Difference between revisions of "Complex endometrial hyperplasia"

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#redirect [[Endometrial_hyperplasia#Complex_endometrial_hyperplasia]]
{{ Infobox external links
| Name          = Complex endometrial hyperplasia
| EHVSC          = 10169
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
'''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:
*[[Complex endometrial hyperplasia with atypia]].
*[[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===
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:<ref name=Ref_GP239>{{Ref GP|239}}</ref><ref name=pmid7074572>{{Cite journal  | last1 = Kurman | first1 = RJ. | last2 = Norris | first2 = HJ. | title = Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. | journal = Cancer | volume = 49 | issue = 12 | pages = 2547-59 | month = Jun | year = 1982 | doi =  | PMID = 7074572 }}</ref><ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Endometrium_11protocol.pdf]. Accessed on: 12 January 2012.</ref>
#[[Desmoplastic stromal response]].
#Confluent cribriform growth. †
#Extensive papillary growth. †
#Severe cytologic atypia. †
 
Note:
* † There is a size cut-off for criteria 2, 3 and 4: > 2.1 mm.<ref name=pmid7074572/>
How to remember '''ABCDE''':
*'''A'''typia '''B'''ad.
*'''C'''onfluent cribriform growth.
*[[desmoplasia|'''D'''esmoplasia]].
*'''E'''xtensive papillary growth.
 
==Sign out==
<pre>
ENDOMETRIUM, BIOPSY:
- COMPLEX ENDOMETRIAL HYPERPLASIA.
-- NEGATIVE FOR CYTOLOGIC ATYPIA.
</pre>
 
<pre>
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.
</pre>
 
==See also==
*[[Endometrial hyperplasia]].
 
==References==
{{Reflist|1}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Endometrial hyperplasia]]

Revision as of 02:48, 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:

Images

Squamous morules - commonly associated with hyperplasia and malignancy:

  • SM - high mag.

  • SM - very high mag.

  • SM - extremely high mag.

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

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

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

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.

Sign out

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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