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
- Simple hyperplasia: increased number of endometrial glands without distortion of architecture
- Complex hyperplasia: increased number of endometrial with complex crowding and budding, but no glandular fusion
Molecular abnormality
- PTEN
- MSI: microsatellite instability, Lynch syndrome
Treatment
- Simple hyperplasia: Progestin
- Complex hyperplasia: Progestin, or surgery
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