Definition/General
Introduction:
Endometrial hyperplasia is abnormal proliferation of endometrial glands and stroma
It results from unopposed estrogen stimulation
Classification includes hyperplasia without atypia and atypical hyperplasia
Atypical hyperplasia is a precursor to endometrioid carcinoma.
Origin:
Results from prolonged estrogen exposure without progesterone
Anovulatory cycles common cause
Exogenous estrogen therapy
Estrogen-producing tumors
Obesity (peripheral estrogen conversion).
Classification:
WHO 2014 classification: Hyperplasia without atypia
Atypical hyperplasia/EIN (Endometrial Intraepithelial Neoplasia)
Old classification: Simple/Complex and With/Without atypia.
Epidemiology:
Peak incidence in perimenopausal women (40-55 years)
Risk factors: Obesity
Diabetes
PCOS
Nulliparity
Late menopause
Estrogen therapy.
Clinical Features
Presentation:
Abnormal uterine bleeding (most common)
Menorrhagia
Metrorrhagia
Postmenopausal bleeding
Intermenstrual bleeding
Amenorrhea followed by heavy bleeding.
Symptoms:
Heavy menstrual bleeding
Prolonged periods
Irregular cycles
Pelvic pain (occasionally)
Anemia symptoms (fatigue, weakness)
Infertility.
Risk Factors:
Unopposed estrogen
Obesity (BMI >30)
PCOS
Diabetes mellitus
Nulliparity
Late menopause (>55 years)
Family history of endometrial cancer.
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Gross Description
Microscopic Description
Immunohistochemistry
Molecular/Genetic
Differential Diagnosis
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Endometrial [biopsy/curettage], [method]
Specimen Adequacy
Specimen is [adequate/inadequate] for evaluation
Histologic Pattern
Shows [architectural pattern] with [glandular features]
Gland-to-Stroma Ratio
Gland-to-stroma ratio: [increased/normal]
Nuclear Features
Nuclear atypia: [absent/mild/moderate/severe]
Mitotic Activity
Mitotic activity: [low/moderate/high]
Classification
[Hyperplasia without atypia/Atypical hyperplasia]
Immunohistochemistry
ER: [positive], PR: [positive/reduced], PTEN: [retained/lost]
Risk Assessment
Risk of progression to carcinoma: [low/high]
Recommendations
Recommend: [hormonal therapy/surgical management/follow-up]
Final Diagnosis
Final diagnosis: Endometrial [hyperplasia without atypia/atypical hyperplasia]