Histopathology of endometrial hyperplasia and endometrial carcinoma

Horn, Lars‐Christian; Meinel, A.; Handzel, Romy; Einenkel, Jens

doi:10.1016/j.anndiagpath.2007.05.002

Cited by 101 publications

(101 citation statements)

References 80 publications

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“…Using the pathology panel diagnoses, the cumulative probabilities of progression for SH, CH, and AH were 10, 10, and 40%, respectively. Therefore, previous estimates of carcinoma risk based on consensus diagnoses of SH, CH, and AH (Kurman et al, 1985;Ferenczy and Gelfand, 1989;Montgomery et al, 2004;Horn et al, 2007) may require revision. Our findings reaffirm the need to improve the sensitivity and specificity of AH diagnoses (Soslow, 2006) and efficiently identify the rare nonatypical EH lesions that are likely to progress.…”

Section: Discussionmentioning

confidence: 99%

Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan

et al. 2007

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Classifying endometrial hyperplasia (EH) according to the severity of glandular crowding (simple hyperplasia (SH) vs complex hyperplasia (CH)) and nuclear atypia (simple atypical hyperplasia (SAH) vs complex atypical hyperplasia (CAH)) should predict subsequent endometrial carcinoma risk, but data on progression are lacking. Our nested case -control study of EH progression included 138 cases, who were diagnosed with EH and then with carcinoma (1970 -2003) at least 1 year (median, 6.5 years) later, and 241 controls, who were individually matched on age, date, and follow-up duration and counter-matched on EH classification. After centralised pathology panel and medical record review, we generated rate ratios (RRs) and 95% confidence intervals (CIs), adjusted for treatment and repeat biopsies. With disordered proliferative endometrium (DPEM) as the referent, AH significantly increased carcinoma risk (RR ¼ 14, 95% CI, 5 -38). Risk was highest 1 -5 years after AH (RR ¼ 48, 95% CI, 8 -294), but remained elevated 5 or more years after AH (RR ¼ 3.5, 95% CI, 1.0 -9.6). Progression risks for SH (RR ¼ 2.0, 95% CI, 0.9 -4.5) and CH (RR ¼ 2.8, 95% CI, 1.0 -7.9) were substantially lower and only slightly higher than the progression risk for DPEM. The higher progression risks for AH could foster management guidelines based on markedly different progression risks for atypical vs non-atypical EH.

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Section: Discussionmentioning

confidence: 99%

Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan

et al. 2007

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“…La simple (también conocida como hiperplasia quística o leve) es una lesión proliferativa que se caracteriza por cambios arquitectónicos en las glándulas de diversos tamaños, con mínimos cambios en la complejidad y densidad glandular y abundante estroma entre las mismas. El epitelio superficial es pseudoestratificado con ocasionales figuras mitóticas y ausencia de atipia nuclear (4)(5)(6)(7)(8)(9). La hiperplasia endometrial compleja es también una lesión proliferativa, en la cual se exhibe un incremento en el número y tamaño de las glándulas endometriales, que lucen apiñadas de forma irregular y con mínimo estroma interpuesto adoptando una morfología característica conocida como patrón de "espalda contra espalda" (4,6,9,10,11) (Figura 1).…”

Section: Introductionunclassified

“…Basándose en la características citológicas, las hiperplasias anteriormente descritas, se subclasifican de una manera mucho más simple: hiperplasia con o sin atipia (4,6,9,10,11). Dicha atipia citológica está caracterizada por un aumento en la estratificación con dispolaridad celular, núcleos hipercromá-ticos, núcleolo prominente, cromatina de aspecto grumoso e incremento de la razón núcleo/citoplasma (5,6,10) (Figura 2).…”

Section: Introductionunclassified

“…Posteriormente el Endometrial Collaborative Group (14) propuso otra clasificación: hiperplasia, neoplasia intraepitelial endometrial (NIE) y adenocarcinoma, que ha demostrado mejores resultados en porcentajes de reproducibilidad que la clasificación de la OMS (9).…”

Section: Introductionunclassified

“…Dadas las dificultades existentes para la categorización de la hiperplasia endometrial atípica o el adenocarcinoma, algunos autores han creado el concepto de neoplasia endometrial intraepitelial, que clasifica aparentemente de manera más eficaz a las pacientes con riesgo alto y bajo de cáncer y con mejor reproducibilidad que la hiperplasia endometrial atípica (9,15,16,17). Sin embargo, la OMS (5,6) aún mantiene la clasificación con base en la histopatología de presencia o no de atipia celular, que se resume en la Tabla I. Dicha clasificación es la que actualmente la mayoría de patólogos aún consideran describiendo estas lesiones intraepiteliales dentro del grupo de las hiperplasias atípicas (5,6,8,9,10,11,18,19).…”

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Hiperplasia Endometrial: Análisis De Serie De Casos Diagnosticados en Biopsia Endometrial

Ayala

Mastrascusa

Martínez

et al. 2010

Rev. chil. obstet. ginecol.

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RESUMENAntecedentes: La hiperplasia endometrial es una entidad en la que existe una proliferación de glándulas endometriales de tamaño y forma irregular, con mayor proporción de glándulas sobre el estroma, a consecuencia de una excesiva exposición a los estrógenos. Aproximadamente, en el 15% de legrados/biopsias endometriales de mujeres postmenopausicas con cuadro clínico de hemorragia uterina anormal, se diagnostica esta entidad. Objetivo: Describir la incidencia y hallazgos histopatológicos en legrado/biopsia endometrial en pacientes de un hospital público de tercer nivel. Métodos: Se revisaron 22.048 procedimientos realizados en el Hospital Universitario de Santander, procesados en el Departamento de Patología de la Universidad Industrial de Santander, en el periodo comprendido entre 1 de enero de 2005 y 31 de diciembre 2008, de los cuales 1.750 correspondieron a legrados/biopsias de endometrio y en 168 de estos se realizó el diagnóstico histopatológico de hiperplasia endometrial. Resultados: Se encontró que el promedio de edad de presentación de está entidad fue de 44,8 años y que el mayor porcentaje de pacientes (68,5%) estuvieron en el grupo de la hiperplasia simple sin atipia. En el 19,7% de los casos hubo evidencia de atipia. Conclusiones: El promedio de edad encontrado y los porcentajes por subgrupos de hiperplasia estuvieron en relación a otros estudios. Se destaca una menor proporción de casos con atipia.PALABRAS CLAVE: Hiperplasia, biopsia de endometrio, atipia SUMMARY Background: Endometrial hyperplasia is an entity in which there is a proliferation of endometrial glands of irregular size and shape, with the highest proportion of glands on the stroma, resulting from excessive exposure to estrogen. Approximately 15% of curettages/endometrial biopsies of postmenopausal women with clinical symptoms of abnormal uterine bleeding is diagnosed this entity. Objective: To describe the incidence and pathological findings in curettage/endometrial biopsy in patients of a tertiary public hospital. Methods: A retrospective review of 22,048 surgical procedures performed in the University Hospital of Santander, processed in the Pathology Department of Industrial University of Santander in the period from 1 January 2005 and 31 December 2008, of which 1,750 corresponded to curettage/biopsy of the endometrium and in 168 of these histopathological diagnosis was made of endometrial hyperplasia. Results: We found that the average age of presentation in this institution was 44.8 years and that the greater percentage of patients (68.5%) were in the group of simple hyperplasia without atypia. In 19.7% of the cases had evidence of atypia. Conclusions: The mean age and percentages found by hyperplasia subgroups were relatively within limits with regard to other studies, although broadly outlined in a lower proportion of cases with atypia.

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Expression of ki‐67 as proliferation biomarker in imprint smears of endometrial carcinoma

Kosmas

Stamoulas

Marouga

et al. 2011

Diagnostic Cytopathology

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The aims of this study were to determine the expression of Ki-67 in type I and type II endometrial adenocarcinomas as well as normal endometrium in imprint smears and to correlate the results with clinicopathologic parameters of primary untreated endometrial cancer patients. During a 29-month period, 255 patients were evaluated with entometrial imprint cytology. Endometrial samples freshly resected from women who underwent total abdominal hysterectomy were studied. One hundred twenty-six patients had endometrial carcinoma and 129 cases were diagnosed as normal endometrium. The expression of Ki-67 was assessed by immunocytochemistry. Positive staining was correlated with increased stage, grade and lymph node metastases. High expression was more frequent in type II than type I endometrial adenocarcinoma and high-grade endometrial carcinoma had higher proportions of Ki-67 positive immunostaining compared with low-grade carcinoma. Proliferative endometrium showed high Ki-67 expression level, even higher than those of grade 1 and type I. On the other hand, secretory endometrium Ki-67 positive cells were markedly diminished and even disappeared. Completely negative staining was found to be related to atrophic endometrium. Immunocytochemical findings from Ki-67 stain, in addition to cytomorphologic features, appeared to be useful for the diagnosis of endometrial carcinoma in endometrial cytology with imprint smears. High Ki-67 expression correlates with morphologic features of aggressiveness and the expression pattern of Ki-67 correspond to the expected cyclic/atrophic pattern in normal endometrium.

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Histopathology of endometrial hyperplasia and endometrial carcinoma

Cited by 101 publications

References 80 publications

Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan

Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan

Hiperplasia Endometrial: Análisis De Serie De Casos Diagnosticados en Biopsia Endometrial

Expression of ki‐67 as proliferation biomarker in imprint smears of endometrial carcinoma

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