Precursors of Corpus Carcinoma Estrogens and Adenomatous Hyperplasia

Abstract

34 histological sections and 9 case histories comprise the case for a causal relationship between estrogen administration (e.g. diethylstilbestrol) and endometrial hyperplastic changes. A pattern of adenomatous hyperplasia of the endometrium emerges which bears constant relation in these cases to estrogen stimulation in both benign and malignant tissues. The data to support this endocrine-tumor relationship was presented in 4 groups exemplified in the accompanying figures and case histories: 1) Endometrial hyperplasia produced by granulosa cell tumors. 2) Endometrial hyperplasia produced by prolonged estrogen administration. 3) Endometrial adenocarcinoma arising in patients receiving prolonged estrogen administration. And 4) endometrial patterns in patients with recurrent episodes of functional bleeding sometimes called stilbestrol bleeding. The typical cystic glandular hyperplasia atypical (metaplastic) hyperplasia and adenocarcinoma occurred side-by-side in some sections. The multifocal processes often separated by areas of typical hyperplasia present the picture of some generally stimulated tissue which has responded more intensely in some areas. There is a characteristic pattern which constantly recurs through these tissues; it is almost papillary in form; and it shares morphological properties with other tissues known to have been stimulated by estrogens. The above pattern is identified as a type of endometrial hyperplasia which is a cancer precursor and the histological pattern suggested that endogenous or exogenous estrogens had a role in the development.