What Do The Results Mean?
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Your biopsy results may be within normal limits, meaning the pathologist found no abnormal cells or cancer, and that the cells looked right for
the timing of the phase when the biopsy was collected during your menstrual cycle.
Abnormal
The endometrium may not appear right for the phase in which it was collected during your cycle. If the pathologist found your endometrium too thick, it is not cycling properly through proliferation and secretion. Only secretory endometrium can shed. It was probably all proliferative or mixed proliferative and secretory growth. The glands are enlarged and irregular. There may be abnormal cells, called atypia.
There are four types of endometrial hyperplasia: Simple, complex, simple atypical, and complex atypical. Simple and complex refer to architecture (overcrowded and intricate glands). If you develop endometrial hyperplasia, remember that 90% of simple and complex cases resolve spontaneously or with medical management. Atypia refers to changes in cell cytology and behavior that is precancerous or cancerous. Patients with atypia are more likely to develop cancer, and are candidates for hysterectomy.
Simple
Simple hyperplasia is also called Swiss cheese endometrium, because the glands resemble the irregular holes in cheese as they dilate and form cysts separated by abundant stroma. Simple hyperplasia causes heavy bleeding but very rarely develops into cancer (less than 2%). The glands are not back-to-back. There are no precancerous changes in the cells.
Complex
Complex hyperplasia is also called adenomatous hyperplasia. There is still only one layer of endometrium. The glands are bunched together back-to-back, instead of evenly distributed, and develop tufts. There is very little stroma. A few of the basal cells may have slightly enlarged nuclei, a change that predisposes the woman to developing endometrial cancer later.
Simple atypical
There is abundant stroma. The glands are enlarged, especially their nuclei. The cells have different forms as they age (pleomorphism). The endometrial cells multiply too quickly, which is a feature of cancer. However, the endometrial cells have not yet penetrated into connective tissue, as true cancer would.
Complex atypical
The glands stratify into layers and crowd together back-to-back. The epithelium forms tufts. The cells develop very dark, large nuclei. The cells can go through many forms as they age (pleomorphism).