Does Ovarian Hyperthecosis Contribute to the Genesis of Endometrial Polyps, Endometrial Hyperplasia, and Endometrioid Carcinoma in Postmenopausal Women? A Clinicopathologic Study of 238 Cases
Cunxian Zhang, C James Sung, M Ruhul Quddus, Rochelle A Simon, W Dwayne Lawrence. Kent Memorial Hospital, Warwick, RI; Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI
Background: Hyperestrinism due to anovulatory cycles is associated with endometrial polyps (ENPO), hyperplasia (ENHY), and endometrioid adenocarcinoma (EMCA) in pre- and perimenopausal patients. ENPO, ENHY, and EMCA also occur in postmenopausal (PMP) patients but the cause is less clear. Hyperthecosis (HT), the presence of luteinized theca cells in the (non-follicular) ovarian stromal parenchyma, may occur to varying degrees in PMP women. HT largely produces androgens that are converted to estrone in the peripheral adipose tissues. Our aim was to determine if there was a correlation between the presence of ovarian HT and the occurrence of ENPO, ENHY, and EMCA in PMP women.
Design: We selected PMP EMCA specimens with both uterus and ovaries removed in 2011 and matched with a benign control group from 2006 to 2011. EMCA cases were subdivided into FIGO G1, FIGO G2, and FIGO G3. Benign control group was subdivided into endometrial atrophy, ENPO, and ENHY. Archival H&E slides were reviewed to identify the presence of HT. The patient's age was also recorded. We used Chi Square test to compare the frequency of HT and Variance of Analysis to compare the patient's age among different groups.
Results: Our study consisted of 238 PMP women: 108 with an EMCA diagnosis and 130 with a benign diagnosis. Within the benign cases, 71 (54.6%) had atrophic endometrium, 32 (24.6%) ENPO, and 27 (20.8%) ENHY. Among the EMCA cases, 48 (44.4%) were FIGO G1, 46 (42.6%) FIGO G2, and 14 (13.0%) FIGO G3. The frequencies of HT in patients with ENPO (46.9%), ENHY (55.6%), FIGO G1 (43.7%), FIGO G2 (54.3%), and FIGO G3 EMCA (57.1%) were each significantly higher than that in patients with atrophic endometrium (23.9%), supporting an association of HT with ENPO, ENHY, and EMCA in PMP women. No significant difference was seen in patient's age among different groups.
Conclusions: Our study indicates that HT with its resultant risk factor of hyperestrinism may contribute to the pathogenesis of ENPO, ENHY, and EMCA in PMP patients. Although some workers postulate that FIGO G3 EMCA may have a different histogenesis from its lower grade counterparts, our study suggests that EMCA of all FIGO grades may share the common risk factor of hyperestrinism.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 125, Tuesday Morning