Difference between revisions of "Endometrial hyperplasia"
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=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=== | ||
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#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> | ||
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**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> | ||
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=WHO system= | ==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. | 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}} | {{Main|Simple endometrial hyperplasia}} | ||
==Simple endometrial hyperplasia with atypia== | ===Simple endometrial hyperplasia with atypia=== | ||
{{Main|Simple endometrial hyperplasia}} | {{Main|Simple endometrial hyperplasia}} | ||
==Complex endometrial hyperplasia== | ===Complex endometrial hyperplasia=== | ||
*Abbreviated ''CEH''. | *Abbreviated ''CEH''. | ||
{{Main|Complex endometrial hyperplasia}} | {{Main|Complex endometrial hyperplasia}} | ||
==Complex endometrial hyperplasia with atypia== | ===Complex endometrial hyperplasia with atypia=== | ||
*[[AKA]] ''complex atypical hyperplasia''. | *[[AKA]] ''complex atypical hyperplasia''. | ||
{{Main|Complex endometrial hyperplasia}} | {{Main|Complex endometrial hyperplasia}} | ||
Latest revision as of 15:42, 27 June 2016
- See Endometrium for an introduction to the topic.
Endometrial hyperplasia, abbreviated EH, is a precursor to endometrial carcinoma.
Overview
WHO endometrial hyperplasia classification of 2014
The 2014 WHO system has two categories:[1]
- Hyperplasia without atypia.
- Atypical hyperplasia/endometrioid intraepithelial neoplasia.
WHO endometrial hyperplasia classification of 1994
The 1994 WHO system is based on determining:[1]
- Gland density (normal/low = simple hyperplasia, high density = complex hyperplasia).
- 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
Two alternative grading systems exist, that are (currently) not widely used:[2]
- European group of experts (1999).
- Endometrial collaborative group/Harvard (2000).
Both consist of two categories, as opposed to four found in the WHO classification.
European group of experts classification
- Endometrial hyperplasia.
- Endometrioid neoplasia.
Endometrial collaborative group/Harvard classification
- Endometrial hyperplasia.
- Endometrial intraepithelial neoplasia (EIN).
WHO classification of 1994
Management of endometrial hyperplasia
- Endometrial hyperplasia with atypia is usually treated with hysterectomy.[3]
- In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).[4]
- Endometrial hyperplasia without atypia is treated by:
- Progestins + close follow-up OR hysterectomy.
Risk of progression to carcinoma as per 1994 system
Approximate risk of progression to endometrial carcinoma - Latta rule of 3s:[5]
| Simple | Complex | |
| Without atypia | 1% | 3% |
| With atypia | 9% † | 27% ‡ |
Notes:
Ki-67
There is one paper that looks at Ki-67:[7]
| Diagnosis | Percent positive |
|---|---|
| Secretory phase endometrium | |
| Proliferative phase endometrium | |
| Simple hyperplasia | |
| Simple hyperplasia with atypia | |
| Complex hyperplasia | |
| Complex hyperplasia with atypia |
WHO system of 1994 - detail articles
Almost all hyperplasia is seen in the context of proliferative-type endometrium. 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
- AKA simple hyperplasia.
Main article: Simple endometrial hyperplasia
Simple endometrial hyperplasia with atypia
Main article: Simple endometrial hyperplasia
Complex endometrial hyperplasia
- Abbreviated CEH.
Main article: Complex endometrial hyperplasia
Complex endometrial hyperplasia with atypia
- AKA complex atypical hyperplasia.
Main article: Complex endometrial hyperplasia
Other
Endometrial hyperplasia with secretory changes
General
- Rare.
- Secretory changes seen in 1-2% of endometrial hyperplasias/endometrial carcinomas.[8]
Microscopic
Features:[9]
- Secretory changes - includes at least one of three following:[10]
- Stromal decidualization.
- Cytoplasmic vacuolization.
- 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[11] mention (mitoses, nuclear atypia, pseudostratified epithelium).
- Bell and Ostrezega[11] 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:
Images:
See also
References
- ↑ 1.0 1.1 Emons, G.; Beckmann, MW.; Schmidt, D.; Mallmann, P. (Feb 2015). "New WHO Classification of Endometrial Hyperplasias.". Geburtshilfe Frauenheilkd 75 (2): 135-136. doi:10.1055/s-0034-1396256. PMID 25797956.
- ↑ Dietel, M. (Nov 2001). "The histological diagnosis of endometrial hyperplasia. Is there a need to simplify?". Virchows Arch 439 (5): 604-8. PMID 11764378.
- ↑ URL: http://www.aafp.org/afp/990600ap/3069.html.
- ↑ URL: http://www.aafp.org/afp/20060801/practice.html.
- ↑ Latta, E. January 2009.
- ↑ 6.0 6.1 Kurman, RJ.; Kaminski, PF.; Norris, HJ. (Jul 1985). "The behavior of endometrial hyperplasia. A long-term study of untreated hyperplasia in 170 patients.". Cancer 56 (2): 403-12. PMID 4005805.
- ↑ Abike, F.; Tapisiz, OL.; Zergeroglu, S.; Dunder, I.; Temizkan, O.; Temizkan, I.; Payasli, A. (2011). "PCNA and Ki-67 in endometrial hyperplasias and evaluation of the potential of malignancy.". Eur J Gynaecol Oncol 32 (1): 77-80. PMID 21446331.
- ↑ Simon RA, Hansen K, Xiong JJ, et al. PTEN status and frequency of endometrial carcinoma and its precursors arising in functional secretory endometrium; an immunohistochemical study of 29 cases. Mod Pathol. 2012;25(Suppl 2): 1248A.
- ↑ Simon RA. CAP Today. June 2012. Accessed on: 24 April 2013.
- ↑ Tresserra, F.; Lopez-Yarto, M.; Grases, PJ.; Ubeda, A.; Pascual, MA.; Labastida, R. (Mar 2003). "Endometrial hyperplasia with secretory changes.". Gynecol Oncol 88 (3): 386-93. PMID 12648591.
- ↑ 11.0 11.1 Bell, CD.; Ostrezega, E. (Aug 1987). "The significance of secretory features and coincident hyperplastic changes in endometrial biopsy specimens.". Hum Pathol 18 (8): 830-8. PMID 3610133.