Endometrial hyperplasia - Revision history

Michael at 15:42, 27 June 2016

2016-06-27T15:42:00Z

← Older revision		Revision as of 15:42, 27 June 2016
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	=WHO system of 1994=		==WHO system of 1994 - detail articles==
	Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes\|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.		Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes\|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.

Michael: /* WHO endometrial hyperplasia classification of 1994 */

2016-06-27T15:40:06Z

WHO endometrial hyperplasia classification of 1994

← Older revision		Revision as of 15:40, 27 June 2016
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	# Presence/absence of nuclear atypia.		# Presence/absence of nuclear atypia.

	It consists of four categories		It consists of four categories:
	*[[Simple endometrial hyperplasia]].		*[[Simple endometrial hyperplasia]].
	*[[Simple endometrial hyperplasia with atypia]].		*[[Simple endometrial hyperplasia with atypia]].

Michael: /* Overview */

2016-06-27T15:39:57Z

Overview

← Older revision		Revision as of 15:39, 27 June 2016
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	=Overview=		=Overview=
	===WHO endometrial hyperplasia classification of 2014===		===WHO endometrial hyperplasia classification of 2014===
	The 2014 WHO system ~~only~~ has two categories:<ref name=pmid25797956 >{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</ref>		The 2014 WHO system has two categories:<ref name=pmid25797956 >{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</ref>
	*Hyperplasia without atypia.		*Hyperplasia without atypia.
	*Atypical hyperplasia/endometrioid intraepithelial neoplasia.		*Atypical hyperplasia/endometrioid intraepithelial neoplasia.

Michael at 15:39, 27 June 2016

2016-06-27T15:39:12Z

← Older revision		Revision as of 15:39, 27 June 2016
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	=Overview=		=Overview=
	The ~~most widely used~~ system ~~is from the World Health Organization (~~WHO).		===WHO endometrial hyperplasia classification of 2014===
			The 2014 WHO system only has two categories:<ref name=pmid25797956 >{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</ref>
			*Hyperplasia without atypia.
			*Atypical hyperplasia/endometrioid intraepithelial neoplasia.

	===WHO endometrial hyperplasia classification of 1994 ~~- overview~~===		===WHO endometrial hyperplasia classification of 1994===
	The WHO system ~~of 1994~~ is based on determining:<ref name=pmid25797956>{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</ref>		The 1994 WHO system is based on determining:<ref name=pmid25797956>{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</ref>
	# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia'').		# Gland density (normal/low = ''simple hyperplasia'', high density = ''complex hyperplasia'').
	# Presence/absence of nuclear atypia.		# Presence/absence of nuclear atypia.

			It consists of four categories
			*[[Simple endometrial hyperplasia]].
			*[[Simple endometrial hyperplasia with atypia]].
			*[[Complex endometrial hyperplasia]].
			*[[Complex endometrial hyperplasia with atypia]].

	===Alternate classifications - overview===		===Alternate classifications - overview===
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	#Endometrial intraepithelial neoplasia (EIN).		#Endometrial intraepithelial neoplasia (EIN).

	==WHO classification==		==WHO classification of 1994==
	===Management of endometrial hyperplasia===		===Management of endometrial hyperplasia===
	*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>URL: [http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html].</ref>		*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>URL: [http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html].</ref>

Michael: /* WHO system of 2014 */

2016-06-27T15:35:32Z

WHO system of 2014

← Older revision		Revision as of 15:35, 27 June 2016
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	*[[AKA]] ''complex atypical hyperplasia''.		*[[AKA]] ''complex atypical hyperplasia''.
	{{Main\|Complex endometrial hyperplasia}}		{{Main\|Complex endometrial hyperplasia}}

	~~=WHO system of 2014=~~
	~~The 2014 WHO system only has two categories:<ref name=pmid25797956/>~~
	*Hyperplasia without atypia.
	*Atypical hyperplasia/endometrioid intraepithelial neoplasia.

	~~Note:~~
	*The newer WHO system dispenses with the terms ''simple'' and ''complex''.<ref name=pmid25797956 >{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</reF>

	=Other=		=Other=

Michael: /* WHO system of 1994 */

2016-06-27T15:34:26Z

WHO system of 1994

← Older revision		Revision as of 15:34, 27 June 2016
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	Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes\|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.		Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes\|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.

	==Simple endometrial hyperplasia==		===Simple endometrial hyperplasia===
	*[[AKA]] ''simple hyperplasia''.		*[[AKA]] ''simple hyperplasia''.
	{{Main\|Simple endometrial hyperplasia}}		{{Main\|Simple endometrial hyperplasia}}

	==Simple endometrial hyperplasia with atypia==		===Simple endometrial hyperplasia with atypia===
	{{Main\|Simple endometrial hyperplasia}}		{{Main\|Simple endometrial hyperplasia}}

	==Complex endometrial hyperplasia==		===Complex endometrial hyperplasia===
	*Abbreviated ''CEH''.		*Abbreviated ''CEH''.
	{{Main\|Complex endometrial hyperplasia}}		{{Main\|Complex endometrial hyperplasia}}

	==Complex endometrial hyperplasia with atypia==		===Complex endometrial hyperplasia with atypia===
	*[[AKA]] ''complex atypical hyperplasia''.		*[[AKA]] ''complex atypical hyperplasia''.
	{{Main\|Complex endometrial hyperplasia}}		{{Main\|Complex endometrial hyperplasia}}

Michael: /* WHO system of 1994 */

2016-06-27T15:34:12Z

WHO system of 1994

← Older revision		Revision as of 15:34, 27 June 2016
Line 89:		Line 89:
	*[[AKA]] ''complex atypical hyperplasia''.		*[[AKA]] ''complex atypical hyperplasia''.
	{{Main\|Complex endometrial hyperplasia}}		{{Main\|Complex endometrial hyperplasia}}

			=WHO system of 2014=
			The 2014 WHO system only has two categories:<ref name=pmid25797956/>
			*Hyperplasia without atypia.
			*Atypical hyperplasia/endometrioid intraepithelial neoplasia.

			Note:
			*The newer WHO system dispenses with the terms ''simple'' and ''complex''.<ref name=pmid25797956 >{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</reF>

	=Other=		=Other=

Michael: /* WHO system */

2016-06-27T15:29:58Z

WHO system

← Older revision		Revision as of 15:29, 27 June 2016
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	\|}		\|}

	=WHO system=		=WHO system of 1994=
	Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes\|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.		Almost all hyperplasia is seen in the context of proliferative-type endometrium. [[Endometrial hyperplasia with secretory changes\|Hyperplasia in the secretory-type endometrium]] is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.

Michael: /* Overview */

2016-06-27T15:29:26Z

Overview

← Older revision		Revision as of 15:29, 27 June 2016
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	The most widely used system is from the World Health Organization (WHO).		The most widely used system is from the World Health Organization (WHO).

	===WHO classification - overview===		===WHO endometrial hyperplasia classification of 1994 - overview===
	The WHO system is based on determining:		The WHO system of 1994 is based on determining:<ref name=pmid25797956>{{Cite journal \| last1 = Emons \| first1 = G. \| last2 = Beckmann \| first2 = MW. \| last3 = Schmidt \| first3 = D. \| last4 = Mallmann \| first4 = P. \| title = New WHO Classification of Endometrial Hyperplasias. \| journal = Geburtshilfe Frauenheilkd \| volume = 75 \| issue = 2 \| pages = 135-136 \| month = Feb \| year = 2015 \| doi = 10.1055/s-0034-1396256 \| PMID = 25797956 }}</ref>
	# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia'').		# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia'').
	# Presence/absence of nuclear atypia.		# Presence/absence of nuclear atypia.
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	**Progestins + close follow-up ''OR'' hysterectomy.		**Progestins + close follow-up ''OR'' hysterectomy.

	===Risk of progression to carcinoma===		===Risk of progression to carcinoma as per 1994 system===
	Approximate risk of progression to [[endometrial carcinoma]] - Latta rule of 3s:<ref>Latta, E. January 2009.</ref>		Approximate risk of progression to [[endometrial carcinoma]] - Latta rule of 3s:<ref>Latta, E. January 2009.</ref>
	{\| class="wikitable"		{\| class="wikitable"

Michael: /* Simple endometrial hyperplasia with atypia */ split out

2014-05-15T14:48:35Z

Simple endometrial hyperplasia with atypia: split out

← Older revision		Revision as of 14:48, 15 May 2014
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	==Simple endometrial hyperplasia with atypia==		==Simple endometrial hyperplasia with atypia==
	~~===General===~~		{{Main\|Simple endometrial hyperplasia}}
	*Very uncommon.

	~~===Microscopic===~~
	~~Features:<ref name=Ref_GP236>~~{{~~Ref GP~~\|~~236}}</ref>~~
	*Irregular dilated glands (with large lumens) - '''important feature'''.
	**Glands described as "animal shapes".
	*Variation of gland size.
	*No nuclear atypia.
	**Uniform columnar nuclei.
	*Normal gland density (gland area in plane of section/total area ~= 1/3).
	*Nuclear atypia:<ref>{{Cite journal \| last1 = Silverberg \| first1 = SG. \| title = Problems in the differential diagnosis of endometrial hyperplasia ~~and carcinoma. \| journal = Mod Pathol \| volume = 13 \| issue = 3 \| pages = 309-27 \| month = Mar \| year = 2000 \| doi = 10.1038/modpathol.3880053 \| PMID = 10757341~~ }}~~</ref>~~
	**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 clear criteria for atypia. Different sources list different features.
	*VL criteria for atypia (all should be present):
	*#Increased NC ratio.
	#Atypical: ~ 1:2
	#Not atypical: ~1:3.
	*#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.
	*#Small nucleoli (~1/5 the size of the nucleus).

	==Complex endometrial hyperplasia==		==Complex endometrial hyperplasia==