Diagnosis Of Hyperplasia Research Articles

Outcomes of Treatment for Endometrial Hyperplasia in Women Younger Than Age 35 Years

INTRODUCTION: The objective of this study was to describe treatment outcomes in young women with endometrial hyperplasia. METHODS: A retrospective cohort study of women younger than 35 years with a biopsy diagnosis of endometrial hyperplasia was performed. Demographics, treatment, and histopathology were compared. The institutional review board at the University of Southern California approved this protocol. RESULTS: Two hundred twenty-three patients were identified: 70 atypical and 153 nonatypical endometrial hyperplasia. Mean age was 29.9±4.1 years, and mean body mass index was 40.1±10.5 kg/m2. There was no difference between groups in age, body mass index, gravidity, or parity. Women with atypical endometrial hyperplasia were more likely to have diabetes (25.7% compared with 13.7%, P=.037) and to have a thicker endometrium on ultrasound examination (15.2 mm compared with 12.1 mm, P=.03). Forty-six (20.6%) women had one biopsy and were lost to follow-up. For women managed nonsurgically, the median number of biopsies was four (range one to 22) and the mean follow-up was 24.1±23.3 months. The most common treatment was systemic progestin therapy (75.6%). Among women treated for nonatypical endometrial hyperplasia, the most recent biopsy was benign in 64 of 102 (62.7%), nonatypical in 24.5%, atypical in 11.8%, and cancer in 1.0%. Among women treated for atypical endometrial hyperplasia, the most recent biopsy was benign in 30 of 56 (53.6%), nonatypical in 19.6%, atypical in 17.9%, and cancer in 8.9%. CONCLUSIONS: After 2 years of treatment, nonatypical endometrial hyperplasia rarely progresses to cancer, but 11.8% progress to atypical endometrial hyperplasia. Atypical endometrial hyperplasia progresses to cancer in 8.9% of patients despite treatment. A high lost-to-follow-up rate highlights the need for aggressive counseling and outreach in this high-risk population.

Predictive Value of Gastrin Levels for the Diagnosis of Gastric Enterochromaffin-Like Cell Hyperplasia in Patients with Hashimoto's Thyroiditis

Aim: Gastrin and chromogranin A (CgA) levels have been tested for the diagnosis of enterochromaffin-like cell hyperplasia (ECLH) in patients with type 1 diabetes and autoimmune atrophic gastritis but not for patients with Hashimoto's thyroiditis (HT). The aim of the study was to develop receiver operating characteristic (ROC) curves for gastrin and CgA levels and other clinical and biochemical parameters, as means for pretest probability of gastric ECLH in patients with HT. Methods: A total of 115 patients with HT were prospectively studied for a median period of 4 (2-7) years. Gastrin, CgA, vitamin B₁₂, anti-parietal cell antibodies, free thyroxine, thyrotropin, and neuron-specific enolase levels were measured. Their predictive values were calculated according to the histological findings for ECLH diagnosis from esophagogastroduodenoscopy-obtained biopsies. Results: Thirteen patients (11.3%) had ECLH. The areas under the curve for gastrin and CgA level were 0.898 (p < 0.001) and 0.853 (p < 0.001), respectively. The product sensitivity × specificity was 0.803 and 0.653 for gastrin and CgA levels >89.5 and >89.1 ng/ml, respectively. Two and 4 patients with ECLH had normal gastrin and CgA levels, respectively. The most specific combined parameters predicting ECLH were gastrin >89.5 ng/ml with concomitant low B₁₂ levels (96.1% specificity). Conclusion: Gastrin levels have high diagnostic accuracy for ECLH identification in patients with HT, and are highly specific when combined with low B₁₂ levels. However, they should be interpreted with caution, as some patients may harbor gastric ECLH even if gastrin levels are not increased, necessitating further follow-up.

Diagnosis and Management of Endometrial Hyperplasia

Diagnosis and Management of Endometrial Hyperplasia

Diagnosis and Management of Endometrial Hyperplasia

Postgraduate Obstetrics & Gynecology 34(7):p 5-6, April 15, 2014. | DOI: 10.1097/01.PGO.0000445187.40810.36

Mammary diffuse fibroadenomatoid hyperplasia in water buffalo (Bubalus bubalis): three cases

The current report describes 3 rare cases of mammary diffuse fibroadenomatoid hyperplasia in water buffalo (Bubalus bubalis). All of the animals were between 10 and 12 months of age. Grossly, the lesions consisted of severe diffuse swelling with homogeneous large masses in the udder. Surgical removal of the masses was curative. Microscopically, there was severe hyperplasia of the mammary epithelium and numerous well-differentiated and mildly pleomorphic acini and their associated ducts. Moderate proliferation of the fibrous connective tissue and the myoepithelial cells near the proliferating acini was also evident. The hyperplastic epithelial cells exhibited positive immunostaining for cytokeratin, estrogen receptors, and progesterone receptors. In addition, the myoepithelial cells displayed moderate positivity for alpha smooth muscle actin. Based on the clinical, morphologic, and immunohistochemical findings, a diagnosis of mammary diffuse fibroadenomatoid hyperplasia with probable hormonal influence was made.

Hyperplasia and Carcinoma in Secretory Endometrium

The diagnosis of endometrial hyperplasia or carcinoma in a background of secretory endometrium can be difficult. We attempt to establish the diagnostic criteria to be used in such cases. We examined 80 cases of endometrial hyperplasia, carcinoma, and other conditions with glandular crowding arising in secretory endometrium, analyzed their morphologic features, assessed the volume percentage stroma in each case and performed Ki67 immunostaining on 27 cases. Thirteen cases each of secretory and gestational endometrium served as controls. The mean age of the patients was 45 yr. The non-neoplastic diseases included simple hyperplasia without atypia (56%), endometrial polyps (12.5%), and chronic endometritis with glandular crowding (3%). The proportion of cases with complex hyperplasia without atypia was 10%. Neoplastic diseases included atypical complex hyperplasia (12.5%) and endometrioid carcinoma (6%). The secretory changes were usually less advanced in the hyperplastic glands than in the background endometrium. The morphologic features that best distinguished hyperplasia or carcinoma from secretory endometrium included glandular crowding that stood out from the background; architectural disorder (the long axes of the glands pointing in different directions or parallel to the endometrial surface); dilated, irregularly shaped glands, including budding or branching glands and staghorn-shaped glands; stroma of a polyp; cribriform or confluent glands in cases of carcinoma; nuclear atypia in cases of atypical hyperplasia and carcinoma; and crowded nonsecretory glands. The volume percentage stroma of neoplastic lesions was less than that of non-neoplastic ones (34% vs. 61%, P=0.000001) and that of secretory endometrium (34% vs. 68%, P=0.000038). Non-neoplastic lesions did not have significantly more crowded glands than secretory endometrium (61% vs. 68%, P=0.11). Gestational endometrium had more crowded glands than non-neoplastic lesions (39% vs. 61%, P=0.000004), an approximately equal volume percentage stroma with complex hyperplasia without atypia (39% vs. 43%, P=0.51), and less crowded glands than neoplastic lesions (39% vs. 34%, P=0.03). The Ki67 index of the neoplastic lesions was higher than that of the controls, including secretory and gestational endometria (positive nuclei per 100 epithelial cells, 44.8 vs. 4.6, P=0.0004), of the non-neoplastic lesions (44.8 vs. 5.4, P=0.002) and of complex hyperplasia without atypia (44.8 vs. 9.3, P=0.007). Hyperplasia and carcinoma in secretory endometrium can be diagnosed on the basis of increased glandular crowding, architectural irregularity, nuclear atypia, and increased Ki67 index.

Odontogenic Myxoma in Elderly Patient

Odontogenic myxomas (OMs) are predominantly found in young adults. This case report provides clinical and microscopic information about an unusual OM in an elderly patient. Woman, 80, had swelling between the upper right canine and premolar. She reported that in the same region 3 years previously a biopsy was performed that prompted a microscopic diagnosis of hyperplasia. Intraoral examination revealed a single, sessile, firm, well-circumscribed lesion, no alteration in color, and no symptoms. Periapical radiography showed thickening of the periodontal ligament.

Linear sebaceous hyperplasia on the chest

Case 1 A 39-year-old Japanese man presented with 6-month history of a group of papules on the chest (Figure 1A). The patient had no specific symptoms, such as itching or tenderness, but visited the clinic worried about the long duration of the lesions. Physical examination showed pinkish white, firm papules of 5 to 10 mm in diameter with sharply demarcated borders. The surface of the papules was smooth and shiny. Dermoscopic examination demonstrated aggregation of yellowish-white clods with linear vessels between or above the clods exhibiting reticular distribution as a whole (Figure 1B). Other papules also showed similar features. High dynamic range (HDR) [1,2] conversion of the dermoscopy photograph further clarified the multi-lobulated clods with a central opening (Figure 1C). Histopathological examination of the biopsied lesions established the diagnosis of sebaceous hyperplasia (SH) (Figure 1D). Based on the clinical, dermoscopic and histopathological findings, the final diagnosis was linear SH on the chest.

A Rare Mediastinal Tumor: Thymolipoma

Thymolipoma is a rare benign tumor of mediastinum. It comprises 2-9% of all thymic neoplasms. A 35-year-old man patient applied to our hospital with chest pain. In physical examination nothing characteristic was found and the routine laboratory findings were not remarkable. A chest radiograph showed no abnormalities however chest multislice computed tomography scans revealed an anterior mediastinal lesion in thymic area. No findings was found in respect of invasion in magnetic resonance imaging. Preoperatively radiological diagnosis was thymic hyperplasia but histopathological diagnosis was thymolipoma. We present the case of thymolipoma phenomenon which causes the chest pain.

Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review

To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia (NRH) in patients with human immunodeficiency virus (HIV). We performed a systematic review of the medical literature regarding NRH in patients with HIV. Inclusion criteria include reports with biopsy proven NRH. We studied the clinical features of NRH, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: "nodular regenerative hyperplasia", "human immunodeficiency virus", "noncirrhotic portal hypertension", "idiopathic portal hypertension", "cryptogenic liver disease", "highly active antiretroviral therapy" and "didanosine". The bibliographies of these studies were subsequently searched for any additional relevant publications. The clinical presentation of patients with NRH varies from patients being completely asymptomatic to the development of portal hypertension - namely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NRH and the use of antiviral therapies such as didanosine. The management of NRH revolves around treating the manifestations of portal hypertension. The prognosis of NRH is generally good since liver function is preserved. A high index of suspicion is required to make a identify NRH. The appropriate management of HIV-infected persons with suspected NRH is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.

Diagnosis and treatment of adrenal medullary hyperplasia: experience from 12 cases.

Objective. To dissect the characteristics of adrenal medullary hyperplasia (AMH) and share our experience of diagnosis and treatment of AMH. Methods. From 1999 to 2013, 12 cases of AMH have been pathologically diagnosed after operation in our hospital. The clinical characteristics, process of diagnosis, treatment, and prognosis during follow-up of all patients are summarized retrospectively. Results. Four cases were trended to be AMH and 6 cases were trended to be pheochromocytoma before operation; moreover, the other two patients were diagnosed accidentally. All patients, except for the patient with mucinous tubular and spindle cell carcinoma of left kidney by open surgery, experienced a smooth laparoscopic adrenalectomy, including 2 with radical nephrectomy, 10 of which experienced unilateral adrenalectomy, 1 was bilaterally partial adrenalectomy, and the remaining one was unilaterally complete removal and then 2/3 partially contralateral excision. After a medium follow-up of 6.5 years, it demonstrated a satisfactory outcome of 8 cured patients and 4 symptomatic improved patients. Conclusions. AMH presents a mimicking morphology and clinical manifestation with pheochromocytoma. Surgery could be the only effective choice for the treatment of AMH and showed a preferable prognosis after a quite long follow-up.

Clinicopathological Correlation of Endomentrium in Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding is the most common problem in gynecology. Approximately 15 - 20% of all hospital admissions are cases of DUB. Histopathology of endometrium is useful for early diagnosis of endometrium hyperplasia and LPD and further management.

Diagnosis and treatment of focal nodular hyperplasia of the liver: Analysis of 176 cases

Diagnosis and treatment of focal nodular hyperplasia of the liver: Analysis of 176 cases

MicroRNA 126 Inhibits the Transition of Endothelial Progenitor Cells to Mesenchymal Cells via the PIK3R2-PI3K/Akt Signalling Pathway

AimsEndothelial progenitor cells (EPCs) are capable of proliferating and differentiating into mature endothelial cells, and they have been considered as potential candidates for coronary heart disease therapy. However, the transition of EPCs to mesenchymal cells is not fully understood. This study aimed to explore the role of microRNA 126 (miR-126) in the endothelial-to-mesenchymal transition (EndMT) induced by transforming growth factor beta 1 (TGFβ1). Methods and ResultsEndMT of rat bone marrow-derived EPCs was induced by TGFβ1 (5 ng/mL) for 7 days. miR-126 expression was depressed in the process of EPC EndMT. The luciferase reporter assay showed that the PI3K regulatory subunit p85 beta (PIK3R2) was a direct target of miR-126 in EPCs. Overexpression of miR-126 by a lentiviral vector (lenti-miR-126) was found to downregulate the mRNA expression of mesenchymal cell markers (α-SMA, sm22-a, and myocardin) and to maintain the mRNA expression of progenitor cell markers (CD34, CD133). In the cellular process of EndMT, there was an increase in the protein expression of PIK3R2 and the nuclear transcription factors FoxO3 and Smad4; PI3K and phosphor-Akt expression decreased, a change that was reversed markedly by overexpression of miR-126. Furthermore, knockdown of PIK3R2 gene expression level showed reversed morphological changes of the EPCs treated with TGFβ1, thereby giving the evidence that PIK3R2 is the target gene of miR-126 during EndMT process. ConclusionsThese results show that miR-126 targets PIK3R2 to inhibit EPC EndMT and that this process involves regulation of the PI3K/Akt signalling pathway. miR-126 has the potential to be used as a biomarker for the early diagnosis of intimal hyperplasia in cardiovascular disease and can even be a therapeutic tool for treating cardiovascular diseases mediated by the EndMT process.

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

IntroductionEndometrial hyperplasia has a high risk for malignant transformation and relapses; existing mini-invasive treatments may lead to irrevocable endometrium destruction. The aims were to analyze receptor systems in endometrial hyperplasia, to evaluate the capabilities of ultrasonography, sonoelastography for diagnosis and treatment control, and to develop treatment algorithm.Materials and methodsWe included 313 women (20–45 years), assessed into the following: group 1 (n = 112) with glandular cystic hyperplasia, group 2 (n = 98) endometrial polyps, and group 3 (n = 103) atypical hyperplasia; and 82 controls who have undergone hysteroscopy before in vitro fertilization in tubal origin infertility were also included. Patients underwent clinical examination, transvaginal ultrasound, immunohistochemical study, and hormonal therapy/hysteroresectoscopy.ResultsIn patients with glandular hyperplasia, we registered increase of endometrium estrogen receptors (75.6% in the epithelium and 30.9% in the stroma; in controls, 43.3% and 29.6%, respectively); in polyps, there was a significant estrogen receptor increase in the stroma (48.2% vs 29.6% in controls), and in atypical hyperplasia, progesterone receptors significantly increased in the stroma. Ki-67 increased (40% to 50%) in the epithelium without changes in the stroma. Ultrasound has a sensitivity of 96% and a specificity of 85% for early detection of endometrial pathology and prediction outcome of intervention, and sonoelastography has a sensitivity of 91% and a specificity of 83% for polyp diagnosis. Personalized treatment was effective in 88.8%, relapse was diagnosed in 11.2% after 6 months, and conservative treatment of atypical hyperplasia was effective in 45%: in 25.8%, ablative hysteroresectoscopy was performed, while in 22.6% with comorbidities, hystero/oophorectomies were performed.ConclusionsThe evaluation of receptor status with ultrasound data in patients with endometrial hyperplasia allows for a clear definition of the treatment policy, avoidance of relapse, treatment optimization, and observation of such patients.

The Effect of Radioiodine on the Intima Media Thickness of the Carotid Artery

Aim: The radiation can induce vessel injury. The result of this injury can be severe and life-threatening. There are a few studies demonstrating an increase in intima-media thickness (IMT) of the common carotid artery (CCA) after radiotherapy, especially in head and neck cancers. We evaluated the effect of I-131 to the IMT of the CCA in the patients who were treated for hyperthyroidism.Methods: 38 patients (25M, 13W) referred to our department for radioiodine treatment with the diagnosis of nodular goitre (25 patients) and diffuse hyperplasia (Graves disease (GD), 13 patients) were included to the prospective study. An USG was performed for all the patients before therapy, 3, 6 and 12 months after radioiodine therapy in order to measure IMT of CCA and the femoral artery (FA). The IMT was measured at the level of proximal part of bulbus anteriorly on the left and right side. The IMT of FA was measured just before the bifurcation.Results: There was a statistically significant increase in IMT of both CCA and FA bilaterally in nodular hyperthyroid patients. However, in the patients with Graves disease, there was only statistically significant increase in the left IMT of CCA at 0-3rd, 0-6th month measurements and in the right IMT of FA at 0-3rd month measurements. Conclusion: Though the limitation of the study is the interobserver and intraobserver variability, it was seen that I-131 therapy might affect the IMT of CCA in the patients with NG. I-131 effect on the IMT of CCA in patients with nodular goitre was higher than the IMT of CCA in patients with GD. I-131 effect on the IMT of CCA might be due to administered dose and adjacency. The interesting point of our study was the increased thickness of IMT in FA. We think that the increase in IMT is due to the systemic effect of radioactivity circulating in the blood vessel. I-131 effect on the IMT of FA in patients with nodular goitre was higher than the IMT of FA in the patients with GD due to I-131 uptake of thyroid gland. Because I-131 uptake was lower in patients with nodular goitre, I-131 in systemic circulation was higher.Conflict of interest:None declared.

The 10 year observational study of adrenal mass pathology in Prof. Dr. Fernando Fonseca Hospital

Objective: Our aims were to observe and resume the variety of adrenal mass pathology in our hospital in a period of 10years and compare it with a current knowledge. Methods: We obtained 40 adult patients' data from the department cards (in-ward data) assuming as a search inclusion criterion the diagnosis of adrenal adenoma and adrenal hyperplasia. 9 patients were excluded because of the established diagnosis of iatrogenic Cushing syndrome. Results: In our patients most of adrenal masses diagnosed were incidentalomas (45%), 7 were found during an investigation of secondary causes of hypertension, 3 on the strong clinical suspicion of Cushing syndrome, 2 during investigation of resistant to treatment hypokalemia.

Reliability Of single photon emission computerized tomography (SPECT) in the diagnosis of condylar hyperplasia

Background: Single photon emission computerized tomography (SPECT) bone scintigraphy has been used to identify cases with condylar hyperplasia in mandibular asymmetry. A difference of uptake of more than 10% between the two sides of the mandibular condyles is considered significant.

The Incidence of Endometrial Hyperplasia and Cancer in 1031 Patients With a Granulosa Cell Tumor of the Ovary

Concurrent presence of endometrial hyperplasia or cancer in patients with granulosa cell tumors (GCTs) is common, with reported incidences of 25.6% to 65.5%. Consequently, bilateral salpingo-oophorectomy and hysterectomy is usually recommended in patients with a GCT, but this remains debatable. Our aim was to evaluate the need for hysterectomy in patients with GCTs by studying the incidence of pathologically confirmed endometrial abnormalities at the time of diagnosis of GCT and during follow-up. All cases of GCT between 1991 and 2012 were evaluated for endometrial pathology using the Dutch nationwide network and registry of histopathology and cytopathology (PALGA). A total of 1031 cases of GCT were identified at a mean ± SD age of 55 ± 17 years. The incidence of GCTs in the period 1991-2012 was 0.61 per 100,000 women per year. Concurrent endometrial cancer at the time of diagnosis of GCT was found in 58 patients (5.9%) and endometrial hyperplasia in 251 patients (25.5%), including complex hyperplasia in 89 patients (9.1%) and simple hyperplasia in 162 patients (16.5%). Long-term follow-up of 490 patients (47.5%) without a hysterectomy showed that endometrial abnormalities were found in 10 patients (2.0%) of which 2 had endometrial cancer. Interestingly, 8 (80%) of the 10 patients with endometrial abnormalities had recurrent GCT at the time of diagnosis of endometrial hyperplasia or cancer. Our data suggest that after surgical removal of GCT, development of an endometrial abnormality, especially cancer, is very rare. Therefore, hysterectomy is not recommended in patients with a GCT without endometrial abnormalities at the time of diagnosis.

A Unique Use of Intraoperative Digital Specimen Radiography in the Treatment of Primary Hyperparathyroidism

Intraoperative evaluation of primary parathyroid specimens historically has been difficult. Frozen section diagnosis is not reliable and time-consuming. A visible rim of compressed normal parathyroid tissue is seen histologically surrounding a parathyroid adenoma and absent in parathyroid hyperplasia. Adjuncts such as radionuclide scanning and intraoperative parathyroid hormone levels help but are indirect methods of evaluation. Intraoperative digital specimen radiography (IDSR) of specimens is a novel technique that was compared with frozen section analysis. The study spanned a 12-month period. Thirty-six patients with primary hyperparathyroidism met eligibility criteria. Resected parathyroid specimens were evaluated with the Bioptics PiXarray100 digital radiograph system and pathologic evaluation. Thirty-nine specimens were evaluated with IDSR, reflecting three patients with multiple glands excised. Thirty patients were pathologically found to have adenomas (83%) and six were hyperplasia (17%). Twenty-seven of 30 adenoma specimens had an IDSR visible rim of compressed tissue (sensitivity 90%) and no hyperplasia specimens had an IDSR visible rim (specificity 100%). Fisher's exact test was significant (P = 0.000). Frozen section correctly diagnosed adenoma in only 16 of 30 specimens (sensitivity 53%). IDSR of parathyroid specimens is a powerful modality in the real-time differentiation of parathyroid adenomas from hyperplasia (sensitivity 90%). This technique is noninferior to the current "gold standard," frozen section (sensitivity 53%). We propose IDSR evaluation of all parathyroid surgical specimens for the immediate diagnosis of adenoma versus hyperplasia.