Difference between revisions of "Simple endometrial hyperplasia"

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#redirect [[Endometrial_hyperplasia#Simple_endometrial_hyperplasia]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =  Simple_endometrial_hyperplasia_-_low_mag.jpg
| Width      =
| Caption    = Simple endometrial hyperplasia. [[H&E stain]].
| Synonyms  =
| Micro      = 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
| LMDDx      = [[disordered proliferative endometrium]], [[complex endometrial hyperplasia]], [[Atrophic endometrium|cystic atrophy of the endometrium]], [[benign endometrial polyp]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[endometrium]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = [[abnormal uterine bleeding]]
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good, may progress to [[endometrial carcinoma]] - esp. with atypia
| Other      =
| ClinDDx    = other cause of [[abnormal uterine bleeding]]
| Tx        =
}}
'''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==
*More common than simple endometrial hyperplasia with atypia.
*Very low risk for progressing to [[endometrioid endometrial carcinoma]].
==Microscopic==
Features:<ref name=Ref_GP236>{{Ref GP|236}}</ref>
*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:<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 universally accepted criteria for atypia. Different sources list different features.
*A proposal 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).
DDx:
*[[Disordered proliferative phase]].
*[[Complex endometrial hyperplasia]] - has increased gland-to-stroma ratio.
*[[Atrophic endometrium|Cystic atrophy of the endometrium]] - does not have proliferative activity.<ref name=pmid16873562>{{Cite journal  | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
*[[Benign endometrial polyp]] - has thick-walled blood vessels; simple endometrial hyperplasia should not be diagnosed in a polyp.<ref name=pmid16873562/>
===Images===
<gallery>
Image:Simple_endometrial_hyperplasia_-_low_mag.jpg | Simple endometrial hyperplasia - low mag. (WC)
Image:Simple_endometrial_hyperplasia_-_high_mag.jpg | Simple endometrial hyperplasia - high mag. (WC)
</gallery>
www:
*[http://www.webpathology.com/image.asp?n=1&Case=568 Simple endometrial hyperplasia without atypia (webpathology.com)].
==See also==
*[[Endometrium]].
*[[Endometrial hyperplasia]].
==References==
{{Reflist|2}}
[[Category:Endometrium]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 15:47, 1 June 2015

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

  • Simple endometrial hyperplasia - low mag. (WC)

  • Simple endometrial hyperplasia - high mag. (WC)

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/.
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