detritus or granular proteinaceous material was only observed in endometrial adenocarcinoma. Mitoses were also observed in adenocarcinoma. In conclusion, although there is no single parameter useful for the cytologic differential diagnosis of endometrial lesions, combined cytologic evaluation can be used to diagnose hyperplasia cytologically.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.6121-6125
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• 2013

Background: Endometrial cancers are the most common gynecologic cancers. Endometrial sampling is a preferred procedure for diagnosis of the endometrial pathology. It is performed routinely in many clinics prior to surgery in order to exclude an endometrial malignancy. We aimed to investigate the accuracy of endometrial sampling in the diagnosis of endometrial pathologies and which findings need intra-operative frozen sections. Materials and Methods: Three hundred nine women applying to a university hospital and undergoing endometrial sampling and hysterectomy between 2010 and 2012 were included to this retrospective study. Data were retrieved from patient files and pathology archives. Results: There was 17 patients with malignancy but endometrial sampling could detect this in only 10 of them. The endometrial sampling sensitivity and specificity of detecting cancer were 58.8% and 100%, with negative and positive predictive values of 97.6%, and 100%, respectively. In 7 patients, the endometrial sampling failed to detect malignancy; 4 of these patients had a preoperative diagnosis of complex atypical endometrial hyperplasia and 2 patients had a post-menopausal endometrial polyps and 1 with simple endometrial hyperplasia. Conclusions: There is an increased risk of malignancy in post-menopausal women especially with endometrial polyps and complex atypia hyperplasia. Endometrial sampling is a good choice for the diagnosis of endometrial pathologies. However, the diagnosis should be confirmed by frozen section in patients with post-menopausal endometrial polyps and complex atypia hyperplasia.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3737-3740
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• 2014

Background: Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia. Materials and Methods: A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test. Results: Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy. Conclusions: The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5423-5425
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• 2014

Purpose: To evaluate the risk factors for endometrial hyperplasia concomitant endometrial polyps in pre- and post-menopausal women. Materials and Methods: A total of 203 patients undergoing endometrial sampling before hysterectomy were evaluated in this retrospective study. Data recorded were age, gravidity, parity, body mass index (BMI: weight(kg)/$height(m)^2$), endometrial thickness (ET), menopausal status, presence of adenomyosis and diabetes mellitus. Results: Endometrial hyperplasia and polyps were detected in 13 patients. There were statistically significant differences in terms of age, menopausal status, morbid obesity and diabetes mellitus (p<0.005). Logistic regression demonstrated that menopausal status and presence of diabetes mellitus were independent risk factors. Conclusions: According to the current study; menopause and diabetes mellitus are strong risk factors for the presence of concomitant endometrial polyps and endometrial hyperplasia.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1689-1692
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• 2014

Background: An easy, reproducible and simple marker is needed to estimate phase of endometrial pathologic lesions such as hyperplasia and endometrial cancer and distinguish from pathologically normal results. We here aimed to clarify associations among neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. Materials and Methods: Patients (n=161) who were admitted with abnormal uterine bleeding and the presence of endometrial cells on cervical cytology or thick endometrium were investigated. The study constituted of three groups according to pathologic diagnosis. Group 1 included endometrial precancerous lesions like hyperplasia (n=63), group 2 included endometrial cancerous lesions (n=38) and group 3 was a pathologically normal group (n=60). Blood samples were obtained just before the curettage procedure and the NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count; similarly, PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. Results: The white blood cell count was significantly higher in patients with cancer than in those with hyperplasia (p=0.005). The platelet count and neutrophil to lymphocyte ratio were significantly higher in patients with cancer than in control patients, but there was significantly no difference between patients with hyperplasia and other groups (p=0.001 and p=0.025 respectively). PLR was significantly lower in control subjects than in other groups (p<0.001), but there was no significant difference between patients with hyperplasia and those with cancer. Conclusions: PLR was significantly lower in control subjects than in other groups. Thus both hyperplasia and cancer may be differentiated from pathologically normal patients by using PLR. White blood cell count was significantly higher in patients with cancer than in those with hyperplasia and pathologically normal patients. Therefore white blood cell count may be used for discriminate hyperplasia to cancer. By using multiple inflammation parameters, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients.

• Korean Journal of Veterinary Pathology
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• v.1 no.2
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• pp.149-152
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• 1997

A 13-years and 8-months old Jindo dog showed vomiting and pale red vulvular discharge. At necropsy, the uterus was swollen and endometrium was diffusely thickened by numerous protruding cysts which measured approximately from 0.5 to 1 cm in diameter. On sectioning the cysts exuded pale red watery fluid. histologically the endometrium was thickened and characterized by mild to moderate edema congestion and hemorrhagic foci. The cystic endometrial glands were lined by a single layer of flattened cuboidal or vacuolated columnar epithelium. Occasional dilated glands had traversed through the submucosa into the myometrial region. Afew mixed inflammatory cells infiltrated in the lamina propria. Bacteriologically Escherichia coli was isolated from the uterine contents. Gross and microscopic finding were consistent with cystic endometrial hyperplasia.

• The Journal of Korean Obstetrics and Gynecology
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• v.34 no.3
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• pp.96-113
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• 2021

Objectives: The purpose of this study is to analyze the effectiveness of herbal medicine that are used for endometrial hyperplasia. Methods: We searched on three databases [PubMed, China national knowledge infrastructure (CNKI), and Oriental medicine advanced searching integrated system (OASIS)] with keywords for Endometrial hyperplasia(English, Korean, and Chinese) and evaluated the risk of bias. Meta-analysis was performed on the selected studies. Results: 15 RCTs were finally selected. According to the analysis, Most of the participants were endometrial hyperplasia without atypia. And the combined therapeutic effects of hormonal medicine and herbal medicine were statistically significant (RR 1.21 [95% CI 1.15, 1.28], P<0.00001), The endometrial thickness tended to be thinner when treated combined therapy. And they also showed improvement on levels of pictorial blood assessment chart (PBAC) and hemoglobin. Also, the therapeutic effects of herbal medicine can be identified as similar to Western medicine, and no superior effects have been confirmed (RR 1.05 [95% CI 0.87, 1.28], P=0.60). Conclusion: The combination Western and herbal medicine was more effective than Western medicine alone treated for endometrial hyperplasia without atypia. Moreover there were also significant improvements in endometrial thickness, PBAC and hemoglobin levels.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.1
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• pp.195-198
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• 2014

Aim: To evaluate precancerous lesions such as hyperplasia and endometrial polyps in obese postmenopausal women. Materials and Methods: Women who were referred with abnormal uterine bleeding in postmenopausal period or the presence of endometrial cells on cervical cytology in our department were investigated. Anthropometric measurements such as height, weight, body mass index, waist/hip ratio and endometrial thickness were compared between a precancerous lesion (hyperplasia and endometrial polyp) group and a pathologically normal group. Results: We detected statistically significant thickening of endometrium in patients with precancerous lesions. Moreover patients with precancerous lesions had higher body mass index than the pathologically normal group. Conclusions: We found elevated precancerous lesion rates in overweight and obese women in the postmenopausal period, of interest given that the prevalence of obesity is increasing in most parts of the world. Although screening for endometrial cancer is not recommended for the general population, in high-risk populations like obese postmenopausal women, it may be very important.