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endometrial hyperplasia |
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endometrial hyperplasia, an abnormal condition characterized by overgrowth of the endometrium resulting from sustained stimulation by estrogen (of endogenous or exogenous origin) that is not opposed by progesterone. Estrogen acts as a growth hormone for the endometrium. Through a complex intercellular mechanism, endometrial cells bind estrogen preferentially and undergo changes characteristic of the proliferative phase of the menstrual cycle. If estrogen stimulation continues for 3 to 6 months without periodic cessation or counteractive progesterone stimulation, as occurs in anovulatory or perimenopausal women and in those receiving replacement estrogen without added progestogen, the endometrium becomes abnormally thickened and glandularized. Unremitting estrogen stimulation eventually causes cystic or adenomatous endometrial hyperplasia. The latter is a premalignant lesion that undergoes malignant degeneration in approximately 25% of cases. The causative relationship between estrogen and endometrial hyperplasia is well established; there is some indication but no proof that estrogen also provokes the change from hyperplasia to neoplasia and malignancy. Endometrial hyperplasia often results in abnormal uterine bleeding. Such bleeding, particularly in older women, constitutes an indication for biopsy or curettage of the endometrium to establish histopathologic diagnosis and to rule out malignancy. A functioning estrogen-secreting tumor is suspected if the woman is not taking estrogen medication. Progestogen therapy is effective in reversing the abnormal histopathologic changes of endometrial hyperplasia. If hyperplasia is adenomatous, hysterectomy is commonly performed. endometrial hyperplasia Adenomatous hyperplasia of endometrium Gynecology A premalignant endometrial lesion of older ♀
Endometrial hyperplasia
Hyperplasia without atypia Glands are crowded w/o cytologic atypia; these have a < 2% progress to carcinoma
Simple hyperplasia Glands are not back-to-back
Complex hyperplasia Glands are back-to-back
Hyperplasia with atypia Glands are crowded with cytologic atypia; ± 23% progress to carcinoma
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The multitude of contemporary names used for lesions equivalent to flat epithelial atypia have included ''columnar cell change or hyperplasia with atypia,'' ''columnar alteration with prominent apical snouts and secretions with atypia,'' ''ductal intraepithelial neoplasia 1-flat type,'' ''atypical cystic lobule,'' ''atypical cystic duct,'' ''small ectatic ducts lined by atypical ductal cells with apocrine snouts,'' and ''clinging in situ duct carcinoma flat type,'' among others. Four women who had an initial endometrial biopsy showing diffuse breakdown during the study period, but who did not have pathologic follow-up within 6 months went on to develop significant endometrial pathology within the subsequent 18 months (2 cases of complex hyperplasia with atypia and 2 cases of grade 1 endometrioid carcinoma). The distinction between complex adenomatous hyperplasia with atypia versus well-differentiated adenocarcinoma is difficult on frozen section analysis, and it is advisable to defer the definitive diagnosis until permanent sections of the entire curettage specimen are examined. Intraoperative Consultation in Gynecologic Pathology by Donna Coffey and Alan L Kaplan and Ibrahim Ramzy / Archives of Pathology & Laboratory Medicine More results |
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