Pathology > Gynecologic > Uterine Corpus > Premalignant Conditions
Objectives Anat & Hist Physiologic Cond. Infections Benign Cond. Benign Neoplasms Premalignant Cond. Malignant Neoplasms

VI. Premalignant Conditions

Objectives:

After completing this section you will be able to:

  • classify the premalignant conditions of the uterine corpus
  • describe epidemiological features including risk factors
  • describe clinical appearance
  • describe/recognize histologic features and grade lesions
  • predict clinical behavior and discuss factors influencing outcome

 

Endometrial hyperplasia

Endometrial hyperplasia refers to a process in which there is a proliferation of endometrial glands of irregular size and shape with an increase in gland/stroma ration compared to proliferative endometrium. It is a morphological continuum that ranges from simple glandular crowding to atypical glands with features indistinguishable from early adenocarcinoma. Most are thought to result from persistent, prolonged estrogenic stimulation of the endometrium. A common cause is a succession of anovulatory cycles. It may also be caused by excessive endogenously produced estrogen in polycystic ovary syndrome including Stein-Leventhal syndrome, functioning granulosa cell tumors of the ovary and excessive ovarian cortical function (cortical stromal hyperplasia) or exogenous administered estrogen.

Clinical features

The condition most commonly occurs in perimenopausal women who then present with abnormal bleeding.

The appearance of the endometrial cavity containing hyperplastic tissue is variable. In many cases, the endometrium is thickened and polypoid, with abundant tissue obtained at endometrial curettage. In others, especially postmenopausal women, curettings are scanty.

Histology

In general, the condition is characterized by proliferation of both glands and stroma. In spite of proliferation of both endometrial components, glandular overcrowding occurs. Endometrial hyperplasia is histologically classified according to:

Architecture as: simple or complex depending on the degree of glandular complexity and crowding, and

Cytologic features as: with or without atypia.

Simple hyperplasia (cystic hyperplasia) — glands are cystically dilated and with occasional outpouching surrounded by abundant densely cellular stroma and give a "Swiss Cheese" appearance. No cellular atypia is present.


Simple hyperplasia with dilated glands

Complex hyperplasia — glands are complex with papillary intraluminal tufting and irregular shapes accompanied by a crowded, back-to-back arrangement with very little intervening stroma. Cellular atypia is absent.

Simple atypical hyperplasia — glands are dispersed within abundant stroma and lined by enlarged cells with increased nuclear-cytoplasmic ratio and pleomorphism.

Complex atypical hyperplasia — characterized by crowded glands showing cellular stratification, piling of epithelium into tufts, and atypia in the form of enlarged, pleomorphic and hyperchromatic nuclei and prominent nucleoli.

The process of hyperplasia may be generalized throughout the endometrial cavity or localized to one or more areas.


Complex atypical hyperplasia with back-to-back arrangement of glands and papillary tufting.

Clinical behavior and premalignant potential

Some revert to normal spontaneously or with medical treatment, others persist as hyperplasia, and a few progresses to endometrial adenocarcinoma. Generally, patients with atypical hyperplasia are more likely to develop carcinoma than those with benign endometrial lesions. The risks are:

  • Complex atypical — 30%
  • Simple atypical — 10%
  • Complex — 3%
  • Simple — 1%

Atypical hyperplasia in postmenopausal women appears to have a higher rate of progression to adenocarcinoma.

Question: What other lesions in the female genital tract are analogous to endometrial hyperplasia?

 

Objectives Anat & Hist Physiologic Cond. Infections Benign Cond. Benign Neoplasms Premalignant Cond. Malignant Neoplasms