Skip to main content
SpringerLink
Log in

Endometrial Hyperplasia, Endometrial Intraepithelial Carcinoma, and Epithelial Cytoplasmic Change

  • Chapter
Diagnosis of Endometrial Biopsies and Curettings

Endometrial hyperplasia is a noninvasive proliferation of the endometrium that results in a morphologic pattern of glands with irregular shapes and varying size. This disorder results from sustained, unopposed estrogen stimulation and presents clinically as abnormal uterine bleeding. Sometimes hyperplasia is encountered incidentally in a biopsy performed for other reasons, such as infertility workup prior to or during hormone replacement therapy. Hyperplasia can mimic a wide variety of normal physiologic changes, artifacts resulting from tissue sampling and processing, benign organic disorders, and well-differentiated adenocarcinoma. Because management of these conditions and the different forms of hyperplasia can range from no treatment to hysterectomy, correct diagnosis is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ronnett BM, Kurman RJ. Precursor lesions of endometrial carcinoma. In: Kurman R, ed. Blaustein’s pathology of the female genital tract. 5th ed. New York: Springer-Verlag; 2002: 467–500.

    Google Scholar 

  2. Norris HJ, Tavassoli FA, Kurman RJ. Endometrial hyperplasia and carcinoma. Diagnostic considerations. Am J Surg Pathol 1983; 7:839–847.

    Article  PubMed  CAS  Google Scholar 

  3. Silverberg SG. Hyperplasia and carcinoma of the endometrium. Semin Diagn Pathol 1988; 5:135–153.

    PubMed  CAS  Google Scholar 

  4. Silverberg SG, Kurman RJ. Tumors of the uterine corpus and gestational trophoblastic disease. Atlas of tumor pathology, 3rd series, Fascicle 3. Washington, DC: Armed Forces Institute of Pathology, 1992.

    Google Scholar 

  5. Kraus FT. High—risk and premalignant lesions of the endometrium. Am J Surg Pathol 1985; 9(Suppl):31–40.

    Google Scholar 

  6. Welch WR, Scully RE. Precancerous lesions of the endometrium. Hum Pathol 1977; 8:503–512.

    Article  PubMed  CAS  Google Scholar 

  7. Silverberg SG. Problems in the differential diagnosis of endometrial hyperplasia and carcinoma. Mod Pathol 2000; 13:309–327.

    Google Scholar 

  8. Chamlian DL, Taylor HB. Endometrial hyperplasia in young women. Obstet Gynecol 1970; 36:659–660.

    PubMed  CAS  Google Scholar 

  9. Lee KR, Scully RE. Complex endometrial hyperplasia and carcinoma in adolescents and young women 15 to 20 years of age: A report of 10 cases. Int J Gynecol Pathol 1989; 8:201–213.

    PubMed  CAS  Google Scholar 

  10. McBride JM. Pre-menopausal cystic hyperplasia and endometrial carcinoma. J Obstet Gynaecol Br Emp 1959; 66:288–296.

    PubMed  CAS  Google Scholar 

  11. Gusberg SB, Kaplan AL. Precursors of corpus cancer. IV. Adenomatous hyperplasia as stage 0 carcinoma of the endometrium. Am J Obstet Gynecol 1963; 87:662–677.

    PubMed  CAS  Google Scholar 

  12. Hertig AT, Sommers SC. Genesis of endometrial carcinoma. I. Study of prior biopsies. Cancer 1949; 2:946–956.

    Article  PubMed  CAS  Google Scholar 

  13. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 1985; 56:403–412.

    Article  PubMed  CAS  Google Scholar 

  14. Tavassoli F, Kraus FT. Endometrial lesion in uteri resected for atypical endometrial hyperplasia. Am J Clin Pathol 1978; 70:772–777.

    Google Scholar 

  15. Deligdisch L, Cohen CJ. Histologic correlates and virulence implications of endometrial carcinoma associated with adenomatous hyperplasia. Cancer 1985; 56:1452.

    Article  PubMed  CAS  Google Scholar 

  16. Buehl IA, Vellios F, Carter JE, Huber CP. Carcinoma in situ of the endometrium. Am J Clin Pathol 1964; 42:594–601.

    PubMed  CAS  Google Scholar 

  17. Campbell PE, Barter RA. The significance of atypical hyperplasia. J Obstet Gynaecol Br Commonw 1961; 68:668–672.

    PubMed  CAS  Google Scholar 

  18. Hertig AT, Sommers SC, Bengaloff H. Genesis of endometrial carcinoma. III. Carcinoma in situ. Cancer 1949; 2:964–971.

    Article  PubMed  CAS  Google Scholar 

  19. Winkler B, Alvarez S, Richart RM, Crum CP. Pitfalls in the diagnosis of endometrial neoplasia. Obstet Gynecol 1984; 64:185–194.

    PubMed  CAS  Google Scholar 

  20. Crum CP, Richart RM, Fenoglio CM. Adenoacanthosis of the endometrium. A clinicopathologic study in premenopausal women. Am J Surg Pathol 1981; 5:15.

    Article  PubMed  CAS  Google Scholar 

  21. Hendrickson MR, Kempson RL. Endometrial epithelial metaplasias: Proliferations frequently misdiagnosed as adenocarcinoma. Report of 89 cases and proposed classification. Am J Surg Pathol 1980; 4:525–542.

    PubMed  CAS  Google Scholar 

  22. Blaustein A. Morular metaplasia misdiagnosed as adenoacanthoma in young women with polycystic ovarian disease. Am J Surg Pathol 1982; 6:223.

    Article  PubMed  CAS  Google Scholar 

  23. Clement PB. Pathology of the uterine corpus. Hum Pathol 1991; 22:776–791.

    Article  PubMed  CAS  Google Scholar 

  24. Ambros RA, Sherman ME, Zahn CM, Bitterman P, Kurman RJ. Endometrial intraepithelial carcinoma: A distinctive lesion specifically associated with tumors displaying serous differentiation. Hum Pathol 1995; 26:1260–1267.

    Article  PubMed  CAS  Google Scholar 

  25. Vellios F. Endometrial hyperplasia and carcinoma in situ. Gynecol Oncol 1974; 2:152–161.

    Article  PubMed  CAS  Google Scholar 

  26. Scully RE, Poulson H, Sobin LH. International histological classification and typing of female genital tract tumours. Berlin: Springer-Verlag, 1994.

    Google Scholar 

  27. Silverberg SG, Kurman RJ, Nogales F, Matter GL, Kubik-Nutch RA, Tavassoli FA. Tumors of the uterine corpus. Epithelial tumours and related lesions. In:World Health Organization Classification of tumours. Pathology and genetics of tumours of the breast and female genital organs. Travassoli FA, Devilee P, eds. Lyon: IARC Press; 2003: 221–232.

    Google Scholar 

  28. Kendall BS, Ronnett BM, Isacson C, Cho KR, Hedrick L, Diener-West M, et al. Reproducibility of the diagnosis of endometrial hyperplasia, atypical hyperplasia, and well–differentiated carcinoma. Am J Surg Pathol 1998; 22:1012–1019.

    Article  PubMed  CAS  Google Scholar 

  29. Bergeron C, Nogales FF, Masseroli M, Abeler V, Duvillard P, Muller-Holzner E, et al. A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens. Am J Surg Pathol 1999; 23:1102–1108.

    Article  PubMed  CAS  Google Scholar 

  30. Wright TC, Holinka CF, Ferenczy A, Gatsonis CA, Mutter GL, Nicosia S, et al. Estradiol-induced hyperplasia in endometrial biopsies from women on hormone replacement therapy. Am J Surg Pathol 2002; 26:1269–1275.

    Article  PubMed  Google Scholar 

  31. Baak JP. The role of computerized morphometric and cytometric feature analysis in endometrial hyperplasia and cancer prognosis. J Cell Biochem Suppl 1995; 23:137–146.

    Article  PubMed  CAS  Google Scholar 

  32. Baak JP, Orbo A, van Diest PJ, Jiwa M, de Bruin P, Broeckaert M, et al. Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias. Am J Surg Pathol 2001; 25:930–935.

    Article  PubMed  CAS  Google Scholar 

  33. Mutter GL, Baak JP, Crum CP, Richart RM, Ferenczy A, Faquin WC. Endometrial precancer diagnosis by histopathology, clonal analysis, and computerized morphometry. J Pathol 2000; 190:462–469.

    Article  PubMed  CAS  Google Scholar 

  34. Mutter GL. Histopathology of genetically defined endometrial precancers. Int J Gynecol Pathol 2000; 19:301–309.

    Article  PubMed  CAS  Google Scholar 

  35. Mutter GL. Endometrial intraepithelial neoplasia (EIN):Will it bring order to chaos? The Endometrial Collaborative Group. Gynecol Oncol 2000; 76:287–290.

    Article  PubMed  CAS  Google Scholar 

  36. Dietel M. The histological diagnosis of endometrial hyperplasia. Is there a need to simplify? Virchows Arch 2001; 439:604–608.

    PubMed  CAS  Google Scholar 

  37. Dunton CJ, Baak JP, Palazzo JP, van Diest PJ, McHugh M, Widra EA. Use of computerized morphometric analyses of endometrial hyperplasias in the prediction of coexistent cancer. Am J Obstet Gynecol 1996; 174:1518–1521.

    Article  PubMed  CAS  Google Scholar 

  38. Baak JP, Wisse-Brekelmans EC, Fleege JC, van der Putten HW, Bezemer PD. Assessment of the risk on endometrial cancer in hyperplasia, by means of morphological and morphometrical features. Pathol Res Pract 1992; 188:856–859.

    PubMed  CAS  Google Scholar 

  39. Hendrickson MR, Kempson RL. Surgical pathology of the uterine corpus (Major problems in pathology series), Vol. 12. Philadelphia: W.B. Saunders; 1980.

    Google Scholar 

  40. Buckley CH, Fox H. Biopsy pathology of the endometrium. 2nd ed. London: Arnold; 2002.

    Google Scholar 

  41. Lehman MB, Hart WR. Simple and complex hyperplastic papillary proliferations of the endometrium: A clinicopathologic study of nine cases of apparently localized papillary lesions with fibrovascular stromal cores and epithelial metaplasia. Am J Surg Pathol 2001; 25:1347–1354.

    Article  PubMed  CAS  Google Scholar 

  42. Kurman RJ, Norris HJ. Evaluation of criteria for distinguishing atypical endometrial hyperplasia from well-differentiated carcinoma. Cancer 1982; 49:2547–2557.

    Article  PubMed  CAS  Google Scholar 

  43. Gray LA, Robertson RWJ, Christopherson WM. Atypical endometrial changes associated with carcinoma. Gynecol Oncol 1974;2:93–100.

    Article  PubMed  CAS  Google Scholar 

  44. King A, Seraj IM, Wagner RJ. Stromal invasion in endometrial carcinoma. Am J Obstet Gynecol 1984; 149:10–14.

    PubMed  CAS  Google Scholar 

  45. Terakawa N, Kigawa J, Taketani Y, Yoshikawa H, Yajima A, Noda K, et al. The behavior of endometrial hyperplasia: A prospective study. Endometrial Hyperplasia Study Group. J Obstet Gynaecol Res 1997; 23:223–230.

    PubMed  CAS  Google Scholar 

  46. Sherman ME. Theories of endometrial carcinogenesis: A multidisciplinary approach. Mod Pathol 2000; 13:295–308.

    Article  PubMed  CAS  Google Scholar 

  47. McCluggage WG, Sumathi VP, McManus DT. Uterine serous carcinoma and endometrial intraepithelial carcinoma arising in endometrial polyps: Report of 5 cases, including 2 associated with tamoxifen therapy. Hum Pathol 2003; 34:939–943.

    Article  PubMed  CAS  Google Scholar 

  48. Soslow RA, Pirog E, Isacson C. Endometrial intraepithelial carcinoma with associated peritoneal carcinomatosis. Am J Surg Pathol 2000; 24:726–732.

    Article  PubMed  CAS  Google Scholar 

  49. Wheeler DT, Bell KA, Kurman RJ, Sherman ME. Minimal uterine serous carcinoma: Diagnosis and clinicopathologic correlation. Am J Surg Pathol 2000; 24:797–806.

    Article  PubMed  CAS  Google Scholar 

  50. Zheng W, Khurana R, Farahmand S, Wang Y, Zhang ZF, Felix JC. p53 immunostaining as a significant adjunct diagnostic method for uterine surface carcinoma: precursor of uterine papillary serous carcinoma. Am J Surg Pathol 1998; 22:1463–1473.

    Article  PubMed  CAS  Google Scholar 

  51. Sherman ME, Bur ME, Kurman RJ. p53 in endometrial cancer and its putative precursors: Evidence for diverse pathways of tumorigenesis. Hum Pathol 1995; 26:1268–1274.

    Article  PubMed  CAS  Google Scholar 

  52. Tashiro H, Isacson C, Levine R, Kurman RJ, Cho KR, Hedrick L. p53 gene mutations are common in uterine serous carcinoma and occur early in their pathogenesis. Am J Pathol 1997; 150:177–185.

    PubMed  CAS  Google Scholar 

  53. McCluggage WG. Recent advances in immunohistochemistry in gynaecological pathology. Histopathology 2002; 40:309–326.

    Article  PubMed  CAS  Google Scholar 

  54. Baergen RN, Warren CD, Isacson C, Ellenson LH. Early uterine serous carcinoma: Clonal origin of extrauterine disease. Int J Gynecol Pathol 2001; 20:214–219.

    Article  PubMed  CAS  Google Scholar 

  55. Zaman SS, Mazur MT. Endometrial papillary syncytial change. A nonspecific alteration associated with active breakdown. Am J Clin Pathol 1993; 99:741–745.

    PubMed  CAS  Google Scholar 

  56. Andersen WA, Taylor PT, Fechner RE, Pinkerton JAV. Endometrial metaplasia associated with endometrial carcinoma. Am J Obstet Gynecol 1987; 157:597–604.

    PubMed  CAS  Google Scholar 

  57. Kaku T, Tsukamoto N, Tsuruchi N, Sugihara K, Kamura T, Nakano H. Endometrial metaplasia associated with endometrial carcinoma. Obstet Gynecol 1992; 80:812–816.

    PubMed  CAS  Google Scholar 

  58. Dutra F. Intraglandular morules of the endometrium. Am J Clin Pathol 1959; 31:60–65.

    PubMed  CAS  Google Scholar 

  59. Masterson R, Armstrong EM, More IAR. The cyclical variation in the percentage of ciliated cells in the normal human endometrium. J Reprod Fertil 1975; 42:537–540.

    Google Scholar 

  60. Rorat E, Wallach RC. Papillary metaplasia of the endometrium: Clinical and histopathologic considerations. Obstet Gynecol 1984; 64:90S–92S.

    PubMed  CAS  Google Scholar 

  61. Nucci MR, Prasad CJ, Crum CP, Mutter GL. Mucinous endometrial epithelial proliferations: A morphologic spectrum of changes with diverse clinical significance. Mod Pathol 1999; 12:1137–1142.

    PubMed  CAS  Google Scholar 

  62. Vang R, Tavassoli FA. Proliferative mucinous lesions of the endometrium: Analysis of existing criteria for diagnosing carcinoma in biopsies and curettings. Int J Surg Pathol 2003; 11:261–270.

    Article  PubMed  Google Scholar 

  63. Tresserra F, Lopez-Yarto M, Grases PJ, Ubeda A, Pascual MA, Labastida R. Endometrial hyperplasia with secretory changes. Gynecol Oncol 2003; 88:386–393.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Upstate Medical University, State University of New York, Syracuse, NY 13210

    Michael T. Mazur MD (Clinical Professor of Pathology)

  2. ClearPath Diagnostics, Syracuse, NY 13202, USA

    Michael T. Mazur MD (Clinical Professor of Pathology)

  3. Departments of Gynecology, Obstetrics and Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA

    Robert J. Kurman MD (Richard W. TeLinde, Distinguished Professor)

  4. The Johns Hopkins University, School of Medicine, Baltimore, MD 21231, USA

    Robert J. Kurman MD (Richard W. TeLinde, Distinguished Professor)

Authors
  1. Michael T. Mazur MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert J. Kurman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer Science+Business Media, Inc.

About this chapter

Cite this chapter

Mazur, M.T., Kurman, R.J. (2005). Endometrial Hyperplasia, Endometrial Intraepithelial Carcinoma, and Epithelial Cytoplasmic Change. In: Diagnosis of Endometrial Biopsies and Curettings. Springer, New York, NY. https://doi.org/10.1007/978-0-387-26321-2_9

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-26321-2_9

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-98615-9

  • Online ISBN: 978-0-387-26321-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation