Management and Clinical Outcomes of Endometrial
Hyperplasia during a 13-Year Period in
Songklanagarind Hospital
Nathapol Sirimusika MD*, Krantarat Peeyananjarassri MD*,
Yuthasak Suphasynth MD*, Virach Wootipoom MD*,
Kanet Kanjanapradit MD**, Alan Geater PhD***
Affiliation :
* Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
** Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
*** Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Background : Endometrial hyperplasia has long been considered a precursor of endometrial cancer but there is no consensus
regarding its management.
Objective : To identify management practices and evaluate outcomes of treatments for women diagnosed with endometrial
hyperplasia (EH).
Material and Method: The medical records of endometrial hyperplasia at Songklanagarind Hospital between January 2000
and December 2012 were retrospectively reviewed.
Results : Two hundred ninety seven patients were diagnosed with endometrial hyperplasia during the study period.
Four patients who did not come for treatment and could not be contacted were excluded. Therefore, 293 patients were
included in the study. Simple hyperplasia (SH) was the most common diagnosis accounting for 79.2% of all cases, followed
by complex hyperplasia (CH) 13.0%, complex atypical hyperplasia (CAH) 5.8%, and simple atypical hyperplasia (SAH)
2.0%. Seventy-eight percent (18/23) of the patients with atypical endometrial hyperplasia were treated by hysterectomy
compared with 9.6% (26/270) of patients without atypia. Of the patients diagnosed with atypical EH, 30.4% (7/23) were
associated with endometrial carcinoma. Overall, 6% (12/201) of the women who had initial non-hysterectomy management
and had additional tissue taken to assess response, had persistent disease, and 1% (2/201) had progressive disease. Eleven
patients (5.9%), who had an initial complete regression during the non-hysterectomy management, experienced a recurrence
to EH and 2.1% (4/187) were found to have recurrence to endometrial cancer.
Conclusion : The majority of patients with atypical hyperplasia were managed by initial hysterectomy. The high risk of
concomitant endometrial cancer supports this choice of treatment. In the non-atypical EH, the initial non-hysterectomy
management was common but EH recurrence and progression to endometrial cancer after the initial regression occurs
often. Therefore, long-term follow-up should be advised.
Keywords : Endometrial hyperplasia, Clinical outcomes, Endometrial carcinoma
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