Clinicopathological and ultrasound assessment of endometrial hyperplasia in perimenopausal women

Moţăţeanu VT, Valentin Teodor Moţăţeanu, Razvan Grigoras Capitanescu, R. Capitanescu, Căpitănescu RG, Răzvan Grigoraș Căpitănescu, Răzvan Grigoraş Căpitănescu, Paitici Ş, Ştefan Paitici, Ștefan Paitici, Maria Victoria Olinca, Olinca MV, Pană RC, Razvan Cosmin Pana, Răzvan Cosmin Pană, Alexandru Cristian Comănescu, A. Comanescu, Comănescu AC, Adrian Victor Tetileanu, Tetileanu AV, Roxana Elena Bohîlțea, Bohîlţea RE, Roxana Elena Bohîlţea, Berceanu C, Costin Berceanu
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie · 2026 · vol. 67(2) , pp. 267–281 · doi:10.47162/rjme.67.2.08 · PMID:42717458 · PMC13657413 · W7212183832
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This study evaluated perimenopausal endometrial hyperplasia, finding that women aged 46–51 exhibited significantly higher adenomyosis prevalence and greater clinicopathological complexity compared to those aged 40–45.

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This multicenter observational study evaluated the clinicopathological, ultrasonographic, and immunohistochemical features of endometrial hyperplasia in 103 perimenopausal women. Participants were stratified into two age-defined subgroups to assess associations between clinical presentation, imaging findings, and histological severity. The results indicated that older patients exhibited greater uterine dimensions, increased endometrial thickness, and a higher prevalence of adenomyosis compared to younger counterparts. Furthermore, advanced nuclear atypia, mitotic activity, and abnormal vascular morphology were significantly more frequent in the older subgroup, highlighting progressive biological complexity during the perimenopausal transition. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

BACKGROUND: Endometrial hyperplasia (EH) is a heterogeneous proliferative endometrial disorder frequently encountered during perimenopause, characterized by variable architectural complexity, cytological atypia and biological behavior. AIM: This study aimed to evaluate the clinical, ultrasonographic (US), histopathological (HP) and immunohistochemical (IHC) features of EH in perimenopausal women and to assess the associations between these parameters. PATIENTS, MATERIALS AND METHODS: This multicenter observational study included 103 perimenopausal women with histopathologically confirmed EH, evaluated between 2020 and 2025. Patients were stratified into two age-defined subgroups: Group A (40-45 years, n=49) and Group B (46-51 years, n=54). All patients underwent standardized US evaluation according to International Endometrial Tumor Analysis (IETA) terminology, followed by HP examination. IHC analysis was performed in selected representative cases. RESULTS: Abnormal uterine bleeding (AUB) was the predominant clinical presentation in both groups. Significant differences between subgroups were observed for previous endometrial biopsy, uterine dimensions, adenomyosis prevalence and endometrial thickness. Group B showed significantly greater uterine dimensions, higher prevalence of adenomyosis and increased mean endometrial thickness. HP evaluation demonstrated a heterogeneous spectrum of architectural, cytological, stromal and vascular alterations. Significant age-related differences were identified for atypical EH∕endometrial intraepithelial neoplasia (EIN), nuclear atypia, increased mitotic activity, vascular proliferation and abnormal vascular morphology, all being more frequent in Group B. IHC assessment further demonstrated substantial biological heterogeneity across EH lesions. CONCLUSIONS: Perimenopausal EH represents a heterogeneous spectrum of proliferative endometrial lesions with progressive clinicopathological complexity during the perimenopausal transition. Integrated US, HP and IHC assessment provides a comprehensive framework for lesion characterization, particularly in morphologically complex cases.
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Clinicopathological and ultrasound assessment of endometrial hyperplasia in perimenopausal women Vol. 67 No. 2, 2026 ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY Valentin Teodor Motateanu, Razvan Grigoras Capitanescu, Stefan Paitici, Maria Victoria Olinca, Razvan Cosmin Pana, Alexandru Cristian Comanescu, Adrian Victor Tetileanu, Roxana Elena Bohiltea, Costin Berceanu Background: Endometrial hyperplasia (EH) is a heterogeneous proliferative endometrial disorder frequently encountered during perimenopause, characterized by variable architectural complexity, cytological atypia and biological behavior. Aim: This study aimed to evaluate the clinical, ultrasonographic (US), histopathological (HP) and immunohistochemical (IHC) features of EH in perimenopausal women and to assess the associations between these parameters. Patients, Materials and Methods: This multicenter observational study included 103 perimenopausal women with histopathologically confirmed EH, evaluated between 2020 and 2025. Patients were stratified into two age-defined subgroups: Group A (40-45 years, n=49) and Group B (46-51 years, n=54). All patients underwent standardized US evaluation according to International Endometrial Tumor Analysis (IETA) terminology, followed by HP examination. IHC analysis was performed in selected representative cases. Results: Abnormal uterine bleeding (AUB) was the predominant clinical presentation in both groups. Significant differences between subgroups were observed for previous endometrial biopsy, uterine dimensions, adenomyosis prevalence and endometrial thickness. Group B showed significantly greater uterine dimensions, higher prevalence of adenomyosis and increased mean endometrial thickness. HP evaluation demonstrated a heterogeneous spectrum of architectural, cytological, stromal and vascular alterations. Significant age-related differences were identified for atypical EH/endometrial intraepithelial neoplasia (EIN), nuclear atypia, increased mitotic activity, vascular proliferation and abnormal vascular morphology, all being more frequent in Group B. IHC assessment further demonstrated substantial biological heterogeneity across EH lesions. Conclusions: Perimenopausal EH represents a heterogeneous spectrum of proliferative endometrial lesions with progressive clinicopathological complexity during the perimenopausal transition. Integrated US, HP and IHC assessment provides a comprehensive framework for lesion characterization, particularly in morphologically complex cases. Corresponding author: Razvan Grigoras Capitanescu, Lecturer, MD, PhD; e-mail: [email protected]; Stefan Paitici, Lecturer, MD, PhD; e-mail: [email protected] DOI: 10.47162/RJME.67.2.08 Download PDF Clinicopathological and ultrasound assessment of endometrial hyperplasia in perimenopausal women PDFDownload contents Journal archive - vol. 67 no. 1, 2026 - vol. 66 no. 4, 2025 - vol. 66 no. 3, 2025 - vol. 66 no. 2, 2025 - vol. 66 no. 1, 2025 - vol. 65 no. 4, 2024 - vol. 65 no. 3, 2024 - vol. 65 no. 2, 2024 - vol. 65 no. 1, 2024 - vol. 64 no. 4, 2023 - vol. 64 no. 3, 2023 - vol. 64 no. 2, 2023 - vol. 64 no. 1, 2023 - vol. 63 no. 4, 2022 - vol. 63 no. 3, 2022 - vol. 63 no. 2, 2022 - vol. 63 no. 1, 2022 - vol. 62 no. 4, 2021 - vol. 62 no. 3, 2021 - vol. 62 no. 2, 2021 - vol. 62 no. 1, 2021 - vol. 61 no. 4, 2020 - vol. 61 no. 3, 2020 - vol. 61 no. 2, 2020 - vol. 61 no. 1, 2020 - vol. 60 no. 4, 2019 - vol. 60 no. 3, 2019 - vol. 60 no. 2, 2019 - vol. 60 no. 1, 2019 - vol. 59 no. 4, 2018 - vol. 59 no. 3, 2018 - vol. 59 no. 2, 2018 - vol. 59 no. 1, 2018 - vol. 58 no. 4, 2017 - vol. 58 no. 3, 2017 - vol. 58 no. 2, 2017 - vol. 58 no. 1, 2017 - vol. 57 no. 4, 2016 - vol. 57 no. 3, 2016 - vol. 57 no. 2 Suppl., 2016 - vol. 57 no. 2, 2016 - vol. 57 no. 1, 2016 - vol. 56 no. 4, 2015 - vol. 56 no. 3, 2015 - vol. 56 no. 2 Suppl., 2015 - vol. 56 no. 2, 2015 - vol. 56 no. 1, 2015 - vol. 55 no. 4, 2014 - vol. 55 no. 3 Suppl., 2014 - vol. 55 no. 3, 2014 - vol. 55 no. 2 Suppl., 2014 - vol. 55 no. 2, 2014 - vol. 55 no. 1, 2014 - vol. 54 no. 4, 2013 - vol. 54 no. 3 Suppl., 2013 - vol. 54 no. 3, 2013 - vol. 54 no. 2, 2013 - vol. 54 no. 1, 2013 - vol. 53 no. 4, 2012 - vol. 53 no. 3 Suppl., 2012 - vol. 53 no. 3, 2012 - vol. 53 no. 2, 2012 - vol. 53 no. 1, 2012 - vol. 52 no. 4, 2011 - vol. 52 no. 3 Suppl., 2011 - vol. 52 no. 3, 2011 - vol. 52 no. 2, 2011 - vol. 52 no. 1 Suppl., 2011 - vol. 52 no. 1, 2011 - vol. 51 no. 4, 2010 - vol. 51 no. 3, 2010 - vol. 51 no. 2, 2010 - vol. 51 no. 1, 2010 - vol. 50 no. 4, 2009 - vol. 50 no. 3, 2009 - vol. 50 no. 2, 2009 - vol. 50 no. 1, 2009 - vol. 49 no. 4, 2008 - vol. 49 no. 3, 2008 - vol. 49 no. 2, 2008 - vol. 49 no. 1, 2008 - vol. 48 no. 4, 2007 - vol. 48 no. 3, 2007 - vol. 48 no. 2, 2007 - vol. 48 no. 1, 2007 - vol. 47 no. 4, 2006 - vol. 47 no. 3, 2006 - vol. 47 no. 2, 2006 - vol. 47 no. 1, 2006 - vol. 46 no. 4, 2005 - vol. 46 no. 3, 2005 - vol. 46 no. 2, 2005 - vol. 46 no. 1, 2005 - vol. 45 no. CI, 2004

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MeSH descriptors

Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia

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estrogen progesterone estrogen estrogen estrogen haematoxylin estrogen estrogen estrogen progesterone estrogen
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homo heidelbergensis noordeloos 2009062 human streptococcus lactis subsp. cremoris noordeloos 2009062

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