Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ACOG Pub Review > CC#5: Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia > Flashcards

CC#5: Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia Flashcards

1
Q

Why is EIN clinically significant?

A

Precursor lesion to endometrial adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Two-tiered classification system for endometrial hyperplasia

A

1) Hyperplasia w/o atypia (benign endometrial hyperplasia)
2) EIN-AEH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Essential histologic criteria for EIN-AEH (2)

A

Crowded glandular architecture, altered epithelial cytology distinct from surrounding endometrium and/or entrapped neoplastic glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Desirable IHC criteria for EIN-AEH

A

Loss of immunoreactivity for PTEN/PAX2/MMR proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does unopposed estrogenic stimulation lead to at level of endometrium?

A

Proliferative glandular epithelial changes/hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is benign hyperplasia a precursor to EIN-AEH/endometrial adenocarcinoma?

A

No, they are biologically distinct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of cancer is EIN-AEH a precursor lesion to?

A

Type I endometrial adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mortality risk among Black pts w/ endometrial cancer compared to White pts w/ endometrial cancer

A

55% higher 5-year mortality risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

One reason that Black individuals have higher mortality rate w/ endometrial cancer

A

More likely to be diagnosed w/ nonendometrioid (aggressive) histologies, though this alone does not account for mortality disparities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Difference between Asian/Pacific Islander pts compared to White pts regarding endometrial cancer presentation

A

Asian/Pacific Islanders more likely to present w/ advanced disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What percentage of pts diagnosed with/ EIN-AEH who undergo hyst will have endometrial cancer in the hyst specimen?

A

~30-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What must be done if fertility-sparing tx is pursued for EIN-AEH?

A

Underlying/Occult endometrial cancer must be excluded via hysteroscopic uterine sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Primary objective in management of pt w/ EIN-AEH (2)

A

R/o endometrial cancer, design tx plan that can prevent/delay progression to endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk per year of EIN-AEH progressing to endometrial cancer

A

~8% per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Advantages of hyst for tx of EIN-AEH (2)

A

Definitive assessment for poss concurrent carcinoma, effective tx of premalignant lesions that require no further therapy or f/u for EIN-AEH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Factors to consider when deciding on concomitant oophorectomy in premenopausal pts (2)

A

Risk of underlying endometrial cancer, risk of surgical menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Is supracervical hyst appropriate in tx of EIN-AEH, why or why not?

A

No, 2/2 inability to assess lowest extent of lesions (which may involve LUS/upper endocervix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Intraop consideration when performing hyst for EIN-AEH

A

Intraop path assessment for occult carcinoma, as detection may require additional surgical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How should morcellation be performed if EIN-AEH (if needed)?

A

Within contained environment (ie surgical bag) to prevent spillage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Downside of morcellation for EIN-AEH

A

Will likely make path interpretation more difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is endometrial ablation appropriate tx for EIN-AEH?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Percentage of pts w/ EIN-AEH or grade 1 adenocarcinoma that demonstrated initial response to progestins; percentage of pts that demonstrated complete response (resolution) of EIN-AEH

A

86%; 66%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Overall rates of EIN-AEH disease regression shown w/ progestin therapy

A

50-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Routes of progesterone administration available (3)

A

PO, IU, combined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Is continuous PO progestin therapy more effective than cyclical therapy?
Yes
26
Adverse effect more likely w/ IU progestin methods; adverse effect more likely w/ PO progestin methods
VB; nausea
27
Recommended LNG-IUD device for management of EIN-AEH; delivery rate of this device
52-mg device; 20mcg/day
28
Progestational agent options for tx of EIN-AEH (4)
Megestrol acetate, medroxyprogesterone acetate, LNG-IUD, LNG-IUD + PO progestin
29
Which progestational tx method has higher regression rate?
LNG-IUD (though continuous PO progestins have been shown to be nearly as effective as LNG-IUD)
30
Regression rate seen w/ combined IU and PO progestins; regression rate seen w/ LNG-IUD alone
85%; 55%
31
Clinical benefits of LNG-IUD over PO progestins (3)
Lower rates of adverse events, higher rates of pt adherence, improved pt-reported health status scores (ie physical functioning, energy levels) over time
32
Recommended surveillance following total hyst w/o coexisting endometrial carcinoma
Not recommended, as surgery eliminates risk of disease progression
33
When is histologic reassessment recommended if EIN-AEH managed w/ progestational agents?
3-6 months
34
Poss outcomes seen on repeat endometrial sampling (4)
Resolution (complete response), regression, persistence, progression
35
Definition of resolution on repeat endometrial sampling
Atrophic/Secretory/ Proliferative endometrium w/o hyperplasia
36
Definition of regression on repeat endometrial sampling
Hyperplasia, but w/o atypia
37
Definition of persistence on repeat endometrial sampling
No change in histology at time of sampling
38
Definition of progression on repeat endometrial sampling
Cancer
39
Next step if no response or some regression during initial 3-6 months of progestin therapy
Consider additional 3-6 months of therapy
40
Next step if no response after 9-12 months of progestin therapy
Consider other management options (ie surgery)
41
Median time to complete resolution in pts w/ EIN-AEH managing w/ progestational agents
6 months (w/ range of 1 month to 18 months)
42
Factor associated w/ lack of response after 3 months of progestin tx
Failure to detect exogenous progesterone effect
43
Factor associated w/ nonresponse after 6 months of tx w/ LNG-IUD
Increased uterine diameter
44
Can repeat endometrial sampling be performed w/ IUD in place?
Yes
45
Method w/ some initial benefit demonstrated in predicting relapse after progestin therapy
Pre-tx hormone receptor expression (PR-A and PR-B) testing
46
Frequency/Duration for which repeat endometrial sampling should occur in pts using progestational agents
q3-6 months x2 years
47
Is recurrence rate of EIN-AEH elevated after initial response to progestational agents?
Yes
48
Recurrence rate for pts w/ EIN-AEH treated w/ progestational agents; median time to recurrence
~23%; 24 months
49
When can surveillance biopsies be discontinued in pts being treated w/ progestational agents?
After 2 years in pts w/o evidence of persistent/ recurrent/progressive disease and if asymptomatic w/o VB
50
When should therapy be continued long-term in pts being treated w/ progestational agents?
Pts who remain at risk for development of endometrial cancer
51
Risk factors for endometrial cancer (8)
Increasing age, late menopause, nulliparity, chronic anovulation, high-risk genetic conditions (ie Lynch syndrome, Cowden syndrome), use of unopposed estrogen therapy, obesity, T2DM
52
Risk of progression from EIN-AEH to carcinoma among pts receiving Megace tx through 4 years; cumulative risk of progression at 19 years after index bx
8.2%; 27.5%
53
Pregnancy rates among premenopausal pts w/ EIN-AEH managed w/ progestational agents
26-3-41.0%
54
Live-birth rate among EIN-AEH pts using ART; live-birth rate among EIN-AEH pts attempting spontaneous pregnancy
39.4%; 14.9%
55
Is IVF s/p fertility-sparing management of EIN-AEH or grade 1 endometrial adenocarcinoma associated w/ increased risk of recurrence?
No
56
Referral to consider in EIN-AEH pts interested in pregnancy
REI, as many pts also have conditions that can adversely affect fertility (ie PCOS, obesity, DM)
57
Percentage of endometrial cancer survivors who have obesity
>75%
58
Lifestyle modification found to have positive effects on health outcomes, including endometrial cancer risk
Weight loss of 7-10% of TBW
59
Referral to consider for obese pts w/ endometrial hyperplasia
Bariatric surgery
60
Positive outcome associated w/ >10% weight loss from TBW
Such pts nearly 4x more likely to respond to LNG-IUD

ACOG Pub Review (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions