هیپرپلازی اندومتر و اصطلاحات گیج کننده!
هیپرپلازی آندومتر تا قبل از سال 2014 بر اساس شکل غدد به دو دسته simple و complex و بر اساس ظاهر سلولها از نظر تغییرات شبه بدخیمی به دو دسته atypical و non-atypical تقسیم میشدند و در نهایت ما چهار نوع هیپرپلازی داشتیم:
simple nonatypical
simple atypical
complex nonatypical
complex atypical
بعدا مشاهده شد که شکل غدد در پروگنوز و درمان تاثیر آنچنان زیادی ندارد و توافق بین پاتولوژیستها برای تعیین حد مشخص بین simple / complex وجود نداشت لذا از سال 2014 WHO اصطلاحات فوق را حذف و هیپرپلازی آندومتر را صرفا بر اساس ظاهر سلولها به دو دسته زیر تقسیم نمود:
- benign (nonatypical) hyperplasia
- atypical hyperplasia (equivalent to endometrial intraepithelial neoplasia / EIN)
- Prior to 2014, the World Health Organization classified endometrial hyperplasia as simple versus complex, and nonatypical versus atypical
- This system suffered from significant interobserver variation (Am J Surg Pathol 2008;32:691)
- Reproducibility improved with a two tier classification (Histopathology 2014;64:284, Int J Gynecol Pathol 2008;27:318)
- Accordingly, the classification system was simplified in 2014, and now divides hyperplasia into two categories, benign (nonatypical) hyperplasia and atypical hyperplasia (equivalent to endometrial intraepithelial neoplasia / EIN)
- The terms “simple” and “complex” have been removed from the classification; they, however, remain in parts of the following text when citing data prior to the 2014 WHO classification
- Non atypical hyperplasia is part of the spectrum of endometrial changes due to unopposed estrogen stimulation
- Incidence: 142 per 100,000 woman-years, peaks in early 50s (Am J Obstet Gynecol 2009;200:678)
- 2 – 4x risk of progression to endometrial carcinoma compared to general population (compared to 45x for atypical hyperplasia / EIN) (Cancer 2005;103:2304)
- < 1% prevalence of carcinoma diagnosis beyond 1 year after diagnosis of benign endometrial hyperplasia (Mod Pathol 2005;18:324, Hum Pathol 2008;39:866)
