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17. Glandular cystic hyperplasia of the endometrium: Difference between revisions

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17. Glandular cystic hyperplasia of the endometrium (view source)

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'''Theory''': Anovulatory cycles are “menstrual” cycles that occur without ovulation, however there can still be bleeding. It can occur now and then in pubertal and menopausal women. Thinking back to the menstrual cycle, we know that the proliferative phase is stimulated by oestrogen while the secretory phase is stimulated by progesterone. If, for some reason, the proliferative phase is prolonged will the endometrium be exposed to oestrogen for a longer time, allowing it to hyperplasia more than normal.[[File:Glandular cystic hyperplasia of the endometrium - cystic dilation.jpg|thumb|Cystic dilation and stroma.]]After menopause the low level of oestrogen in the blood causes the patients to experience a variety of symptoms, like increased risk for osteoporosis. This can be treated with postmenopausal hormone therapy however this increases the risk for endometrial hyperplasia.
'''Theory''': Anovulatory cycles are “menstrual” cycles that occur without ovulation, however there can still be bleeding. It can occur now and then in pubertal and menopausal women. Thinking back to the menstrual cycle, we know that the proliferative phase is stimulated by oestrogen while the secretory phase is stimulated by progesterone. If, for some reason, the proliferative phase is prolonged will the endometrium be exposed to oestrogen for a longer time, allowing it to hyperplasia more than normal.[[File:Glandular cystic hyperplasia of the endometrium - cystic dilation.jpg|thumb|Cystic dilation and stroma.]]After menopause the low level of oestrogen in the blood causes the patients to experience a variety of symptoms, like increased risk for osteoporosis. This can be treated with postmenopausal hormone therapy however this increases the risk for endometrial hyperplasia.


 
Four subtypes of endometrial hyperplasia exist. They can all lead to cancer, but different types have different risks. They are, in order from lowest to highest risk for developing cancer:
 
Four subtypes of endometrial hyperplasia exist. They can all lead to cancer, but different types have different risks. They are, in order from lowest to highest risk for developing cancer:[[File:Glandular cystic hyperplasia of the endometrium - gland hyperplasia.jpg|thumb|Here you can see the increased number of glands.]]
* Simple hyperplasia without atypia 1%
* Simple hyperplasia without atypia 1%
* Simple hyperplasia with atypia (~5%)
* Simple hyperplasia with atypia (~5%)
* Complex hyperplasia without atypia (~20%)
* Complex hyperplasia without atypia (~20%)
* Complex hyperplasia with atypia 40%
* Complex hyperplasia with atypia 40%
 
[[File:Glandular cystic hyperplasia of the endometrium - gland hyperplasia.jpg|thumb|Here you can see the increased number of glands.]]We don’t have to know how to distinguish the different types or what atypia means. The percentages in brackets are not to be known. Patients with a diagnosis of complex atypical hyperplasia should always consider a hysterectomy.
We don’t have to know how to distinguish the different types or what atypia means. The percentages in brackets are not to be known. Patients with a diagnosis of complex atypical hyperplasia should always consider a hysterectomy.


Three things point to that there is hyperplasia in this endometrial sample. The number of glands is increased compared to the physiological, there is uterine stroma present, and we can see cystic dilation in some of the glands.
Three things point to that there is hyperplasia in this endometrial sample. The number of glands is increased compared to the physiological, there is uterine stroma present, and we can see cystic dilation in some of the glands.