atypical complex hyperplasia

atypical complex hyperplasia (endometrium)

A condition affecting the endometrial glands and stroma which is associated with a marked increased risk of future adenocarcinoma of the endometrium.
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It should be emphasized that the reports on associated carcinomas in hysterectomy specimens relate only to atypical hyperplasias, but the distinction between complex hyperplasia and atypical complex hyperplasia has been shown to be difficult enough that one must assume that even a lesion diagnosed as complex hyperplasia without atypia might harbor a carcinoma in the subsequent hysterectomy specimen.
Although the absolute values for proportions of cases with an eventual diagnosis of carcinoma varied from series to series, atypical complex hyperplasia always showed by far the highest rate of progression, with actual figures varying from 20% to 40% or greater.
Also beginning in the 1980s, however, publications have appeared that challenged this concept on the basis of 2 types of observations: (1) atypical complex hyperplasia has been reported to be a poorly reproducible diagnosis, with experts differing in significant proportions of cases not only with referring pathologists but also with each other (24,58,59); and (2) carcinoma can be found in uteri removed within 1 or 2 months after the diagnosis of atypical hyperplasia in a significant proportion of cases, making it unclear whether those carcinomas diagnosed many years later really represent progression or merely persistence.
Although this system appears to have many advantages, studies with both larger numbers of cases and more pathologists from different institutions not associated with the original investigators are needed before EIN is fully accepted as the heir apparent to atypical complex hyperplasia.
One would be to try to find out what is wrong with the current system in order to improve both the diagnostic reproducibility and the positive predictive value of a diagnosis of atypical complex hyperplasia, and studies are currently under way in this area.
The endometrium: pathologic principles and pitfalls
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