Simple endometrial hyperplasia

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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

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.

General

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):
    1. Increased NC ratio.
      • Atypical: ~ 1:2
      • Not atypical: ~1:3.
    2. 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.
    3. Small nucleoli (~1/5 the size of the nucleus).

DDx:

Images

www:

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. 236. ISBN 978-0443069208.
  2. 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. 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. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/.