Page 523 - Concise Pathology for Exam Preparation ( PDFDrive )

508 SECTION II Diseases of Organ Systems

Q. Classify endometrial hyperplasia. Write briefly on its different types.

Ans. Proliferation of glandular and stromal tissue, associated with prolonged, profuse
and irregular uterine bleeding in menopausal or postmenopausal women is known as
endometrial hyperplasia.

Classification
International Society for Gynaecological Pathology classifies endometrial hyperplasia
into:
1. Simple hyperplasia without atypia
2. Simple hyperplasia with atypia
3. Complex hyperplasia without atypia
4. Complex hyperplasia with atypia

WHO has recently recommended that endometrial hyperplasia should be classified into two
major categories - “non-atypical hyperplasia” and “atypical hyperplasia (endometrial
intraepithelial neoplasia)”.

Gross Morphology

Diffuse thickening of endometrium with a velvety appearance or focal overgrowth, which
may be mistaken for a polyp.

Microscopy
Increase in endometrial glands relative to the stroma.
1. International Society for Gynaecological Pathology Classification
Simple Hyperplasia Without Atypia
• Cystically dilated glands with occasional outpouching (Swiss cheeses appearance)
• Mild increase in gland to stroma ratio and focal crowding of glands
• Epithelial morphology resembles proliferative endometrium
• Thought to be due to persistent oestrogenic influence and less than 1% progress to
endometrial carcinoma
Simple Hyperplasia With Atypia
• Architecture is like simple hyperplasia but there is presence of cellular atypia, eg, loss
of polarity, open chromatin and prominent nucleoli.
• Approximately, 8% progress to endometrial carcinoma.
Complex Hyperplasia Without Atypia
• Complex crowded glands with branching and minimal intervening stroma
• Epithelial stratification (2–4 layers)
• Mitotic activity (5–10 mitotic figures/10 HPF)
• No cytological atypia
• Approximately, 3% progress to endometrial carcinoma
Complex Hyperplasia With Atypia
• Complex architecture with epithelial atypia (resembles well-differentiated adenocarci-
noma).
• Approximately, 25–40% patients having complex hyperplasia with atypia develop
adenocarcinoma.
2. WHO Classification
Non-atypical Hyperplasia
Increase in number, size and variation in shape of the glands is seen. Even with a back-to-
back arrangement of glands, some intervening stroma is visible. This type of hyperplasia
results from persistent oestrogenic stimulation and rarely gives rise to endometrial cancer.

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