PREMALIGNANT LESIONS OF THE ENDOMETRIUM

Course overview

PREMALIGNANT LESIONS OF THE ENDOMETRIUM ARE A CHARACTERISTIC SEQUENCE OF ATYPICAL ENDOMETRIAL HYPERPLASIA OR INTRAEPITHELIAL NEOPLASIA THAT MAY GIVE RISE TO THE TWO MAIN TYPES OF ENDOMETRIAL CARCINOMAS. TYPE 1 OCCURS IN ESTROGEN PREDOMINANCE AND/OR PROGESTERONE INSUFFICIENCY STATE AND RESEMBLES PROLIFERATIVE ENDOMETRIUM. TYPE 2 IS THE SEROUS TYPE OF ENDOMETRIAL CARCINOMA NORMALLY SEEN WITH POSTMENOPAUSAL ENDOMETRIAL ATROPHY, WHERE MUTATION OF P53 LEADS TO INTRAEPITHELIAL CARCINOMA AND PROGRESSION. TYPE 1, ON THE OTHER HAND, HARBORS THE INACTIVATION OF PTEN AND OTHER PATHWAYS. THE PRESENTING SYMPTOMS FOR PREMALIGNANT LESIONS ARE MENORRHAGIA AND METRORRHAGIA (TYPE 1) AND POSTMENOPAUSAL BLEEDING (TYPE 2). MANAGEMENT OF PREMALIGNANT LESIONS INCLUDES HYSTERECTOMY (TOTAL HYSTERECTOMY, NOT SUPRACERVICAL HYSTERECTOMY). IN SELECTED YOUNGER PATIENTS WANTING TO HAVE CHILDREN, MEDICAL MANAGEMENT WITH HIGH-DOSE GESTAGEN THERAPY WITH APPROPRIATE CLOSE HISTOLOGICAL MONITORING MAY BE DONE. UNTREATED, ALMOST ALL PREMALIGNANT LESIONS OF ENDOMETRIUM WOULD PROGRESS TO INVASIVE CARCINOMA OVER A PERIOD OF A FEW YEARS. THIS ACTIVITY HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN MANAGING PATIENTS SUFFERING FROM PREMALIGNANT LESIONS OF THE ENDOMETRIUM.