CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2009; 30(04): 131-135
DOI: 10.4103/0971-5851.65335

Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India

Shalinee Rao
Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry - 605 006, India
Sandhya Sundaram
Department of Pathology, Sri Ramachandra University, Porur, Chennai - 600 116, India
Raghavan Narasimhan
Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry - 605 006, India
› Author Affiliations


Background:The biological behavior of endometrial carcinoma differs in epidemiology, presentation, and prognosis, suggesting that there are two fundamentally different pathogenic types of disease: type I (estrogen related, endometrioid type) and type II (non-estrogen related, non-endometrioid type). Untreated hyperplasia can develop into an endometrioid type of adenocarcinoma, hence, it is important to recognize the former type. In contrast to cervical cancers, there are limited studies with respect to the biology of hyperplastic lesions documented from India. This was a 16-year retrospective study, carried out to determine the nature and outcome of proliferative lesions of the endometrium in a referral center from south India.Materials and Methods:A histopathological diagnosis of the endometrial hyperplasia, polyp, and carcinoma, on endometrial biopsy and hysterectomy specimens, over a 16 year period (1983 to 1999), were recorded in a computer and the case slides were reviewed. Using the computer software Foxpro, the patients who had come more than once for a subsequent or previous biopsy were identified. An attempt was made to look for progression, regression or a static nature of the lesion in the follow-up cases.Results:A total of 1778 cases were studied, and only 74 patients with endometrial hyperplasia and five cases of benign endometrial polyp had follow-up endometrial histopathology. Hyperplasia cases included 59 cases of simple hyperplasia, 10 cases of complex hyperplasia without atypia, and five cases with atypia. The predominant age for patients with all types of hyperplasias was 41 - 50 years. Progression to a higher grade was seen in 8.10%, regression to a lower grade was seen in 9.45%, lesions reverted to a normal pattern in 10.81% cases, and lesions persisted in 70.27% of the cases. A mixed pattern was seen in 54 cases, with predominant coexistent lesion being simple and complex hyperplasia without atypia.Conclusion:The fate of the hyperplastic lesion of the endometrium showed a varied pattern. Follow-up cases predominantly showed persistence of the lesion, possibly resulting from a fluctuating but higher level of estrogenic stimulus. Hence, it was not only the high levels of estrogen that influenced the biology, but its sustenance for a prolonged period.

Publication History

Article published online:
19 November 2021

© 2009. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 O′Dowd MJ, Philipp EE. Cancer of the uterus. The history of Obstetrics and Gynaecology. 1 st ed. New York: Parthenon Publishing Group; 1994. p. 571-80.
  • 2 Ronnett BM, Kurman RJ. Precursor lesions of endometrial carcinoma. In: Kurman RJ, editor. Blaustein′s Pathology of the Female Genital Tract. 5 th ed. New York: Springer-Verlag; 2002. p. 467-500.
  • 3 Gusberg Sb, Moore Db, Martin F. Precursors of corpus cancer: A clinical and pathological study of adenomatous hyperplasia. Am J Obstet Gynecol 1954;68:1472-81.
  • 4 Fox H, Buckley CH. The endometrial hyperplasias and their relationship to endometrial neoplasia. Histopathology 1982;6:493-510.
  • 5 Horn LC, Meinel A, Handzel R, Einenkel J. Histopathology of endometrial hyperplasia and endometrial carcinoma: An update. Ann Diagn Pathol 2007;11:297-311.
  • 6 Lee KR, Scully RE. Complex endometrial hyperplasia and carcinoma in adolescents and young women 15 to 20 years of age: A report of 10 cases. Int J Gynecol Pathol 1989;8:201-13.
  • 7 Schroder R. Endometrial hyperplasia in relation to genital function. Am J Obstet Gynecol 1954;68:294-309.
  • 8 Whitehead MI, Townsend PT, Pryse-Davies J, Ryder TA, King RJ. Effects of estrogens and progestins on the biochemistry and morphology of the postmenopausal endometrium. N Engl J Med 1981;305:1599-605.
  • 9 Gusberg SB, Hall RE. Precursors of endometrial carcinoma. Obstet Gynecol 1961;17:397-412.
  • 10 Chamlian DL, Taylor HB. Endometrial hyperplasia in young women. Obstet Gynecol 1970;36:659-66.
  • 11 Koss LG. Proliferative disorders and carcinoma of the endometrium. Diagnostic Cytology and its histopathologic bases. 5 th ed. Philadelphia: Lippincott Williams & Wilkins, 1992:422-465.
  • 12 McBride JM. Premenopausal cystic hyperplasia and endometrial carcinoma. J Obstet Gynaecol Br Emp 1959;66:288-96.
  • 13 Tabata T, Yamawaki T, Yabana T, Ida M, Nishimura K, Nose Y. Natural history of endometrial hyperplasia: Study of 77 patients. Arch Gynecol Obstet 2001;265:85-8.
  • 14 Yokosuka K, Teshima H, Yamakawa Y, Hasumi K. Characteristic of cystic glandular hyperplasia as a precursor of endometrial carcinoma. Nippon Sanka Fujinka Gakkai Zasshi 1994;46:1241-6.
  • 15 Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of "untreated" hyperplasia in 170 patients. Cancer 1985;56:403-12.
  • 16 Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke JJ 2 nd , et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study. Cancer 2006;106:812-9.
  • 17 Kistner RW. Histological effects of progestins on hyperplasia and carcinoma in situ of the endometrium. Cancer 1959;12:1106-22.
  • 18 Anderson MC. Endometrial hyperplasia. In: Anderson MC, Symmers WC, Fox H, editors. Female reproductive system, Systemic pathology. 3 rd ed. Edinburgh: Churchill Livingstone; 1991. p. 171-84.
  • 19 Kelly P, Dobbs SP, McCluggage WG. Endometrial hyperplasia involving endometrial polyps: Report of a series and discussion of the significance in an endometrial biopsy specimen. BJOG 2007;114:944-50.
  • 20 Antunes A Jr, Costa-Paiva L, Arthuso M, Costa JV, Pinto-Neto AM. Endometrial polyps in pre-and postmenopausal women: factors associated with malignancy. Maturitas 2007;57:415-21.