A 28-year-old woman presents with an endometrial biopsy showing complex hyperplasia with atypia. What is the risk of concurrent or progression to endometrial carcinoma if untreated, and what is the recommended management?

• A ~1% risk of carcinoma; manage with progestins and annual surveillance biopsies
• B ~23–29% risk of concurrent carcinoma; hysterectomy recommended for women who have completed childbearing ✓
• C ~5% risk of carcinoma; observe annually if asymptomatic
• D ~50% risk; requires immediate radical hysterectomy with lymphadenectomy

Explanation

Endometrial complex hyperplasia with atypia (now termed endometrial intraepithelial neoplasm, EIN) carries approximately 23–29% risk of concurrent endometrial carcinoma found at hysterectomy, and substantial progression risk if untreated. Standard management for women who have completed childbearing is total hysterectomy (bilateral salpingo-oophorectomy if postmenopausal or high-risk). For women desiring fertility preservation, high-dose progestin therapy with close endometrial sampling every 3–6 months is an alternative.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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