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Endometrial Hyperplasia 1

Endometrial hyperplasia


Vignette: A 26-year-old female comes to her gynecologist for a routine checkup. She mentions that she has been experiencing irregular menstrual cycles for the past six months. On examination, the doctor notes a slightly enlarged uterus. A biopsy of the endometrium is taken and sent for histological examination. The histological image shows an endometrium with increased glandular proliferation and a high gland-to-stroma ratio. The glands are tortuous and have a saw-toothed appearance. Which of the following is the best diagnosis?


A) Atrophic endometrium

B) Proliferative phase endometrium

C) Secretory phase endometrium

D) Endometrial hyperplasia

E) Endometrial carcinoma


D) Endometrial hyperplasia


Endometrial hyperplasia is a condition that occurs when the endometrium, the lining of the uterus, becomes too thick. It is not cancer, but in some cases, it can lead to cancer. It is most commonly caused by an excess of estrogen without progesterone. The histology of endometrial hyperplasia shows increased glandular proliferation with a high gland-to-stroma ratio. The glands often appear tortuous and have a saw-toothed appearance. These features distinguish it from normal proliferative or secretory phase endometrium. In contrast, endometrial carcinoma, which can arise from untreated endometrial hyperplasia, shows frankly malignant cells and usually involves invasion into the myometrium.


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