Characterising Endometrial Hyperplasias: The role of immunohistochemistry and pathological classification to gauge neoplastic potential.

Peter Sanderson, Arantza Esnal-Zufiurre, Hilary Critchley, Philippa Saunders, Mark Arends, Alistair Williams

Research output: Contribution to conferencePosterpeer-review

Abstract / Description of output

Endometrial hyperplasias (EHs) represent a spectrum of morphological endometrial alterations. Atypical EHs are considered premalignant lesions for endometrioid endometrial cancer. Two classification systems exist for EHs: 1) The World Health Organisation (WHO) 1994 system; widely used in UK gynaecological practice, dividing EHs into 4 groups based on architectural and cytological features and 2) The Endometrial Intraepithelial Neoplasia (EIN) 2000 system; adopted by the WHO in 2014, dividing EHs into 2 groups, with emphasis on diagnostic reproducibility and recognition that EIN lesions are monoclonal premalignancies. Our aim is to investigate neoplastic vs. endocrine-driven variations within EHs, via characterisation of key molecular features in the context of these classification systems.
Pathology records coded as EH within NHS Lothian were reviewed (n=143) from 2004-2009. After exclusions, diagnostic samples (n=127) were evaluated by an expert gynaecological pathologist (blinded to diagnosis) to: 1) Confirm WHO94 diagnosis and 2) Reclassify under EIN criteria. Corresponding FFPE sections were obtained and immunohistochemistry (IHC) performed for markers predicted to be informative, including: PTEN, Ki67 and HAND2.
Original WHO94 diagnoses and expert pathologist WHO94 review diagnoses were concordant in 52% of cases (n=66). 7% (n=9) originally diagnosed as simple non-atypical hyperplasia and 12% (n=15) originally diagnosed as complex non-atypical hyperplasia were reclassified as EIN. IHC was evaluated to support EIN classification.
Interobserver variation when diagnosing EHs using WHO94 classification is apparent. Disparity between EH classification systems may create potential for under/overtreatment. IHC panels can provide a valuable adjunct to pathological diagnosis when assessing EH neoplastic potential.
Original languageEnglish
Publication statusPublished - 3 Mar 2016
EventRCOG Annual Academic Meeting - Royal College of Obstetricians & Gynaecologists, London, United Kingdom
Duration: 3 Mar 20164 Mar 2016


ConferenceRCOG Annual Academic Meeting
Country/TerritoryUnited Kingdom


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