Endometrial hyperplasia

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See Endometrium for dating and benign pathologies.

Endometrial hyperplasia, abbreviated EH, is a precursor to endometrial carcinoma.

The most widely used system is from the World Health Organization (WHO). The WHO system is based on determining:

  1. Gland density (normal = simple hyperplasia, high density = complex hyperplasia), and
  2. Presence of atypia.

WHO system

Simple endometrial hyperplasia

Features:

  • Irregular gland shape.
  • Variation of gland size.
  • With or without atypia.
    • Most commonly seen without atypia.

DDx:

Images:

Complex endometrial hyperplasia

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 cancer vs. complex endometrial hyperplasia

  • Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
  • Diagnosis of complex EH is based on histology (cytologic features).

Note: An alternative grading system from Harvard exists. It is not widely used. It defines a term called endometrial intraepithelial neoplasia (EIN).

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.

Endometrial carcinoma

Endometrial hyperplasia (EH) is a risk for the development of endometrioid endometrial carcinoma.

Risk of progression to carcinoma

Approximate risk of progression to carcinoma:[3]

Simple Complex
Without atypia 1% 3%
With atypia 9% 27%

See also

References