Classification and pathogenesis
Endometrial pathology is a diffuse or focal proliferation of glandular and stromal structures. According to the WHO classification, endometrial polyps as well as simple and complex hyperplasia, including those with cellular atypia, are distinguished.
The main triggering mechanism is relative or absolute hyperestrogenism against the background of progesterone deficiency. Additional influence is exerted by metabolic disorders, obesity, diabetes mellitus, arterial hypertension, and chronic inflammatory processes that disrupt the balance between proliferation and apoptosis.
Morphological forms and precancer
Histological variants include glandular hyperplasia, polyps, and atypical changes:
- Endometrial polyps: benign pedunculated formations from the basal layer (glandular, fibrous, glandular-fibrous).
- Atypical hyperplasia: characterized by structural rearrangement of glands, loss of epithelial polarity, nuclear hyperchromasia, and high mitotic activity.
- Malignancy risk: simple form without atypia progresses to cancer in 1% of cases, while complex atypical forms — up to 29%.
Diagnostics and verification methods
The diagnostic algorithm combines screening and invasive techniques:
- Transvaginal ultrasound (assessment of M-echo thickness and endometrial structure).
- Aspiration biopsy for screening and monitoring.
- Hysteroscopy with fractional diagnostic curettage.
Visual inspection allows assessing the condition of the mucosa, but the final diagnosis is established strictly based on the results of histological examination of the scraping.
Principles of treatment
Therapeutic tactics depend on the patient's age and the nature of the pathology. In the reproductive period, hormone therapy is prescribed after curettage. In case of recurrent hyperplasia without atypia in women over 35, surgical treatment in the form of endometrial ablation is used.
Briefly: answers to topical questions
Which pathological processes are classified as background diseases of the cervix?
- True erosion — a defect of the stratified squamous epithelium on the vaginal portion of the cervix.
- Cervical ectropion — displacement of the columnar epithelium onto the vaginal part.
- Ectropion — a combination of ectropion and cervical deformation.
- Leukoplakia (simple) — local keratinization processes of the stratified squamous epithelium.
- Cervical polyps — benign formations of the cervical canal.
How is cervical intraepithelial neoplasia (CIN) classified according to the degree of epithelial involvement?
- CIN I — mild (slight) dysplasia involving the lower third of the epithelial layer.
- CIN II — moderate dysplasia involving the lower two thirds of the epithelium.
- CIN III — severe dysplasia and carcinoma in situ, involving the entire epithelial layer throughout its full thickness or more than two thirds.
Which layers of the stratified squamous epithelium of the cervix are affected in CIN I, CIN II, and CIN III?
- CIN I — pathological cell changes are limited to the lower third of the epithelial layer.
- CIN II — atypical cells affect the lower two thirds of the epithelial layer.
- CIN III — the entire epithelial layer is affected throughout its full thickness.
Which types of human papillomavirus (HPV) are considered high oncogenic risk for cervical lesions?
High oncogenic risk human papillomaviruses include serotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, as well as 59, 66, and 68. The most dangerous are types 16 and 18, which account for about 80% of cervical cancer and severe dysplasia cases.
Which colposcopic findings are classified as abnormal (atypical)?
- Acetowhite epithelium (AWE) — areas of epithelium that turn white and dense after treatment with acid.
- Mosaic and punctation — vascular patterns in the form of mosaic or punctate structures.
- Iodine-negative zone — areas that do not stain with Lugol's solution.
- Pathological vessels — altered blood vessel structures.
Which categories of squamous epithelial changes are distinguished according to the Bethesda cytologic classification?
- LSIL (Low-grade squamous intraepithelial lesion) — low-grade squamous intraepithelial lesions, including koilocytosis, CIN I, and cervical condylomas.
- HSIL (High-grade squamous intraepithelial lesion) — high-grade squamous intraepithelial lesions, including CIN II, CIN III, and carcinoma in situ.
How does true cervical erosion morphologically differ from ectropion (pseudo-erosion)?
True erosion is a defect of the stratified squamous epithelium with its desquamation and exposure of the underlying basement membrane while partially preserving the basal layer. Ectropion is characterized by the replacement of the stratified squamous epithelium on the vaginal portion of the cervix with columnar epithelium.
What excisional surgical methods are used for CIN II–III?
- Cervical conization (radiosurgical, laser, or electroconization), in moderate and severe dysplasia combined with endocervical curettage.
What ablative (destructive) methods are used to treat benign background cervical processes?
- Cryodestruction.
- Laser coagulation or laser vaporization.
- Radiosurgical treatment.
- For ectropion, diathermoelectroconization is also used.
Hyperplasia without atypia — observe and treat with hormones; atypia and adenomatous polyps — a direct path to oncological control.
Class and exam questions
Which endometrial changes are classified as precancerous?
Precancerous conditions of the endometrium include hyperplasia with atypia and adenomatous polyps.
What is the primary method for confirming the diagnosis?
Final verification of the diagnosis is possible only based on the results of histological examination of the uterine mucosal scraping.
What are the main symptoms of hyperplastic processes?
The main manifestation is uterine bleeding, most commonly as acyclic metrorrhagia or menorrhagia; infertility or an asymptomatic course is less frequently observed.
What else to study on this topic
- Blood flow features in color Doppler mapping
- Differential diagnosis of fibrous polyps and submucosal myoma
- Role of metabolic and endocrine disorders and metabolic syndrome
- Hysteroscopic appearance in various forms of hyperplasia
- Indications and contraindications for endometrial ablation
Master the entire topic in the "Obstetrics and Gynecology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on «Background and Precancerous Cervical Diseases» and 973 more pages on the subject
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