Evaluation of ovarian lesions inducing endometrial hyperplasia or carcinoma in a tertiary care hospital in Southern India

Background: Excessive and prolonged estrogenic stimulation results in endometrial hyperplasias or endometrioid adenocarcinomas. One of the major reasons for an excess endogenous estrogen production is estrogen secreting ovarian lesions which could either be neoplastic or non-neoplastic. Aims: This was a study done to evaluate and correlate presence of ovarian lesions in uterus harboring endometrial hyperplasia or endometrial carcinoma. Materials and Methods: This was a retrospective study conducted at a referral hospital in South India over a 16-year period. Histology of ovaries were studied in panhysterectomy cases with a tissue diagnosis of endometrial hyperplasia or endometrial carcinoma. The data was evaluated as only percentage. Results: A total of 118 specimens revealed pathological proliferative lesion of the endometrium with endometrial hyperplasias occurring in 78 (66.1%) and endometrioid adenocarcinoma in the remaining 40 (33.9%) cases. Fifty-two cases showed lesions in ovary/ovaries. Forty-two (35.6%) of them revealed estrogen-secreting lesions in ovaries. The rest showed non-estrogen producing lesions. Follicular cyst was the predominant estrogen elaborating lesions in the ovary with 23 cases (44.2%). In 21.1% of cases, ovaries featured stromal hyperplasia and 7.7% showed granulosa cell tumor. Only one (1.9%) case of thecoma was identified. Two cases showed twin lesions with follicular cyst and stromal hyperplasia. All patients except for one were in post-menopausal age group. Conclusion: Follicular cyst was the predominant lesion associated with endometrial hyperplasia and endometrioid adenocarcinoma of endometrium in post-menopausal age group. In addition, hyperplastic lesions in endometrium can occur in non-hormonal secreting ovarian epithelial tumors possibly due to functioning stromal cells.