Endometrial hyperplasia
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- See Endometrium for dating and benign pathologies.
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:
- Gland density (normal = simple hyperplasia, high density = complex hyperplasia), and
- 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
Management of endometrial hyperplasia
- Endometrial hyperplasia with atypia is usually treated with hysterectomy.[1]
- In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).[2]
- Endometrial hyperplasia without atypia is treated by:
- Progestins + close follow-up OR hysterectomy.
Risk of progression to carcinoma
Approximate risk of progression to carcinoma:[3]
| 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:
- Irregular gland shape.
- Variation of gland size.
- No nuclear atypia.
- Uniform columnar nuclei.
DDx:
Images:
Simple endometrial hyperplasia with atypia
Microscopic
Features:
- Irregular gland shape.
- Variation of gland size.
- Nuclear atypia:[4]
- Loss of basal nuclear stratification - important.
- Nuclear size variation.
- Nuclear rounding.
- Nuclei lacking atypical = uniform columnar nuclei.
- Nucleoli.
Complex endometrial hyperplasia
Microscopic
Features:
- Increase in size & number of glands + irreg. shape.
- Need cribriform architecture.
- Two "touching" glands are likely one gland in section.
- Cell stratification.
- Nuclear enlargement.
- Mitoses common.
- May occur with atypia.
Notes:
- Normal gland-to-stroma ratio is 1:3.
Images:
- Endometrial hyperplasia (webpathology.com).
- Complex endometrial hyperplasia with atypia (webpathology.com).
Endometrial carcinoma vs. complex endometrial hyperplasia:
- Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
- Diagnosis of complex EH is based on histology (cytologic features).
See also
References
- ↑ http://www.aafp.org/afp/990600ap/3069.html
- ↑ http://www.aafp.org/afp/20060801/practice.html
- ↑ LAE Jan 2009.
- ↑ Silverberg, SG. (Mar 2000). "Problems in the differential diagnosis of endometrial hyperplasia and carcinoma.". Mod Pathol 13 (3): 309-27. doi:10.1038/modpathol.3880053. PMID 10757341.