Introduction/Background Atypical endometrial hyperplasia (AEH) is a benign lesion that can precede or coexist with endometrial carcinoma. The difference between the initial pathology diagnostic of AEH and the definitive pathology result can lead to either an insufficient surgical treatment or an excessive surgical treatment. The objective of this study was to identify clinico-pathologic factors for concurrent endometrial carcinoma in patients with AEH.

Methodology The records of patients who underwent hysterectomy for preoperatively diagnosed AEH were retrospectively reviewed. This study spanned over 3 years, from 1st of December 2020 to 30th of November 2023 in gynaecology and obstetrics department B- Charles Nicolle Hospital-Tunis- Tunisia. Clinico-pathologic factors were examined to identify independent risk factors of concurrent endometrial carcinoma in a multivariate logistic regression model.

Results A total of 41 patients were included. Obesity was present in 53.7% of the cases, diabetes in 51.3% of the cases and high blood pressure in 46.3% of the cases. Transvaginal ultrasound showed endometrial thickness in 91% of the cases. The most common histologic subtype in preoperative endometrial biopsy was complex hyperplasia with atypia (CAH) (72.72%). Final pathology showed 65.85% of endometrioïd carcinoma grade 1 or grade 2, stage I or II. Endometrial carcinoma was discovered in 53.65% of CAH.

In multivariate analysis, BMI ≥ 35 kg/m2 (p = 0.020), diabetes mellitus (p = 0.036), high blood pressure (p = 0.003), endometrial thickness greater than 10 mm (p = 0.0005) and the preoperative diagnosis of CAH (p = 0.042) were independent predictors of concurrent endometrial carcinoma.

Conclusion Obesity, diabetes, high blood pressure, endometrial thickness greater than 10 mm and CAH can predict concurrent endometrial carcinoma in AEH patients.

Disclosures We declare that we have no conflicts of interest.