Endometrial polyp,

hyperplasia, carcinoma
Dr: Salah Ahmed
 Endometrial polyps

- are focal benign overgrowth of endometrium

- most common located on the fundus
- may protrude into vagina and may cause bleeding
Endometrial polyp ( fibrous stroma harboring dilated
glands lined by columnar epithelium
 Endometrial hyperplasia

- exaggerated endometrial proliferation due to excess of estrogen

- can be preneoplastic
- hyperplasia is classified based on crowding of glands and presence of atypia
into:
1- simple hyperplasia
2- complex hyperplasia
3- atypical hyperplasia
- these changes depend on the level and duration of the estrogen excess
- risk factors: (estrogen excess)
1- failure of ovulation (e.g around the menopause)
2- prolonged administration of estrogen
3- estrogen-producing ovarian lesions (polycystic ovaries)
4- cortical stromal hyperplasia
5- granulosa-theca cell tumors of the ovary
6- obesity ( because adipose tissue processes steroid precursors into
estrogens)
A) Simple hyperplasia
- crowding of glands without atypia some of them are dilated (cystic
hyperplasia) :Swiss cheese
- only 1% of cases progress to adenocarcinoma
B) Complex hyperplasia
- crowding and branching of glands without cellular atypia
- 3% of cases progress to adenocarcinoma
C) Atypical hyperplasia
- complex hyperplasia with atypia ( hyperchromatic nuclei, mitotic
figures )
- commonly progresses to adenocarcinoma
- treated may be with Tamoxifen (antiestrogen) or hysterectomy
 Endometrial carcinoma

- endometrial carcinoma is the most frequent cancer of the female

genital tract
Epidemiology and Pathogenesis:
- common between the ages of 55 and 65 years
- arises in two clinical settings:
1- in perimenopausal women with estrogen excess (endometrioid
carcinoma)
2- in older women with endometrial atrophy (serous carcinoma)
- Pathogenesis: 1) Endometrioid type:
- related to excess of estrogen
- the risk factors:
1- nulliparity
2- early menarche or late menopause
3- obesity (increased synthesis of estrogens )
 4- Diabetes Hypertension Infertility: women tend to be
nulliparous, often with anovulatory cycles.
5- prolonged estrogen replacement therapy
6- estrogen-secreting ovarian lesions
7- endometrial hyperplasia
- genetic abnormality: 1- mutations in DNA mismatch repair gene
2- mutations in PTEN, a tumor suppressor
gene
2) Serous type:
- is a distinct type
- It typically arises in a background of atrophy
- sometimes arises in endometrial polyp
- nearly all cases have mutations in the p53 tumor
suppressor gene
Morphology:
- Endometrioid carcinomas: - closely resemble normal endometrium
- may be exophytic or infiltrative
- may infiltrate the myometrium and enter
vascular spaces, with metastases to regional lymph nodes
- four stages: stage I: confined to the corpus
stage II: involvement of the
cervix
stage III: beyond the uterus
but within the true pelvis
stage IV: distant metastases
or involvement of other viscera
- Serous carcinoma: - forms small tufts and papillae rather than the glands
- has much greater cytologic atypia
- They behave as poorly differentiated cancers and
are aggressive
Endometrioid carcinoma )C ( Serous carcinoma of the endometrium displaying (A, B)
formation of papillae and marked cytologic atypia )D (Immunohistochemical stain for
.p53 reveals accumulation of mutant p53 in serous carcinoma
Clinical course:- first clinical indication is marked leukorrhea and
irregular bleeding
- With progression, the uterus becomes enlarged
and fixed
- metastases to cervix, tubes, ovaries, vagina, broad
ligament, regional LN, lungs, liver
Thank you