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endometrial hyperplasia

Saturday 29 January 2005

PO

Definition: Endometrial hyperplasia is defined as endometrial proliferation with an increase in gland to stroma ratio (from 2:1 to 3:1). It is divided into simple hyperplasia (with or without atypia) and complex hyperplasia (with or without atypia) according to the WHO Classification.

Endometrial hyperplasia is an example of abnormal hormone-induced hyperplasia. After a normal menstrual period, there is a rapid burst of proliferative activity that is stimulated by pituitary hormones and ovarian estrogen.

In regards to endometrial hyperplasia - simple hyperplasia is non-branching, complex is branching. Atypia refers to the cellular characteristics.

Images

- http://www.webpathology.com/image.asp?case=568&n=1

Parameters

- simple / complex

  • If the hyperplastic glands are not branching, the lesion is "simple".
  • If the hyperplastic glands are branching, the lesion is "complex".
  • Complexity carries a low risk of development of adenocarcinoma.

- No atypia / Atypia

  • Simple hyperplasia with atypia has an increased risk of adenocarcinoma.

Types

- simple endometrial hyperplasia

  • simple endometrial hyperplasia with atypia

- complex endometrial hyperplasia

Types

- simple endometrial hyperplasia without atypia

- simple endometrial hyperplasia with atypia

- complex endometrial hyperplasia without atypia

  • There is no evidence of invasion.
  • The basement membrane is intact around the glands and there is no desmoplastic response.
  • There is an overgrowth of endometrial glands, making this hyperplasia.
  • The glands are branching so the lesion is complex.
  • If they were non-branching, it would be classified as simple hyperplasia.
  • The cells are not dysplastic / atypical : complex hyperplasia without atypia.
  • It carries an increased risk of developing adenocarcinoma.

- complex endometrial hyperplasia with atypia

Differential Diagnosis

- artifacts
- endometrial polyp
- endometritis
- metaplasia of the endometrium
- normal endometrium
- uterine endometrioid adenocarcinoma

See also

- endometrial biopsy

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