Endometrial Hyperplasia

by Carlo Raj, MD

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    00:01 Here we have endometrial hyperplasia.

    00:04 From now on, the two conditions that you want to group together include endometrial hyperplasia and endometrial carcinoma.

    00:12 The reason for that is because when it comes to prognosis and what your next step of management would be, you’d find this to be quite interesting and unfortunate.

    00:21 Endometrial hyperplasia and carcinoma, both extremely responsive to estrogen.

    00:26 So therefore, related to abnormally high, prolonged level of estrogen stimulation.

    00:33 So what might you be thinking about? You might be thinking about a lady who had early menarche, late menopause.

    00:38 Whew.

    00:39 tons of exposure to estrogen.

    00:42 What else? Maybe she ends up developing polycystic ovarian syndrome and polycystic ovarian syndrome is quite a bit of estrogen that the female is producing.

    00:52 Also, she maybe perhaps is a candidate for hormone replacement therapy.

    00:59 A hormone that in fact that you’re replacing is estrogen.

    01:01 Unfortunately, there’s every possibility that she might then develop endometrial hyperplasia/endometrial cancer.

    01:11 Detected by abnormal bleeding especially post menopausal.

    01:16 So what are you going to find? You’d do a pelvic exam and, when you do so, if you take a look at the cervical os, from the cervical os, you’d notice that there’s bleeding.

    01:24 That should clue you that perhaps your patient is suffering from endometrial hyperplasia and carcinoma.

    01:30 It is a risk factor for endometrial cancer and it’s absolutely based on a very important topic, cellular atypia.

    01:40 So what does that mean to you? If you find endometrial hyperplasia, and upon biopsy, you find that the cell here is showing normal nucleus.

    01:52 In other words, it’s not showing atypia.

    01:54 It doesn’t look “ugly.” Next step of management at this point would be followup and you always worry about whether or not this hyperplasia could move on to something more severe.

    02:06 Well, followup will be something that’s important.

    02:10 However, if there’s nuclear atypia, whoa, it changes everything.

    02:15 With endometrial hyperplasia, if upon histologic examination, you’d find nuclear atypia.

    02:21 Next step of management? Hysterectomy, okay? Completely different.

    02:28 Once again, if you don’t find nuclear atypia, maybe follow up, maybe progesterone.

    02:33 If you find nuclear atypia, because of the risk of cancer, do not joke around.

    02:39 Do not take chances.

    02:41 You have to remove the uterus.

    About the Lecture

    The lecture Endometrial Hyperplasia by Carlo Raj, MD is from the course Uterine and Fallopian Tube Disease.

    Included Quiz Questions

    1. Exposure to estrogen levels that are abnormally high relative to progesterone levels
    2. High cyclical testosterone exposure
    3. Insulin resistance
    4. Exposure to high levels of FSH/LH
    5. Exposure to progesterone levels that are abnormally high relative to estrogen levels
    1. Vaginal bleeding
    2. Severe pelvic pain
    3. Cyclical abdominal pain
    4. Clue cells on Pap smear
    5. Increased urinary frequency and palpable pelvic mass
    1. Cellular atypia
    2. Increased glandular cells
    3. Hyperplastic stroma
    4. Increased number of blood vessels
    5. Neutrophils

    Author of lecture Endometrial Hyperplasia

     Carlo Raj, MD

    Carlo Raj, MD

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