UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Classification and diagnosis of endometrial hyperplasia

Authors
Robert L Giuntoli, II, MD
Howard A Zacur, MD, PhD
Section Editors
Barbara Goff, MD
Rochelle L Garcia, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Endometrial hyperplasia is characterized by a proliferation of endometrial glands of irregular size and shape. Compared with proliferative endometrium, there is an increase in the endometrial gland to stroma ratio. Endometrial hyperplasia virtually always results from chronic estrogen stimulation unopposed by the counterbalancing effects of progesterone [1].

The classification, clinical manifestations, diagnosis, and evaluation of endometrial hyperplasia are reviewed here. Related topics can be found separately:

Management of endometrial hyperplasia (See "Management of endometrial hyperplasia".)

Other etiologies of abnormal uterine bleeding (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women" and "Postmenopausal uterine bleeding".)

Endometrial cancer (See "Endometrial carcinoma: Epidemiology and risk factors".)

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Apr 2015. | This topic last updated: Nov 24, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
References
Top
  1. Hedrick Ellenson L, Ronnett BM, Kurman RJ. Precursor Lesions of Endometrial Carcinoma. In: Blaustein's Pathology of the Female Genital Tract, 6th ed, Kurman RJ, Hedrick Ellenson L, Ronnett, BM. (Eds), Springer, New York 2010. p.360-361.
  2. Scully RE, Bonfiglio TA, Kurman, et al. Uterine corpus. In: Histological Typing of Female Genital Tract Tumours, 2nd ed., Springer-Verlag, New York 1994. p.13.
  3. Zaino RJ, Kauderer J, Trimble CL, et al. Reproducibility of the diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer 2006; 106:804.
  4. Kendall BS, Ronnett BM, Isacson C, et al. Reproducibility of the diagnosis of endometrial hyperplasia, atypical hyperplasia, and well-differentiated carcinoma. Am J Surg Pathol 1998; 22:1012.
  5. Bergeron C, Nogales FF, Masseroli M, 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.
  6. Skov BG, Broholm H, Engel U, et al. Comparison of the reproducibility of the WHO classifications of 1975 and 1994 of endometrial hyperplasia. Int J Gynecol Pathol 1997; 16:33.
  7. Lacey JV Jr, Chia VM. Endometrial hyperplasia and the risk of progression to carcinoma. Maturitas 2009; 63:39.
  8. Trimble CL, Kauderer J, Zaino R, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer 2006; 106:812.
  9. 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.
  10. Lacey JV Jr, Sherman ME, Rush BB, et al. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28:788.
  11. Rakha E, Wong SC, Soomro I, et al. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol 2012; 36:1683.
  12. Mutter GL. Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The Endometrial Collaborative Group. Gynecol Oncol 2000; 76:287.
  13. Baak JP, Ørbo A, van Diest PJ, 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.
  14. Mutter GL, Baak JP, Crum CP, et al. Endometrial precancer diagnosis by histopathology, clonal analysis, and computerized morphometry. J Pathol 2000; 190:462.
  15. Baak JP, Mutter GL, Robboy S, et al. The molecular genetics and morphometry-based endometrial intraepithelial neoplasia classification system predicts disease progression in endometrial hyperplasia more accurately than the 1994 World Health Organization classification system. Cancer 2005; 103:2304.
  16. Hecht JL, Ince TA, Baak JP, et al. Prediction of endometrial carcinoma by subjective endometrial intraepithelial neoplasia diagnosis. Mod Pathol 2005; 18:324.
  17. Trimble CL, Method M, Leitao M, et al. Management of endometrial precancers. Obstet Gynecol 2012; 120:1160.
  18. Reed SD, Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009; 200:678.e1.
  19. Twu NF, Chen SS. Five-year follow-up of patients with recurrent postmenopausal bleeding. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:628.
  20. Ronghe R, Gaudoin M. Women with recurrent postmenopausal bleeding should be re-investigated but are not more likely to have endometrial cancer. Menopause Int 2010; 16:9.
  21. Suh-Burgmann E, Hung YY, Armstrong MA. Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage. Obstet Gynecol 2009; 114:523.