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Balloon thermoablation in a woman with complex endometrial hyperplasia with atypia. A case report
1Departments of Obstetrics and Gynecology and of Pathology and Laboratory Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA. obgvam@ttuhsc.edu
Background:
Endometrial ablation is an alternative to hysterectomy in patients with menorrhagia refractory to medical therapy. The histologic changes in the hyperplastic endometrium secondary to endometrial ablation are not well understood.
Case Report:
A 44-year-old woman, gravida 4, para 4, had menorrhagia, was at high risk for medical treatment and underwent thermal balloon ablation. The dilatation and curettage specimen at the time of the procedure revealed complex hyperplasia of the endometrium with atypia. Subsequently a hysterectomy was performed, and the pathology specimen showed scarring, fibrosis and focal, weakly proliferative phase endometrium. There was no evidence of hyperplasia or malignancy.
Conclusion:
Endometrial ablation with a thermal balloon seems to have resulted in resolution of endometrial hyperplasia. However, hyperplasia of the endometrium should still be a contraindication to such a procedure because of the inability to accurately assess the endometrium after ablation.