Endometrial hyperplasia

Endometrial hyperplasia 

Updated: 12/16/2020

© Jun Wang, MD, PhD

General features
  • Over proliferation of endometrial glands
  • Associated with polycystic ovarian disease (Stein-Leventhal syndrome), ovarian granulosa cell tumors (functional), ovarian cortical stromal hyperplasia, estrogen replacement therapy without progestational agents and high body mass index
  • Classified according to architecture (simple vs. complex) and cytological features (with or without atypia)
  • Simple hyperplasia: Usually no cytological atypia, slightly increased risk for endometrial carcinoma
  • Complex hyperplasia: Commonly with cytological atypia, high risk of adenocarcinoma of endometrium
Endometrial intraepithelial neoplasm
  • A preferred term for atypical endometrial hyperplasia, precancerous lesion
  • Diagnostic criteria
Area of glands greater than stroma (volume percentage stroma less than 55%)
Cytology differs between architecturally crowded focus and background
Maximum linear dimension exceeds 1 mm
Exclude benign mimics
Exclude cancer
Pathogenesis
  • Prolonged estrogenic stimulation with reduced progestational activity
Clinical presentations
  • Asymptomatic or uterine bleeding
Key pathological findings
Molecular abnormality
Treatment
  • Simple hyperplasia: Progestin
  • Complex hyperplasia: Progestin, or surgery

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