Retrospective Histologic Examination of Endometrium in Curetting and Hysterectomy Specimens Following Estrogen Therapy

Abstract

Elevated levels of estrogen with low progesterone levels may develop for prolonged periods during estrogen therapy for menopausal complaints, for gonadal dysgenesis, or pituitary deficiency, for the treatment of breast cancer or as oral contraceptives. We present from a retrospective study of women receiving such therapy the histologic changes that occurred in their endometrium (curettings) or later in their uteri, extirpated for various reasons.

The histologic changes that we observed over a period of more than 3 years are recorded in an alphabetically arranged card catalog of the patients; that system allowed us to record information about previous therapy prescribed by other clinicians in a community of 100,000 persons. The various forms of endometrial hyperplasia we saw in the curettings are of great interest, since such changes are not uniformly evaluated or classified in the literature, and they require close cooperation with the gynecologist. We placed special importance on trying to differentiate histologically between reversible atypical endometrial hyperplasia and true endometrial carcinoma.

It is worth noting that a pronounced endometrial hyperplasia in curettings rarely was correlated with similar prognostically uncertain changes in the extirpated uterus. We suggest that a histologic grading system of definite markers or criteria be devised, so that the changes can be better classified, compared, and treated.