Uterus: Endometrial hyperplasia
A
45 yr old woman complained of excessive menstrual bleeding. The
uterus was bulky.
The endometrium was noted to be thickened on hysteroscopy.
1.
What are differential diagnoses?
Adenomyosis
Endometrial hyperplasia
Endometrial carcinoma
2.
Describe
the histological features.
Simple
/ mild / cystic hyperplasia.
Cystically
dilated endometrial glands.
Thickened
endometrial lining �
multilayered epithelium due to proliferation.
Outpouching
and infoldings of glands.
Increased
stroma between glands �
stromal proliferation.
3.
How
do you distinguish it from endometrial adenocarcinoma invading the myometrium
histologically?
Endometrial
hyperplasia:
No cytological atypia
Glands with regular contour
No invasion into myometrium
Adenocarcinoma:
Cytological atypia
Malignant stratified columnar
epithelium
Invasion into myometrium
4.
What
is the relationship between endometrial hyperplasia and adenocarcinoma?
Endometrial
hyperplasia may progress through a spectrum of atypical changes to endometrial
adenocarcinoma. Higher
risk with increasing levels of atypia
5.
What
is the relationship between these 2 conditions and hormones?
Both
endometrial hyperplasia and adenocarcinoma are associated with excessive ovarian
hormones, abnormal, prolonged stimulation by oestrogen leads to hyperplasia and
eventually adenocarcinoma
6.
Account
for the heavy menstrual flow.
Endometrial
hyperplasia �
increased endometrial thickness �
increased menstrual shedding �
heavy menstrual flow
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Copyright � Joseph Ong 2003