Spontaneous endometrial hyperplasia. A prospective, 5 year follow-up of 246 patients after abrasio only, including 380 patients followed-up for 2 years.

The treatment of patients with endometrial hyperplasia differs widely, ranging from immediate hysterectomy to no treatment or follow-up at all. This is due to the fact that a vital question has not been answered, namely: is endometrial hyperplasia a predecessor to carcinoma or not? In order to investigate whether endometrial hyperplasia is a premalignant state we have followed up 246 patients with abrasio only for 5 years. We found that there was no higher risk of CGH and adenomatous hyperplasia developing into a carcinomatous state than in normal cases. We found it possible to follow up these patients with abrasio only as scheduled. The very few patients developing carcinoma did so already at the first control after 3 months. Among atypical endometrial hyperplasias there was an increased risk of developing endometrial carcinoma. We could divide these patients into two groups: one with very severe atypia so close to carcinoma that an immediate hysterectomy was recommended. Nine out of 12 had already developed carcinoma at the time of the operation. In another group of 21 patients followed with abrasio only, 2 had developed carcinoma at the first control. This means that among 368 patients with endometrial hyperplasia followed-up with abrasio for 2 years, 13 were found to have carcinoma. Twelve patients with very severe atypia were recommended to have an operation and 9 were found to have cancer. Among the other 356 patients, 4 were found to have cancer at the first control (2 with an initial diagnosis of CGH and 2 with atypical hyperplasia).