A 45-years old woman with diagnosis of atypical adenomatous hyperplasia of the endometrium should be treated by :
**Core Concept**
Atypical adenomatous hyperplasia of the endometrium is a precancerous lesion that increases the risk of developing endometrial cancer. The treatment of choice aims to prevent progression to malignancy and involves surgical intervention.
**Why the Correct Answer is Right**
The correct answer is **prophylactic hysterectomy**. This surgical approach involves the removal of the uterus, which eliminates the risk of endometrial cancer and eliminates the need for long-term surveillance. The decision for prophylactic hysterectomy is based on the patient's age, desire for future fertility, and the risk of progression to malignancy.
**Why Each Wrong Option is Incorrect**
**Option A:** **Endometrial ablation** is a procedure that destroys the lining of the uterus but does not address the underlying precancerous lesion. It is not suitable for atypical adenomatous hyperplasia.
**Option B:** **Hormonal therapy** may be used to manage symptoms and slow down the growth of the lesion, but it does not eliminate the risk of progression to malignancy.
**Option C:** **Endometrial biopsy with follow-up** may be used for surveillance in younger patients, but it is not the definitive treatment for atypical adenomatous hyperplasia.
**Clinical Pearl / High-Yield Fact**
Prophylactic hysterectomy is often recommended for women with atypical adenomatous hyperplasia who are over 40 years old and have completed childbearing.
**Correct Answer: D. Prophylactic hysterectomy**