Endometrioid hyperplasias and adenocarcinomas of the endometrium: Anatomopathological and epidemiological analysis in a series of HNC cases between 2017 and 2024

Abstract

Endometrial hyperplasia (EH) is recognized by the increase in the gland-to-stroma ratio and by the irregularity and complexity of the glandular architecture. In developed countries there are an estimated 200.000 new cases per year. Atypical HE is the precursor lesion of low-grade endometrioid adenocarcinoma (EA) and shows glandular crowding and irregularity in addition to cytological atypia. It was proposed to analyze the anatomopathological and epidemiological characteristics of HE and endometrial AE. Analysis of the anatomopathological and epidemiological characteristics of HE and endometrial AE was proposed. 

An observational, descriptive, retrospective and cross-sectional study was designed with an sample size of 55 cases. We worked with a database from the pathology service. Cases with diagnoses consistent with the topic raised between 01/01/17 and 01/15/24 were included. The variables of age, reason for consultation and degree of differentiation according to the FIGO system were used. A count was made, percentages were established, double-entry tables were made and graphs were constructed. 

The average age of the patients was 60.31 years and the most frequent reason for consultation was abnormal uterine bleeding. The diagnosis of HE represented 32.73% (18 cases), while that of AE was 67.27% (37 cases). 23.64% of the cases were HE without atypia, 9.09% HE with atypia, 32.73% well-differentiated EA, 29.09% moderately differentiated EA, and 5.45 poorly differentiated EA. 

Establishing an accurate diagnosis between atypical HE and AE is a diagnostic challenge faced by the pathologist in curettage materials. Highlighting this deference in pathology reports is good practice. In women who have fulfilled their fertility wishes, performing hysterectomy will allow an accurate diagnosis to be established and will also have a therapeutic effect. The ages of presentation of these pathologies coincide with those found in other works. However, a striking difference was that in the experience of other authors when faced with a diagnosis of atypical HE in curettage material when performing the hysterectomy, the vast majority corresponded to the same diagnosis, while in our work the majority corresponded to EA almost always of low grade (FIGO 1 and 2).