PRE‐MENOPAUSAL CYSTIC HYPERPLASIA AND ENDOMETRIAL CARCINOM

CYSTIC glandular hyperplasia of the endometrium is in most cases a frankly benign lesion, both clinically and histologically. In some cases, however, the degree of epithelial proliferative activity is so extreme that the resemblance to adenocarcinoma is very striking and indeed in some instances there may be considerable doubt as to whether the lesion is in fact malignant. This has led to the opinion that cystic glandular hyperplasia is a precancerous condition. Since hyperplasia of the endometrium is closely related to oestrogenic activity it has been inferred that endometrial carcinoma is the result of long-continued action of the oestrogen. The apparently high incidence of endometrial carcinoma in cases of granulosa cell and thecoma tumours of the ovary has given support to the view that oestrogenic activity, endometrial hyperplasia and carcinoma are closely related. From a study af the genital tract in post-menopausal women suffering from endometrial carcinoma I (McBride, 1955) came to the conclusion that there was no evidence of a continuing abnormal oestrogen activity. But it seemed that this did not rule out the possibility that abnormal oestrogen influence might have been present some years before the development or discovery of the carcinoma. Such an influence could conceivably be manifested by an episode of cystic glandular hyperplasia of the endometrium during the later years of childbearing life or actually at the time of the menopause. Further support for this idea is provided by frequent association of “retrogressive hyperplasia” or cystic atrophy and carcinoma of the endometrium reported by Novak and Richardson (1941) and McBride (1955). The former authors considered that “retrogressive hyperplasia” was an endometrial pattern found in the post-menopausal woman who had suffered from active hyperplasia at the time of the menopause. If this were the correct explanation of the development of an endometrium with numerous cystic glands then a follow-up of cases of menopausal menorrhagia associated with cystic glandular hyperplasia should reveal a Considerable proportion of cases of endometrial carcinoma. It has been shown by Hertig and Somers (1949) who studied prior biopsies in cases of endometrial carcinoma that many of these patients had previously had endometrial hyperplasia, commonly of an adenomatous pattern. It therefore seems important to determine if endometrial hyperplasia is a frequent precursor of carcinoma. The problem has an important clinical bearing. Although hysterectomy is frequently performed in cases of excessive bleeding at the menopause associated with endometrial hyperplasia, the induction of an artificial menopause by X-rays or radium is still common practice. If hyperplasia were frequently followed by carcinoma this would be a powerful argument in favour of the surgical treatment of this condition. The literature in connexion with this subject is very involved and there are few straightforward follow-up studies of cases of cystic glandular hyperplasia apart from that by Hintz (1929). One of the first lines of approach was based on the impression that patients who had