Hysteroscopic View of Endometrial Atypia: A Review of Two Cases

Background: Hysteroscopy enables direct visualization of the endometrial cavity via the cervix with an endoscope and a light source. Diagnostic and therapeutic indications include: abnormal uterine bleeding; postmenopausal endometrial thickening; removal of endometrial polyps; resection of submucosal myomata; incision of uterine septa; directly visualizing and removing intrauterine foreign bodies; hysteroscopic sterilization; recurrent miscarriages; endocervical lesions; lysis of uterine synechiae; abnormal hysterosalpingography; and infertility. Cases:Case 1: A 73-year-old postmenopausal female presented with right lower-quadrant abdominal fullness, and she had a thickened endometrium (9.4 mm) on noted on ultrasound. An outpatient endometrial biopsy was attempted but was unsuccessful because the patient had cervical stenosis. She underwent hysteroscopy and dilation and curettage (D&C). Hysteroscopy revealed the presence of lesions in the endometrial cavity, and samples of these lesions showed focal marked nuclear atypia histopathologically. Case 2: A 61-year-old postmenopausal female with a history of leiomyomata uteri, 2 ectopic pregnancies, and human papilloma virus, presented with postmenopausal bleeding. On ultrasound, her endometrium noted to be slightly irregular but was normal in texture and thickness (4.8 mm). She underwent hysteroscopy and D&C. Hysteroscopy showed the presence lesions in the endometrial cavity, and samples of these lesions showed mitotic figures histopathologically. Results: Both patients elected to undergo robot-assisted hysterectomy and bilateral salpingo-oophorectomy. Conclusions: On hysteroscopy, these 2 patients had yellowish endometrial lesions, and biopsy revealed the presence of atypical cells. These characteristic hysteroscopic findings may possibly be associated with endometrial nuclear atypia. It would be useful to investigate similar hysteroscopic findings with histopathology. (J GYNECOL SURG 31:180)