Leczenie rozrostów endometrium – kiedy nie operować

Cooperation between gynecologist and pathologist is essential for both proper diagnosis and treatment.Inappropriate diagnosis of endometrial hyperplasia guides wrong clinical therapy, which can be very differentdepending on the type of hyperplasia found. Until 1994 the classification of endometrial lesions had been inchaos. The World Health Organization (WHO) 1994 classification is based on the seminal work of Kurman,Kaminski and Norris (1985) ordered the terminology, according to degree of architectural complexity andcrowding of endometrial glands and the presence or absence of cytological atypia resulting in a classificationsystem of simple or complex hyperplasia, with/or without atypia. In the same time Mutter and the InternationalEndometrial Collaborative Group has proposed a new term, “endometrial intraepithelial neoplasia” (EIN), tocharacterize early malignant lesions and classified endometrial lesions in 2 group: benign Endometrial Hyperplasia(EH), Endometrial Intraepithelial Neoplasia (EIN). The new classification is based on integrated morphological,genetic molecular, cell biological and prognostic morphometrical studies and seems to be satisfying in practicalmedicine due to it is simple, reproducible, and may contribute to a better predict regression and progression toadenocarcinoma and correlation between surgical pathology and clinical management. Treatment guidelinesrecommend that women with complex hyperplasia can be treated with progestins and women with atypicalhyperplasia should be treated with hysterectomy. Treatment regimens should be individualised and hysterectomywith bilateral oophorectomy considered a somewhat aggressive form of management.