Endometrial Hyperplasia

Endometrial Hyperplasia:

Excessive proliferation of endometrial glands and to less extent endometrial stroma.
Due to excessive oestrogen stimulation.

Its significance progression to carcinoma.
25% of endometrial cancer, had a history of hyperplasia.

Classification of endometrial hyperplasia:
1- Simple H. Without atypia:
Increased no. Of glands & normal architecture.
90% regress , 1% progress to CA.
2 - Complex H. Without atypia:
Crowded irregular glands.
80% regress ,3% progress to CA.
3 - Simple H. With Atypia:
With cytological atypia (nuclei more prominent & nuclear pleomorphism.
4 - Complex H. With atypia.

Patho-physiology:
Endogenous oestrogen unapposed by progesterone
PCOD.
Obesity.
Tumours (granulosa cell tumour).
Medications: Tamoxifen.
Late menapause.
Presentation:
Post menapausal bleeding.
Heavy menstrual bleeding.
Diagnosis:
History & Physical exam.
Investigations: TVUS: endometrial thickness.
Endometrial biopsy:
- Outpatient biopsy (pipelle biopsy)
- D&C.
- Hysteroscopy.
MRI scan if TVUS not possible.