Endometrial Hyperplasia

Simple Hyperplasia

  • Normal to slightly increased gland to stromal ratio
  • Proliferative endometrium
  • Cystically dilated glands of variabe sizes (diffuse compared to a few in disordered proliferative endometrium)
  • Oval nuclei maintaining orientation to basement membrane

*simple hyperplasia is due to unopposed/prolonged oestrogen exposure. A diffuse process. Features of prolonged oestrogen exposure include pseudo-decidualisation and cystic dilatation of glands.

Complex Hyperplasia

  • Increase in the gland to stromal ratio with glandular crowding
  • More focal

Atypical Hyperplasia

  • Nuclear rounding
  • Presence of nucleoli
  • Nuclear stratification
  • Loss of polarity
  • Nuclear atypia should be assessed carefully in areas without metaplasia (ie ciliated cell metaplasia)


My approach to the interpretation of endometrial biopsies and curretttings. McCluggage. J Clin Pathol. 2006 August; 59(8): 801–812.

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