Endometrial hyperplasia
- See Endometrium for dating and benign pathologies.
Endometrial hyperplasia, abbreviated EH, is a precursor to endometrial carcinoma.
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
- Presence of atypia.
WHO system
Simple endometrial hyperplasia
Features:
- Irregular gland shape.
- Variation of gland size.
- With or without atypia.
- Most commonly seen without atypia.
DDx:
Images:
Complex endometrial hyperplasia
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 hyperplasia (webpathology.com).
- Complex endometrial hyperplasia with atypia (webpathology.com).
Endometrial cancer vs. complex endometrial hyperplasia
- Complex endometrial hyperplasia: non-confluent (glands distinct from one another).
- 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).
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.
Endometrial carcinoma
Main article: 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:[3]
| Simple | Complex | |
| Without atypia | 1% | 3% |
| With atypia | 9% | 27% |