Endometrial hyperplasia vs Endometrial carcinoma
How to tell Endometrial hyperplasia and Endometrial carcinoma apart when a board question makes them look alike.
Hyperplasia is proliferative precursor from unopposed estrogen; carcinoma is invasive malignancy causing abnormal or postmenopausal bleeding.
Side by side
Endometrial hyperplasia causes abnormal uterine bleeding from unopposed estrogen stimulation and may show gland crowding with or without atypia.
Endometrial carcinoma causes postmenopausal or abnormal uterine bleeding, often endometrioid type linked to estrogen exposure or serous type linked to p53 mutations.
Chronic estrogen without progesterone drives proliferation of endometrial glands and increases malignancy risk when atypia is present.
Endometrial carcinoma develops from precursor hyperplasia in type I disease or from atrophic endometrium with p53 alterations in type II disease.
Biopsy showing proliferative gland crowding, atypical hyperplasia, obesity, anovulation, PCOS, or estrogen therapy support hyperplasia.
Biopsy showing invasive malignant glands, postmenopausal bleeding, endometrial thickening, or serous papillary histology supports carcinoma.
The trap
Both can bleed and share estrogen risk factors, so biopsy evidence of invasion and atypia severity matter.
The repair move
For endometrial bleeding, use age, estrogen risk, and biopsy architecture to separate precursor from cancer.
Try a free question
CoreA 47-year-old G0 with PCOS and BMI 38 kg/m^2 has 6 months of irregular heavy menses. Endometrial biopsy shows complex glandular crowding without cytologic atypia. Endometrial thickness on ultrasound is 14 mm. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Endometrial hyperplasia without atypia. Unopposed estrogen exposure (PCOS, obesity, anovulation) drives endometrial gland proliferation; hyperplasia without atypia is the precursor lesion with low cancer progression risk and is treated with progestin therapy.
Why the other choices are tempting
- B. Hyperplasia with atypia (endometrial intraepithelial neoplasia) shows cytologic atypia and has much higher progression risk to cancer.
- C. Endometrial adenocarcinoma shows invasive malignant glands beyond the basement membrane.
- D. Normal proliferative endometrium has organized glands without crowding.
- E. Endometrial polyp is a focal stromal-glandular outgrowth, not diffuse gland crowding.
Flashcards
Tap a card to flip it.
What hormonal state drives endometrial hyperplasia?
Unopposed estrogen drives endometrial hyperplasia.
What symptom is classic for endometrial carcinoma?
Postmenopausal bleeding is classic for endometrial carcinoma.
Quick answers
What is the fastest way to tell Endometrial hyperplasia from Endometrial carcinoma?
Hyperplasia is proliferative precursor from unopposed estrogen; carcinoma is invasive malignancy causing abnormal or postmenopausal bleeding.
What is the key clue for Endometrial hyperplasia?
Endometrial hyperplasia causes abnormal uterine bleeding from unopposed estrogen stimulation and may show gland crowding with or without atypia.
What is the key clue for Endometrial carcinoma?
Endometrial carcinoma causes postmenopausal or abnormal uterine bleeding, often endometrioid type linked to estrogen exposure or serous type linked to p53 mutations.
What is the common trap with Endometrial hyperplasia vs Endometrial carcinoma?
Both can bleed and share estrogen risk factors, so biopsy evidence of invasion and atypia severity matter.