48,790
edits
(30 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
:''See [[Endometrium]] for | :''See [[Endometrium]] for an introduction to the topic.'' | ||
'''Endometrial hyperplasia''', abbreviated '''EH''', is a precursor to [[endometrial carcinoma]]. | '''Endometrial hyperplasia''', abbreviated '''EH''', is a precursor to [[endometrial carcinoma]]. | ||
=Overview= | =Overview= | ||
The | ===WHO endometrial hyperplasia classification of 2014=== | ||
The 2014 WHO system has two categories:<ref name=pmid25797956 >{{Cite journal | last1 = Emons | first1 = G. | last2 = Beckmann | first2 = MW. | last3 = Schmidt | first3 = D. | last4 = Mallmann | first4 = P. | title = New WHO Classification of Endometrial Hyperplasias. | journal = Geburtshilfe Frauenheilkd | volume = 75 | issue = 2 | pages = 135-136 | month = Feb | year = 2015 | doi = 10.1055/s-0034-1396256 | PMID = 25797956 }}</ref> | |||
*Hyperplasia without atypia. | |||
*Atypical hyperplasia/endometrioid intraepithelial neoplasia. | |||
===WHO classification | ===WHO endometrial hyperplasia classification of 1994=== | ||
The WHO system is based on determining: | The 1994 WHO system is based on determining:<ref name=pmid25797956>{{Cite journal | last1 = Emons | first1 = G. | last2 = Beckmann | first2 = MW. | last3 = Schmidt | first3 = D. | last4 = Mallmann | first4 = P. | title = New WHO Classification of Endometrial Hyperplasias. | journal = Geburtshilfe Frauenheilkd | volume = 75 | issue = 2 | pages = 135-136 | month = Feb | year = 2015 | doi = 10.1055/s-0034-1396256 | PMID = 25797956 }}</ref> | ||
# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia''). | # Gland density (normal/low = ''simple hyperplasia'', high density = ''complex hyperplasia''). | ||
# Presence/absence of nuclear atypia. | # Presence/absence of nuclear atypia. | ||
It consists of four categories: | |||
*[[Simple endometrial hyperplasia]]. | |||
*[[Simple endometrial hyperplasia with atypia]]. | |||
*[[Complex endometrial hyperplasia]]. | |||
*[[Complex endometrial hyperplasia with atypia]]. | |||
===Alternate classifications - overview=== | ===Alternate classifications - overview=== | ||
Line 25: | Line 34: | ||
#Endometrial intraepithelial neoplasia (EIN). | #Endometrial intraepithelial neoplasia (EIN). | ||
==WHO classification== | ==WHO classification of 1994== | ||
===Management of endometrial hyperplasia=== | ===Management of endometrial hyperplasia=== | ||
*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>URL: [http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html].</ref> | *Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>URL: [http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html].</ref> | ||
Line 32: | Line 41: | ||
**Progestins + close follow-up ''OR'' hysterectomy. | **Progestins + close follow-up ''OR'' hysterectomy. | ||
===Risk of progression to carcinoma=== | ===Risk of progression to carcinoma as per 1994 system=== | ||
Approximate risk of progression to [[endometrial carcinoma]] - Latta rule of 3s:<ref>Latta, E. January 2009.</ref> | Approximate risk of progression to [[endometrial carcinoma]] - Latta rule of 3s:<ref>Latta, E. January 2009.</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
Line 47: | Line 56: | ||
* ‡ 29% is the true number.<ref name=pmid4005805/> | * ‡ 29% is the true number.<ref name=pmid4005805/> | ||
=WHO system= | ===Ki-67=== | ||
Almost all hyperplasia is seen in the context of proliferative-type | There is one paper that looks at Ki-67:<ref>{{Cite journal | last1 = Abike | first1 = F. | last2 = Tapisiz | first2 = OL. | last3 = Zergeroglu | first3 = S. | last4 = Dunder | first4 = I. | last5 = Temizkan | first5 = O. | last6 = Temizkan | first6 = I. | last7 = Payasli | first7 = A. | title = PCNA and Ki-67 in endometrial hyperplasias and evaluation of the potential of malignancy. | journal = Eur J Gynaecol Oncol | volume = 32 | issue = 1 | pages = 77-80 | month = | year = 2011 | doi = | PMID = 21446331 }}</ref> | ||
{| class="wikitable sortable" | |||
! Diagnosis | |||
! Percent positive | |||
|- | |||
| [[Secretory phase endometrium]] | |||
| <center>15%</center> | |||
|- | |||
| [[Proliferative phase endometrium]] | |||
| <center>42%</center> | |||
|- | |||
| [[Simple endometrial hyperplasia|Simple hyperplasia]] | |||
| <center>26%</center> | |||
|- | |||
| [[Simple endometrial hyperplasia with atypia|Simple hyperplasia with atypia]] | |||
| <center>23%</center> | |||
|- | |||
| [[Complex endometrial hyperplasia|Complex hyperplasia]] | |||
| <center>16%</center> | |||
|- | |||
| [[Complex endometrial hyperplasia with atypia|Complex hyperplasia with atypia]] | |||
| <center>42%</center> | |||
|} | |||
==WHO system of 1994 - detail articles== | |||
Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology. | |||
==Simple endometrial hyperplasia== | ===Simple endometrial hyperplasia=== | ||
*[[AKA]] ''simple hyperplasia''. | *[[AKA]] ''simple hyperplasia''. | ||
{{Main|Simple endometrial hyperplasia}} | |||
===Simple endometrial hyperplasia with atypia=== | |||
{{Main|Simple endometrial hyperplasia}} | |||
===Complex endometrial hyperplasia=== | |||
*Abbreviated ''CEH''. | |||
* | {{Main|Complex endometrial hyperplasia}} | ||
===Complex endometrial hyperplasia with atypia=== | |||
Complex endometrial hyperplasia | |||
*[[AKA]] ''complex atypical hyperplasia''. | *[[AKA]] ''complex atypical hyperplasia''. | ||
{{Main|Complex endometrial hyperplasia}} | |||
=Other= | =Other= | ||
Line 214: | Line 111: | ||
*#Cytoplasmic vacuolization. | *#Cytoplasmic vacuolization. | ||
*#Intraluminal secretions. | *#Intraluminal secretions. | ||
* | *Proliferative-type epithelium. † | ||
**Mitoses. | |||
**Nuclear atypia. | |||
**Pseudostratified epithelium. | |||
Notes: | |||
* † This is ''not'' precisely defined. I suppose it is some of the things Bell and Ostrezega<ref name=pmid3610133/> mention (mitoses, nuclear atypia, pseudostratified epithelium). | |||
**Bell and Ostrezega<ref name=pmid3610133>{{Cite journal | last1 = Bell | first1 = CD. | last2 = Ostrezega | first2 = E. | title = The significance of secretory features and coincident hyperplastic changes in endometrial biopsy specimens. | journal = Hum Pathol | volume = 18 | issue = 8 | pages = 830-8 | month = Aug | year = 1987 | doi = | PMID = 3610133 }}</ref> give a laundry list for differentiating ''benign secretory endometrium'' from ''hyperplasia with secretory changes'': focal architectural abnormalities, metaplastic ciliated & "clear" cells, sharp luminal border, epithelial pseudopalisading, nuclear atypia, vesicular nuclei, mitoses. | |||
DDx: | DDx: | ||
*[[Secretory phase endometrium]]. | *[[Secretory phase endometrium]]. | ||
*[[Endometrium with hormonal changes]]. | *[[Endometrium with hormonal changes]]. | ||
Images: | |||
*[http://www.cap.org/apps/docs/cap_today/0612/0612a_qa.pdf Endometrial hyperplasia with secretory changes (cap.org)]. | |||
=See also= | =See also= |
edits