7.2 POJA-L1684+1544+1686. Simple endometrial hyperplasia (uterus in menopause, human)
7.2 POJA-L1684+1544+1686
Title: Simple endometrial hyperplasia (uterus in menopause, human)
Description: Stain: Hematoxylin-eosin.
(A): Survey. (1) surface and basal endometrium with normal glands and cystically dilated glands; (2) myometrium and (3) arcuate arteries.
(B): Normal appearing endometrial glands and two cystic enlarged glands. In all lumina some proteinaceous debris is present and the stroma shows a high cellularity with scattered mitoses.
(C): (4) lumen of a cystic gland with cuboidal lining; (5) normal endometrial gland with cylindrical lining. There are no signs of nuclear- and cell atypia nor proliferations of aberrant glandular structures. (Partly by courtesy of G. P. Vooijs MD PhD, former Head of the Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands).
Clinical background: Hyperplasia of the endometrium is the result of an increased proliferation of the endometrium due to the persistent influence and effect of continuous production of oestrogens for example due to a persistent follicle cyste, polycystic ovarium syndrome, hyperthecosis or exogenous administration of oestrogens. In the case of a persisting follicle ovulation is absent and there is no corpus luteum and hence no or minor production of progesterone. There is no secretion phase of the endometrium because due to the continuous stimulation by oestrogens there will be a persistence of the proliferative phase. The macroscopic aspects of normal endometrium and hyperplastic ones appear to be identical, but the latter show more focal or diffuse endometrial thickening. Curettement results in increased amount of endomtrial tissue. Microscopically three types of hyperplasia can be discerned:
Keywords/Mesh: female reproductive organs, uterus, cysts, endometrial hyperplasia, genitalia, female., menopause, hyperplasia, histology, POJA collection
Title: Simple endometrial hyperplasia (uterus in menopause, human)
Description: Stain: Hematoxylin-eosin.
(A): Survey. (1) surface and basal endometrium with normal glands and cystically dilated glands; (2) myometrium and (3) arcuate arteries.
(B): Normal appearing endometrial glands and two cystic enlarged glands. In all lumina some proteinaceous debris is present and the stroma shows a high cellularity with scattered mitoses.
(C): (4) lumen of a cystic gland with cuboidal lining; (5) normal endometrial gland with cylindrical lining. There are no signs of nuclear- and cell atypia nor proliferations of aberrant glandular structures. (Partly by courtesy of G. P. Vooijs MD PhD, former Head of the Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands).
Clinical background: Hyperplasia of the endometrium is the result of an increased proliferation of the endometrium due to the persistent influence and effect of continuous production of oestrogens for example due to a persistent follicle cyste, polycystic ovarium syndrome, hyperthecosis or exogenous administration of oestrogens. In the case of a persisting follicle ovulation is absent and there is no corpus luteum and hence no or minor production of progesterone. There is no secretion phase of the endometrium because due to the continuous stimulation by oestrogens there will be a persistence of the proliferative phase. The macroscopic aspects of normal endometrium and hyperplastic ones appear to be identical, but the latter show more focal or diffuse endometrial thickening. Curettement results in increased amount of endomtrial tissue. Microscopically three types of hyperplasia can be discerned:
- (1): Simple endometrial hyperplasia (often called cystic glandular hyperplasia. Within a widened endometrial stroma the amount of glands are increased and many glands are dilated with flattened or cuboid epithelium or even show cystic malformations. Numerous epithelial mitoses are observed, but there is no atypia. The stromal cells are found packed together showing frequently mitoses and often hyaline depositions are localized. Spiral arteries are less well developed but the surface capillaries are well represented and sometimes dilated, too.
- (2): Complex endometrial hyperplasia. A diffuse and focally presented hyperplasia with only an increase in the amount of glandular structures closely packed together with compact cellular stromal tissue that contains frequently foam cells. In contrast to the cystic hyperplasia branched knobby-like projections of the glands are present. The glandular lining is pseudostratified with lots of mitoses, but no atypia is observed.
- (3): Atypical hyperplasia. Generally this is a focal process and characterized by a strong proliferation of endometrial glands with branched knobby-like projections. Often papillary and syncytial proliferations are bulging into the glanular lumina. The cellular lining shows atypia such as anisocytose and large atypic cells as well as multiple pseudostratifying cells are present. Hyperchromatic nuclei with prominent nucleoli and frequently mitoses are observed. Due to the increase of amount as well of the sizes of the glands the stromal tissue is hardly observable. If focally the glandular epithelial cytoplasms stain strongly eosinofilic and increase in sizes it might indicate an adenocarcinoma in situ. The cellular changes of atypical hyperplasia are identical to the endometrial carcinoma however the latter show more invasiveness into the surrounding stroma as well as into the myometrial tissues. In most cases (80%) atypic hyperplasia deteriorates malignantly.
Keywords/Mesh: female reproductive organs, uterus, cysts, endometrial hyperplasia, genitalia, female., menopause, hyperplasia, histology, POJA collection