Complex endometrial hyperplasia

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Complex endometrial hyperplasia
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EHVSC 10169

Complex endometrial hyperplasia, abbreviated CEH, is a relatively common pre-malignant pathology of the endometrium.

It is generally subdivided into complex endometrial hyperplasia without atypia and complex endometrial hyperplasia with atypia.

Microscopic

Features:

  • Increase in size & number of glands + irregular shape - key feature.
  • Cell stratification.
  • Nuclear enlargement.
  • Mitoses common.
  • No nuclear atypia.

Notes:

  • Normal "gland-to-stroma ratio" is 1:3.
  • Two "touching" glands may be one gland in section.

DDx:

Endometrial carcinoma versus complex endometrial hyperplasia

Complex endometrial hyperplasia:

  • Non-confluent - glands distinct from one another.

Classic criteria for endometrial carcinoma

This is pimping material that shows up on exams.

Endometrial carcinoma has one of the following:[1][2][3]

  1. Desmoplastic stromal response.
  2. Confluent cribriform growth. †
  3. Extensive papillary growth. †
  4. Severe cytologic atypia. †

Note:

  • † There is a size cut-off for criteria 2, 3 and 4: > 2.1 mm.[2]

How to remember ABCDE:

  • Atypia Bad.
  • Confluent cribriform growth.
  • Desmoplasia.
  • Extensive papillary growth.


Images

Complex endometrial hyperplasia:

Squamous morules - commonly associated with hyperplasia and malignancy:

Fused glands suggestive of CEH in a polyp:

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ENDOMETRIUM, BIOPSY: 
- COMPLEX ENDOMETRIAL HYPERPLASIA.
-- NEGATIVE FOR CYTOLOGIC ATYPIA. 
ENDOMETRIUM, BIOPSY:
- SMALL FOCUS OF COMPLEX ENDOMETRIAL HYPERPLASIA WITHOUT ATYPIA, WITH
  SQUAMOUS MORULES.
- ENDOMETRIAL POLYP WITH ONE ATYPICAL GLAND AND A SQUAMOUS MORULE.
- SCANT ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.

See also

References

  1. Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 239. ISBN 978-0443069208.
  2. 2.0 2.1 Kurman, RJ.; Norris, HJ. (Jun 1982). "Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma.". Cancer 49 (12): 2547-59. PMID 7074572.
  3. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.