A 54-year-old woman with abnormal uterine bleeding undergoes endometrial sampling, which shows endometrial intraepithelial neoplasia (atypical hyperplasia) without evidence of carcinoma. If the uterus is left untreated, what is the approximate lifetime risk of progression to endometrioid carcinoma?
- A Approximately 5%
- B Approximately 15%
- C Approximately 30% ✓
- D Approximately 60%
Correct answer: C. Approximately 30%
Explanation
Untreated atypical hyperplasia or EIN progresses to endometrioid carcinoma in roughly one-third of women, which is why hysterectomy is preferred once fertility is complete and progestin therapy is used only under surveillance. Simple hyperplasia without atypia progresses in only around 1%, while complex hyperplasia without atypia progresses in about 3%, so those options underestimate the risk dramatically. A 60% figure would apply to foci of concurrent undetected carcinoma found in some hysterectomy series, not to progression risk.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.