Difference between revisions of "Endometrial hyperplasia"

From Libre Pathology
Jump to navigation Jump to search
(re-arrange, subdivide/split)
Line 2: Line 2:
'''Endometrial hyperplasia''', abbreviated '''EH''', is a precursor to [[endometrial carcinoma]].
'''Endometrial hyperplasia''', abbreviated '''EH''', is a precursor to [[endometrial carcinoma]].


=Overview=
The most widely used system is from the World Health Organization (WHO). The WHO system is based on determining:
The most widely used system is from the World Health Organization (WHO). The WHO system is based on determining:
# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia''), and
# Gland density (normal = ''simple hyperplasia'', high density = ''complex hyperplasia''), and
# Presence of atypia.  
# Presence of atypia.  
An alternative grading system from Harvard exists.  It is not widely used. It defines a term called ''endometrial intraepithelial neoplasia'' (EIN). 


==WHO system==
==WHO system==
===Simple endometrial hyperplasia===
===Management of endometrial hyperplasia===
*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>[http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html]</ref>
**In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).<ref>[http://www.aafp.org/afp/20060801/practice.html http://www.aafp.org/afp/20060801/practice.html]</ref>
*Endometrial hyperplasia without atypia is treated by:
**Progestins + close follow-up ''OR'' hysterectomy.
 
===Risk of progression to carcinoma===
Approximate risk of progression to carcinoma:<ref>LAE Jan 2009.</ref>
{| class="wikitable"
| || '''Simple''' || '''Complex'''
|-
| Without atypia || 1% || 3%
|-
| With atypia || 9% || 27%
|-
|}
 
=WHO system=
==Simple endometrial hyperplasia==
 
===General===
*More common than simple endometrial hyperplasia with atypia.
 
===Microscopic===
Features:
Features:
*Irregular gland shape.
*Irregular gland shape.
*Variation of gland size.
*Variation of gland size.
*With or without atypia.
*No nuclear atypia.
**Most commonly seen without atypia.
**Uniform columnar nuclei.


DDx:
DDx:
Line 21: Line 47:
*[http://commons.wikimedia.org/wiki/File:Simple_endometrial_hyperplasia_-_high_mag.jpg Simple endometrial hyperplasia - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Simple_endometrial_hyperplasia_-_high_mag.jpg Simple endometrial hyperplasia - high mag. (WC)].


===Complex endometrial hyperplasia===
==Simple endometrial hyperplasia with atypia==
===Microscopic===
Features:
*Irregular gland shape.
*Variation of gland size.
*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 - '''important'''.
**Nuclear size variation.
**Nuclear rounding.
***Nuclei lacking atypical = uniform columnar nuclei.
**Nucleoli.
 
==Complex endometrial hyperplasia==
 
===Microscopic===
Features:
Features:
*Increase in size & number of glands + irreg. shape.
*Increase in size & number of glands + irreg. shape.
Line 38: Line 78:
*[http://www.webpathology.com/image.asp?n=2&Case=568 Complex endometrial hyperplasia with atypia (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=568 Complex endometrial hyperplasia with atypia (webpathology.com)].


==Endometrial cancer vs. complex endometrial hyperplasia==
[[Endometrial carcinoma]] vs. complex endometrial hyperplasia:
*Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
*Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
*Diagnosis of complex EH is based on histology (cytologic features).
*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). 
=See also=
 
==Management of endometrial hyperplasia==
*Endometrial hyperplasia with atypia is usually treated with hysterectomy.<ref>[http://www.aafp.org/afp/990600ap/3069.html http://www.aafp.org/afp/990600ap/3069.html]</ref>
**In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).<ref>[http://www.aafp.org/afp/20060801/practice.html http://www.aafp.org/afp/20060801/practice.html]</ref>
*Endometrial hyperplasia without atypia is treated by:
**Progestins + close follow-up ''OR'' hysterectomy.
 
==Endometrial carcinoma==
{{main|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:<ref>LAE Jan 2009.</ref>
{| class="wikitable"
| || '''Simple''' || '''Complex'''
|-
| Without atypia || 1% || 3%
|-
| With atypia || 9% || 27%
|-
|}
 
==See also==
*[[Endometrium]].
*[[Endometrium]].
*[[Endometrial carcinoma]].
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]

Revision as of 15:28, 6 November 2011

See Endometrium for dating and benign pathologies.

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

Overview

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.

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

WHO system

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.

Risk of progression to carcinoma

Approximate risk of progression to carcinoma:[3]

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

WHO system

Simple endometrial hyperplasia

General

  • More common than simple endometrial hyperplasia with atypia.

Microscopic

Features:

  • Irregular gland shape.
  • Variation of gland size.
  • No nuclear atypia.
    • Uniform columnar nuclei.

DDx:

Images:

Simple endometrial hyperplasia with atypia

Microscopic

Features:

  • Irregular gland shape.
  • Variation of gland size.
  • Nuclear atypia:[4]
    • Loss of basal nuclear stratification - important.
    • Nuclear size variation.
    • Nuclear rounding.
      • Nuclei lacking atypical = uniform columnar nuclei.
    • Nucleoli.

Complex endometrial hyperplasia

Microscopic

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 carcinoma vs. complex endometrial hyperplasia:

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

See also

References

  1. ↑ http://www.aafp.org/afp/990600ap/3069.html
  2. ↑ http://www.aafp.org/afp/20060801/practice.html
  3. ↑ LAE Jan 2009.
  4. ↑ 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.
Retrieved from "https://librepathology.org/w/index.php?title=Endometrial_hyperplasia&oldid=9372"