The significance of secretory features and coincident hyperplastic changes in endometrial biopsy specimens

The clinical and pathological characteristics of endometrial hyperplasia simulating or coexisting with secretory endometrium were studied in 35 cases of women with at least one biopsy diagnosed as secretory endometrium and another biopsy diagnosed as endometrial hyperplasia or neoplasia. The biopsy samples were examined histologically by semiquantitative methods to detect features that could aid in distinguishing secretory endometrium from hyperplastic endometrium existing focally in secretory endometrium or simulating secretory endometrium. Important histologic features were focal architectural abnormalities, epithelial pseudopalisading, a vesicular nuclear appearance, nuclear atypia, mitoses, the presence of metaplastic ciliated and "clear" cells, and a sharp luminal margin indicating absence of cytoplasmic secretion. The distribution of patients' ages fell between that of perimenopausal women with only secretory features on biopsy (curettage) and that of women with hyperplastic endometrium on biopsy. Twenty-nine per cent of the women in the study group had diabetes or hypertension, and 29 per cent had leiomyomata or adenomyosis at eventual hysterectomy. Patients followed up showed persistence of hyperplasia and progression to a more severe degree of cytologic atypia on later biopsy samples. Recommendations are made for improved detection of these hyperplastic changes and for careful follow-up of patients.