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.”
First line treatment for patients with endometrial hyperplasia
without atypia is progestin therapy.
02:03
Medical or surgical treatment is now considered superior for most cases
excluding those with a very low risk of progression to endometrial carcinoma,
such as a premenopausal patient.
02:15
However,
if there’s nuclear atypia,
whoa, it changes everything.
02:20
With endometrial hyperplasia,
if upon histologic examination,
you’d find nuclear atypia.
02:26
Next step of management?
Hysterectomy, okay?
Completely different.
02:33
In some select patients that have endometrial hyperplasia with atypia,
but are still wanting to become pregnant, progestin therapy
and very close follow-up are an acceptable option.
02:43
Once again, if you don’t
find nuclear atypia,
maybe follow up,
maybe progesterone.
02:48
If you find nuclear atypia,
because of the risk of
cancer, do not joke around.
02:54
Do not take chances.