Endometrial hyperplasia differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Endometrial hyperplasia must be differentiated from conditions that have a similar [[ultrasound]] findings such as normal thickening during the secretory phase, [[sessile]] [[endometrial polyp]], submucosal uterine [[fibroid]]s, [[endometrial cancer]], an adherent intrauterine blood clot, and [[pregnancy]]. | [[Endometrial]] [[hyperplasia]] must be [[Differentiate|differentiated]] from [[Condition|conditions]] that have a similar [[ultrasound]] findings such as [[normal]] thickening during the [[Secretory phase|secretory]] [[Secretory phase|phase]], [[sessile]] [[endometrial polyp]], [[submucosal]] [[uterine]] [[fibroid]]s, [[endometrial cancer]], an adherent intrauterine [[blood]] [[clot]], and [[pregnancy]]. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Endometrial hyperplasia must be differentiated from the following conditions that have abnormal thickening of the [[uterus]]:<ref name="pmid8184058">{{cite journal| author=Hulka CA, Hall DA, McCarthy K, Simeone JF| title=Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography. | journal=Radiology | year= 1994 | volume= 191 | issue= 3 | pages= 755-8 | pmid=8184058 | doi=10.1148/radiology.191.3.8184058 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8184058 }} </ref><ref name="wp">Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 3, 2016.</ref><ref name="ol">Abnormally thickened endometrium: differential diagnosis. Radiopedia. http://radiopaedia.org/articles/abnormally-thickened-endometrium-differential-diagnosis Accessed on March 3, 2016.</ref> | *[[Endometrial]] [[hyperplasia]] must be [[Differentiate|differentiated]] from the following [[conditions]] that have [[abnormal]] thickening of the [[uterus]]:<ref name="pmid8184058">{{cite journal| author=Hulka CA, Hall DA, McCarthy K, Simeone JF| title=Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography. | journal=Radiology | year= 1994 | volume= 191 | issue= 3 | pages= 755-8 | pmid=8184058 | doi=10.1148/radiology.191.3.8184058 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8184058 }} </ref><ref name="wp">Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 3, 2016.</ref><ref name="ol">Abnormally thickened endometrium: differential diagnosis. Radiopedia. http://radiopaedia.org/articles/abnormally-thickened-endometrium-differential-diagnosis Accessed on March 3, 2016.</ref> | ||
===Pregnancy related=== | ===Pregnancy related=== | ||
*Early [[pregnancy]] prior to sac being visualized (<5 weeks of gestation) | *Early [[pregnancy]] prior to [[Yolk sac|sac]] being visualized (<5 weeks of [[gestation]]) | ||
*[[Ectopic pregnancy]] (thickened [[endometrium]] and sometimes fluid collection or pseudo[[gestational sac]] can be associated) | *[[Ectopic pregnancy]] (thickened [[endometrium]] and sometimes [[fluid]] collection or pseudo[[gestational sac]] can be associated) | ||
*[[Retained products of conception]] (heterogeneously thickened [[endometrium]] with increased [[vascularity]]) | *[[Retained products of conception]] ([[Heterogeneous|heterogeneously]] thickened [[endometrium]] with increased [[vascularity]]) | ||
*Adherent intra-uterine blood clot (heterogeneous [[endometrium]] with no vascularity) | *Adherent intra-uterine [[blood]] [[clot]] ([[heterogeneous]] [[endometrium]] with no [[vascularity]]) | ||
*[[Molar pregnancy]] thickened with multiple small cystic spaces | *[[Molar pregnancy]] thickened with multiple small [[cystic]] spaces | ||
*[[Endometritis]] (prominent hyperechoic [[endometrium]] with of without fluid and debris) | *[[Endometritis]] (prominent hyperechoic [[endometrium]] with of without [[fluid]] and debris) | ||
===Non-pregnancy related=== | ===Non-pregnancy related=== | ||
*[[Endometrial carcinoma]] (variable appearance) | *[[Endometrial carcinoma]] ([[variable]] [[appearance]]) | ||
*Endometrial [[polyp]] or polyps (usually hyperechoic, often focal, look for vascular stalk) | *[[Endometrial]] [[polyp]] or [[polyps]] (usually hyperechoic, often focal, look for [[vascular]] stalk) | ||
*Submucosal uterine [[fibroid]]s | *[[Submucosal]] [[uterine]] [[fibroid]]s | ||
*Intrauterine adhesions (irregular echogenic areas with focal thickening) | *Intrauterine [[adhesions]] (irregular [[echogenic]] areas with focal thickening) | ||
===Potential biomarkers=== | ===Potential biomarkers=== | ||
* The absence of [[PAX2]] expression on immunohistochemistry is helpful in delineating EIN<ref name="pmid23086768">{{cite journal |vauthors=Quick CM, Laury AR, Monte NM, Mutter GL |title=Utility of PAX2 as a marker for diagnosis of endometrial intraepithelial neoplasia |journal=Am. J. Clin. Pathol. |volume=138 |issue=5 |pages=678–84 |date=November 2012 |pmid=23086768 |doi=10.1309/AJCP8OMLT7KDWLMF |url=}}</ref><ref name="pmid10699996">{{cite journal |vauthors=Mutter GL, Baak JP, Crum CP, Richart RM, Ferenczy A, Faquin WC |title=Endometrial precancer diagnosis by histopathology, clonal analysis, and computerized morphometry |journal=J. Pathol. |volume=190 |issue=4 |pages=462–9 |date=March 2000 |pmid=10699996 |doi=10.1002/(SICI)1096-9896(200003)190:4<462::AID-PATH590>3.0.CO;2-D |url=}}</ref><ref name="pmid22317873">{{cite journal |vauthors=Allison KH, Upson K, Reed SD, Jordan CD, Newton KM, Doherty J, Swisher EM, Garcia RL |title=PAX2 loss by immunohistochemistry occurs early and often in endometrial hyperplasia |journal=Int. J. Gynecol. Pathol. |volume=31 |issue=2 |pages=151–159 |date=March 2012 |pmid=22317873 |pmc=4646427 |doi=10.1097/PGP.0b013e318226b376 |url=}}</ref><ref name="pmid24556060">{{cite journal |vauthors=Laas E, Ballester M, Cortez A, Gonin J, Daraï E, Graesslin O |title=Supervised clustering of immunohistochemical markers to distinguish atypical endometrial hyperplasia from grade 1 endometrial cancer |journal=Gynecol. Oncol. |volume=133 |issue=2 |pages=205–10 |date=May 2014 |pmid=24556060 |doi=10.1016/j.ygyno.2014.02.018 |url=}}</ref> | * The absence of [[PAX2]] [[expression]] on [[immunohistochemistry]] is helpful in delineating EIN<ref name="pmid23086768">{{cite journal |vauthors=Quick CM, Laury AR, Monte NM, Mutter GL |title=Utility of PAX2 as a marker for diagnosis of endometrial intraepithelial neoplasia |journal=Am. J. Clin. Pathol. |volume=138 |issue=5 |pages=678–84 |date=November 2012 |pmid=23086768 |doi=10.1309/AJCP8OMLT7KDWLMF |url=}}</ref><ref name="pmid10699996">{{cite journal |vauthors=Mutter GL, Baak JP, Crum CP, Richart RM, Ferenczy A, Faquin WC |title=Endometrial precancer diagnosis by histopathology, clonal analysis, and computerized morphometry |journal=J. Pathol. |volume=190 |issue=4 |pages=462–9 |date=March 2000 |pmid=10699996 |doi=10.1002/(SICI)1096-9896(200003)190:4<462::AID-PATH590>3.0.CO;2-D |url=}}</ref><ref name="pmid22317873">{{cite journal |vauthors=Allison KH, Upson K, Reed SD, Jordan CD, Newton KM, Doherty J, Swisher EM, Garcia RL |title=PAX2 loss by immunohistochemistry occurs early and often in endometrial hyperplasia |journal=Int. J. Gynecol. Pathol. |volume=31 |issue=2 |pages=151–159 |date=March 2012 |pmid=22317873 |pmc=4646427 |doi=10.1097/PGP.0b013e318226b376 |url=}}</ref><ref name="pmid24556060">{{cite journal |vauthors=Laas E, Ballester M, Cortez A, Gonin J, Daraï E, Graesslin O |title=Supervised clustering of immunohistochemical markers to distinguish atypical endometrial hyperplasia from grade 1 endometrial cancer |journal=Gynecol. Oncol. |volume=133 |issue=2 |pages=205–10 |date=May 2014 |pmid=24556060 |doi=10.1016/j.ygyno.2014.02.018 |url=}}</ref> | ||
* MMP-9 | * MMP-9 | ||
* [[BCL-2]] overexpression | * [[BCL-2]] [[overexpression]] | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 16:24, 7 May 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Swathi Venkatesan, M.B.B.S.[2]
Overview
Endometrial hyperplasia must be differentiated from conditions that have a similar ultrasound findings such as normal thickening during the secretory phase, sessile endometrial polyp, submucosal uterine fibroids, endometrial cancer, an adherent intrauterine blood clot, and pregnancy.
Differential Diagnosis
- Endometrial hyperplasia must be differentiated from the following conditions that have abnormal thickening of the uterus:[1][2][3]
- Early pregnancy prior to sac being visualized (<5 weeks of gestation)
- Ectopic pregnancy (thickened endometrium and sometimes fluid collection or pseudogestational sac can be associated)
- Retained products of conception (heterogeneously thickened endometrium with increased vascularity)
- Adherent intra-uterine blood clot (heterogeneous endometrium with no vascularity)
- Molar pregnancy thickened with multiple small cystic spaces
- Endometritis (prominent hyperechoic endometrium with of without fluid and debris)
- Endometrial carcinoma (variable appearance)
- Endometrial polyp or polyps (usually hyperechoic, often focal, look for vascular stalk)
- Submucosal uterine fibroids
- Intrauterine adhesions (irregular echogenic areas with focal thickening)
Potential biomarkers
- The absence of PAX2 expression on immunohistochemistry is helpful in delineating EIN[4][5][6][7]
- MMP-9
- BCL-2 overexpression
References
- ↑ Hulka CA, Hall DA, McCarthy K, Simeone JF (1994). "Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography". Radiology. 191 (3): 755–8. doi:10.1148/radiology.191.3.8184058. PMID 8184058.
- ↑ Endometrial hyperplasia. Radiopedia. http://radiopaedia.org/articles/endometrial-hyperplasia-1 Accessed on March 3, 2016.
- ↑ Abnormally thickened endometrium: differential diagnosis. Radiopedia. http://radiopaedia.org/articles/abnormally-thickened-endometrium-differential-diagnosis Accessed on March 3, 2016.
- ↑ Quick CM, Laury AR, Monte NM, Mutter GL (November 2012). "Utility of PAX2 as a marker for diagnosis of endometrial intraepithelial neoplasia". Am. J. Clin. Pathol. 138 (5): 678–84. doi:10.1309/AJCP8OMLT7KDWLMF. PMID 23086768.
- ↑ Mutter GL, Baak JP, Crum CP, Richart RM, Ferenczy A, Faquin WC (March 2000). "Endometrial precancer diagnosis by histopathology, clonal analysis, and computerized morphometry". J. Pathol. 190 (4): 462–9. doi:10.1002/(SICI)1096-9896(200003)190:4<462::AID-PATH590>3.0.CO;2-D. PMID 10699996.
- ↑ Allison KH, Upson K, Reed SD, Jordan CD, Newton KM, Doherty J, Swisher EM, Garcia RL (March 2012). "PAX2 loss by immunohistochemistry occurs early and often in endometrial hyperplasia". Int. J. Gynecol. Pathol. 31 (2): 151–159. doi:10.1097/PGP.0b013e318226b376. PMC 4646427. PMID 22317873.
- ↑ Laas E, Ballester M, Cortez A, Gonin J, Daraï E, Graesslin O (May 2014). "Supervised clustering of immunohistochemical markers to distinguish atypical endometrial hyperplasia from grade 1 endometrial cancer". Gynecol. Oncol. 133 (2): 205–10. doi:10.1016/j.ygyno.2014.02.018. PMID 24556060.