Endometrial hyperplasia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2] , Soujanya Thummathati, MBBS [3]

Overview

Endometrial hyperplasia must be differentiated from conditions that have a similar ultrasound findings such as normal thickening during the secretory phase, sessile endometrial polyp, submucosal uterine fibroids, endometrial cancer, an adherent intrauterine blood clot, and pregnancy.

Differential Diagnosis

• Endometrial hyperplasia must be differentiated from the following conditions that have abnormal thickening of the uterus:

Pregnancy related

• Early pregnancy prior to sac being visualized (<5 weeks of gestation)
• Ectopic pregnancy (thickened endometrium and sometimes fluid collection or pseudogestational sac can be associated)
• Retained products of conception (heterogeneously thickened endometrium with increased vascularity)
• Adherent intra-uterine blood clot (heterogeneous endometrium with no vascularity)
• Molar pregnancy thickened with multiple small cystic spaces
• Endometritis (prominent hyperechoic endometrium with of without fluid and debris)

Non-pregnancy related

• Endometrial carcinoma (variable appearance)
• Endometrial polyp or polyps (usually hyperechoic, often focal, look for vascular stalk)
• Submucosal uterine fibroids
• Intrauterine adhesions (irregular echogenic areas with focal thickening)

Potential biomarkers

• The absence of PAX2 expression on immunohistochemistry is helpful in delineating EIN
• MMP-9
• BCL-2 overexpression