Morular endometrial metaplasia: review of the literature and proposal of the management.

PURPOSE OF INVESTIGATION: Morular endometrial metaplasia is a rare condition that can be often misdiagnosed and overtreated, because it can be mistaken for a malignant disease. The aim of this review was to update the current opinion on the significance of this pathology and its risk for potential malignancies. MATERIALS AND METHODS: The authors report their experience of two cases of morular metaplasia involving very young women managed conservatively with hysteroscopic resection of the affected areas. RESULTS: Hysteroscopic resection of these lesions can be an adequate and fertility-sparing treatment of morular metaplasia in women of childbearing age. CONCLUSIONS: Morular metaplasia has indeed a mutational origin but it is a benign and hormonally inert condition. The risk to develop cancer is closely associated with premalignant or malignant endometrioid glandular proliferations that are often associated with hysthological finding of morules rather than with morules themselves. Management of this condition requires trained pathologists and gynecologists and should be adapted to the age of the patient.

Atypical endometrial lesions: hysteroscopic resection as an alternative to hysterectomy.

BACKGROUND: Endometrial hyperplasia is a precursor to endometrial carcinoma: the risk of progression to invasive endometrial cancer is increased in postmenopausal women and much more in cases of atypical endometrial hyperplasia (25%-30%). In addition, in 12.7% to 42.6% of cases according to various studies, endometrial cancer coexists in patients with diagnosis of atypical endometrial hyperplasia. The aim of this study was to evaluate the correlation between radical hysteroscopic resection of atypical endometrial lesions and the histopathological examination of the uterus. MATERIALS AND METHODS: The authors collected 25 patients referring to the Department of Woman and Child Health, in the University of Padua (Italy) from January 2008 to June 2012, undergoing hysteroscopic resection for atypical polyps and focal atypical endometrial hyperplasia, and following hysterectomy within 30 days. Average age, menopausal status, hormone replacement therapy, body mass index (BMI), presence of hypertension and diabetes, and taking tamoxifen were reported. RESULTS: After hysteroscopic resection in all patients atypical polyps and focal endometrial hyperplasia were confirmed. The hystopathologic evaluation of the uterus reported: in only two (8%) cases, the persistence of atypical endometrial lesion, whereas in 23 (92%) cases the endometrial tissue was negative for atypia or malignancy. CONCLUSIONS: Radical endometrial resection by hysteroscopy may serve as an alternative to hysterectomy in selected patients with atypical focal endometrial lesions, not only in fertile women, but also in patients who refuse hysterectomy or present high anesthesiologic and surgical risks, regardless of the risk of recurrence, and with the necessity of undergoing hysteroscopic close follow-up.