Difference between revisions of "Complex endometrial hyperplasia"

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Line 25: Line 25:
*[[Complex endometrial hyperplasia with atypia]].
*[[Complex endometrial hyperplasia with atypia]].
*[[Endometrioid endometrial carcinoma]] - see ''[[endometrial carcinoma versus complex endometrial hyperplasia]]''.
*[[Endometrioid endometrial carcinoma]] - see ''[[endometrial carcinoma versus complex endometrial hyperplasia]]''.
===Images===
*[http://www.webpathology.com/image.asp?n=1&Case=568 Endometrial hyperplasia (webpathology.com)].
[[Squamous morules]] - commonly associated with hyperplasia and malignancy:
<gallery>
Image: Squamous morule 2 - endometrium -- high mag.jpg | SM - high mag.
Image: Squamous morule 2 - endometrium -- very high mag.jpg | SM - very high mag.
Image: Squamous morule 2 - endometrium -- extremely high mag.jpg | SM - extremely high mag.
</gallery>
<gallery>
Image: Endometrial polyp with fused glands -- low mag.jpg | Endometrial polyp with fused glands - low mag. (WC)
Image: Endometrial polyp with fused glands -- intermed mag.jpg | Endometrial polyp with fused glands - intermed. mag. (WC)
Image: Endometrial polyp with fused glands -- high mag.jpg | Endometrial polyp with fused glands - high mag. (WC)
</gallery>


===Endometrial carcinoma versus complex endometrial hyperplasia===
===Endometrial carcinoma versus complex endometrial hyperplasia===
Line 63: Line 47:
*[[desmoplasia|'''D'''esmoplasia]].
*[[desmoplasia|'''D'''esmoplasia]].
*'''E'''xtensive papillary growth.
*'''E'''xtensive papillary growth.
===Images===
Complex endometrial hyperplasia:
<gallery>
Image: Complex endometrial hyperplasia -- low mag.jpg | CEH - low mag.
Image: Complex endometrial hyperplasia -- intermed mag.jpg | CEH - intermed. mag.
Image: Complex endometrial hyperplasia -- high mag.jpg | CEH - high mag.
</gallery>
[[Squamous morules]] - commonly associated with hyperplasia and malignancy:
<gallery>
Image: Squamous morule 2 - endometrium -- high mag.jpg | SM - high mag.
Image: Squamous morule 2 - endometrium -- very high mag.jpg | SM - very high mag.
Image: Squamous morule 2 - endometrium -- extremely high mag.jpg | SM - extremely high mag.
</gallery>
Fused glands suggestive of CEH in a polyp:
<gallery>
Image: Endometrial polyp with fused glands -- low mag.jpg | Endometrial polyp with fused glands - low mag. (WC)
Image: Endometrial polyp with fused glands -- intermed mag.jpg | Endometrial polyp with fused glands - intermed. mag. (WC)
Image: Endometrial polyp with fused glands -- high mag.jpg | Endometrial polyp with fused glands - high mag. (WC)
</gallery>
www:
*[http://www.webpathology.com/image.asp?n=1&Case=568 Endometrial hyperplasia (webpathology.com)].


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Revision as of 02:51, 20 December 2013

Complex endometrial hyperplasia
External resources
EHVSC 10169

Complex endometrial hyperplasia, abbreviated CEH, is a relatively common pre-malignant pathology of the endometrium.

It is generally subdivided into complex endometrial hyperplasia without atypia and complex endometrial hyperplasia with atypia.

Microscopic

Features:

  • Increase in size & number of glands + irregular shape - key feature.
  • Cell stratification.
  • Nuclear enlargement.
  • Mitoses common.
  • No nuclear atypia.

Notes:

  • Normal "gland-to-stroma ratio" is 1:3.
  • Two "touching" glands may be one gland in section.

DDx:

Endometrial carcinoma versus complex endometrial hyperplasia

Complex endometrial hyperplasia:

  • Non-confluent - glands distinct from one another.

Classic criteria for endometrial carcinoma

This is pimping material that shows up on exams.

Endometrial carcinoma has one of the following:[1][2][3]

  1. Desmoplastic stromal response.
  2. Confluent cribriform growth. †
  3. Extensive papillary growth. †
  4. Severe cytologic atypia. †

Note:

  • † There is a size cut-off for criteria 2, 3 and 4: > 2.1 mm.[2]

How to remember ABCDE:

  • Atypia Bad.
  • Confluent cribriform growth.
  • Desmoplasia.
  • Extensive papillary growth.


Images

Complex endometrial hyperplasia:

  • CEH - low mag.

  • CEH - intermed. mag.

  • CEH - high mag.

Squamous morules - commonly associated with hyperplasia and malignancy:

  • SM - high mag.

  • SM - very high mag.

  • SM - extremely high mag.

Fused glands suggestive of CEH in a polyp:

  • Endometrial polyp with fused glands - low mag. (WC)

  • Endometrial polyp with fused glands - intermed. mag. (WC)

  • Endometrial polyp with fused glands - high mag. (WC)

www:

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ENDOMETRIUM, BIOPSY: 
- COMPLEX ENDOMETRIAL HYPERPLASIA.
-- NEGATIVE FOR CYTOLOGIC ATYPIA. 

ENDOMETRIUM, BIOPSY:
- SMALL FOCUS OF COMPLEX ENDOMETRIAL HYPERPLASIA WITHOUT ATYPIA, WITH
  SQUAMOUS MORULES.
- ENDOMETRIAL POLYP WITH ONE ATYPICAL GLAND AND A SQUAMOUS MORULE.
- SCANT ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.

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. 239. ISBN 978-0443069208.
  2. ↑ 2.0 2.1 Kurman, RJ.; Norris, HJ. (Jun 1982). "Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma.". Cancer 49 (12): 2547-59. PMID 7074572.
  3. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf. Accessed on: 12 January 2012.
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