Difference between revisions of "Endometrial hyperplasia"

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Endometrial hyperplasia (view source)

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'''Endometrial hyperplasia''', abbreviated '''EH''', is a precursor to [[endometrial carcinoma]].
'''Endometrial hyperplasia''', abbreviated '''EH''', is a precursor to [[endometrial carcinoma]].


=Overview=
The most widely used system is from the World Health Organization (WHO). The WHO system is based on determining:
The most widely used system is from the World Health Organization (WHO). The WHO system is based on determining:
# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia''), and
# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia''), and
# Presence of atypia.  
# Presence of atypia.  
An alternative grading system from Harvard exists.  It is not widely used. It defines a term called ''endometrial intraepithelial neoplasia'' (EIN). 


==WHO system==
==WHO system==
===Simple endometrial hyperplasia===
===Management of endometrial hyperplasia===
*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>[http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html]</ref>
**In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).<ref>[http://www.aafp.org/afp/20060801/practice.html http://www.aafp.org/afp/20060801/practice.html]</ref>
*Endometrial hyperplasia without atypia is treated by:
**Progestins + close follow-up ''OR'' hysterectomy.
 
===Risk of progression to carcinoma===
Approximate risk of progression to carcinoma:<ref>LAE Jan 2009.</ref>
{| class="wikitable"
| || '''Simple''' || '''Complex'''
|-
| Without atypia || 1% || 3%
|-
| With atypia || 9% || 27%
|-
|}
 
=WHO system=
==Simple endometrial hyperplasia==
 
===General===
*More common than simple endometrial hyperplasia with atypia.
 
===Microscopic===
Features:
Features:
*Irregular gland shape.
*Irregular gland shape.
*Variation of gland size.
*Variation of gland size.
*With or without atypia.
*No nuclear atypia.
**Most commonly seen without atypia.
**Uniform columnar nuclei.


DDx:
DDx:
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*[http://commons.wikimedia.org/wiki/File:Simple_endometrial_hyperplasia_-_high_mag.jpg Simple endometrial hyperplasia - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Simple_endometrial_hyperplasia_-_high_mag.jpg Simple endometrial hyperplasia - high mag. (WC)].


===Complex endometrial hyperplasia===
==Simple endometrial hyperplasia with atypia==
===Microscopic===
Features:
*Irregular gland shape.
*Variation of gland size.
*Nuclear atypia:<ref>{{Cite journal  | last1 = Silverberg | first1 = SG. | title = Problems in the differential diagnosis of endometrial hyperplasia and carcinoma. | journal = Mod Pathol | volume = 13 | issue = 3 | pages = 309-27 | month = Mar | year = 2000 | doi = 10.1038/modpathol.3880053 | PMID = 10757341 }}</ref>
**Loss of basal nuclear stratification - '''important'''.
**Nuclear size variation.
**Nuclear rounding.
***Nuclei lacking atypical = uniform columnar nuclei.
**Nucleoli.
 
==Complex endometrial hyperplasia==
 
===Microscopic===
Features:
Features:
*Increase in size & number of glands + irreg. shape.
*Increase in size & number of glands + irreg. shape.
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*[http://www.webpathology.com/image.asp?n=2&Case=568 Complex endometrial hyperplasia with atypia (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=568 Complex endometrial hyperplasia with atypia (webpathology.com)].


==Endometrial cancer vs. complex endometrial hyperplasia==
[[Endometrial carcinoma]] vs. complex endometrial hyperplasia:
*Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
*Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
*Diagnosis of complex EH is based on histology (cytologic features).
*Diagnosis of complex EH is based on histology (cytologic features).


Note: An alternative grading system from Harvard exists.  It is not widely used. It defines a term called ''endometrial intraepithelial neoplasia'' (EIN). 
=See also=
 
==Management of endometrial hyperplasia==
*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>[http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html]</ref>
**In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).<ref>[http://www.aafp.org/afp/20060801/practice.html http://www.aafp.org/afp/20060801/practice.html]</ref>
*Endometrial hyperplasia without atypia is treated by:
**Progestins + close follow-up ''OR'' hysterectomy.
 
==Endometrial carcinoma==
{{main|Endometrial carcinoma}}
Endometrial hyperplasia (EH) is a risk for the development of ''endometrioid endometrial carcinoma''.
 
===Risk of progression to carcinoma===
Approximate risk of progression to carcinoma:<ref>LAE Jan 2009.</ref>
{| class="wikitable"
| || '''Simple''' || '''Complex'''
|-
| Without atypia || 1% || 3%
|-
| With atypia || 9% || 27%
|-
|}
 
==See also==
*[[Endometrium]].
*[[Endometrium]].
*[[Endometrial carcinoma]].
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
Michael
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