Simple endometrial hyperplasia
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Simple endometrial hyperplasia, abbreviated SEH, is an uncommon pre-malignant change of the endometrium. Like complex endometrial hyperplasia, it is subdivided into with atypia and without atypia.
| Simple endometrial hyperplasia | |
|---|---|
| Diagnosis in short | |
 Simple endometrial hyperplasia. H&E stain. | |
|
| |
| LM | irregular dilated glands (described as "animal shapes"), variation of gland size, normal gland density (gland area in plane of section/total area ~= 1/3), +/-nuclear atypia (see below) |
| Subtypes | with atypia, without atypia |
| LM DDx | disordered proliferative endometrium, complex endometrial hyperplasia, cystic atrophy of the endometrium, benign endometrial polyp |
| Site | endometrium |
|
| |
| Signs | abnormal uterine bleeding |
| Prognosis | good, may progress to endometrial carcinoma - esp. with atypia |
| Clin. DDx | other cause of abnormal uterine bleeding |
General
- More common than simple endometrial hyperplasia with atypia.
- Very low risk for progressing to endometrioid endometrial carcinoma.
Microscopic
Features:[1]
- Irregular dilated glands (with large lumens) - key feature.
- Glands described as "animal shapes".
- Variation of gland size.
- Normal gland density (gland area in plane of section/total area ~= 1/3).
- +/-Nuclear atypia:[2]
- Loss of basal nuclear stratification.
- Nuclear size variation.
- Nuclear rounding.
- Nuclei lacking atypical = uniform columnar nuclei.
- Nucleoli.
- Hyperchromasia or vesicular nuclei.
Notes:
- There are no universally accepted criteria for atypia. Different sources list different features.
- A proposal for atypia (all should be present):
- Increased NC ratio.
- Atypical: ~ 1:2
- Not atypical: ~1:3.
- Oval nuclei with small major axis to minor axis ratio.
- Atypical: major axis:minor axis = <=2:1.
- Not atypical: major axis:minor axis = >=3:1
- NB: round nuclei: major axis:minor axis = 1:1.
- Small nucleoli (~1/5 the size of the nucleus).
- Increased NC ratio.
DDx:
- Disordered proliferative phase.
- Complex endometrial hyperplasia - has increased gland-to-stroma ratio.
- Cystic atrophy of the endometrium - does not have proliferative activity.[3]
- Benign endometrial polyp - has thick-walled blood vessels; simple endometrial hyperplasia should not be diagnosed in a polyp.[3]
Images
Simple endometrial hyperplasia - low mag. (WC)
Simple endometrial hyperplasia - high mag. (WC)
www:
See also
References
- ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 236. ISBN 978-0443069208.
- ↑ 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.
- ↑ 3.0 3.1 McCluggage, WG. (Aug 2006). "My approach to the interpretation of endometrial biopsies and curettings.". J Clin Pathol 59 (8): 801-12. doi:10.1136/jcp.2005.029702. PMC 1860448. PMID 16873562. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/.