Lax S F
Institut für Klinische Pathologie und Molekularpathologie, LKH Graz II, Standort West, Akademisches Lehrkrankenhaus der Medizinischen Universität Graz, Göstinger Straße 22, 8020, Graz, Österreich.
Pathologe. 2019 Feb;40(1):13-20. doi: 10.1007/s00292-019-0568-5.
The 2014 WHO classification distinguishes between endometrial hyperplasia without atypia (EH) and atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (AEH/EIN). AEH/EIN is characterized by crowded glands with cytologically atypical epithelium separated by little intervening stroma. Cellular atypia is characterized by nuclear enlargement and rounding, pleomorphism, loss of polarity, and presence of nucleoli. The diagnosis of atypia is facilitated by comparison with areas of adjacent normal and non-atypical glands, respectively. AEH/EIN is often associated with squamous but also secretory and mucinous metaplasia. Loss of PTEN and/or PAX2 immunoreactivity occurs in up to two thirds of AEH/EIN. In contrast, invasive low-grade endometrioid carcinoma shows confluent growth with loss of stroma and formation of labyrinth-like or cribriform structures. Differential diagnosis includes different forms of metaplasias, papillary proliferations, and hyperplastic polyps. Epithelial metaplasia may be present in various benign endometrial lesions as well as in endometrioid adenocarcinoma. AEH/EIN may also occur in endometrial polyps. Progestin therapy of AEH/EIN has low level of evidence but frequently leads to complete regression. Serous intraepithelial carcinoma (SEIC) is characterized by high-grade cellular atypia and polymorphism, detachment of cells, a mutant immunoreactive pattern for the P53 and an increased Ki67 labeling index. Although designated as precursor of serous carcinoma of the endometrium, biologically it is considered a non-invasive serous carcinoma since it may already be associated with massive extrauterine spread.
2014年世界卫生组织（WHO）分类将无异型性的子宫内膜增生（EH）与非典型子宫内膜增生/子宫内膜样上皮内瘤变（AEH/EIN）区分开来。AEH/EIN的特征是腺体密集，上皮细胞具有细胞学上的异型性，其间质分隔很少。细胞异型性的特征是细胞核增大、变圆、多形性、极性丧失以及核仁的存在。通过分别与相邻正常和无异型性腺体区域进行比较，有助于异型性的诊断。AEH/EIN常伴有鳞状化生，也可伴有分泌性和黏液性化生。高达三分之二的AEH/EIN存在PTEN和/或PAX2免疫反应性缺失。相比之下，浸润性低级别子宫内膜样癌表现为融合性生长，间质消失，形成迷宫样或筛状结构。鉴别诊断包括不同形式的化生、乳头状增生和增生性息肉。上皮化生可存在于各种良性子宫内膜病变以及子宫内膜样腺癌中。AEH/EIN也可发生于子宫内膜息肉。AEH/EIN的孕激素治疗证据水平较低，但常导致完全消退。浆液性上皮内癌（SEIC）的特征是细胞高级别异型性和多形性、细胞脱落、P53突变免疫反应模式以及Ki67标记指数增加。尽管被指定为子宫内膜浆液性癌的前驱病变，但从生物学角度来看，它被认为是一种非浸润性浆液性癌，因为它可能已经伴有广泛的子宫外扩散。
