Problems in the differential diagnosis of endometrial hyperplasia and carcinoma

Mod Pathol. 2000 Mar;13(3):309-27. doi: 10.1038/modpathol.3880053.


The differential diagnosis of endometrial hyperplasia and well-differentiated endometrioid adenocarcinoma is complicated not only by the resemblance of these lesions to each other, but also by their tendency to be overdiagnosed (particularly hyperplasia) on the background of polyps, endometritis, artifacts, and even normally cycling endometrium. Atypical hyperplasia may also be overdiagnosed when epithelial metaplastic changes occur in simple or complex hyperplasia without atypia. Low-grade adenocarcinomas are best recognized by architectural evidence of stromal invasion, usually in the form of stromal disappearance, desmoplasia, necrosis, or combinations of these findings between adjacent glands. Endometrioid adenocarcinomas are usually Type 1 cancers associated with manifestations of endogenous or exogenous hyperestrogenic stimulation and a favorable prognosis. Subtypes include adenocarcinomas with squamous differentiation and secretory, ciliated cell and villoglandular variants. Rules and pitfalls in the grading of endometrioid adenocarcinomas and the estimation and reporting of myometrial invasion are presented.

Publication types

  • Review

MeSH terms

  • Carcinoma, Endometrioid / classification
  • Carcinoma, Endometrioid / diagnosis*
  • Diagnosis, Differential
  • Disease Progression
  • Endometrial Hyperplasia / classification
  • Endometrial Hyperplasia / diagnosis*
  • Endometrial Neoplasms / classification
  • Endometrial Neoplasms / diagnosis*
  • Female
  • Humans
  • Myometrium / pathology
  • Neoplasm Invasiveness
  • Neoplasm Staging