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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Much is known about the pathophysiology and pathogenesis of the polycystic ovary syndrome (PCO). The key clinical features are inappropriate gonadotropin secretion, altered production rates, binding and metabolism of steroids and androgen excess, all resulting in defeminization, anovulatory infertility, obesity and endometrial hyperplasia. Management should be based on the patient's reproductive goals. Adjunct measures can control hirsutism.
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PMID:The polycystic ovary syndrome. 668 20

Occult endometrial carcinoma is a detectable disease using commercially available sampling devices and cytohistologic techniques. A cohort of 2586 asymptomatic women (98% past the age of 45, 78% caucasian) was screened. Of these women, 1567 were screened twice, and 187 were screened three times. The prevalence and incidence rates of endometrial carcinoma, as defined in the present study, including four missed cases, were 6.96 per 1000 and 1.71 per 1000 women years, respectively. The prevalence rate was 7.38 per 1000 for caucasian women and 5.40 per 1000 for women of other races. An epidemiologic evaluation suggested that the onset of menopause past the age of 49 was the only statistically significant risk factor, whereas race, parity, estrogen intake, and obesity, as calculated by the Quetelet index, were not statistically significant. The present study strongly suggests that in asymptomatic women past the age of 50, endometrial hyperplasia does not necessarily precede or accompany the development of endometrial carcinoma. Two distinct mechanisms may be responsible for the onset of endometrial cancer: endometrial hyperplasia occurring in the symptomatic and younger woman; and endometrial adenocarcinoma occurring ab initio in the older patient.
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PMID:Detection of endometrial carcinoma and hyperplasia in asymptomatic women. 673 31

This review of the connection between unopposed estrogen therapy for climacteric symptoms and the development of endometrial hyperplasia briefly outlines the history of the association, and then concentrates on clinical classification problems which muddy the attempts to come to a clear understanding of the relationship between estrogen replacement therapy (ERT) and endometrial cancer. Little agreement exists about the definition of endometrial pathology and of the malignant potentials of different types of hyperplasia. This paper classifies 4 types of hyperplasia: 1) cystic hyperplasia, which has the risk of malignant change of less than 2%; 2) adenomatous hyperplasia, which has a risk of malignant change from 12-25%; 3) atypical hyperplasia, which has a malignancy potential of 45%; and 4) carcinoma in situ, which is malignant. The following conditions are discussed as they are associated with endometrial hyperplasia and adenocarcinoma: 1) obesity; 2) anovulation; 3) late menopause; 4) Stein-Leventhal syndrome; 5) functioning ovarian tumors; and 6) diabetes history. In addition hypertension and cancers of the breast and ovary occur more often with endometrial cancer than would be expected by chance. The remainder of the paper discusses the administration of exogenous estrogens unopposed, exogenous progestins, and their concurrent use, especially in controlling menopausal symptoms. Prevention, diagnosis, and treatment of hyperplasia are discussed. In terms of prevention, a study showed that low-dose cyclical Premarin (.625 mg) resulted in an incidence of hyperplasia of 7% and with higher doses (1.25 mg) rose to 15%. The addition of d-norgestrel for 7 days to the high dose of Premarin reduced incidences to 3%, whereas estrogen plus low-dose norethindrone resulted in 0% incidence of cystic hyperplasia. It is recommended that the unopposed use of estrogens be avoided if possible, although short-term therapy up to 6 months is probably safe. Longer term therapy must have added progestogen, and endometrial sampling in the form of Vabra curettage should be performed every year in patients taking unopposed estrogens and every 3 years in patients taking combined estrogen therapy.
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PMID:Oestrogens and endometrial hyperplasia. 699 95

Adenocarcinoma of the endometrium in patients 40 years of age or younger is rare and accounts for 2.9% of all endometrial cancers diagnosed in the study community. However, the diagnosis of malignancy was confirmed in only 32 of 54 patients (59.2%) with pathologic material available for review. None of the 32 patients had Stein-Leventhal syndrome or was receiving sequential oral contraceptives. Obesity was found in only 37.5%, nulligravidity in 37.5%, and hypertension in 25%. In 81%, the presenting symptom was abnormal vaginal bleeding, and 6 patients (19%) had coexisting ovarian neoplasms (4 endometrioid carcinomas, 1 mucinous cystadenocarcinoma, and 1 adenocarcinoma arising in a cystic teratoma). Atypical endometrial hyperplasia, previously interpreted as well-differentiated adenocarcinoma, was diagnosed in 11 of 22 patients. The pathologic criteria for establishing a diagnosis of atypical endometrial hyperplasia and distinguishing it from well differentiated adenocarcinoma of the endometrium are emphasized. Thirteen of 32 patients received no radiation therapy and none developed pelvic recurrence or metastatic tumor. The 2 deaths from tumor were in patients with stage 3 ovarian cancer, and no patients died of endometrial carcinoma. The current policy is to treat patients with atypical endometrial hyperplasia and well-differentiated adenocarcinoma (clinical stage I, pathology confirmed) by hysterectomy without irradiation treatment. Because of 6 of the 32 patients (19%) had coexisting ovarian neoplasms, careful examination of the adnexa at the time of clinical staging is emphasized.
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PMID:Endometrial carcinoma in women 40 years of age or younger. 701 3

Eleven cases of an unusual endometrial glandular proliferation associated with early pregnancy are reported. All lesions were incidental discoveries in first-trimester gestational endometria (two elective abortions; five spontaneous abortions; three hydatidiform moles; one tubal ectopic pregnancy). Most patients (nine of 11; 82%) were older than 30 years of age; associated clinical features included oligoovulation (two), hypertension (one), and obesity (one). All lesions were small and localized, and displayed similar histological features of variable severity including glandular expansion with smooth external contours; epithelial stratification (4 to 15 layers); cribriforming (focal to extensive); mitotic activity; bland nuclear cytology; and prominent intraglandular calcifications (eight cases; 72%). Although the natural history of these distinctive pregnancy-associated endometrial lesions was unknown, nine lesions were initially classified as benign, and two were interpreted as atypical endometrial hyperplasia or focal adenocarcinoma. Follow-up for an average of 34 months (range, 18 to 56) in nine patients showed no residual endometrial lesion (seven endometrial curettages and two hysterectomies). Three patients followed by curettage have subsequently completed successful pregnancies. This unusual lesion may represent a localized, endometrial proliferation induced by pregnancy; although some endometrial lesions may display striking architectural complexity, follow-up to date suggests a benign behavior.
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PMID:Localized endometrial proliferations associated with pregnancy: clinical and histopathologic features of 11 cases. 759 Jun 98

We report a 44-year-old woman in whom intestinal bypass for obesity at age 23 resulted in chronic malabsorption. After hysterectomy for menorrhagia due to atypical endometrial hyperplasia, the finding of myometrial lipofuscinosis led to a demonstration of vitamin E deficiency. Vitamin E supplementation led to an unexpected improvement in the unsteadiness of gait and slurring of speech of which she had also complained. We suggest that supplementation with vitamin E should be routine in all patients with persistent severe steatorrhoea.
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PMID:Symptomatic vitamin E deficiency diagnosed after histological recognition of myometrial lipofuscinosis. 765 82

Flow-cytometric studies have demonstrated that DNA aneuploidy and proliferative activity are independent prognostic factors in endometrial carcinoma. The authors performed flow-cytometric analysis of the nuclear DNA content of 46 fresh endometrial adenocarcinomas to investigate tumor DNA ploidy and cell-cycle kinetics in relation to histologic features with known prognostic significance, mitotic activity (assessed quantitatively), and clinical features suggestive of hyperestrogenism. Thirty-five tumors (76%) were DNA-diploid, and 11 (24%) were DNA-aneuploid. DNA aneuploidy correlated significantly with two histologic features: high cytologic grade (P < .027) and five or more atypical mitoses per 50 high-power fields (P < .001). The presence of one or more atypical mitosis per 50 high-power fields, evaluated independent of DNA ploidy, was associated with stage III or IV tumors (P < .015). A low proliferative index correlated with tumors with grade 1 architecture (P < .006) and grade 1 or 2 cytology (P < .017); a high proliferative index correlated with vascular invasion by tumor (P < .027). DNA ploidy and proliferative activity did not correlate with any feature indicative of estrogenic status including age, parity, menopausal status, obesity, hypertension, diabetes, exogenous estrogen use, or endometrial hyperplasia. Therefore, in endometrial adenocarcinoma, estrogenic status does not correlate with DNA ploidy or proliferative activity; proliferative activity correlates with tumor grade; and atypical mitoses appear to be highly associated with both DNA aneuploidy and advanced tumor stage, and as such, may identify tumors with a poor prognosis.
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PMID:Flow-cytometric analysis of nuclear DNA content in endometrial adenocarcinoma. Atypical mitoses are associated with DNA aneuploidy. 808 58

In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interval between menopause and the onset of abnormal vaginal bleeding in postmenopausal women, 381 cases with a complete medical history and available histologic findings were enrolled in this study at the National Taiwan University Hospital from 1989 to 1991. The results showed that 212 (55.6%) of these women had normal histologic findings and 83 (21.9%) had benign pathologic findings, whereas 14 (3.6%) had cervical intraepithelial neoplasia (CIN), 42 (11%) had endometrial hyperplasia, 19 (5%) had cervical cancer and 11 (2.9%) had endometrial cancer. Twenty-nine (7.6%) of the cases suffered from either CIN III or cervical cancer; this number was twice as high as those with endometrial atypical hyperplasia and endometrial cancer (n = 13, 3.4%). In addition, various risk factors, especially obesity, were found to be significantly correlated with malignancy. Fractional curettage should be performed for postmenopausal bleeding patients to ensure accurate diagnosis and correct management.
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PMID:Clinical study of 381 postmenopausal bleeding patients. 810 77

A 38 year old patient with multiple known risk factors for endometrial carcinoma (monophasic cycles, obesity, familial prediabetes, nulliparity, polycystic ovaries with diffuse thecal hyperplasia) presented with metrorrhagia caused by an endometrial lesion for which the diagnosis hesitated between atypical endometrial hyperplasia and carcinoma. Hysterectomy was performed because of the presence of a bicornuate uterus, obesity of 130 kg and the patient's lack of desire to have children. Examination of the uterus did not reveal any myometrial invasion in contact with the hyperplastic endometrium. The discovery of an endometrioid carcinomatous metastasis in the lower third of the vagina one year later allowed the retrospective detection of a 3 mm endometrioid carcinoma in the isthmus. No other metastases or recurrence were observed with a follow-up of 5 years.
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PMID:[Endometrioid adenocarcinoma of the uterine isthmus associated with atypical endometrial hyperplasia and polycystic ovaries. Apropos of a case with bicornuate uterus in a 38 year old woman]. 827 61

A cohort study has been carried out to investigate risk factors for cancer as well as hyperplasia of the endometrium. Over the 13 years for which we followed 25,000 women aged 40-65 (who took part in a population-based screening programme for breast cancer), 111 cases of endometrial cancer and 109 cases of endometrial hyperplasia were diagnosed. A comparison of the outcome between the two disease entities revealed that large body weight among postmenopausal women and the use of oestrogenic drugs at all ages were risk factors for both cancer and hyperplasia of the endometrium. However, reproductive histories and premenopausal steroid profiles differed. Steroid excretion determinations in urine samples collected years before diagnosis provided further evidence in favour of the hypothesis of unopposed action of oestrogens in the aetiology of endometrial cancer. In women who were to develop endometrial hyperplasia or cancer the obesity-oestrogen relationship was stronger than in those who remained free of endometrial disease during the period of follow-up. The possible significance of differences in aromatase activity among the obese is considered.
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PMID:A comparative study of risk factors for hyperplasia and cancer of the endometrium. 873 77


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