17. Glandular cystic hyperplasia of the endometrium: Difference between revisions
(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]]'''Staining''': HE | ||
'''Organ''': Uterine tissue acquired by curettage | '''Organ''': Uterine tissue acquired by curettage | ||
'''Description''': | '''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. | ||
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 | ||
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'''Theory''': | '''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. | 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.[[File:Glandular cystic hyperplasia of the endometrium - cystic dilation.jpg|thumb|Cystic dilation and stroma.]]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. | ||
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. | 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%) | ||
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Curettage is a method of scraping tissues using an instrument called a curette. | Curettage is a method of scraping tissues using an instrument called a curette. | ||
[[Category:Pathology 1 - Histopathology slides]] | [[Category:Pathology 1 - Histopathology slides]] | ||
Revision as of 11:23, 5 July 2024
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:
- 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
- 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.
Curettage is a method of scraping tissues using an instrument called a curette.