Carcinoma in situ of the endometrium

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Carcinoma in situ of the endometrium is the name applied to a complex hyperplastic glandular pattern in the endometrium also labeled atypical hyperplasia or adenomatous hyperplasia. When these latter names are applied they are usually modified by “severe” or “marked.” This lesion is often followed by or accompanies definite adenocarcinoma. Indeed, the terms are sometimes applied to lesions already carcinoma!There is an accumulation of evidence to suggest that endometrial carcinoma is preceded by changes atypical for the normal menstrual cycle. Such changes may be general or focal. There is no proof that carcinoma may appear suddenly in an absolutely normal endometrium. Indeed, we have never observed carcinoma to arise from normal endometrium. There is evidence to suggest there has been some prior abnormality and so, the carcinoma may well have arisen in such a focus.Only rarely is cystic hyperplasia followed by carcinoma. The more complex the hyperplastic pattern the greater is the likelihood of subsequent adenocarcinoma.The role of estrogen in the development of endometrial carcinoma is obscure. That hyperplasia of sequential patterns, carcinoma in situ and adenocarcinoma may be produced in rabbits by estrogen has been shown: methylcholanthrene may produce similar results. Only on rare occasions does estrogen seem definitely at fault in the human. Many patients take estrogens for a considerable time without ill effect.Management of the patient with carcinoma in situ has been modified with knowledge of the synthetic progestins and clomiphene citrate. It is known that hysterectomy will cure carcinoma in situ but many of the pateints present as infertility problems so a less final form of therapy should be attempted.In general, the interpretation of the many changes within the spectrum bridging the obviously normal and obviously malignant requires human judgment based upon experience. It is logical to expect that the interpretation of preinvasive changes will show great variation from pathologist to pathologist. Even the same pathologist may not always be consistent in viewing the same specimen at different times. Hence, it is small wonder that there is so much confusion over nomenclature, criteria and even validity itself of carcinoma in situ as an entity.