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

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Created page with "'''Staining''': HE '''Organ''': Uterine tissue acquired by curettage '''Description''': The uterine tissue morphology is mostly lost during the curettage. We can only see fragments of the endometrium. Normal uterine glands can be seen, however some of them have a (sometimes extremely) enlarged lumen. Normal uterine stroma can be seen. The total number of glands are increased compared to physiological. '''Diagnosis''': Endometrial hyperplasia, simple type without aty..."
 
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'''Staining''': HE
[[File:Glandular cystic hyperplasia of the endometrium - overview.jpg|thumb|Overview of the slide|329x329px]]'''Staining''': HE     '''Organ''': Uterine tissue acquired by curettage


'''Organ''': Uterine tissue acquired by curettage
'''Description''': The uterine tissue morphology is mostly lost during the curettage. We can only see fragments of the endometrium. Normal uterine glands can be seen, however some of them have a (sometimes extremely) enlarged lumen. Normal uterine stroma can be seen. The total number of glands are increased compared to physiological.
 
'''Description''':
 
The uterine tissue morphology is mostly lost during the curettage. We can only see fragments of the endometrium.
 
Normal uterine glands can be seen, however some of them have a (sometimes extremely) enlarged lumen. Normal uterine stroma can be seen. The total number of glands are increased compared to physiological.


'''Diagnosis''': Endometrial hyperplasia, simple type without atypia
'''Diagnosis''': Endometrial hyperplasia, simple type without atypia


'''Causes''':
'''Causes''': Any condition characterised by increased oestrogen, including anovulatory cycles, postmenopausal oestrogen therapy, polycystic ovary syndrome, and obesity
 
* Anovulatory cycle
* Postmenopausal oestrogen therapy
* Polycystic ovary syndrome
* Obesity
 
'''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.
 
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:
 
* Simple hyperplasia without atypia 1%
* Simple hyperplasia with atypia (~5%)
* Complex hyperplasia without atypia (~20%)
* Complex hyperplasia with atypia 40%
 
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
'''Theory''': Anovulatory cycles are “menstrual” cycles that occur without ovulation. It can occur now and then in pubertal and menopausal women. In the menstrual cycle, the proliferative phase is stimulated by oestrogen while the secretory phase is stimulated by progesterone. If, for some reason, the proliferative phase is prolonged, the endometrium will be exposed to oestrogen for a longer time, allowing it to turn more hyperplastic than normal.[[File:Glandular cystic hyperplasia of the endometrium - cystic dilation.jpg|thumb|254x254px]]After menopause the low level of oestrogen in the blood causes the patients to experience a variety of symptoms. This can be treated with postmenopausal hormone therapy however this may increase the risk for endometrial hyperplasia.
* There is uterine stroma present
* We can see cystic dilation in some of the glands.


Cystic dilation means that some glands have a large lumen. If there was no stroma present it would indicate 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: Simple hyperplasia without atypia 1%, simple hyperplasia with atypia (~5%), complex hyperplasia without atypia (~20%), complex hyperplasia with atypia 40%. Patients with a diagnosis of complex atypical hyperplasia should always consider a hysterectomy.[[File:Glandular cystic hyperplasia of the endometrium - gland hyperplasia.jpg|thumb|Note the increased number of glands.|256x256px|left]]''We don’t have to know how to distinguish the different types or what atypia means in this context. The percentages in brackets are not to be known.''


Curettage is a method of scraping tissues using an instrument called a curette.
Three things point to that there is hyperplasia in this endometrial sample. The number of glands is increased compared to the normal, there is uterine stroma present, and we can see cystic dilation in some of the glands. Cystic dilation means that some glands have a large lumen. If there was no stroma present it would indicate cancer. Curettage is a method of scraping tissues using a ''curette''.
[[File:Glandular cystic hyperplasia of the endometrium - overview.jpg|center|thumb|Overview of the slide]]
[[File:Glandular cystic hyperplasia of the endometrium - cystic dilation.jpg|center|thumb|Cystic dilation and stroma.]]
[[File:Glandular cystic hyperplasia of the endometrium - gland hyperplasia.jpg|center|thumb|Here you can see the increased number of glands.]]
[[Category:Pathology 1 - Histopathology slides]]
[[Category:Pathology 1 - Histopathology slides]]

Latest revision as of 11:37, 5 July 2024

Overview of the slide

Staining: HE Organ: Uterine tissue acquired by curettage

Description: The uterine tissue morphology is mostly lost during the curettage. We can only see fragments of the endometrium. Normal uterine glands can be seen, however some of them have a (sometimes extremely) enlarged lumen. Normal uterine stroma can be seen. The total number of glands are increased compared to physiological.

Diagnosis: Endometrial hyperplasia, simple type without atypia

Causes: Any condition characterised by increased oestrogen, including anovulatory cycles, postmenopausal oestrogen therapy, polycystic ovary syndrome, and obesity

Theory: Anovulatory cycles are “menstrual” cycles that occur without ovulation. It can occur now and then in pubertal and menopausal women. In the menstrual cycle, the proliferative phase is stimulated by oestrogen while the secretory phase is stimulated by progesterone. If, for some reason, the proliferative phase is prolonged, the endometrium will be exposed to oestrogen for a longer time, allowing it to turn more hyperplastic than normal.

After menopause the low level of oestrogen in the blood causes the patients to experience a variety of symptoms. This can be treated with postmenopausal hormone therapy however this may increase 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: Simple hyperplasia without atypia 1%, simple hyperplasia with atypia (~5%), complex hyperplasia without atypia (~20%), complex hyperplasia with atypia 40%. Patients with a diagnosis of complex atypical hyperplasia should always consider a hysterectomy.

Note the increased number of glands.

We don’t have to know how to distinguish the different types or what atypia means in this context. The percentages in brackets are not to be known.

Three things point to that there is hyperplasia in this endometrial sample. The number of glands is increased compared to the normal, there is uterine stroma present, and we can see cystic dilation in some of the glands. Cystic dilation means that some glands have a large lumen. If there was no stroma present it would indicate cancer. Curettage is a method of scraping tissues using a curette.