Endometrial hyperplasia classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Endometrial hyperplasia}} | {{Endometrial hyperplasia}} | ||
{{CMG}}{{ | {{CMG}}{{Swathi}} | ||
==Overview== | ==Overview== | ||
Endometrial hyperplasia is further classified based on [[histology]] into simple and complex types. Endometrial hyperplasia can also be classified based on the presence or absence of cellular [[atypia]]; hyperplasia with cellular [[atypia]] and hyperplasia without cellular atypia. | |||
==Classification== | ==Classification== | ||
Endometrial hyperplasia may be classified | ===The [[World Health Organization]] (WHO) Classification System=== | ||
====The [[WHO]] Classification (1994)==== | |||
*[[Endometrial]] [[hyperplasia]] may be [[Classification|classified]] based on [[glandular]] complexity and [[nuclear]] atypicality into the following types:<ref name="qq">Scully RE. Histological typing of female genital tract tumours. Springer; 1994.</ref><ref name="wp">Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 3, 2016.</ref><ref name="pmid12130438">{{cite journal| author=Jorizzo JR, Chen MY, Martin D, Dyer RB, Weber TM| title=Spectrum of endometrial hyperplasia and its mimics on saline hysterosonography. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 2 | pages= 385-9 | pmid=12130438 | doi=10.2214/ajr.179.2.1790385 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12130438 }} </ref> | |||
{{familytree/start |summary=Endometrial hyperplasia classification}} | {{familytree/start |summary=Endometrial hyperplasia classification}} | ||
{{familytree |boxstyle=background: #DCDCDC; | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Endometrial hyperplasia'''</div>}} | {{familytree |boxstyle=background: #DCDCDC; | | | | | | | | | | A01 |A01=<div style="width: 12em; padding:0.2em;">'''Endometrial hyperplasia'''</div>}} | ||
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</div>|B02=<div style="width: 9em; padding:0.2em;">'''Complex'''</div>}} | </div>|B02=<div style="width: 9em; padding:0.2em;">'''Complex'''</div>}} | ||
{{familytree |boxstyle=background: #DCDCDC; | | | | |,|-|^|-|.| | | |,|-|^|-|.|}} | {{familytree |boxstyle=background: #DCDCDC; | | | | |,|-|^|-|.| | | |,|-|^|-|.|}} | ||
{{familytree |boxstyle=background: #DCDCDC; | | | | C01 | | C02 | | C03 | | C04|C01=<div style="width: 9em; padding:0.2em;">'''Simple hyperplasia with atypia ''' | {{familytree |boxstyle=background: #DCDCDC; | | | | C01 | | C02 | | C03 | | C04|C01=<div style="width: 9em; padding:0.2em;">'''Simple hyperplasia with cellular atypia ''' | ||
</div>|C02=<div style="width: 9em; padding:0.2em;">'''Simple hyperplasia without atypia'''</div>|C03=<div style="width: 9em; padding:0.2em;">'''Complex hyperplasia with atypia ''' | </div>|C02=<div style="width: 9em; padding:0.2em;">'''Simple hyperplasia without cellular atypia'''</div>|C03=<div style="width: 9em; padding:0.2em;">'''Complex hyperplasia with cellular atypia ''' | ||
</div>|C04=<div style="width: 9em; padding:0.2em;">'''Complex hyperplasia without atypia ''' | </div>|C04=<div style="width: 9em; padding:0.2em;">'''Complex hyperplasia without cellular atypia ''' | ||
</div>|}} | </div>|}} | ||
{{familytree/end}} | {{familytree/end}} | ||
====The New WHO Classification (2014)==== | |||
*The updated [[WHO]] [[classification]] has been proposed to simplify [[clinical]] [[Decision making|decision]] [[Decision making|making]], particularly when making treatment choices.<ref name="pmid25797956">{{cite journal| author=Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO)| title=New WHO Classification of Endometrial Hyperplasias. | journal=Geburtshilfe Frauenheilkd | year= 2015 | volume= 75 | issue= 2 | pages= 135-136 | pmid=25797956 | doi=10.1055/s-0034-1396256 | pmc=PMC4361167 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25797956 }} </ref> | |||
**Simple [[hyperplasia]] without [[atypia]] | |||
**Simple [[hyperplasia]] is characterized by: | |||
***[[Dense|Densely]] packed, [[Cystic|cystically]] [[Dilate|dilated]], [[variable]] sized [[glands]] separated by [[normal]] intervening [[stroma]] ( Figure 10 ). Although | |||
***3:1 gland-to-stroma ratio. | |||
***Ciliated cells | |||
***Squamous morular metaplasia | |||
**Complex hyperplasia without atypia | |||
**Complex hyperplasia without atypia is defined as: | |||
***Glands with abnormal, irregular architecture set in a background of scant intervening stroma | |||
***Some stroma must be present, | |||
***Basement membrane lining individual glands and a rim of intervening endometrial-type stroma between them. In addition to back-to-back and cribriform-like arrangements, other glandular architectural abnormalities warranting designation of complex hyperplasia include | |||
***Outpouchings, | |||
***Infoldings, and budding | |||
***Squamous or morular metaplasia | |||
***Eosinophilic and ciliated cell changes | |||
**Simple hyperplasia with atypia | |||
**Complex hyperplasia with atypia | |||
***Increased gland-to-stroma ratio (≥3:1) | |||
***Gland complexity—caused by: | |||
****Branching | |||
****Outward budding | |||
****Internal papillary infoldings | |||
****Internal bridge | |||
**Hyperplasia without [[atypia]] | |||
**Atypical hyperplasia/endometrioid intraepithelial neoplasia | |||
===The Endometrial Intraepithelial Neoplasia (EIN) Classification=== | |||
Endometrial changes may be classified according to the International Endometrial Collaborative Group into two types:<ref name="pmid10684697">{{cite journal| author=Mutter GL| title=Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The Endometrial Collaborative Group. | journal=Gynecol Oncol | year= 2000 | volume= 76 | issue= 3 | pages= 287-90 | pmid=10684697 | doi=10.1006/gyno.1999.5580 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10684697 }} </ref><ref name="pmid15623473">{{cite journal| author=Baak JP, Mutter GL| title=EIN and WHO94. | journal=J Clin Pathol | year= 2005 | volume= 58 | issue= 1 | pages= 1-6 | pmid=15623473 | doi=10.1136/jcp.2004.021071 | pmc=PMC1770545 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15623473 }} </ref> | |||
* [[Benign]] hyperplasia (a hormone dependent diffuse lesion, which is polyclonal) | |||
** Benign endometrial hyperplasia is mostly observed with anovulation or after prolonged exposure to estrogen. | |||
** The morphology of endometrial hyperplasia varies from proliferative endometrium with a few cysts to heavier endometria with many dilated and contorted glands that are designated as "cystic glandular hyperplasia," "mild hyperplasia," or "simple hyperplasia." | |||
* Endometrial intraepithelial neoplasia | |||
** Endometrial precancers | |||
** Epithelial crowding depicts less stromal volume which is approximately half of total tissue volume in non secretory endometrium | |||
** Typically cells appear morphologically clonal and distinct from the surrounding endometrium. | |||
** With advanced stage, it may become a more diffuse lesion | |||
** In the beginning a localized clonal proliferation, which is [[monoclonal]] and [[neoplastic]] (EIN) | |||
* The D-score is an integral part of the EIN classification : | |||
** It is a measure of stromal volume as a proportion of total tissue volume (stroma + epithelium + gland lumen) | |||
* The D-score is assigned based on evaluation with computerized morphometry | |||
** Using this method, specimens are classified as: | |||
*** Benign (D >1) | |||
*** Indeterminate (0< D <1) | |||
*** EIN (D <0).<ref name="pmid11420465">{{cite journal |vauthors=Baak JP, Ørbo A, van Diest PJ, Jiwa M, de Bruin P, Broeckaert M, Snijders W, Boodt PJ, Fons G, Burger C, Verheijen RH, Houben PW, The HS, Kenemans P |title=Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias |journal=Am. J. Surg. Pathol. |volume=25 |issue=7 |pages=930–5 |date=July 2001 |pmid=11420465 |doi= |url=}}</ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Swathi Venkatesan, M.B.B.S.[2]
Overview
Endometrial hyperplasia is further classified based on histology into simple and complex types. Endometrial hyperplasia can also be classified based on the presence or absence of cellular atypia; hyperplasia with cellular atypia and hyperplasia without cellular atypia.
Classification
The World Health Organization (WHO) Classification System
The WHO Classification (1994)
- Endometrial hyperplasia may be classified based on glandular complexity and nuclear atypicality into the following types:[1][2][3]
Endometrial hyperplasia | |||||||||||||||||||||||||||||||||||||
Simple
| Complex | ||||||||||||||||||||||||||||||||||||
Simple hyperplasia with cellular atypia
| Simple hyperplasia without cellular atypia | Complex hyperplasia with cellular atypia
| Complex hyperplasia without cellular atypia
| ||||||||||||||||||||||||||||||||||
The New WHO Classification (2014)
- The updated WHO classification has been proposed to simplify clinical decision making, particularly when making treatment choices.[4]
- Simple hyperplasia without atypia
- Simple hyperplasia is characterized by:
- Complex hyperplasia without atypia
- Complex hyperplasia without atypia is defined as:
- Glands with abnormal, irregular architecture set in a background of scant intervening stroma
- Some stroma must be present,
- Basement membrane lining individual glands and a rim of intervening endometrial-type stroma between them. In addition to back-to-back and cribriform-like arrangements, other glandular architectural abnormalities warranting designation of complex hyperplasia include
- Outpouchings,
- Infoldings, and budding
- Squamous or morular metaplasia
- Eosinophilic and ciliated cell changes
- Simple hyperplasia with atypia
- Complex hyperplasia with atypia
- Increased gland-to-stroma ratio (≥3:1)
- Gland complexity—caused by:
- Branching
- Outward budding
- Internal papillary infoldings
- Internal bridge
- Hyperplasia without atypia
- Atypical hyperplasia/endometrioid intraepithelial neoplasia
The Endometrial Intraepithelial Neoplasia (EIN) Classification
Endometrial changes may be classified according to the International Endometrial Collaborative Group into two types:[5][6]
- Benign hyperplasia (a hormone dependent diffuse lesion, which is polyclonal)
- Benign endometrial hyperplasia is mostly observed with anovulation or after prolonged exposure to estrogen.
- The morphology of endometrial hyperplasia varies from proliferative endometrium with a few cysts to heavier endometria with many dilated and contorted glands that are designated as "cystic glandular hyperplasia," "mild hyperplasia," or "simple hyperplasia."
- Endometrial intraepithelial neoplasia
- Endometrial precancers
- Epithelial crowding depicts less stromal volume which is approximately half of total tissue volume in non secretory endometrium
- Typically cells appear morphologically clonal and distinct from the surrounding endometrium.
- With advanced stage, it may become a more diffuse lesion
- In the beginning a localized clonal proliferation, which is monoclonal and neoplastic (EIN)
- The D-score is an integral part of the EIN classification :
- It is a measure of stromal volume as a proportion of total tissue volume (stroma + epithelium + gland lumen)
- The D-score is assigned based on evaluation with computerized morphometry
- Using this method, specimens are classified as:
- Benign (D >1)
- Indeterminate (0< D <1)
- EIN (D <0).[7]
- Using this method, specimens are classified as:
References
- ↑ Scully RE. Histological typing of female genital tract tumours. Springer; 1994.
- ↑ Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 3, 2016.
- ↑ Jorizzo JR, Chen MY, Martin D, Dyer RB, Weber TM (2002). "Spectrum of endometrial hyperplasia and its mimics on saline hysterosonography". AJR Am J Roentgenol. 179 (2): 385–9. doi:10.2214/ajr.179.2.1790385. PMID 12130438.
- ↑ Emons G, Beckmann MW, Schmidt D, Mallmann P, Uterus commission of the Gynecological Oncology Working Group (AGO) (2015). "New WHO Classification of Endometrial Hyperplasias". Geburtshilfe Frauenheilkd. 75 (2): 135–136. doi:10.1055/s-0034-1396256. PMC 4361167. PMID 25797956.
- ↑ Mutter GL (2000). "Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The Endometrial Collaborative Group". Gynecol Oncol. 76 (3): 287–90. doi:10.1006/gyno.1999.5580. PMID 10684697.
- ↑ Baak JP, Mutter GL (2005). "EIN and WHO94". J Clin Pathol. 58 (1): 1–6. doi:10.1136/jcp.2004.021071. PMC 1770545. PMID 15623473.
- ↑ Baak JP, Ørbo A, van Diest PJ, Jiwa M, de Bruin P, Broeckaert M, Snijders W, Boodt PJ, Fons G, Burger C, Verheijen RH, Houben PW, The HS, Kenemans P (July 2001). "Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias". Am. J. Surg. Pathol. 25 (7): 930–5. PMID 11420465.