Endometrial hyperplasia

Endometrial hyperplasia (EH) refers to an increased proliferation of the endometrial glands relative to the stroma. One of the main concerns is the potential malignant transformation of the endometrial hyperplasia to the endometrial carcinoma.

It affects women of all age groups 12.

A great majority of patients present with abnormal uterine bleeding. 

Hyperplasia with increased gland to stroma ratio; there is a spectrum of endometrial changes ranging from glandular atypia to frank neoplasia.

There are several types of endometrial hyperplasia, which include:

Hyperplasia can be also classified into two broad groups 5:

Associations

Unopposed oestrogen stimulation (either from an endogenous or exogenous source) is implicated in its pathogenesis; some of these conditions are:

Ultrasound

Imaging the endometrium on days 5-10 of a woman's cycle reduces the variability in endometrial thickness.

  • premenopausal
    • normal endometrial thickness depends on the stage of the menstrual cycle, but a thickness of >15 mm is considered top normal in the secretory phase
    • hyperplasia can be reliably excluded in patients only when the endometrium measures less than 6 mm 1
  • postmenopausal
    • a thickness of >5 mm is considered abnormal

The appearance can be non-specific and cannot reliably allow differentiation between hyperplasia and carcinoma 5. Usually, there is a homogeneous increase in endometrial thickness, but endometrial hyperplasia may also cause asymmetric/focal thickening with surface irregularity, an appearance that is suspicious for carcinoma.

Pelvic MRI
  • T2: hyperplasia is often isointense to hypointense to normal endometrium 7

Up to one-third of endometrial carcinoma is believed to be preceded by hyperplasia. A biopsy is required for a definitive diagnosis.

Because endometrial hyperplasia has a non-specific appearance, any focal abnormality should lead to biopsy if there is clinical suspicion for malignancy (e.g. vaginal bleeding).

On ultrasound, appearances can potentially simulate:


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Article Information

rID: 13019
Section: Pathology
Synonyms or Alternate Spellings:
  • Hyperplasia of the endometrium
  • Endometrial hyperplasia (EH)
  • Endometrial hyperplasia - general
  • Hyperplasia of endometrium

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