Anatomy of endometriosis and metabolic disease

2021-05-13 11:48 AM

Buehl and Vellios use this term to refer to hyperplastic glands, hyperplastic chromatin, the resulting chromatin, irregular nuclear membrane.

Some old nomenclatures

Cystic hyperplasia: This is the most common form. Enlarged glands, variable in size, are lined by a high, scattered layer of stromal epithelium with a mitotic pattern. The epithelium can be arranged in many layers.

Adenocarcinoma: Adenocarcinoma has many different meanings depending on the author.

According to Gusberg, glandular hyperplasia includes all forms of hyperplasia except cystic hyperplasia and has 3 levels: mild, moderate and severe. Severe hyperplasia is equivalent to atypical hyperplasia.

Hertig and Sommers used the term glandular hyperplasia to refer to images of papillary glands and shoots.

Vellios and Buehl use this term to refer to the endometrium that does not have cell malformation.

Atypical Hyperplasia: Novak and Rutledge use this term to describe the endometrium hyperplasia with an increase in the number of glands, less inter-glandular stroma. Glands have a large, regular nucleus, without nuclear malformation.

Campbell and Barter rely on a complex structural image of the route to classify atypical hyperplasia. Vellios, on the other hand, classified in this group all glands with nuclear malformations, cellular malformations, regardless of whether the endothelial glands are interlocked or disjointed.

Carcinoma in situ: Hertig uses this term to refer to local hyperplasia of the endothelium with large glandular cells, loss of polarity, eosinophils or alkalosis. The glands are large and small unevenly, sometimes there are papillae in the lumen of the glands, but the nucleus is pale, the nuclear membrane is not uniform, the chromatin is smooth.

Buehl and Vellios use this term to refer to hyperplastic glands, dark nuclear chromatin, the resulting chromatin, irregular nuclear membrane, large nucleus, and eosinophilic cytoplasm. The routes do not crowd each other, some places have the shape of a screen.

Welch and Scully use this word to refer to a pathological picture of adenocarcinoma, but not more than 5 or 6 glands.


According to the classification of the World Association of Gynaecological Pathologists, endometrial hyperplasia is divided into:

Endometrial hyperplasia, not invasive.

Pure hyperplasia (no cell malformations).

Complex hyperplasia (glandular hyperplasia, no cell malformations).

Atypical hyperplasia (glandular hyperplasia, with cellular malformations).

Endometrial hyperplasia, infiltration (malignant).


Endometrial hyperplasia can thicken the endothelium but hyperplasia can also be localized, in the form of endothelial polyps. Therefore, diagnosis of hyperplasia is based on microscopic imaging rather than on the amount of endothelium biopsied.


Including the following forms:

Hyperplasia, no cell malformations: Endothelial glands increase in number compared to the stroma, glandular cells with an oval nucleus, all at the base of cells like normal endothelial glands at the stage of development. The glands are slightly dilated, the surrounding stroma is abundant in pure endothelial hyperplasia.

In complex endothelial hyperplasia, the glandular ducts zigzag, jostle each other, with little stroma around the gland. The adrenal gland can be cascaded to 2 or 4 rows and can have many mitotic images. The glandular cells are not deformed.

Hyperplasia, with cellular malformations (atypical endometrial hyperplasia): Atypical hyperplasia of the endometrium includes an increase in the number of endometrial glands and is accompanied by a cellular malformation.

Cell enlargement, loss of polarity and the rate of the nucleus to cytoplasm increases. The nucleus is large, unevenly small, the chromosome ends up, has a large nucleus and an irregular nuclear membrane, and is usually round instead of oval. The surrounding stroma of the gland can be more or less, tubular glands or complex. The adenocarcinoma can be layered and has many divisions.

Infertility: common in endometrial hyperplasia, which is the replacement of the endometrium with a tissue that is not normally present in the uterus, which can be seen in many conditions such as polyps, endometritis. uterus, trauma, vitamin A deficiency, endometrial hyperplasia and endometrial cancer.

Prickly metaplasia: Rare in normal endothelium, seen in 5% of endothelial hyperplasia without cell malformations and in 25% of atypical endothelial hyperplasia (with cellular malformation). The metamorphic dendritic cells are often evenly equal, forming localized dendritic nests in the lumen.

Hirsutism (oviductal): common in mild forms of endothelial hyperplasia, with hair cells transforming similar to that of the ovarian epithelium, interspersed with hairless cells. moved on. This form is also found in the endometrium in the elderly and in endometriosis.

Mucous metaplasia: cells that resemble cervical cells in the uterus, most rarely. Mucous cells are usually localized, with a high cylindrical shape, a bright cytoplasm, and a nucleus located at the base of the cell.

Other forms: Eosinophilia, bright cell metabolic, papilloma, etc.

Endometrial hyperplasia and endometrial carcinoma

2% of endothelial hyperplasia without cell malformation progressed to carcinoma, while 23% of atypical hyperplasia (with cell malformations) progressed to carcinoma.

In women under 40 years of age, with simple or complex endometrial hyperplasia, treatment requiring only follow-up and periodic endothelial biopsy are sufficient. If there is atypical endometrial hyperplasia, a partial endothelial biopsy (cervix and endothelium) should be performed in the operating room, to ensure complete biopsy. If the patient still wants to continue giving birth, hormonal treatment, close monitoring and periodic endothelial biopsy.

In women over 40 years of age with simple or complicated endometrial hyperplasia due to not ovulation, medroxyprogesterone can be monitored or treated. 80% of endothelial hyperplasia has no spontaneous cell malformation.

If the patient has atypical hyperplasia and is over 50 years old, the uterus should be removed. If the patient is 40-50 years old, progestin can be treated and periodically monitored with endothelial biopsy every 3 months. If hyperplasia persists, the uterus should be removed. 60% of atypical endometrial hyperplasia go away on its own.