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Endometrial hyperplasia

Atypical hyperplasia

Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 25 March 2013, last major update November 2011
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.


● If diagnosed at biopsy or curettage, 15%-50% of immediate hysterectomy specimens will have adenocarcinoma, some myoinvasive


● Hysterectomy (Eur J Obstet Gynecol Reprod Biol 2010;150:80)

Micro description

● Cytologic atypia, usually focal, in a background of complex and rarely simple hyperplasia
● Usually cellular dyspolarity, irregular stratification, anisocytosis, nuclear rounding, nucleomegaly, hyperchromatism, chromatin clumping and enlarged nucleoli
● May have marked cytoplasmic eosinophilia or eosinophilic necrotic debris within the atypical cells
● Should contrast “atypical” gland with adjacent “non-atypical” glands
● Sternberg suggests calling lesions “borderline” if unable to rule out well differentiated carcinoma
● Atypical secretory hyperplasia: resembles day 17 endometrium but with atypia

Micro images

Complex endometrial hyperplasia with atypia
Various images

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Fig 1: Atypical simple hyperplasia: The lower left quadrant of this illustration shows simple hyperplasia without atypia, but the remainder of the field is occupied by glands with more eosinophilic cytoplasm and irregularly stratified nuclei.
Fig 2: Atypical simple hyperplasia: higher magnification of the upper left-hand portion of the above figure shows glands lined by cells with eosinophilic cytoplasm and dyspolaric, stratified nuclei with moderate anisonucleosis and hyperchromatism. Prominent nucleoli are seen in many of the nuclei. Necrotic debris is present in some gland lumina
Fig 3: Atypical complex hyerplasia: The irregularly shaped glands in this case are very closely packed but are still separated by residual endometrial stroma.
Fig 4: Higher magnification of another field from the above figure demonstrates mild cytologic atypia at the lower right, characterized by increased nuclear roundness, clearing of nuclear chromatin, and occasional prominent nucleoli
Fig 5: The glandular epithelium here is extremely atypical, but residual endometrial stroma separates all glands in this field. Because of the severity of the atypia, a specimen such as this should be examined thoroughly to rule out the concomitant presence of carcinoma
Fig 6: In addition to dyspolarity, stratification, and nuclear atypia, there are also papillary infoldings (top) into a large endometrial gland in this illustration

Differential diagnosis

● Metaplastic changes
● Atypical hyperplasia with secretory changes resembles secretory carcinoma

Additional references

Mod Pathol 2000;13:309

End of Uterus > Endometrial hyperplasia > Atypical hyperplasia

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