Hyperplasia is a condition characterized by an increase in the number of cells in a tissue or organ (with the exception of tumor tissue). The result of the development of this disease is a neoplasm or a noticeable increase in the size of the organ.
Hyperplasia subsequently develops of a wide variety of influences affecting the reproduction of stimulating cells. Thus, antigenic stimuli, oncogenic substances, tissue growth stimulants or the loss of an organ or part of a tissue for any reason can provoke development. Physiological hyperplasia is the growth of mammary gland epithelium during pregnancy, the manifestation of glandular hyperplasia before or during menstruation, and other similar manifestations.
As an example of hyperplasia progressing in pathological conditions, one can name an increase in the volume of structural elements in patients with certain forms of anemia of myeloid tissue. In addition, hyperplastic processes can occur in the lymphoreticular tissue of the lymph nodes, as an immune response in the spleen, in case of diseases of an infectious nature.
Variety of shapes
In medicine, there are several main types:
- Physiological hyperplasia. Tissue proliferation occurs, which is functional or temporary. For example, mammary gland hyperplasia, during feeding or during pregnancy.
- Pathological hyperplasia. Due to a number of provoking factors, tissue proliferation occurs.
In addition, this disease can be focal, diffuse and polypous:
- With a focal form, a clear localization of the process in the form of separate sections is observed.
- With diffuse hyperplasia, the surface of the entire layer is affected.
- The polypous form is characterized by uneven growth of the connecting elements. In this case, hyperplasia can provoke the development of poor-quality formations and cysts.
Diffuse hyperplasia of the thyroid gland
This disease occurs in the event of a compensatory reaction of the thyroid gland to iodine deficiency. Moreover, the term "diffuse" means that the pathology affects the entire organ: an increase in its size occurs due to the multiplication of gland cells in order to maintain the secretion of thyroid hormones that promote metabolism, enhance oxygen absorption, maintain an energy level.
Thyroid iodine is required to maintain its hormonal activity. Lack or absence of iodine intake contributes to the proliferation of gland cells and subsequently can lead to its dysfunction.
Adrenal hyperplasia
This disease can be nodular or diffuse. It accompanies invariable adrenal tissue in the case of a pineal tumor and Cushing's syndrome. In adults, this form of hyperplasia, especially left-sided, is very difficult to recognize when examined by ultrasound and remains the subject of study by MRI and CT.
Sometimes diffuse adrenal hyperplasia is accompanied by organ enlargement while maintaining the normal appearance of the glands - in the form of hypoechoic formations surrounded by fatty tissue. In the case of nodular hyperplasia in the area of the "fat triangle" you can see rounded, homogeneous hypoechoic formations. They are rather difficult to distinguish from an adenoma by an echographic picture.
Prostate - benign hyperplasia
About 85% of men over 50 are affected by this disease. Benign prostatic hyperplasia is characterized by the formation of several small nodules (or one) on the prostate, which, gradually spreading, begin to put pressure on the urethra, which subsequently causes difficulty with urination.
This disease does not cause metastasis, this factor distinguishes it from prostate cancer, so it is called benign hyperplasia. However, it does not have a clear cause of occurrence and, as a rule, is associated with male menopause.
Uterine endometrium
Hyperplasia is a benign increase in the thickness and volume of the inner lining of the uterus. It can occur as a result of the reproduction of both glandular and other tissue cells. This disease can lead to a violation of the functional activity of the endometrium (problems with conception, irregular menstruation).
Under normal conditions, the endometrium under the influence of estrogen grows in the first period of the cycle, under the influence of progesterone in the second period of the cycle it is restrained. In pathology, endometrial growth occurs uncontrollably, it is able to capture both the entire inner shell and individual parts (focal hyperplasia).
Varieties of endometrial hyperplasia
By the predominance of some elements in the growing endometrium, the following are distinguished:
- Glandular hyperplasia. The glands of the endometrium grow in excess.
- Polypous hyperplasia. There is a focal growth of the endometrium, which has a glandular, glandular-fibrous, and also fibrous nature. This kind of hyperplasia rarely becomes malignant, but can serve as the basis for the development of gynecological diseases.
- Adenomatous hyperplasia with the presence of atypical cells, precancerous. In this case, degeneration into cancer of this type of hyperplasia can reach about 10%.
- Cystic glandular hyperplasia. Glands and cysts grow about the same.
Causes of occurrence
To date, the main cause of this disease is the excess with a relative lack of progesterone of the physiological level of estrogen. This condition can lead to:
- Transitional age with impaired hormonal metabolism and hormonal surges.
- Female obesity.
- Polycystic ovary syndrome.
- Menopause period.
- Taking drugs containing estrogen without taking progesterone.
Very often, endometrial hyperplasia (expert reviews confirm this) is manifested in women before menopause and in young nulliparous girls.
Concomitant diseases that enhance the manifestation of hyperplasia are problems with the adrenal glands and breast, thyroid disease, diabetes of both types, as well as hypertension. Hyperplasia can also be caused by factors such as:
- Heredity for genital diseases.
- Adenominosis.
- Uterine fibroids.
- Abortion and curettage.
- Inflammatory processes of the genitals.
Causes of development and types of glandular endometrial hyperplasia
The main causes of glandular hyperplasia:
- Anovulation.
- Overweight.
- The presence of follicular cysts.
- Menopause.
Also dangerous is the syndrome of persistence of the follicle, glycemia and tumors of granulosa cells.
Lack of treatment and untimely diagnosis of this disease is fraught with such a dangerous consequence as the development of endometrial cancer. Mostly at risk are girls suffering from atypical ademonatous hyperplasia, and women after menopause. It is focal and diffuse hyperplasia that are the precancerous forms of this disease.
Other forms of endometrial hyperplasia are considered to be the intensive spread of glandular epithelium, cystic enlarged glands, as well as glandular cystic hyperplasia.
Symptoms
In most cases, glandular hyperplasia occurs without pronounced clinical symptoms. In this case, dysfunctional uterine bleeding caused by menstrual irregularities (delayed menstruation) is considered common manifestations. These bleeding can be both profuse and prolonged, and blood loss - profuse or moderate. As a result, anemic symptoms develop: loss of appetite, fatigue, weakness.
Between menstruation, spotting can be observed. Quite often infertility occurs in women due to anovulation. That is, infertility is the reason for going to the doctor, who subsequently diagnoses this disease. Symptoms also include pain in the lower abdomen.
Diagnosis of glandular hyperplasia can be carried out through diagnostic curettage, which is performed immediately before menstruation. Quite often, ultrasound and hysteroscopy are used in the diagnosis.
Focal hyperplasia
Focal hyperplasia (expert reviews indicate this) can threaten cancer and infertility. A mild character or asymptomatic course allows you to detect this disease only during ultrasound or during a gynecological examination.
Focal hyperplasia usually develops subsequently hormonal disorders, after suffering somatic diseases and abortions, or against the background of glandular type hyperplasia.
Focal uterine epithelial hyperplasia is diagnosed based on the following symptoms:
- spotting after the cessation of menstruation;
- acyclic or cyclic menstrual irregularities.
The treatment of this disease is carried out in two main ways:
- The medication method is with the help of special drugs, including hormonal ones.
- Surgical or surgical method - by curettage of the uterine cavity.
Diagnosis of endometrial hyperplasia
The basis for the diagnosis of this disease is examination by a gynecologist, conducting instrumental and laboratory studies.
The main diagnostic methods include:
- Ultrasound of the appendages and uterus with a vaginal probe.
- Hysteroscopy with a sampling of material for histological examination.
- Diagnostic curettage of the uterine cavity.
- If it is necessary to clarify the type of hyperplasia, an aspiration biopsy is performed .
One of the most important laboratory tests is the determination of the level of sex hormones and the thyroid gland, as well as the adrenal glands, in blood serum.
It is important to remember that any form of hyperplasia needs to be accurately diagnosed and revealed by the truth of the cause that led to tissue enlargement.
Treatment
If hyperplasia has been diagnosed, treatment is immediate. The method is selected based on the manifestations of the disease and the age of the patient.
The most effective way is diagnostic curettage or hysteroscopic removal with a diffuse endometrial process.
If the treatment process is multi-stage in nature, then, first of all, emergency or planned curettage is carried out. The first option is resorted to for anemia or bleeding.
Once the histology results are obtained, the specialist can prescribe the following treatment methods:
- At the age of more than 35 years, gonadotropin antagonists are prescribed.
- Intrauterine device Mirena with gestagens.
- In the second period of the cycle, gestagen drugs are prescribed (Dufaston, Utrozhestan).
- In order to non-operatively stop bleeding in girls at a young age, it is allowed to use oral contraceptives in fairly large doses.
- Combined oral contraception (Regulon, Yarina, Zhanin) is prescribed for 6 months with the traditional regimen.
The drugs mentioned above create an effect similar to menopause, but it is reversible.
After curettage for another six months, control is carried out, if a relapse of the adenomatous form of hyperplasia is observed, then removal of the uterus is indicated . With other recurring forms and ineffectiveness of the other methods of treatment, artificial destruction of the endometrium (ablation) is performed.
Prognosis and complications
The most dangerous complication of endometrial hyperplasia is its transformation into uterine cancer. However, bleeding and relapses with the development of infertility and anemia are no less dangerous.
In most cases, the prognosis is favorable: as a result of surgery and prima drugs for 6-12 months, this disease can be completely cured.
Prevention
The most important measures for the prevention of endometrial hyperplasia are the prevention of stressful situations, the active fight against overweight and the immediate treatment of monthly cycle disorders. In addition, timely gynecological examination of women is very important.
Sometimes, for young girls, a specialist can recommend hormonal drugs for prevention, which help reduce the risk of endometrial hyperplasia and cancer. Any woman should be aware that if uterine bleeding occurs, you should immediately consult a specialist. Remember that a timely visit to a doctor will help to avoid most problems in the future.