Complex endometrial hyperplasia: Difference between revisions

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| Width      =
| Width      =
| Caption    = Complex endometrial hyperplasia. [[H&E stain]].
| Caption    = Complex endometrial hyperplasia. [[H&E stain]].
| Micro      =
| Micro      = increase in size & number of glands + irregular shape, nuclear pseudostratification, nuclear enlargement, mitoses common, +/-nuclear atypia (round nuclei ~ 2-3x the size of a lymphocyte, grey/translucent chromatin, nucleoli)
| Subtypes  =
| Subtypes  = CEH [[NOS]] (CEH without atypia), CEH with atypia
| LMDDx      =
| LMDDx      = [[endometrioid endometrial carcinoma]], artifactual gland crowding
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      =
| Gross      = thickened endometrium
| Grossing  =
| Grossing  = [[hysterectomy for endometrial hyperplasia grossing]]
| Site      = [[endometrium]] - see ''[[endometrial hyperplasia]]
| Site      = [[endometrium]] - see ''[[endometrial hyperplasia]]
| Assdx      = [[obesity]]
| Assdx      = [[obesity]], [[endometrium with squamous morules]]
| Syndromes  =
| Syndromes  =
| Clinicalhx = usu. premenopausal or perimenopausal
| Clinicalhx = usu. premenopausal or perimenopausal
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| Prognosis  =
| Prognosis  =
| Other      =
| Other      =
| ClinDDx    = [[dysfunctional uterine bleeding]] (diagnosis of exclusion), [[endometrial carcinoma]], [[inactive endometrium|atrophy]]
| ClinDDx    = [[dysfunctional uterine bleeding]] (diagnosis of exclusion), [[endometrial carcinoma]], [[inactive endometrium|atrophy]], [[endometrial polyp]], others
}}
}}
{{ Infobox external links
{{ Infobox external links
| Name          = Complex endometrial hyperplasia
| Name          = Complex endometrial hyperplasia
| EHVSC          = 10169
| EHVSC          = 10169  
| EHVSC_mult    = {{EHVSC3|10181|CEH with atypia}}
| pathprotocols  =  
| pathprotocols  =  
| wikipedia      =
| wikipedia      =
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It is generally subdivided into '''complex endometrial hyperplasia without atypia''' and '''complex endometrial hyperplasia with atypia'''.
It is generally subdivided into '''complex endometrial hyperplasia without atypia''' and '''complex endometrial hyperplasia with atypia'''.
'''CEH with atypia''' is also known as '''complex atypical hyperplasia'''.
==General==
*Usually premenopausal or perimenopausal women.
*Associated with [[obesity]].
*High risk of transformation to [[endometrial carcinoma]] especially when with atypia.
==Gross==
*Endometrial thickening.


==Microscopic==
==Microscopic==
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*Nuclear enlargement.
*Nuclear enlargement.
*Mitoses common.
*Mitoses common.
*No nuclear atypia.
*+/-Nuclear atypia:
**Round nuclei ~ 2-3x the size of a lymphocyte.
**Grey/translucent chromatin.
**Nucleoli.


Notes:  
Notes:  
*Normal "gland-to-stroma ratio" is 1:3.
*Normal "gland-to-stroma ratio" is 1:3.
*Two "touching" glands may be one gland in section.
*Two "touching" glands may be one gland in section.
*Atypical nuclei often hide between non-typical nuclei, like peg cells in the [[fallopian tube]].
*[[Squamous morules]] commonly seen.


DDx:
DDx:
*[[Complex endometrial hyperplasia with atypia]].
*Artifactual gland crowding due to fragmentation - white space around the glands.
*[[Endometrial gland coiling]] - no sharp transition, moderate stroma between the glands horizontally.
*[[Endometrioid endometrial carcinoma]] - see ''[[endometrial carcinoma versus complex endometrial hyperplasia]]''.
*[[Endometrioid endometrial carcinoma]] - see ''[[endometrial carcinoma versus complex endometrial hyperplasia]]''.
 
*Benign papillary proliferation of the endometrium.<ref name=pmid23211295>{{Cite journal  | last1 = Ip | first1 = PP. | last2 = Irving | first2 = JA. | last3 = McCluggage | first3 = WG. | last4 = Clement | first4 = PB. | last5 = Young | first5 = RH. | title = Papillary proliferation of the endometrium: a clinicopathologic study of 59 cases of simple and complex papillae without cytologic atypia. | journal = Am J Surg Pathol | volume = 37 | issue = 2 | pages = 167-77 | month = Feb | year = 2013 | doi = 10.1097/PAS.0b013e318272d428 | PMID = 23211295 }}</ref>
===Endometrial carcinoma versus complex endometrial hyperplasia===
===Endometrial carcinoma versus complex endometrial hyperplasia===
Complex endometrial hyperplasia:  
Complex endometrial hyperplasia:  
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*[[desmoplasia|'''D'''esmoplasia]].
*[[desmoplasia|'''D'''esmoplasia]].
*'''E'''xtensive papillary growth.
*'''E'''xtensive papillary growth.


===Images===
===Images===
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Image: Endometrial polyp with fused glands -- high mag.jpg | Endometrial polyp with fused glands - high mag. (WC)
Image: Endometrial polyp with fused glands -- high mag.jpg | Endometrial polyp with fused glands - high mag. (WC)
</gallery>
</gallery>
www:
www:
*[http://www.webpathology.com/image.asp?n=1&Case=568 Endometrial hyperplasia (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=3&Case=568 Complex endometrial hyperplasia without atypia (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=4&Case=568 Complex endometrial hyperplasia without atypia (webpathology.com)].


==Sign out==
==Sign out==
===Complex endometrial hyperplasia without atypia===
===CEH without atypia===
<pre>
<pre>
ENDOMETRIUM, BIOPSY:  
ENDOMETRIUM, BIOPSY:  
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- SCANT ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- SCANT ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
</pre>
</pre>
====Hysterectomy====
<pre>
UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- FOCAL COMPLEX ENDOMETRIAL HYPERPLASIA WITHOUT ATYPIA.
- LEIOMYOMAS.
- FIBROUS ADHESIONS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.
</pre>
=====Micro=====
The sections show endometrium with pseudostratified glands and glandular dilation. On one
section the gland-to-stroma ratio is increased and the glands are very focally back-to-back. Significant gland cribriforming is not identified. No nuclear atypia is apparent. Stromal desmoplasia is not identified.
===CEH with atypia===
====Insufficient confluence for carcinoma====
<pre>
ENDOMETRIUM, BIOPSY:
- COMPLEX ENDOMETRIAL HYPERPLASIA WITH ATYPIA, SEE COMMENT.
COMMENT:
The sections show architecturally complex crowded glands with focal
morular squamous metaplasia and focal cribriforming.  Desmoplasia
is not identified. The degree of gland confluence is not considered
sufficient for the diagnosis of endometrial carcinoma. Nuclear atypia
is present focally.
</pre>
====Insufficient extent for carcinoma====
<pre>
ENDOMETRIUM, BIOPSY:
- COMPLEX ENDOMETRIAL HYPERPLASIA WITH ATYPIA, SEE COMMENT.
COMMENT:
The sections show architecturally complex back-to-back glands with focal
morular squamous metaplasia and cribriforming. Desmoplasia is not present.
The extent, i.e. the size of the abnormality, is not considered sufficient
for the diagnosis of endometrial carcinoma.
</pre>
====Micro====
=====CEH with atypia=====
The sections show endometrium with atypical hyperchromatic, densely packed branching glands.  The nuclei of the atypical glands focally are round, 2-3x the size of a lymphocyte, and have grey/translucent chromatin and small nucleoli. No papillary or cribriform changes are appreciated.  No desmoplastic stroma is identified.


==See also==
==See also==
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==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Endometrial hyperplasia]]
[[Category:Endometrial hyperplasia]]
Retrieved from "https://librepathology.org/wiki/Complex_endometrial_hyperplasia"