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Difference between revisions of "Complex endometrial hyperplasia"
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Complex endometrial hyperplasia (view source)
Revision as of 14:24, 2 March 2017
, 14:24, 2 March 2017→Microscopic
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Complex endometrial hyperplasia -- intermed mag.jpg | |||
| Width = | |||
| Caption = Complex endometrial hyperplasia. [[H&E stain]]. | |||
| 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 = CEH [[NOS]] (CEH without atypia), CEH with atypia | |||
| LMDDx = [[endometrioid endometrial carcinoma]], artifactual gland crowding | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = thickened endometrium | |||
| Grossing = [[hysterectomy for endometrial hyperplasia grossing]] | |||
| Site = [[endometrium]] - see ''[[endometrial hyperplasia]] | |||
| Assdx = [[obesity]], [[endometrium with squamous morules]] | |||
| Syndromes = | |||
| Clinicalhx = usu. premenopausal or perimenopausal | |||
| Signs = | |||
| Symptoms = [[abnormal uterine bleeding]] (AUB) | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| 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== | ||
| Line 16: | Line 56: | ||
*Nuclear enlargement. | *Nuclear enlargement. | ||
*Mitoses common. | *Mitoses common. | ||
* | *+/-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: | ||
*[[ | *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: | ||
| Line 47: | Line 93: | ||
*[[desmoplasia|'''D'''esmoplasia]]. | *[[desmoplasia|'''D'''esmoplasia]]. | ||
*'''E'''xtensive papillary growth. | *'''E'''xtensive papillary growth. | ||
===Images=== | ===Images=== | ||
| Line 70: | Line 115: | ||
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= | *[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== | ||
===CEH without atypia=== | |||
<pre> | <pre> | ||
ENDOMETRIUM, BIOPSY: | ENDOMETRIUM, BIOPSY: | ||
| Line 88: | Line 134: | ||
- 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== | ||
*[[Endometrial hyperplasia]]. | *[[Endometrial hyperplasia]]. | ||
*[[Endometrial carcinoma]]. | |||
*[[Gynecologic pathology]]. | |||
==References== | ==References== | ||
{{Reflist| | {{Reflist|2}} | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Endometrial hyperplasia]] | [[Category:Endometrial hyperplasia]] | ||