Endometrial polyp with complex hyperplasia and atypia (Pathology)

Case contributed by Dr Mikkaela McCormack

Presentation

Specimen was received without any accompanying clinical information. The curetted tissue fragments measured 15 x 10 x 4 mm in aggregate.

Patient Data

Age: 70 years
Gender: Female

The sections consist of background endometrium displaying changes of cystic atrophy.  Several fragments have a polypoid appearance, which in areas show an increased gland-to-stroma ratio and a spindled, fibrous stroma.  Focally, the glandular architecture is crowded, with complex cribriform patterns.  These glands display cellular stratification and crowding, with pleomoprhic, enlarged nuclei showing coarse chromatin, prominent nucleoli and scattered mitotic figures.   

Note: No evidence of malignancy was present within the tissue sampled.   

Legends for individual slides:

  1. Background endometrium with changes of cystic atrophy. 
  2. Background endometrium.
  3. Cystically dilated glands with tubal metaplasia. 
  4. Low-power view of polyp - smooth rounded outline covered in epithelium, with increased numbers of glands compared to the background endometrium. 
  5. Glands show varying degrees of crowding, set within a fibrous, spindled stroma containing scattered vessels. 
  6. Most glands maintain simple tubular outlines, whilst occasional glands show a more complex and cribriform architecture. There is no back-to-back gland formation. 
  7. Crowded glands with complex architecture. 
  8. Lining epithelium shows nuclear stratification, with enlarged, irregular nuclei, elevated nuclear:cytoplasmic ratios, and coarse chromatin. Increased numbers of mitotic figures are present. The same cytological atypia is present in glands with both simple and complex architecture. 
  9. Lining epithelium shows nuclear stratification, with enlarged, irregular nuclei, elevated nuclear:cytoplasmic ratios, and coarse chromatin. Increased numbers of mitotic figures are present. 

Case Discussion

Making the finding of endometrial hyperplasia within a polyp has clinical implications for the patient’s future treatment – making the diagnosis of atypical hyperplasia can result in a hysterectomy. Where atypical hyperplasia is identified in a polyp, there is a high chance (>50%) that there will be atypical hyperplasia or carcinoma within the non-polypoid endometrium.

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