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Case 22 - A 40-Year-Old G0 Woman with Endometrial Intraepithelial Neoplasia Desiring Hysterectomy
- By Katherine M. Smith
Edited by Todd R. Jenkins, University of Alabama, Birmingham, Lisa Keder, Abimola Famuyide, Kimberly S. Gecsi, David Chelmow
Book:

Surgical Gynecology

Published online:

19 November 2021

Print publication:

02 December 2021, pp 61-63
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Summary

A 40-year-old nulligravid woman last menstrual period 15 weeks ago presents with irregular menstrual bleeding. Upon questioning, she has had irregular cycles for the last 20 years. She has never taken any hormonal medication to regulate her bleeding. She has never been pregnant despite not using contraception since age 21. You perform an endometrial biopsy and the pathologic diagnosis is endometrial intraepithelial neoplasia (EIN). She does not desire future fertility. Her past medical history is significant for hypertension and morbid obesity. She was recently diagnosed with diabetes and has adjusted her diet to try and control her blood sugar. She requests to have a hysterectomy for treatment of her irregular menses. She denies any significant family history of breast, ovarian, or colon cancer. She has no past surgical history. She is currently taking hydrochlorothiazide 25 mg PO daily and has no known drug allergies.

2 - Basic pathology of gynaecological cancer
- By Raji Ganesan, Birmingham Women’s Healthcare NHS Trust
Edited by Nigel Acheson, David Luesley
Book:

Gynaecological Oncology for the MRCOG and Beyond

Published online:

05 August 2014

Print publication:

01 January 2011, pp 15-34
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Summary

This chapter describes the salient features that would enable the gynaecologist to aid and understand the pathologist in examination of specimens removed for diagnosis and definitive surgery for gynaecological cancers. Cervical intraepithelial neoplasia (CIN) is the term used to describe proliferative intraepithelial squamous lesions that display abnormal maturation and cytonuclear atypia. The diagnosis of endometrial hyperplasia has been shown to be an area of gynaecological pathology with low diagnostic reproducibility. Mixed tumours of the uterus contain a mixture of glands and mesenchymal tissue: müllerian adenomyomas, including adenomyoma of endocervical type, typical adenomyomas of endometrioid type, atypical polypoid adenomyoma. There are three main groups of primary ovarian tumours: epithelial tumours that are derived from müllerian epithelium; sex-cord or stromal tumours, derived from the ovarian stroma, sex-cord derivatives or both; and germ cell tumours, which originate from the ovarian germ cells.

18 - Endometrial cancer: prevention, screening, and early detection
from Part IV - Cancer prevention
- By Ellen Sakornbut, University of Iowa
Edited by Jo Ann Rosenfeld, The Johns Hopkins University
Book:

Women's Health in Mid-Life

Published online:

21 August 2009

Print publication:

25 March 2004, pp 293-310
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Summary

Endometrial carcinoma is one of the most common cancers in women, with an incidence of 2.6%. This chapter examines the effects of the woman's hormonal environment on the development of endometrial hyperplasia and endometrial carcinoma, additional risk factors, and preventive measures for this common malignancy. When hormonetherapy consisted of unopposed estrogen, a higher incidence of endometrial hyperplasia and carcinoma was found in women on this therapy compared with non-treated women. A systematic review of randomized controlled trials found unopposed estrogen therapy in moderate to high doses to be associated with significant increases in rates of endometrial hyperplasia. The risk of endometrial carcinoma in complex atypical hyperplasia is approximately 25%, and warrants surgical management with hysterectomy and salpingoophorectomy. The accuracy of endometrial biopsy as compared with dilation and curettage in detection of endometrial carcinoma ranges from 91 to 99.6% with sampling devices such as the Pipelle.