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Related Concept Videos

Cellular Adaptation IV: Dysplasia and Metaplasia01:24

Cellular Adaptation IV: Dysplasia and Metaplasia

DysplasiaDysplasia refers to abnormal changes in the size, shape, and organization of mature cells, characterized by pleomorphism, nuclear abnormalities, and increased mitotic activity. It commonly affects epithelial tissues, including the cervix, gastrointestinal tract, respiratory mucosa, and endometrium. Although it may occur alongside hyperplasia, dysplasia is not a true adaptive response but a preneoplastic change with potential to progress to cancer.When confined above the basement...
Cellular Adaptation III: Hyperplasia01:26

Cellular Adaptation III: Hyperplasia

Hyperplasia is an increase in the number of cells in a tissue or organ due to enhanced cell division. It is an adaptive, controlled response to stimuli such as injury, hormones, or stress, involving mitosis to produce genetically identical cells and support tissue repair and regeneration.Tissue CapacityCertain tissues, including the epidermis, intestinal epithelium, bone marrow, and fibroblasts, have a high potential for hyperplasia. Others, such as bone, cartilage, and smooth muscle, show...
Proliferative Phase01:20

Proliferative Phase

The proliferative phase typically occurs after menstruation and lasts between 6 to 13 days in a standard 28-day cycle. This phase involves the reconstruction of the endometrium, guided by estrogen produced by the developing ovarian follicle.
Notably, the stratum basale, the basal layer of the endometrium, including the basal parts of the uterine glands, remains unaffected by menstruation. Stem cells in this layer undergo mitosis, regenerating the stratum functionalis and thickening the...
Histology of the Uterus01:19

Histology of the Uterus

The uterine wall consists of three histological layers: the perimetrium, myometrium, and endometrium. The outermost perimetrium is a thin, serous membrane connected with the broad ligament on the sides, which helps anchor the uterus in the pelvic cavity. The thickest layer, myometrium, is mainly made up of smooth muscle tissue bundles. Its contractions are vital in facilitating the expulsion of the uterine lining, fetus, and placenta during menstruation and childbirth.
The endometrium is the...

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The endometrial hyperplasias revisited.

Efthimios Sivridis1, Alexandra Giatromanolaki

  • 1Department of Pathology, Democritus University of Thrace, Alexandroupolis 68100, Greece. esivrid@med.duth.gr

Virchows Archiv : an International Journal of Pathology
|August 30, 2008
PubMed
Summary

Classifications of endometrial hyperplasia have evolved, with the WHO 1994 system distinguishing precancerous lesions by cytological atypia. A newer endometrial intraepithelial neoplasia (EIN) concept aims for better reproducibility in identifying these pre-cancerous endometrial changes.

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Area of Science:

  • Gynecologic Pathology
  • Oncology
  • Cellular Biology

Background:

  • Endometrial lesions present a spectrum from benign to malignant, including pre-invasive stages.
  • Previous classifications of endometrial hyperplasia, like the WHO 1994 system, distinguished precancerous lesions (atypical hyperplasia) but faced challenges with reproducibility.
  • Inconsistencies in terminology and definitions have historically complicated the accurate identification of precancerous endometrial changes.

Purpose of the Study:

  • To review the evolution of endometrial hyperplasia classifications.
  • To introduce and discuss the novel endometrial intraepithelial neoplasia (EIN) classification system.
  • To highlight the criteria and potential impact of the EIN concept on diagnosing pre-malignant endometrial lesions.

Main Methods:

  • Review of existing literature on endometrial hyperplasia classification systems.
  • Analysis of the diagnostic criteria proposed for the endometrial intraepithelial neoplasia (EIN) classification.
  • Discussion of the strengths and weaknesses of the revised WHO 1994 classification and the proposed EIN criteria.

Main Results:

  • The WHO 1994 classification introduced cytological atypia to differentiate benign from precancerous endometrial hyperplasia but was criticized for complexity and reproducibility.
  • A new classification proposes endometrial intraepithelial neoplasia (EIN) as a precancerous lesion, defined by monoclonal growth, crowded glands (>1mm), and altered epithelium.
  • The EIN concept aims to improve diagnostic reproducibility for pre-invasive endometrial lesions, though it has faced scrutiny regarding independent validation.

Conclusions:

  • The classification of endometrial hyperplasia has evolved to better identify pre-cancerous lesions.
  • The endometrial intraepithelial neoplasia (EIN) concept offers a new framework for diagnosing precancerous endometrial changes with potentially improved reproducibility.
  • Further validation and acceptance of the EIN classification are necessary to standardize the diagnosis of endometrial intraepithelial neoplasia.