Early pathomorphological markers of oncogenesis in atypical endometrial hyperplasia in patients with polyposis

Large clinical studies have established that usually both endometrial and cervical polyps are benign pathologies, but in 0.2–1.5% their malignant transformation may occur, which is more often diagnosed in women with risk factors.Management of patients with polyps and endometrial hyperplasia depends on many factors and requires the establishment of clear hysteroscopic and morphological criteria by which it is possible to reliably predict the oncological risk, timely determine adequate treatment and its results.The objective: to study the pathomorphological characteristics of endometrial hyperplasia with atypia in patients with polyposis for determination of early pathomorphological markers of oncogenesis. Materials and methods. A prospective, randomized cohort study was conducted in 72 patients aged 21 to 57 years with abnormal uterine bleeding, endometrial hyperplasia, and polyps. All patients underwent hysteroresectoscopy as a treatment method with histological examination of the removed material.Histological and morphometric examination of endometrial biopsies was performed. According to the results of the pathomorphological conclusion, two study groups were formed: I group – 38 women with endometrial hyperplasia without atypia, II group – 14 patients with endometrial hyperplasia with atypia, the control group included 20 women without endometrial hyperplastic processes.Results. It was established that in endometrial hyperplasia without atypia, the glands were located unevenly, had different shapes and sizes, but the glandular epithelium structurally differed slightly from the proliferation stage (simple hyperplasia). The stromal component was dominated by fibroblast-like cells, moderately expressed, mainly lymphocytic, infiltration, congestive pleurisy. Clinically significant morphometric changes in epithelial cells were not detected.In the II group of patients a pronounced structural reorganization of the endometrium with glands of various shapes and sizes was detected, the glandular structures had an irregular shape with numerous papillary invaginations, micropapillary formations with the formation of “epithelial septa”.The glandular epithelium was observed mainly multi-row with loss of polarity relative to the basement membrane, foci of adenoacanthosis. Blood vessels are unevenly distributed, thin-walled, with signs of stasis and thrombi. Morphometry demonstrated the presence of numerous mitoses, including pathological ones, both in epithelial cells and in the stroma, and a violation of the nuclear-cytoplasmic ratio.Therefore, according to the results of the study the presence of dysplastic or malignant diseases can be suspected at early stages in patients with endometrial hyperplasia and the presence of clinically safe endometrial or cervical polyps, and for their identification, hysteroscopy with pathomorphological assessment of oncological risk is proposed.Conclusions. In patients with endometrial hyperplasia with signs of atypia in the presence of endometrial polyps, an increase in the area of ​​the cell nucleus, an increase in the nuclear-cytoplasmic ratio, as well as mitoses, including pathological ones, are often found. The presence of hyperplasia in combination with endometrial polyps requires the earliest possible pathomorphological diagnosis of the endometrium in order to verify pathological atypical histological changes in endometrial cells and polyps, which may be predictors of malignancy.Timely diagnosis and histological identification of endometrial hyperplasia with atypia is extremely important for preserving the reproductive health of women and preventing their malignancy and cancer risk.