Endometrial hyperplasia: recent updates and clinicopathological correlation

Endometrial carcinoma is one of the most common carcinomas affecting women worldwide, and detecting them at the level of precursor lesions can reduce the morbidity and mortality. The aim of this study is to perform a comparative analysis of the two- and four-tier systems on the basis of clinical features and establishe a clinico-pathological correlation. A 5-year study was conducted on histopathologically diagnosed cases of endometrial hyperplasia from the gynecological specimens received in the department of Pathology. The study included 34 cases of endometrial hyperplasia. Hyperplasia without atypia (91.2%) and simple hyperplasia without atypia (82.35%) was the most common type as per the two- and four-tier system, respectively. Hyperplasia without atypia was most common in the fourth to fifth decade of life (54.84%), atypical hyperplasia in the third to fifth decade of life (66.66%), and EIN presented after the sixth decade of life. Hyperplasia without atypia presented most commonly with menorrhagia (64.52%) and atypical hyperplasia/EIN with post-menopausal bleeding (66.66%). Both were more common in multiparous women (87.10 and 66.66%, respectively). Morphologically, variable-sized glands with cystic dilatation (70.6%) and the absence of atypia (91%) was most common. The case of EIN was associated with endometrioid adenocarcinoma. Leiomyoma (3 cases), adenomyosis (2 cases), and endometritis (1 case) were the associated lesions. Abnormal uterine bleeding should raise a suspicion of endometrial hyperplasia, and every specimen received should be examined thoroughly, because histopathological examination is essential to give the diagnosis. Endometrial hyperplasia without atypia was the commonest type diagnosed.