endometrial hyperplasia
Introduction
Introduction Endometrial hyperplasia has a certain tendency to cancer, so it is classified as precancerous lesions. However, according to long-term observation, the vast majority of endometrial hyperplasia is a reversible lesion, or maintain a persistent benign state. Only a few cases may develop cancer after a longer interval. Endometrial hyperplasia is common in middle-aged women over the age of 35. Based on clinical manifestations, combined with histological examination, a diagnosis can be made. Methods for histological diagnosis include endometrial tissue scraping biopsy, dilatation and curettage, and vacuum aspiration.
Cause
Cause
1. Endogenous estrogen:
(1) non-ovulation: in adolescent girls, perimenopausal women, hypothalamic-pituitary-ovarian axis disorders, polycystic ovary syndrome, etc., can have no ovulation, so that the endometrium is more persistent It is affected by estrogen, no progesterone antagonist, lacks the transformation of the periodic secretory phase, and is in a state of hyperplasia for a long time. In 41 patients with endometrial atypical hyperplasia under 40 years old in Beijing Union Hospital, except for focal dysplasia, more than 80% of the endometrium had no secretory phase; 70% of basal body temperature was single-phase. Therefore, most patients have no ovulation.
(2) Obesity: In obese women, androstenedione secreted by the adrenal gland is converted into estrone by aromatase in adipose tissue; the more adipose tissue, the stronger the transformation ability, the higher the level of estrone in plasma. Causes the effects of persistent estrogen.
(3) Endocrine functional tumors: Endocrine functional tumors are rare tumors, but they account for 7.5% of endocrine functional tumors in the research statistics of Peking Union Medical College Hospital. The gonad function of the pituitary gland is abnormal, and ovarian granulosa cell tumor is also a tumor that continuously secretes estrogen.
2. Exogenous estrogen:
(1) Estrogen replacement therapy (ERT): peri-menopausal or postmenopausal, due to estrogen deficiency and menopausal syndrome, the same fashion may have osteoporosis, abnormal lipid metabolism, cardiovascular changes, and even brain cells Changes in activities, etc. Therefore, ERT has been widely used and has achieved good results. However, ERT alone has estrogen, which stimulates endometrial hyperplasia. With estrogen alone, there is a 20% endometrial hyperplasia in women (Woodruff 1994), and the application of ERT is often over the years, even for the rest of the life, long-term, if not combined with progesterone, there will be Severe intimal hyperplasia, or even endometrial cancer.
(2) Application of tamoxifen: Tamoxifen TAM has anti-estrogen effects and is therefore used in postmenopausal women with advanced breast cancer. In the low estrogen condition, TAM has a weak estrogen-like effect, so long-term use of TAM can also cause endometrial hyperplasia. Cohen (1996) reported that 164 cases of postmenopausal TAM, endometriosis occurred in 20.7%, and the incidence of endometrial lesions was related to the duration of TAM. For those who took >48 months, 30.8% had endometrial lesions, including simple hyperplasia of the endometrium and complex hyperplasia, and there were individual endometrial cancers. Therefore, postmenopausal breast cancer patients should pay more attention to this during TAM. In the Cohen (1996) group, 12 cases of breast cancer were treated with progesterone during TAM administration. In all cases, the endometrial stroma was decidual.
Examine
an examination
Related inspection
Immunosuppressive acidic protein anti-oval zona pellucida antibody (AZP) hysterosalpingography endometrial biopsy
Based on clinical manifestations, combined with histological examination, a diagnosis can be made. Methods for histological diagnosis include endometrial tissue scraping biopsy, dilatation and curettage, and vacuum aspiration. Because endometrial dysplasia sometimes manifests as scattered and single focal lesions, sometimes coexisting with endometrial adenocarcinoma, curettage or endometrial diagnosis of endometrial atypical hyperplasia and hysterectomy, found 35% to 50% Patients with endometrial adenocarcinoma in their uterus (Hunter, 1994; Widra, 1995; Lu Weiguo, 2001). Therefore, the endometrial tissue of the entire uterine cavity surface must be obtained for diagnosis.
Compared with endometrial biopsy, curettage is more comprehensive. However, some parts may be missed when the teeth are not scratched, especially at the double uterus and the bottom of the palace. Negative pressure suction has a negative pressure attraction to make the endometrial detachment more complete, and the diagnosis will be more comprehensive and reliable. Therefore, among the three diagnostic methods, the accuracy of suction with negative pressure is the highest. It can also be combined with the specific circumstances of the patient to make specific choices.
Laboratory examination: hysteroscopy, the use of hysteroscopy can not only see the endometrial condition from the appearance of the endometrium, and can be used for curettage or negative pressure suction under direct vision, the examination diagnosis is more detailed and comprehensive.
Other auxiliary inspections:
1. X-ray or CT examination: examination of the pituitary sella and fundus visual field to exclude pituitary tumors.
2. Serum hormone determination: B-ultrasound or laparoscopy to understand the presence or absence of polycystic ovary.
3. Determination of basal body temperature: It can be understood whether there is ovulation, that is, the body temperature is biphasic type, and the function of the corpus luteum can be understood according to the curvature of the body temperature rise and the length of the maintenance time after the rise.
Diagnosis
Differential diagnosis
Endometrial thickening after menopause: Endometrial hyperplasia has a certain tendency to cancer, so it is classified as precancerous lesions. However, according to long-term observation, the vast majority of endometrial hyperplasia is a reversible lesion, or maintain a persistent benign state. Only a few cases may develop cancer after a longer interval. Postmenopausal endometrial thickening generally occurs in postmenopausal women with abnormal vaginal bleeding. In this case, a diagnostic curettage can generally be performed. Clinical manifestations of irregular large amount of abnormal uterine bleeding, patients may have persistent bleeding after prolonged amenorrhea, clinically suspected of miscarriage, can also be characterized by shortened cycle, prolonged menstruation, bleeding time up to 1 month.
Endometrial obstruction: Under normal circumstances, the endometrium covers the surface of the uterine cavity. If the endometrium grows in other parts of the body due to certain factors, it can become endometriosis. This ectopic endometrium has histological not only glandular glands, but also endometrial stroma; functionally with estrogen levels, which vary with the menstrual cycle, but only partially Affected by progesterone, it can produce a small amount of "menstruation" and cause various clinical phenomena. If the patient is pregnant, the ectopic endometrium may have a decidual change. Although this ectopic endometrium grows in other tissues or organs, it is different from the invasion of malignant tumors. The peak of the disease is 30 to 40 years old. The actual incidence of endometriosis is much higher than that seen in clinical practice. For example, in the laparotomy of other gynecological diseases and careful examination of the excised uterine attachment specimens, it can be found that about 20 to 25% of patients have ectopic endometrium.
Endometriosis: Endometriosis is a gynecological disease caused by the growth of the endometrium anywhere outside the uterine cavity. Such as in the ovary, uterine fibular ligament, posterior wall serosa, uterine rectal sulcus and pelvic peritoneum of the sigmoid colon, etc., can also occur in the myometrium, so clinically endometriosis is divided into external Endometriosis and endometriosis. Patients often complain of infertility, dysmenorrhea and pelvic pain. Domestic and foreign reports of endometriosis patients with infertility rate of about 40%. The relationship between this disease and infertility has been the focus of clinical care, and endometriosis is one of the main causes of infertility. Therefore, in the clinical, women with complaints of infertility, if the fallopian tube is patency, the basal body temperature is biphasic, the endometrial response is good, and the post-trial test is normal, the possibility of endometriosis should be considered. Based on clinical manifestations, combined with histological examination, a diagnosis can be made. Methods for histological diagnosis include endometrial tissue scraping biopsy, dilatation and curettage, and vacuum aspiration.
Because endometrial dysplasia sometimes manifests as scattered and single focal lesions, sometimes coexisting with endometrial adenocarcinoma, curettage or endometrial diagnosis of endometrial atypical hyperplasia and hysterectomy, found 35% to 50% Patients with endometrial adenocarcinoma in their uterus (Hunter, 1994; Widra, 1995; Lu Weiguo, 2001). Therefore, the endometrial tissue of the entire uterine cavity surface must be obtained for diagnosis.
Compared with endometrial biopsy, curettage is more comprehensive. However, some parts may be missed when the teeth are not scratched, especially at the double uterus and the bottom of the palace. Negative pressure suction has a negative pressure attraction to make the endometrial detachment more complete, and the diagnosis will be more comprehensive and reliable. Therefore, among the three diagnostic methods, the accuracy of suction with negative pressure is the highest. It can also be combined with the specific circumstances of the patient to make specific choices.
Laboratory examination: hysteroscopy, the use of hysteroscopy can not only see the endometrial condition from the appearance of the endometrium, and can be used for curettage or negative pressure suction under direct vision, the examination diagnosis is more detailed and comprehensive.
Other auxiliary inspections:
1. X-ray or CT examination: examination of the pituitary sella and fundus visual field, in order to exclude pituitary tumors.
2. Serum hormone determination: B-ultrasound or laparoscopy to understand the presence or absence of polycystic ovary.
3. Determination of basal body temperature: It can be understood whether there is ovulation, that is, the body temperature is biphasic type, and the function of the corpus luteum can be understood according to the curvature of the body temperature rise and the length of the maintenance time after the rise.
