Mazur Michael T
Department of Pathology, State University of New York, Upstate Medical University, Syracuse, New York, 13210 USA.
Ann Diagn Pathol. 2005 Jun;9(3):174-81. doi: 10.1016/j.anndiagpath.2005.03.001.
Hyperplasia of the endometrium is a process characterized by an irregular, noninvasive proliferation of glands with a variable amount of stroma. Precise classification of endometrial hyperplasia in biopsy material is important in order to identify those hyperplasias that are likely to be precursors of endometrial adenocarcinoma. The current World Health Organization (WHO) classification provides a scheme that has become widely accepted, primarily dividing hyperplasias in to those with and those without cytologic atypia while the degree of glandular crowding (simple vs. complex) has secondary importance. A wide variety of other endometrial changes, ranging from artifacts, metaplasias and polyps to well-differentiated adenocarcinoma must be considered in the differential diagnosis. Well-differentiated adenocarcinoma is diagnosed when one of 3 essential criteria is found in biopsy specimens: (1) a confluent gland pattern; (2) an extensive papillary pattern; or (3) a desmoplastic stromal response. Using the WHO classification allows segregation of endometrial hyperplasia into clinically meaningful categories. Strict morphologic criteria also enable separation of hyperplasia from well-differentiated adenocarcinoma.
子宫内膜增生是一个以腺体不规则、非侵袭性增殖并伴有不同数量间质为特征的过程。对活检材料中的子宫内膜增生进行精确分类，对于识别那些可能是子宫内膜腺癌前驱病变的增生情况很重要。世界卫生组织（WHO）目前的分类提供了一个已被广泛接受的方案，主要将增生分为有细胞学异型性和无细胞学异型性两类，而腺体拥挤程度（单纯性与复杂性）则为次要因素。在鉴别诊断中必须考虑各种各样的其他子宫内膜变化，从人为假象、化生、息肉到高分化腺癌。当在活检标本中发现以下3个基本标准之一时，即可诊断为高分化腺癌：（1）融合性腺体模式；（2）广泛的乳头状模式；或（3）促纤维增生性间质反应。采用WHO分类可将子宫内膜增生分为具有临床意义的类别。严格的形态学标准也能将增生与高分化腺癌区分开来。
