Endometiral Hiperplazilere Güncel Klinik Yaklaşımlar
Özet
Endometrial hiperplaziler, karşılanmamış östrojene maruziyet sonucu endometrial kavitedeki bez ve stromal yapıların abartılı fizyolojik değişikliklerinden karsinoma kadar uzanan proliferasyonlarıdır. Ortalama görülme yaşı 45-55 olan bu durum, Dünya Sağlık Örgütü'ne göre atipisiz ve atipili olmak üzere ikiye ayrılır. Tedavi; yaş, fertilite isteği, atipi varlığı ve ek hastalıklara göre planlanır. Fertilite isteği olan atipisiz olgularda izlem veya progestin ağırlıklı medikal tedavi uygulanırken, histerektominin yeri neredeyse yoktur. Fertilite isteği olan atipili hiperplazilerde ise eş zamanlı kanser riski nedeniyle yaklaşım zordur; medroksiprogesteron asetat tedavisi, yakın takip ve son yıllarda hormonal tedavi öncesi histeroskopi ile lezyonların rezeksiyonu gibi yöntemler kullanılır. Fertilite arzusu olmayan veya takibe uyamayacak peri-postmenopozal gruptaki atipisiz olgularda progesteron tedavisi veya histerektomi seçeneği sunulurken, peri-postmenopozal dönemdeki atipili hiperplazilerde yüksek malignite progresyonu ve eş zamanlı karsinom riski nedeniyle ilk ve kesin tedavi seçeneği frozen section eşliğinde histerektomidir.
Endometrial hyperplasias are proliferations ranging from exaggerated physiological changes to carcinoma, resulting from continuous estrogen exposure without progesterone in the endometrial cavity. Classified by the WHO into non-atypical and atypical types, their management depends on age, fertility desire, presence of atypia, and comorbidities. For patients wishing to preserve fertility, non-atypical cases are primary managed with follow-up or medical progestin therapy rather than hysterectomy, while atypical cases present a clinical challenge due to concurrent cancer risks, requiring progestin treatment, close biopsy monitoring, or promising combined hysteroscopic resection. In peri-postmenopausal women, non-atypical hyperplasia is investigated for its underlying cause and treated with progesterone or hysterectomy if monitoring compliance is low, whereas atypical endometrial hyperplasia in this age group mandates hysterectomy with frozen section as the primary and definitive treatment due to high progression and co-existing endometrioid carcinoma risks.
Referanslar
Berek JS and Hacker NF. BerekandHacker’sGynecologicOncology. 6th ed. Philadelphia, USA: ……. ; 2015:390-442.)
.Reed SD, Voigt LF, Newter KM, Garcia R, Allisontik et al. Progestin therapy of complex of endomerial hyperplasia with and without atypia, ObstetGynecal, 113(3): 655662, 2009)
Bultini M1, Jordan S1, WebbPM.The effect of thalevenorgestrel releasing intrauterine system on endometriyal hiperplasia:An Australian study and systematic review.Aust on New Zeland J of obsGyn 49:316322, 2009)
Hacker NF, Marsden DE, Optimal management of endometriyal hyperplasia, Best praticed Reserch Clinicalobs: Gunvol 15 no: 313405, 2001)
Agorastos t, Vaitsiv, Pantazisk, Efstathiadis E et al.Aromatase inhibitor anastrajele for treating endometriyal hyperplasia in obese postmenopausal women. E, J.Obstet Gynecal and Reprod Biology 1/8:239240, 2009
LİH, ChenX, Qiae1.Letrozole as primary therapy for endometrial hyperplasia in young women.İnt. S. Obst. Gune 100:1012, 2008
Burn JL, Descart E, Boubli B, Dallay D. Endometriyal hyperplasia a reviewI. Gynecalobstet Bixelrepred (puris) 35:542550, 2006.
Ushiyima K, Yahato H, Konishi I, Yasug T, Sarto T etal. Multicenterphase II. Study of fertility sparing treatment with medraxiprogesteroneacetate for endometriyal carcinoma and atypical hyperplasia in young women. J.Clin.oneal, 90:434440
Jobo T, Kawaguchi M, Imai M, Kurometo H. Treatment for complex atypical hyperplasia of the endometrium. EurJ.Gynecaloncal 22:365368, 2001.)
I.D. Gallos, J. Yap, M. Rajkhowa, D.M. Luesley, A. Coomarasamy, J.K. Gupta ; Regression, relapse, and livebirth rates with fertility-sparing therapy for endometrial cancer and atypical endometrial hyperplasia: a systematic review and metaanalysis Am J ObstetGynecol, 207 (4) (2012), pp. 266 e1-12).
I. Mazzon, G. Corrado, V. Masciullo, D. Morricone, G. Ferrandina, G. Scambia ;Conservative surgical management of stage IA endometrial carcinoma for fertility preservation Fertil Steril, 93 (4) (2010), pp. 1286-1289)
P. De Marzi, A. Bergamini, S. Luchini, M. Petrone, G.L. Taccagni, G. Mangili, et al. Hysteroscopic resection in fertility-sparing surgery for atypical hyperplasia and endometrial cancer: safety and efficacy J Minim InvasiveGynecol, 22 (7) (2015), pp. 1178-1182
F. Falcone, G. Laurelli, S. Losito, M. Di Napoli, V. Granata, S. Greggi ; Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer ; J Gynecol Oncol, 28 (1) (2017), p. e2
P. Giampaolino, A. DiSpiezioSardo, A. Mollo et al. Hysteroscopic endometrial focal resection followed by levonorgestrel intrauterine device insertion as a fertility-sparin gtreatment of atypical endometria hyperplasia and early endometrial cancer: a retrospectivestudy J Minim InvasiveGynecol, 26 (4) (2019), pp. 648-656
Ali Ayhan , Yusuf Aytac Tohma, Mehmet Tunc . Fertility preservation in early-stage endometrial cancer and endometrial intraepithelial neoplasia: A single-center experience , Taiwan J Obstet Gynecol. 2020 May;59(3):415-419. doi: 10.1016/j.tjog.2020.03.014.
Novac L, Grigore T, Cernea N, Niculescu M, Catarcea S. Incidence of endometriyal carcinoma in patients with endometriyal hyperplasia. Eur 1 Gynecal Oncal 26: 561563, 2005.
Raltonachaıyonont M, Angsuvathana S, Techatrisak Ketal Clinical and pathological responses of progestin therapy for non-atypical endometriyalhyperplasia a prospective study J. Obstet Gynecal Res.31:98106, 2005
