Endometrial hyperplasia classification
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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 may be broadly classified based on histology into simple and complex types. Endometrial hyperplasia may also be classified based on the presence or absence of cellular atypia (hyperplasia with cellular atypia and hyperplasia without cellular atypia).[1][2][3]
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
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The New WHO Classification (2014)
- The new WHO classification has been proposed to simplify clinical decision making, particularly when making treatment choices.[4]
- Endometrial hyperplasia may be classified according to new WHO classification (1994) into:
- 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)
- Endometrial intraepithelial neoplasia
- In the beginning a localized clonal proliferation, which is monoclonal and neoplastic (EIN)
Benign endometrial hyperplasia (EH, non-neoplastic) – Changes typically observed with anovulation or other etiology of prolonged exposure to estrogen. The morphology of EH varies from proliferative endometrium with a few cysts (persistent proliferative endometrium) to bulkier endometria with many dilated and contorted glands that in other systems have been designated as "cystic glandular hyperplasia," "mild hyperplasia," or "simple hyperplasia."
●Endometrial intraepithelial neoplasia (EIN) – Endometrial precancers. Epithelial crowding in EIN displaces stroma to a point at which stromal volume is less than approximately half of total tissue volume in nonsecretory endometrium, and typically cells appear morphologically clonal and distinct from the surrounding endometrium.
- With advanced stage, it may become a more diffuse lesion
- Cancer
The D-score is an integral part of the EIN classification [13,14]. It is a measure of stromal volume as a proportion of total tissue volume (stroma + epithelium + gland lumen). Using this method, specimens are classified as benign (D >1), indeterminate (0< D <1), or EIN (D <0). The D-score is assigned based on evaluation with computerized morphometry.[7]
References
- ↑ 1.0 1.1 Scully RE. Histological typing of female genital tract tumours. Springer; 1994.
- ↑ 2.0 2.1 Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 3, 2016.
- ↑ 3.0 3.1 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.