What is the histopathology report for endometrial hyperplasia (Endometrial Hyperplasia)?

From the Guidelines

The histopathology report for endometrial hyperplasia typically reveals an abnormal proliferation of endometrial glands with increased gland-to-stroma ratio, characterized by architectural complexity and mild nuclear atypia. The specimen shows irregularly shaped glands that are crowded but maintain some intervening stroma. Cytologically, the glandular epithelium demonstrates mild nuclear atypia with slight enlargement, minimal pleomorphism, and preserved nuclear polarity. These features are consistent with simple endometrial hyperplasia without atypia, as described in the management of uterine neoplasms 1. The endometrial stroma appears compact with no evidence of invasion. No significant inflammatory infiltrate is present. The findings suggest a hormonal imbalance with excess estrogen stimulation relative to progesterone. This condition carries a low risk (less than 5%) of progression to endometrial carcinoma but requires clinical follow-up, as noted in the guidelines for endometrial cancer 1. Some key points to consider in the management of endometrial hyperplasia include:

• The importance of accurate histological diagnosis, which may involve review by an expert pathologist 1
• The use of dilatation and curettage (D&C) as the optimal method for obtaining histologic characteristics 1
• The consideration of conservative management approaches, such as medical treatment with oral progestins, in patients with grade 1 endometrial carcinoma or premalignant disease like atypical hyperplasia (AH) 1
• The need for close follow-up during and after treatment, as well as the potential need for future hysterectomy in case of treatment failure or after pregnancies 1 Progesterone therapy is typically recommended, such as medroxyprogesterone acetate 10mg daily for 10-14 days each month for 3-6 months, or continuous combined hormonal therapy if appropriate, as a treatment option for endometrial hyperplasia. A follow-up endometrial sampling is advised after completion of hormonal therapy to confirm regression of the hyperplasia, in line with the latest clinical practice guidelines 1.

From the Research

Histopathology Report for Endometrial Hyperplasia

The histopathology report for endometrial hyperplasia is based on the classification system endorsed by the International Society of Gynecological Pathologists, which categorizes the condition into two main groups: hyperplasias with and without atypia, further subdivided into simple and complex hyperplasia 2.

Classification and Characteristics

• Simple hyperplasia without atypia: characterized by a slightly disordered pattern that exaggerates the alterations seen in the late proliferative phase of the menstrual cycle 3.
• Complex hyperplasia without atypia: exhibits irregular, hyperchromatic lesions that are similar to endometrioid adenocarcinoma, but without atypia 3.
• Simple hyperplasia with atypia and complex hyperplasia with atypia: have a higher risk of progressing to endometrial carcinoma, with approximately 20% of patients with atypical hyperplasia developing invasive cancer, most frequently in postmenopausal women 2.

Clinical and Histomorphologic Features

• The most common clinical presentation is menorrhagia, followed by postmenopausal bleeding 4.
• The majority of cases occur in premenopausal women, with the maximum number of cases found in the 41-50 years age group 4.
• Histomorphologic features include a gland-stroma ratio, variable-sized glands with cystic dilatation, and the absence of atypia in most cases 4.

Prognostic Factors and Treatment

• The most important prognostic factor is cellular atypia, with atypical hyperplasia having a higher risk of progressing to invasive cancer 2.
• Treatment depends on the histologic type, patient's age, and whether the hyperplasia is a result of endogenous or exogenous estrogen overexpression 2.
• Women under 40 years of age with simple or complex hyperplasia without atypia can be safely treated with gestagens, while postmenopausal women with simple or complex hyperplasia with atypia require surgery, including removal of the uterus and ovaries 2.

Correlation Between Preoperative and Postoperative Histologic Findings

• The correlation between preoperative and postoperative endometrial histologic findings is statistically insignificant, indicating that postoperative diagnosis may differ from preoperative diagnosis, especially in cases with simple endometrial hyperplasia without atypia 5.