Endometrial hyperplasia
- See Endometrium for an introduction to the topic.
Endometrial hyperplasia, abbreviated EH, is a precursor to endometrial carcinoma.
Overview
WHO endometrial hyperplasia classification of 2014
The 2014 WHO system has two categories:[1]
- Hyperplasia without atypia.
- Atypical hyperplasia/endometrioid intraepithelial neoplasia.
WHO endometrial hyperplasia classification of 1994
The 1994 WHO system is based on determining:[1]
- Gland density (normal/low = simple hyperplasia, high density = complex hyperplasia).
- Presence/absence of nuclear atypia.
It consists of four categories
- Simple endometrial hyperplasia.
- Simple endometrial hyperplasia with atypia.
- Complex endometrial hyperplasia.
- Complex endometrial hyperplasia with atypia.
Alternate classifications - overview
Two alternative grading systems exist, that are (currently) not widely used:[2]
- European group of experts (1999).
- Endometrial collaborative group/Harvard (2000).
Both consist of two categories, as opposed to four found in the WHO classification.
European group of experts classification
- Endometrial hyperplasia.
- Endometrioid neoplasia.
Endometrial collaborative group/Harvard classification
- Endometrial hyperplasia.
- Endometrial intraepithelial neoplasia (EIN).
WHO classification of 1994
Management of endometrial hyperplasia
- Endometrial hyperplasia with atypia is usually treated with hysterectomy.[3]
- In women who want to maintain fertility it may be treated with progestin + short interval re-biopsies (q3 months).[4]
- Endometrial hyperplasia without atypia is treated by:
- Progestins + close follow-up OR hysterectomy.
Risk of progression to carcinoma as per 1994 system
Approximate risk of progression to endometrial carcinoma - Latta rule of 3s:[5]
| Simple | Complex | |
| Without atypia | 1% | 3% |
| With atypia | 9% † | 27% ‡ |
Notes:
Ki-67
There is one paper that looks at Ki-67:[7]
| Diagnosis | Percent positive |
|---|---|
| Secretory phase endometrium | |
| Proliferative phase endometrium | |
| Simple hyperplasia | |
| Simple hyperplasia with atypia | |
| Complex hyperplasia | |
| Complex hyperplasia with atypia |
WHO system of 1994
Almost all hyperplasia is seen in the context of proliferative-type endometrium. Hyperplasia in the secretory-type endometrium is extremely rare and something diagnosed by or in consultation with an expert in gynecologic pathology.
Simple endometrial hyperplasia
- AKA simple hyperplasia.
Main article: Simple endometrial hyperplasia
Simple endometrial hyperplasia with atypia
Main article: Simple endometrial hyperplasia
Complex endometrial hyperplasia
- Abbreviated CEH.
Main article: Complex endometrial hyperplasia
Complex endometrial hyperplasia with atypia
- AKA complex atypical hyperplasia.
Main article: Complex endometrial hyperplasia
Other
Endometrial hyperplasia with secretory changes
General
- Rare.
- Secretory changes seen in 1-2% of endometrial hyperplasias/endometrial carcinomas.[8]
Microscopic
Features:[9]
- Secretory changes - includes at least one of three following:[10]
- Stromal decidualization.
- Cytoplasmic vacuolization.
- Intraluminal secretions.
- Proliferative-type epithelium. †
- Mitoses.
- Nuclear atypia.
- Pseudostratified epithelium.
Notes:
- † This is not precisely defined. I suppose it is some of the things Bell and Ostrezega[11] mention (mitoses, nuclear atypia, pseudostratified epithelium).
- Bell and Ostrezega[11] give a laundry list for differentiating benign secretory endometrium from hyperplasia with secretory changes: focal architectural abnormalities, metaplastic ciliated & "clear" cells, sharp luminal border, epithelial pseudopalisading, nuclear atypia, vesicular nuclei, mitoses.
DDx:
Images:
See also
References
- ↑ 1.0 1.1 Emons, G.; Beckmann, MW.; Schmidt, D.; Mallmann, P. (Feb 2015). "New WHO Classification of Endometrial Hyperplasias.". Geburtshilfe Frauenheilkd 75 (2): 135-136. doi:10.1055/s-0034-1396256. PMID 25797956.
- ↑ Dietel, M. (Nov 2001). "The histological diagnosis of endometrial hyperplasia. Is there a need to simplify?". Virchows Arch 439 (5): 604-8. PMID 11764378.
- ↑ URL: http://www.aafp.org/afp/990600ap/3069.html.
- ↑ URL: http://www.aafp.org/afp/20060801/practice.html.
- ↑ Latta, E. January 2009.
- ↑ 6.0 6.1 Kurman, RJ.; Kaminski, PF.; Norris, HJ. (Jul 1985). "The behavior of endometrial hyperplasia. A long-term study of untreated hyperplasia in 170 patients.". Cancer 56 (2): 403-12. PMID 4005805.
- ↑ Abike, F.; Tapisiz, OL.; Zergeroglu, S.; Dunder, I.; Temizkan, O.; Temizkan, I.; Payasli, A. (2011). "PCNA and Ki-67 in endometrial hyperplasias and evaluation of the potential of malignancy.". Eur J Gynaecol Oncol 32 (1): 77-80. PMID 21446331.
- ↑ Simon RA, Hansen K, Xiong JJ, et al. PTEN status and frequency of endometrial carcinoma and its precursors arising in functional secretory endometrium; an immunohistochemical study of 29 cases. Mod Pathol. 2012;25(Suppl 2): 1248A.
- ↑ Simon RA. CAP Today. June 2012. Accessed on: 24 April 2013.
- ↑ Tresserra, F.; Lopez-Yarto, M.; Grases, PJ.; Ubeda, A.; Pascual, MA.; Labastida, R. (Mar 2003). "Endometrial hyperplasia with secretory changes.". Gynecol Oncol 88 (3): 386-93. PMID 12648591.
- ↑ 11.0 11.1 Bell, CD.; Ostrezega, E. (Aug 1987). "The significance of secretory features and coincident hyperplastic changes in endometrial biopsy specimens.". Hum Pathol 18 (8): 830-8. PMID 3610133.