Diagnosis Of Hyperplasia Research Articles

CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease.

ObjectiveThe purpose of this study was to determine whether a CT interpretation with imaging pattern analysis differentiates Kikuchi disease (KD) from the two more frequently encountered differential lymph nodes diagnoses of tuberculous lymphadenopathy (TL) and reactive hyperplasia (RH).Materials and methodsBetween January 2012 and July 2015, 20 patients with KD (6 men, 14 women; mean age, 27.80 years), 36 patients with RH (10 men, 26 women; mean age, 33.08 years) and 34 patients with TL (17 men, 17 women; mean age, 39.82 years) were pathologically diagnosed using US-guided fine needle aspiration biopsy, core needle biopsy, or surgical excisional biopsy. We recorded the total number, location, and size of the affected cervical lymph nodes, and two radiologists reviewed the characteristic imaging findings, including the presence of necrosis, cortical enhancement pattern, perinodal infiltration, conglomeration and nodal calcification, to form a consensus. In addition, we compared two attenuation indices on the nonnecrotic portion of the affected lymph nodes, nodal cortical attenuation (NCA) and the ratio of NCA to the adjacent muscle (NCA/M).ResultsConglomeration, enhancement pattern and NCA/M values were independent predictive CT features to distinguish KD from RH. Age and enhancement pattern discriminated KD from TL. Only the mean NCA/M value was a statistically significant CT feature (p = .008) in differentiating KD from both RH+TL. The mean NCA/M of KD (1.67 ± 0.20) was significantly higher than that of RH (1.49 ± 0.20) or TL (1.47 ± 0.21).ConclusionOur results indicate that in case of nonnecrotic lymphadenopathy, a higher NCA/M index can differentiate KD from RH and TL. In addition, the enhancement pattern according to the degree of necrosis discriminated between KD and TL in the case of necrotic lymphadenopathy.

Transrectal ultrasound-guided biopsy of the prostate: Histological pattern of prostatic diseases seen in Sokoto Northwest Nigeria

Background: Transrectal prostate biopsy is an important procedure in histological confirmation of prostate diagnosis. It is not a common practice in our environment. The aim of this study is to present our experience on transrectal ultrasound-guided prostate biopsy, and to evaluate the histological pattern of prostatic diseases seen in our practice.Methods: This is a retrospective review of the data of all consecutive patients who had the procedure of transrectal ultrasound-guided biopsy of the prostate in our centre from January 2010 to December 2014. Three hundred and nineteen (319) patients with complete records were analyzed. Data were collected from patients' hospital files, and histology laboratory register. Data analysis was done with SPSS version 21.0. Descriptive statistics, and ANOVA were used to analyzed variables in the study population.Results: The ratio of cancer to benign prostatic hyperplasia (BPH) in the study was 0.80. Thirty subjects had prostatitis associated with their histological diagnosis (28 subjects with BPH, 2 subjects with cancer of the prostate), while 2 patients had schistosomiasis of the prostate with BPH. The main indication for prostate biopsy in this study was an elevated serum prostate-specific antigen (PSA) seen in 65.8% of subjects. The mean age, prostate volume and PSA in the study (n=319) was 65.7±110.10 years, 95.7±861.12mLs, and 50.2±756.43ng/mL. It was 65.34±10.54 years, 90.48±53.51mLs and 18.98±20.48ng/mL in the group with the diagnosis of nodular hyperplasia (n=177). While in those with the diagnosis of prostate cancer (n=142) it was 66.17±9.52 years, 100.77±67.66mLs and 73.86±63.20ng/mL respectively. The main presenting complaint in the study was lower urinary tract symptoms LUTS (89.7%).Conclusion: BPH and prostate cancer are the most frequently diagnosed prostatic diseases in the study environment where prostatitis is often seen co-existing with BPH. Clinicians in the study area should be aware of schistosomiasis of the prostate in patients with BPH.Keywords: prostate biopsy, transrectal ultrasound, benign prostatic hyperplasia, prostatic schistosomiasis, prostate cancer

Comparison of 99mTc-MDP SPECT qualitative vs quantitative results in patients with suspected condylar hyperplasia.

To compare qualitative vs quantitative results of Single Photon Emission Computerised Tomography (SPECT), calculated from percentage of 99mTc-MDP (methylene diphosphonate) uptake, in condyles of patients with a presumptive clinical diagnosis of condylar hyperplasia. A retrospective, descriptive study was conducted on the 99mTc-MDP SPECT bone scintigraphy reports from 51 patients, with clinical impression of facial asymmetry related to condylar hyperplasia referred by their specialist in orthodontics or maxillofacial surgery, to a nuclear medicine department in order to take this type of test. Quantitative data from 99mTc-MDP condylar uptake of each were obtained and compared with qualitative image interpretation reported by a nuclear medicine expert. The concordances between the 51 qualitative and quantitative reports results was established. The total sample included 32 women (63%) and 19 men (37%). The patient age range was 13-45 years (21±8 years). According to qualitative reports, 19 patients were positive for right side condylar hyperplasia, 12 for left side condylar hyperplasia, with 8 bilateral, and 12 negative. The quantitative reports diagnosed 16 positives for right side condylar hyperplasia, 10 for left side condylar hyperplasia, and 25 negatives. Nuclear medicine images are an important diagnostic tool, but the qualitative interpretation of the images is not as reliable as the quantitative calculation. The agreement between the two types of report is low (39.2%, Kappa=0.13; P>.2). The main limitation of quantitative reports is that they do not register bilateral condylar hyperplasia cases.

Comparison of 99mTc-MDP SPECT qualitative vs quantitative results in patients with suspected condylar hyperplasia

ObjectiveTo compare qualitative vs quantitative results of Single Photon Emission Computerised Tomography (SPECT), calculated from percentage of 99mTc-MDP (methylene diphosphonate) uptake, in condyles of patients with a possible clinical diagnosis of condylar hyperplasia. Materials and methodA retrospective, descriptive study was conducted on the 99mTc-MDP SPECT bone scintigraphy reports from 51 patients, with clinical impression of facial asymmetry related to condylar hyperplasia referred by their specialist in orthodontics or maxillofacial surgery, to a nuclear medicine department in order to take this type of test. Quantitative data from 99mTc-MDP condylar uptake of each were obtained and compared with qualitative image interpretation reported by a nuclear medicine expert. ResultsThe concordances between the 51 qualitative and quantitative reports results was established. The total sample included 32 women (63%) and 19 men (37%). The patient age range was 13–45 years (21±8 years). According to qualitative reports, 19 patients were positive for right side condylar hyperplasia, 12 for left side condylar hyperplasia, with 8 bilateral, and 12 negative. The quantitative reports diagnosed 16 positives for right side condylar hyperplasia, 10 for left side condylar hyperplasia, and 25 negatives. ConclusionsNuclear medicine images are an important diagnostic tool, but the qualitative interpretation of the images is not as reliable as the quantitative calculation. The agreement between the two types of report is low (39.2%, Kappa=0.13; p>0.2).The main limitation of quantitative reports is that they do not register bilateral condylar hyperplasia cases.

Expression of p63 Protein to Differentiate Benign Prostatic Hyperplasia and Carcinoma of Prostate in Pakistani Population

AbstractBackground: Prostate cancer is the world’s foremost and second cause of cancer associated death typically in males after lung cancer. Histopathological diagnosis of prostatic hyperplasia and prostatic carcinoma can be challenging. The expression of p63 can be used in diagnosis and differentiation of benign pro-static hyperplasia from carcinoma of prostate.Materials and Methods: We studied sixty prostatic biopsies obtained by TURP and radical prostatectomy. For each case, clinical data was collected. The tissue sections were then diagnosed on basis of routine hematoxylin and eosin. Then immunohistochemical (IHC) analysis was performed on routinely processed, forma-lin-fixed, paraffin embedded tissue. We also analyzed P63 expression in regions of benign prostatic hyperplasia and prostatic adenocarcinoma. Moreover, detailed examination of tissue sections was observed with light microscopy.Results: Mean age of patients with adenocarcinoma was 70 ± 12 years however mean age in prostate hyperplasia cases was 66 ± 8 years. With the use of Receiver Operative Characteristic Curve (ROC), the optimal cut point found of PSA was 30.0ng/ml. The results showed that prostate specific antigen (PSA) at this cutoff had a sensitivity of 71.4%, with specificity of 74.4% and accuracy of 73.3%. So PSA could not be considered reliable independently for the diagnosis of carcinoma of prostate. Benign cases in the present study were exclusively positive for immunohistoche-mical expression of p63 while all the cases of prostatic carcinomas expressed negative pattern of staining.Conclusion: Immunostaining with p63 is useful to differentiate benign prostatic hyperplasia from pro-static carcinoma, so it may be used as valuable tool in the diagnosis of prostatic carcinoma.

Reassessing risk models for atypical hyperplasia: age may not matter.

The aim of this study was to investigate the influence of age at diagnosis of atypical hyperplasia ("atypia", ductal [ADH], lobular [ALH], or severe ADH) on the risk of developing subsequent invasive breast cancer or ductal carcinoma in situ (DCIS). Using standard survival analysis methods, we retrospectively analyzed 1353 women not treated with chemoprevention among a cohort of 2370 women diagnosed with atypical hyperplasia to determine the risk relationship between age at diagnosis and subsequent breast cancer. For all atypia diagnoses combined, our cohort showed a 5-, 10-, and 15-year risk of invasive breast cancer or DCIS of 0.56, 1.25, and 1.30, respectively, with no significant difference in the (65,75] year age group. For women aged (35,75] years, we observed no significant difference in the 15-year risk of invasive breast cancer or DCIS after atypical hyperplasia, although the baseline risk for a 40-year-old woman is approximately 1/8 the risk of a 70-year-old woman. The risks associated with invasive breast cancer or DCIS for women in our cohort diagnosed with ADH, severe ADH, or ALH, regardless of age, were 7.6% (95% CI 5.9-9.3%) at 5years, 25.1% (20.7-29.2%) at 10years, and 40.1% (32.8-46.6%) at 15years. In contrast to current risk prediction models (e.g., Gail, Tyrer-Cuzick) which assume that the risk of developing breast cancer increases in relation to age at diagnosis of atypia, we found the 15-year cancer risk in our cohort was not significantly different for women between the ages of 35 (excluded) and 75. This implies that the "hits" received by the breast tissue along the "high-risk pathway" to cancer might possibly supersede other factors such as age.

Гиперпластические процессы эндометрия. Возможности коррекции натуропатическими препаратами

The article presents modern aspects of etiopathogenetic factors of endometrium hyperplastic processes. Modern data on the classification, diagnosis and therapy of endometrial hyperplasia was analyzed. The possibility of using modern naturopathic drugs «Normomens» on the basis of extracts of Vitex agnus castus, Zingiber officinale, Trigonella foenum graecum, Pyrus malus and «Normocycle» containing extracts of Symplocos racemosa, Asparagus racemosus, Glycyrrhiza glabra, Curcuma longa was theoretically substantiated in the therapy of endometrium hyperplastic processes. Key words: endometrium hyperplastic processes, Normomens, Normocycle.

Evidence of the Impact of Diet, Fluid Intake, Caffeine, Alcohol and Tobacco on Lower Urinary Tract Symptoms: A Systematic Review.

Diet, fluid intake and caffeine, alcohol and tobacco use may have effects on lower urinary tract symptoms. Constructive changes in these modifiable nonurological factors are suggested to improve lower urinary tract symptoms. To better understand the relationship between nonurological factors and lower urinary tract symptoms, we performed a systematic literature review to examine, grade and summarize reported associations between lower urinary tract symptoms and diet, fluid intake and caffeine, tobacco and alcohol use. We performed PubMed® searches for eligible articles providing evidence on associations between 1 or more nonurological factors and lower urinary tract symptoms. A modified Oxford scale was used to grade the evidence. We reviewed 111 articles addressing diet (28 studies), fluid intake (21) and caffeine (21), alcohol (26) and tobacco use (44). The evidence grade was generally low (6% level 1, 24% level 2, 11% level 3 and 59% level 4). Fluid intake and caffeine use were associated with urinary frequency and urgency in men and women. Modest alcohol use was associated with decreased likelihood of benign prostatic hyperplasia diagnosis and reduced lower urinary tract symptoms in men. Associations between lower urinary tract symptoms and ingestion of certain foods and tobacco were inconsistent. Evidence of associations between lower urinary tract symptoms and diet, fluid intake and caffeine, alcohol and tobacco use is sparse and mostly observational. However, there is evidence of associations between increased fluid and caffeine intake and urinary frequency/urgency, and between modest alcohol intake and decreased benign prostatic hyperplasia diagnosis and lower urinary tract symptoms. Given the importance of these nonurological factors in daily life, and their perceived impact on lower urinary tract symptoms, higher quality evidence is needed.

Agreement of histopathological findings of uterine curettage and hysterectomy specimens in women with abnormal uterine bleeding.

Objectives:To examined the diagnostic value of dilatation and curettage (D&C) in patients with abnormal uterine bleeding (AUB) by conducting a histopathological examination of endometrial tissues by D&C and hysterectomy.Methods:In this retrospective study, the medical records of 163 women who had been hospitalized in the Obstetrics and Gynecology Ward, Amir-al-Momenin Hospital, Semnan, Iran between 2010 and 2015 for diagnostic curettage due to AUB and who had undergone hysterectomy were investigated. The patients’ characteristics and histopathologic results of curettage and hysterectomy were extracted, and sensitivity and specificity and positive and negative predictive values of curettage were calculated.Results:The mean ± standard deviation age of the patients was 49.8±7.8 years. The sensitivity values of D&C in the diagnosis of endometrial pathologies was 49.1%, specificity 84.5%, positive 60.5%, and negative predictive 77.5%. The sensitivities of D&C in the diagnosis of various endometrial hyperplasia was 62.5%, disordered proliferative endometrium 36.8%, and endometrial cancer 83.3%. Of 6 patients with endometrial polyps on performing hysterectomy, no patient was diagnosed by curettage.Conclusions:Dilatation and curettage has acceptable sensitivity in the diagnosis of endometrial cancer, low sensitivity in the diagnosis of endometrial hyperplasia, and very low sensitivity in the diagnosis of disordered proliferative endometrium and endometrial polyps.

Abnormal Uterine Bleeding Is Associated With Increased BMP7 Expression in Human Endometrium.

Abnormal uterine bleeding (AUB), a common health concern of women, is a heterogeneous clinical entity that is traditionally categorized into organic and nonorganic causes. Despite varied pharmacologic treatments, few offer sustained efficacy, as most are empiric, unfocused, and do not directly address underlying dysregulated molecular mechanisms. Characterization of such molecular derangements affords the opportunity to develop and use novel, more successful treatments for AUB. Given its implication in other organ systems, we hypothesized that bone morphogenetic protein (BMP) expression is altered in patients with AUB and hence comprehensively investigated dysregulation of BMP signaling pathways by systematically screening 489 samples from 365 patients for differences in the expression of BMP2, 4, 6, and 7 ligands, BMPR1A and B receptors, and downstream SMAD4, 6, and 7 proteins. Expression analysis was correlated clinically with data abstracted from medical records, including bleeding history, age at procedure, ethnicity, body mass index, hormone treatment, and histological diagnosis of fibroids, polyps, adenomyosis, hyperplasia, and cancer. Expression of BMP7 ligand was significantly increased in patients with AUB (H-score: 18.0 vs 26.7; P < .0001). Patients reporting heavy menstrual bleeding (menorrhagia) as their specific AUB pattern demonstrated significantly higher BMP7 expression. Significantly, no differences in the expression of any other BMP ligands, receptors, or SMAD proteins were observed in this large patient cohort. However, expression of BMPR1A, BMPR1B, and SMAD4 was significantly decreased in cancer compared to benign samples. Our study demonstrates that BMP7 is a promising target for future investigation and pharmacologic treatment of AUB.

Heterogeneity in esophageal and gastric cardia precursor progression during six-year endoscopic surveillance after population-based screening in a Chinese high-risk region.

BackgroundThe study was conducted to examine esophageal and gastric cardia precursor progression.MethodsAfter population‐based baseline screening, 145 precursor and 335 chronic inflammation cases were endoscopically surveyed for six years.ResultsSurveillance of interval and baseline diagnoses for 18 severe dysplasia (SD) cases later detected were: 13, 23, 39, and 44 months since a diagnosis of chronic inflammation in four cases; 6, 6, 6, 11, 13, 16, 16, and 23 months since mild dysplasia (mD) diagnoses in eight; and 6, 9, 10, 13, 18, and 48 months since moderate dysplasia (MD) diagnoses in six. Rates for 11 carcinoma in situ (Cis) cases later detected were: 7 and 18 months since basal cell hyperplasia (Bch) diagnoses in two; and 6, 6, 9, 13, 13, 18, 35, 44, and 50 months since MD diagnoses in nine. In 10 cancer cases later detected, rates were: 6, 6, 7, 18, 19, 34, 36, and 48 months since SD diagnoses in eight cases with submucosal carcinoma; 46 months since MD diagnosis in a T 2 N 0 M 0 carcinoma case; and 52 months since Bch diagnosis in another T 2 N 0 M 0 case.ConclusionEsophageal and gastric cardia precursors are heterogeneous. Male gender, advanced age, family history of upper gastrointestinal cancer, and multifocal dysplasia are significant independent predictors for progression, and Bch/mD, MD, and SD constitute three distinctive entities regarding the risk of cancer.

The validity of SPECT/CT in diagnosis of condylar hyperplasia

PurposeTo study the diagnostic validity of hybrid single photon emission computed tomography (SPECT) integrated with multidetector computed tomography (SPECT/CT) in diagnosis of condylar hyperplasia (CH). Subjects and methods20 patients with suspected CH underwent SPECT/CT were studied during the period from August 2015 to January 2017. ResultsIncreased bone activity was noted in the affected condyles for all CH patients. The relative percentage uptake on the affected side was significantly higher than the uptake on the contralateral side (56.9±5.35 vs 43±2.6%, P<0.0001). Also, the condyle to clivus ratio on the affected side was significantly higher than that on contralateral side (1.64±0.27 vs 1.31±0.10, P=0.0001). The diagnostic performance of SPECT/CT in diagnosis of CH was demonstrated as a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 85.7%, 100%, 100%, 75%, and 90% respectively. Analyses of the relative percentage uptake, radiotracer uptake ratio and condyle to clivus ratio were calculated with a cutoff values of <53%, >1.11 and <1.4 respectively, giving a 100% sensitivity and 100% specificity for detecting the hyperactivity in mandibular condyle. ConclusionSPECT/CT had a high diagnostic validity in assessment of CH and can provide a reference for treatment options.

Correlation between single photon emission computed tomography and histopathologic findings in condylar hyperplasia of the temporomandibular joint

PurposeTo analyse the correlation between the level of activity measured in the single photon emission computed tomography (SPECT) and the pathological findings in patients with condylar hyperplasia (CH). Materials and methodsAll patients evaluated in our department between 2007 and 2014 with a diagnosis of condylar hyperplasia who had undergone SPECT, evidenced signs of activity, and had undergone surgery were included. We included 28 patients, of whom 20 were women and 8 men. ResultsThe male:female ratio was 2,5:1. The mean age of the subjects was 24.4 years at the time of diagnosis (with a range between 14 and 42 years). In 19 cases the affected condyle was the right, and in the remaining 9 it was the left (ratio R:L 2,1:1). On the SPECT, in 16 patients a high level of activity was identified (57.1%) and in the remaining 12 a low level (42.9%). Only 13 patients (6 in the low-activity group and 7 in the high-activity group) presented with islands of cartilage. When comparing the results between the two groups, the main differences were observed in the parameters related to the islands of cartilage. These were more frequent in the group with high activity compared with low activity (5.5 versus 0 per mm2 of median). Besides being more frequent, these islands were larger (more than double) in the high-activity group (385.1 μm versus 169.7 μm of median). This is the only statistically significant difference found, a fact that can be explained by the small sample size in the study. ConclusionRadioisotope tests are the best indicator of the level of activity in condylar hyperplasia, which seems to be directly related to the intensity signal collection.

Diagnosis and treatment of unilateral condylar hyperplasia

Diagnosis and treatment of unilateral condylar hyperplasia

Expression change of serum total prostate specific antigen with age and its significance in differential diagnosis of prostate cancer

Objective To evaluate the changes of serum total prostate specific antigen (TPSA) with age and its significance in differential diagnosis of prostate cancer (PCa) and prostatic hyperplasia (BPH). Methods TPSA and free prostate specific antigen (FPSA) in 146 cases of PCa, 108 cases of BPH and 210 cases of healthy subjects were detected by electrochemiluminescence. Results There was a positive correlation between age and serum TPSA level (r = 0.265, P < 0.01). The levels of TPSA in PCa and BPH groups were (85.40±56.70) μg/L and (7.90±7.00) μg/L, and the difference was statistically significant (t = 8.310, P = 0.001); FPSA levels were (5.16±4.90) μg/L, (1.50±1.36) μg/L, and the difference was statistically significant (t = 3.152, P = 0.030). In patients with TPSA levels ranging from 4.0 to 20.0 μg/L (diagnostic gray zone), the levels of TPSA in PCa and BPH groups were (8.82±4.01) μg/L and (8.41±3.95) μg/L, and the difference had no statistical significance (t = 0.198, P = 0.256); The levels of FPSA were (1.18±0.91) μg/L and (2.32±1.20) μg/L, the ratio of FPSA/TPSA were 0.12±0.08 and 0.24±0.23, and the differences were statistically significant (t = 23.56, P = 0.020; t = 32.45, P = 0.006). When FPSA/TPSA ratio was 0.16, its sensitivity and specificity for PCa were 84.4 % and 79.8 %, respectively. Conclusions Serum TPSA levels vary with age, and 95 % of all age groups should be used as the medical criterion to improve the specificity and accuracy of PSA in diagnosing with PCa. The ratio of FPSA/TPSA has a significant clinical value in differential diagnosis of PCa and BPH in patients with TPSA in diagnostic gray zone. Key words: Prostate specific antigen; Reference value; Diagnostic grey zone; Diagnosis, differential

Giant nodular pseudoangiomatous stromal hyperplasia of the breast with fbroadenomatoid myxoid changes: a potential pitfall in the differential diagnosis of phyllodes tumor

ABSTRACT A 21-year old woman presented with a 17-cm left breast mass. Physical examination and ultrasound revealed the mass to be well-circumscribed, homogeneous and freely mobile, suggestive of giant fibroadenoma or phyllodes tumor. The mass was surgically excised and initially interpreted as benign phyllodes tumor. Subsequent slide review established the diagnosis of nodular pseudoangiomatous stromal hyperplasia (PASH) associated with fibroadenomatoid areas and myxoid stromal changes. This case illustrates the difficulty encountered in recognizing nodular PASH. A thorough discussion of the histopathologic differential diagnosis of nodular PASH is provided.

上顎前歯部歯槽に生じた骨軟骨腫の1例

An 84-year-old woman visited our department because of a mass in the alveolus of the anterior maxilla. The lesion was pedunculated, measuring 11 × 10 mm, and hard in consistency. A dental radiogram revealed a radiopaque core, which was connected to underlying alveolar bone. Under a clinical diagnosis of fibrous hyperplasia with bone formation, the lesion was excised by cutting its pedicle with a bone chisel, and the underlying bone was smoothed with a bur under local anesthesia. Pathological examination demonstrated the formation of bone, which was covered by cartilage in the submucosal connective tissue, and osteochondroma was diagnosed. There has been no recurrence as of 3 years 4 months after the operation.

An audit of endometrial hyperplasias at the Lagos University Teaching Hospital.

There has been much controversy and confusion surrounding the endometrial hyperplasias stemming from the use of a wide variety of terminologies and also from the pathophysiologic mechanisms underlying the various entities. The current classification by the World Health Organization (WHO) published in 2014 clarifies these issues. The aim of this study, therefore, was to audit and standardize cases of endometrial hyperplasia diagnosed in our institution from 2007 to 2011. The slides and request forms of cases diagnosed as endometrial hyperplasias at the Department of Anatomic and Molecular Pathology from January 1, 2007, to December 31, 2011 were retrieved, reviewed, and reported according to the WHO 2014 classification scheme. Hyperplasia without atypia accounted for the vast majority of cases (95.5%) and was the most common in the 5th decade. Concordance rates of 74.5% and 100% were found between endometrial hyperplasias without atypia and atypical hyperplasias with their previous diagnoses, respectively. The WHO classification scheme standardizes and simplifies the terminology used in the diagnosis of endometrial hyperplasias, while reflecting, at the same time, the current understanding of genetic changes that provide information necessary for prognostication and treatment.

New concepts for an old problem: the diagnosis of endometrial hyperplasia.

BACKGROUNDEndometrial hyperplasia (EH) is a uterine pathology representing a spectrum of morphological endometrial alterations. It is predominantly characterized by an increase in the endometrial gland-to-stroma ratio when compared to normal proliferative endometrium. The clinical significance of EH lies in the associated risk of progression to endometrioid endometrial cancer (EC) and ‘atypical’ forms of EH are regarded as premalignant lesions. Traditional histopathological classification systems for EH exhibit wide and varying degrees of diagnostic reproducibility and, as a consequence, standardized patient management can be challenging.OBJECTIVE AND RATIONALEEC is the most common gynaecological malignancy in developed countries. The incidence of EC is rising, with alarming increases described in the 40–44-year-old age group. This review appraises the current EH classification systems used to stratify women at risk of malignant progression to EC. In addition, we summarize the evidence base regarding the use of immunohistochemical biomarkers for EH and discuss an emerging role for genomic analysis.SEARCH METHODSPubMed, Medline and the Cochrane Database were searched for original peer-reviewed primary and review articles, from January 2000 to January 2016. The following search terms were used: ‘endometrial hyperplasia’, ‘endometrial intraepithelial neoplasia’, ‘atypical hyperplasia’, ‘complex atypical hyperplasia’, ‘biomarker’, ‘immunohistochemistry’, ‘progression’, ‘genomic’, ‘classification’ and ‘stratification’.OUTCOMESRecent changes to EH classification reflect our current understanding of the genesis of endometrioid ECs. The concept of endometrial intraepithelial neoplasia (EIN) as a mutationally activated, monoclonal pre-malignancy represents a fundamental shift from the previously held notion that unopposed oestrogenic stimulation causes ever-increasing hyperplastic proliferation, with accumulating cytological atypia that imperceptibly leads to the development of endometrioid EC. Our review highlights several key biomarker candidates that have been described as both diagnostic tools for EH and markers of progression to EC. We propose that, moving forwards, a ‘panel’ approach of combinations of the immunohistochemical biomarkers described in this review may be more informative since no single candidate can currently fill the entire role.WIDER IMPLICATIONSEC has historically been considered a predominantly postmenopausal disease. Owing in part to the current unprecedented rates of obesity, we are starting to see signs of a shift towards a rising incidence of EC amongst pre- and peri-menopausal woman. This creates unique challenges both diagnostically and therapeutically. Furthering our understanding of the premalignant stages of EC development will allow us to pursue earlier diagnosis and facilitate appropriate stratification of women at risk of developing EC, permitting timely and appropriate therapeutic interventions.

Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?

In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. Retrospective cross-sectional study. A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively.