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Extra info for Advances in Surgical Pathology: Endometrial Carcinoma
FIGURE 3-4: Simple hyperplasia. Note the proliferation of dilated endometrial glands with no or slight outpouchings. Chapter 3 • Endometrial Hyperplasia 21 FIGURE 3-5: Complex hyperplasia. Note the proliferation of endometrial glands of variable size and shape with outpouchings. A FIGURE 3-6: Simple hyperplasia with atypia (A). Note the nuclear enlargement, round nuclei, irregular distribution of the chromatin, and variable presence of nucleoli (B and C). (continued) 22 Section II • Histopathology B C FIGURE 3-6: (continued) Chapter 3 • Endometrial Hyperplasia 23 A B FIGURE 3-7: Complex hyperplasia with atypia (A).
Continued) 22 Section II • Histopathology B C FIGURE 3-6: (continued) Chapter 3 • Endometrial Hyperplasia 23 A B FIGURE 3-7: Complex hyperplasia with atypia (A). Note the nuclear enlargement, round nuclei, irregular distribution of the chromatin, and variable presence of nucleoli (B). 24 Section II • Histopathology Metaplastic Changes Nuclear changes typically seen in the endometrial glands undergoing metaplastic changes can be misinterpreted as atypia. For example, in ciliated or eosinophilic cell metaplasia, the nuclei can be enlarged and rounded; however, the chromatin distribution is uniform, and the nuclear contour is regular.
14 Patients with complex endometrial hyperplasia with atypia who are postmenopausal or premenopausal and do not wish to preserve their fertility are treated surgically. 15 PROBLEMS WITH THE WHO CLASSIFICATION OF ENDOMETRIAL HYPERPLASIA Despite the clinical relevance of the WHO classification for endometrial hyperplasia, this classification has had problems with its reproducibility. 65. , lack of strict definitions to determine what constitutes a “shift in the gland-to-stroma ratio in favor of the glands,” “architectural changes,” and “cytologic atypia”).