Clinicopathological and ultrasound assessment of endometrial hyperplasia in perimenopausal women

Moţăţeanu VT, Valentin Teodor Moţăţeanu, Răzvan Grigoraş Căpitănescu, Razvan Grigoras Capitanescu, R. Capitanescu, Căpitănescu RG, Paitici Ş, Ștefan Paitici, Ştefan Paitici, Maria Victoria Olinca, Olinca MV, Pană RC, Razvan Cosmin Pana, Răzvan Cosmin Pană, Alexandru Cristian Comănescu, A. Comanescu, Comănescu AC, Adrian Victor Tetileanu, Tetileanu AV, Roxana Elena Bohîlțea, Bohîlţea RE, Roxana Elena Bohîlţea, Berceanu C, Costin Berceanu
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie · 2026 · vol. 67(2) , pp. 267–281 · doi:10.47162/rjme.67.2.08 · PMID:42717458 · W7212183832
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This study evaluated perimenopausal endometrial hyperplasia, finding that women aged 46–51 exhibited significantly higher adenomyosis prevalence and greater clinicopathological complexity compared to those aged 40–45.

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Abstract

BACKGROUND: Endometrial hyperplasia (EH) is a heterogeneous proliferative endometrial disorder frequently encountered during perimenopause, characterized by variable architectural complexity, cytological atypia and biological behavior. AIM: This study aimed to evaluate the clinical, ultrasonographic (US), histopathological (HP) and immunohistochemical (IHC) features of EH in perimenopausal women and to assess the associations between these parameters. PATIENTS, MATERIALS AND METHODS: This multicenter observational study included 103 perimenopausal women with histopathologically confirmed EH, evaluated between 2020 and 2025. Patients were stratified into two age-defined subgroups: Group A (40-45 years, n=49) and Group B (46-51 years, n=54). All patients underwent standardized US evaluation according to International Endometrial Tumor Analysis (IETA) terminology, followed by HP examination. IHC analysis was performed in selected representative cases. RESULTS: Abnormal uterine bleeding (AUB) was the predominant clinical presentation in both groups. Significant differences between subgroups were observed for previous endometrial biopsy, uterine dimensions, adenomyosis prevalence and endometrial thickness. Group B showed significantly greater uterine dimensions, higher prevalence of adenomyosis and increased mean endometrial thickness. HP evaluation demonstrated a heterogeneous spectrum of architectural, cytological, stromal and vascular alterations. Significant age-related differences were identified for atypical EH∕endometrial intraepithelial neoplasia (EIN), nuclear atypia, increased mitotic activity, vascular proliferation and abnormal vascular morphology, all being more frequent in Group B. IHC assessment further demonstrated substantial biological heterogeneity across EH lesions. CONCLUSIONS: Perimenopausal EH represents a heterogeneous spectrum of proliferative endometrial lesions with progressive clinicopathological complexity during the perimenopausal transition. Integrated US, HP and IHC assessment provides a comprehensive framework for lesion characterization, particularly in morphologically complex cases.

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MeSH descriptors

Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia

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