More CD3 + T cells are in endometrium in the proliferative phase and equivalent numbers in the secretory phase of the cycle in women with disease compared to controls (Bulmer et al. The most common histomorphological pattern was Endometrial Hyperplasia without atypia in 43. Disordered proliferative endometrium is an exaggeration of the normal proliferative phase cause by failed ovulation or minor prolongation of estrogen stimulation. More African American women had a. 09%) followed by endometrial hyperplasia in 21cases (23. 6%) cases. proliferative endometrium: Endometrial hypertrophy due to estrogen stimulation during the preovulatory phase of the menstrual cycle. Menopause Forum. Often, however, an organic cause is not identifiable and curettage may show atrophic endometrium (3) proliferative endometrium (4) and rarely secretory endometrium (5). It results from the unopposed estrogenic stimulation of the endometrial tissue with a relative deficiency of the counterbalancing effects of progesterone. 75% and endometrial carcinoma in 11. 3 Menstrual endometrium. g. . . 0% of cases followed by Secretory endometrium in 15. 1%) and disordered proliferative endometrium. The events of the uterine cycle are regulated by the estrogen and progesterone produced by the ovaries during the ovarian cycle. Benign endometrial polyp - has thick-walled blood vessels; simple endometrial hyperplasia should not be diagnosed in a polyp. 56%). Proliferative phase endometrium - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles or <50% of cells in the. , a discrepancy between proliferative. The changes associated with anovulatory bleeding, which are referred to as. Doctor has suggested wait & watch and 3 months progesterone treatment. We have described the dynamics of the pattern of growth of the endometrium throughout the follicular phase in a large, heterogeneous, infertile population, as well as how this growth pattern is affected by different treatment medications and underlying. 13, 14 However, it maintains high T 2 WI. The endometrial glands increase in size and new blood vessels develop. The metaplasia doesn't mean anything significant, and the glandular and stromal breakdown. The Proliferative Phase. The findings in endometrial biopsies taken for abnormal uterine bleeding can show a wide range of appearances that reflect the cyclical changes in the endometrium in women during their reproductive years; accordingly, the histopathological diagnosis provides a description of the features observed microscopically (e. …were disordered proliferative endometrium (15. We applied this latter technique for the first time on proliferative endometrial biopsies obtained during ovarian stimulation for in-cycle outcome prediction, in an attempt to overcome inter-cycle variability. Cytological and histological examinations were conducted on 138 benign cases and 26 abnormal cases, including 24 cases with disordered proliferative phase (DOP) and 2 cases with simple endometrial. During the same period, there are concurrent changes in the endometrium, which is why the follicular phase is also known as the proliferative phase. 7, 9,12,15 The cause of bleeding in the proliferative phase of endometrium is due to. Disordered or dyssynchronous endometrium suggests ovulatory dysfunction. LM. Gurmukh Singh answered. Normal Proliferative Phase Endometrium: The glands are spaced out (left panel) with ample stroma in between (gland:stroma ratio <1). Although the proliferation of the endometrium is part of a healthy cycle, things can go wrong during this phase. 5, and 0. Similar to nonatypical hyperplasia, benign endometrium during the proliferative and secretory phases can mimic AEH/EIN. , Athanassiadou P. 2 Secretory phase endometrium; 6. In any case, the management of simple endometrial hyperplasia. , 2014). Plasma cells can be seen in disordered proliferative or breakdown endometrium in the absence of infection (Hum Pathol 2007;38:581) Spindled stromal cells Endometrial dating is unreliable due to frequent out of phase morphology (Am J Reprod Immunol 2011;66:410) Higher prevalence in proliferative phase (Reprod Biomed Online. A 'billable code' is detailed enough to be used to specify a medical diagnosis. Our study provides preliminary evidence that the DNA flow. Endometrial hyperplasia (EH) is categorized into two groups: EH without atypia and EH with atypia (also referred to as endometrial. Disordered proliferative endometrium can cause spotting between periods. 62% of our cases with the highest incidence in 40-49 years age group. 1% of cases and these findings were consistent with findings in study done by Jetley et al. Should be easily regulated with hormones such as low dose b. 2% (6). Disordered Proliferation. This diagnosis means that after examining your tissue sample under the microscope, your pathologist saw irregular and dilated endometrial glands in the proliferative phase (growing phase). 9%), endometrial hyperplasia in 25 women (21. It results from the unopposed estrogenic stimulation of the endometrial tissue with a relative deficiency of the counterbalancing. Stromal staining of Ki67 was found to be more apparent in the secretory phase, however, it was found to be lower than that of the endometrial glands in the proliferative phase. 13, 14 However, it maintains high T 2 WI signal. 5 mm in thickness, and the surface and glands are lined by a low columnar to cuboidal epithelium devoid of either proliferative or secretory activity, which. respectively). Early proliferative endometrium (days 3–6). 6. Glands pseudostratified? Pseudostratified glands are normal in the proliferative phase endometrium, hyperplasias, malignancy. also known as a period), nine days for the proliferative phase (when the endometrium is developing), zero days for ovulation (when a ripe ova, or egg cell, is deposited from an. 4% cases. Endometrial polyps (EMPs) are common exophytic masses associated with abnormal uterine bleeding and infertility. The secondary histologic features of chronic endometritis like gland architectural irregularity, spindled stroma, stromal edema and hemorrhage with the. It is further classified. Analysis of postmenopausal women who underwent endometrial sampling from 1997 to 2006 and were followed clinically through. of PTEN protein in patients with endometrial intraepithelial neoplasia compared to endometrial adenocarcinoma and proliferative phase. At the start of the menstrual cycle, the ovaries secrete the estrogen hormone, triggering the endometrium to enter a proliferative phase, during which it. Disordered proliferative endometrium and endometrial hyperplasia was observed in 6 patients (8. The pathognomonic feature is cystic changes of individual glands distributed randomly throughout the entire hormonally responsive region of the endometrium (superficial. 7% patients, and proliferative phase pattern and. Disordered proliferative endometrium accounted for 5. Another finding is “disordered proliferative endometrium,” where glandular irregularity exceeds normal proliferative endometrium but falls short of hyperplasia without atypia. EH represents a spectrum of irregular morphological alterations, whereby abnormal proliferation of the endometrial glands results in an increase in gland-to-stroma ratio when compared to endometrium from the proliferative phase of the cycle (Ellenson et al. 3. Disordered proliferative endometrium is an exaggeration of the normal proliferative phase; and, as such, much of the tissue is similar to that seen in normal proliferative endometrium. Atrophic endometrium:EH represents a spectrum of irregular morphological alterations, whereby abnormal proliferation of the endometrial glands results in an increase in gland-to-stroma ratio when compared to endometrium from the proliferative phase of the cycle (Ellenson et al. Endometrium, curettage: Disordered proliferative endometrium with focus of hyperplasia without atypia Endometrium, biopsy: AH / EIN focally bordering on endometrial endometrioid adenocarcinoma (FIGO grade I) (see comment) Comment: There are rare minute foci suspicious for a FIGO grade 1 endometrioid endometrial. normal endometrial thickness despite tamoxifen use, i. In a study of 111 premenopausal women with abnormal uterine. 8 may differ. In the proliferative phase, the endometrium gradually thickens with an increase in E. 2, 34 Endometrioid. Metaplasia in Endometrium is diagnosed by a pathologist on. Normal. Endometrial hyperplasia is caused by an imbalance in the hormones involved in the normal menstrual cycle. HYPERPLASIA) VERSUS DISORDERED PROLIFERATIVE ENDOMETRIUM •All part of a spectrum •Probably no (at most minimal) risk of progression •Don’t worry too much about distinction- not clinically important (don’t let clinicians tell you it is) •Tend to call disordered proliferative in perimenopausal years; tend to call hyperplasia Also part of the differential diagnosis of simple hyperplasia are normal cycling endometrium, disordered proliferative phase, various compression artifacts, and chronic endometritis. 0 mm in thickness, so by the late proliferative phase, a biopsy obtains a moderate amount of tissue. 86: Endometrial Carcinoma: 0: 0. Endometrium, curettage: Disordered proliferative endometrium with focus of hyperplasia without atypia Endometrium, biopsy: AH / EIN focally bordering on endometrial endometrioid adenocarcinoma (FIGO grade I) (see comment) Comment: There are rare minute foci suspicious for a FIGO grade 1 endometrioid endometrial adenocarcinoma. A result of disordered or crowded glands is common with anovulatory cycles due to prolonged estrogen stimulation without postovulatory progesterone exposure. 8% cases in the present study, this is in contrast to other studies where a substantially higher incidence of 25. The most common histopathological diagnosis was proliferative endometrium (28. 6% smaller. The distinction between SH and disordered proliferative endometrium is often difficult, since one may arise from the other, and mixed lesions are frequent. May be day 5-13 - if the menstruation is not included. 0; range, 1. Adenomyosis and endometriosis are chronic conditions that affect the endometrium, the tissue lining of the uterus. , 1996). Disordered proliferative endometrium is an. included disordered proliferative 26%, weakly proliferative 26%, inactive endometrium 26%, weakly secretory 07%, desynchronized endometrium 07% and simple hyperplasia 07%. D & C report shows no malignancy is there. Proliferative phase (days 6 - 14): Stratum functionalis is regenerated by cells from stratum basalisDisordered proliferative phase. Endometrial hyperplasia without atypia (as in the 2020 WHO classification) is defined as the proliferation of endometrial glands of irregular size and shape without significant cytological atypia. "Exodus" pattern is a term used to describe exfoliation of endometrial cells during the proliferative phase. Patients presenting with secretory phase were 32 (16%). 9 vs 30. In this situation the endometrium is proliferative but shows focal gland irregularities including dilatation and. 3%). . Proliferative endometrium on the other hand was seen in only 6. 5%); other causes include benign endometrial polyp (11. The follicular phase of the female menstrual cycle includes the maturation of ovarian follicles to prepare one of them for release during ovulation. Although the proliferation of the endometrium is part of a healthy cycle, things can go wrong during this phase. breakdown. 9 Ablated endometrium;weakly proliferative endometrium with occasional mitotic figures and a thin functionalis layer. It is a mixture of cystically dilated, budding, and tubular glands in a. Other noninflammatory disorders of uterus, except cervix (N85) Endometrial hyperplasia, unspecified (N85. This is the American ICD-10-CM version of N85. Eosinophilic and Ciliated Cell Metaplasia in Endometrium is a type of metaplasia noted in the uterine corpus. A. g. Applicable To. 8%), luteal phase defects 3 cases (1. People between 50 and 60 are most likely to develop endometrial hyperplasia. Very heavy periods. Balls of cells? Blue - likely menstrual (stromal. 2 vs 64. Obstetrics and Gynecology 41 years experience. 00 may differ. 0001) and had a higher body mass index (33. Read More. 6 kg/m 2; P<. 23010. Pathology 51 years experience. Tamoxifen at 20 mg/d exerts a time-dependent proliferative effect on the endometrium, particularly in premenopausal and early postmenopausal women. 8 may differ. 2014; 42:134–142. The commonest finding observed in the study was proliferative phase endometrium (37. This is the American ICD-10-CM version of N85. HYPERPLASIA) VERSUS DISORDERED PROLIFERATIVE ENDOMETRIUM •All part of a spectrum •Probably no (at most minimal) risk of progression •Don’t worry too much about distinction- not clinically important (don’t let clinicians tell you it is) •Tend to call disordered proliferative in perimenopausal years; tend to call hyperplasiaIn the human endometrium, estrogen drives tissue repair and epithelial proliferation during the proliferative phase and estrogen and progesterone promote thickening of the endometrium following ovulation. 6 Disordered proliferative endometrium; 7. Proliferative endometrium indicates the follicular phase; whereas, secretory endometrium indicates luteal phase. Five days for the menstrual phase (when a woman's endometrium is being expelled, also known as a period), nine days for the proliferative phase (when the endometrium is developing), zero days for ovulation (when a ripe ova, or egg cell, is. The main purpose of the endometrium is to provide an attachment site and a source of nourishment to an early embryo. A result of disordered or crowded glands is common with anovulatory cycles due to. 9 vs 30. Applicable To. Hormone levels in the body begin to rise again after your period, which initiates changes to the endometrial lining. 7. Glands. Thickened: lining of your uterus: may be a hormone effect and responsive to oral contraceptives. Endometrium in proliferative phase, secretory phase, endometrial polyps, and disordered proliferative endometrium were studied for the presence of plasma cells. Irregular - may be seen in secretory phase endometrium, menses, disordered proliferative endometrium (focal), simple endometrial hyperplasia (diffuse). Common reasons for these procedures include: Abnormal (dysfunctional) uterine bleeding. 00) N85. Contact your doctor if you experience: Menstrual bleeding that is heavier or longer-lasting than usual. If the biopsy was done in the first half of the cycle, the endometrium is expected to be in proliferative phase. 4% of patients. At the end of this stage, around the 14th day, the. Endometrial hyperplasia is caused by an imbalance in the hormones involved in the normal menstrual cycle. 1 b) [ 6 ]. During. Most of the studies reported an increased positivity for Bcl-2 in the proliferative phase endometrium as compared to other phases of the menstrual cycle. 8%), luteal phase defects 3 cases (1. Proliferative endometrium is a term pathologists use to describe the changes seen in the endometrium during the first half of the menstrual cycle. N85. When the follicular phase begins, levels of estrogen and progesterone are low. When your body prepares a layer of endometrial cells for attachment of a fertilized egg, that layer is called proliferative endometrium. Endometrial cells have an insufficient supply of glucose, leading to disordered endometrial development. Histologically, the proliferative phase is classified into anovulatory, persistent proliferative endometrium and cystic glandular hyperplasia and the remodelling phase. Should be easily regulated with hormones such as low dose b. 2,. A significant number of cases showed disordered proliferative pattern in this study. ICD-10-CM Diagnosis Code D07. 1 Images 3 Sign out 3. The stromal cells are arranged in a compact manner. 65%). Contact your doctor if you experience: Menstrual bleeding that is heavier or. Obstetrics and Gynecology 27 years experience. 7 Endometrium with changes due to exogenous hormones; 7. The aim of this review is to update current issues and provide a classification with a practical clinicopathological approach. N85. 8%) and menstrual endometrium (3. The specimens were all from patients with dysfunctional uterine bleeding and include 30 poorly active endometrium, 16 atrophic endometrium, 2 weakly proliferative endometrium, 3 disordered. We reviewed benign. Monoclonal growth and mutation of tumor-suppressor genes are measurable features of the premalignant phase of endometrial tumorigenesis that can be directly ascertained in paraffin-embedded. This is the American ICD-10-CM version of N85. Endometrium in proliferative phase, secretory phase, endometrial polyps, and disordered proliferative endometrium were studied for the presence of plasma cells. Some consider disordered proliferative endometrium (DPE) a synonym for anovulatory endometrium. 45 These in vivo and in vitro findings showed that. Furthermore, 962 women met the inclusion criteria. Disordered proliferative phase was the commonest (16%) functional cause of abnormal bleeding and diagnosis. 8 became effective on October 1, 2023. 17 Secretory phase 50 31. 3. . Hence, it is also known as Metaplastic Changes in Endometrial Glands. Summary. Endometrial Changes During the Menopause An endometrium that atrophies and loses it functional layer, with endometrial stroma that becomes fibrous andTo evaluate prevalence, clinical and sonographic characteristics and long-term outcome of Estrogenic/proliferative Endometrium (EE) in women with postmenopausal bleeding (PMB). Relation to disordered proliferative endometrium. Endometrial hyperplasia tends to occur in people who are transitioning to menopause or who have gone through menopause. EH with atypia is neoplastic and may progress or coexist with endometrial carcinoma. Ultrasound. Women with a proliferative endometrium were younger (61. Screening for endocervical or endometrial cancer. Atrophy of uterus, acquired. Disordered proliferative endometrium; E. Contrary to endometrial hyperplasia, proliferative endometrium has not been associated with the risk of endometrial cancer. Proliferative endometrium (PE) is found in up to 15% of women older than 50 years who undergo endometrial sampling. 18). In secretory and proliferative endometrium it was comparable to normal secretory and proliferative. During the menstrual cycle, the endometrium grows under the influence of two major hormones estrogen and progesterone. Metaplasia is defined as a change of one cell type to another cell type. It generally occurs due to long. Methods. Diseases of the genitourinary system. The diagnosis of disordered proliferative phase should be reserved for cases in which assessment is based on intact, well-oriented fragments of tissue. Report attached. This phase is variable in length and. 8% , 46. Dr. Of the 142 specimens, 59 (41. Inactive to atrophic (50 - 74%), proliferative (18. Proliferative phase 54 34. Admittedly, non-cycling proliferative lesions in the endometrium include those with an increased probability of developing into endometrial adenocarcinoma (atypical hyperplasia) and those running a limited risk of such progression (all other forms of endometrial hyperplasia and weakly proliferative endometrium). Two scenarios are seen with anovulation depending on the etiology: (1) high estrogen levels due to persistence of one or (more commonly) multiple follicles without progression into the luteal phase leading to a pattern described as “ disordered proliferative endometrium,” or (2) premature involution of the Graafian follicle with rapidly. Dr. Dr. Disordered endometrial proliferation is associated with various conditions. Transition from disordered proliferative-phase endometrium (with subtle architectural alterations) to SH (with irregularly shaped, cystically dilated glands) may be seen. Endometritis; Endometrium; Endometrium with changes due to exogenous hormones; Endometrium with psammoma bodies; Endometrium with squamous morules; P. The specimens were all from patients with dysfunctional uterine bleeding and include 30 poorly active endometrium, 16 atrophic endometrium, 2 weakly proliferative endometrium, 3 disordered. 10. 85 FindingsDisordered proliferative endometrium is an exaggerated proliferative phase representing chronic anovulation in the perimenopausal years. Two thirds of proliferative endometrium with breakdown showed plasma cells (19% grade 1,. The endometrium may develop endometrial hyperplasia (EH), which includes non-neoplastic entities (disordered proliferative endometrium, benign hyperplasia, simple and complex hyperplasias without atypia) characterized by a proliferation of endometrial glands, and endometrial intraepithelial neoplasms (EIN),. The most common cause of uterine bleeding was found to be proliferative phase endometrium; that were 649 cases (56. An initial proliferative phase leading to hypertrophy and a second or remodelling phase, characterized by increasing morphokinetic and biochemical alterations of gland cells. 79 Pill endometrium 5 3. Endometrium with hormonal changes. 2%), and. Discussion. 9 vs 30. Ralph Boling answered. Biopsy proliferative phase endometrium with disorder features and focal stromal breakdown. Furthermore, 962 women met the inclusion criteria. At least she chatted to you as much as possible about the results. Plasma cells are the hallmark of chronic endometritis but are not specific for upper tract infection. In some cases, the endometrium thickens too much, leading to excessive endometrial tissue in the. 16%) and simple hyperplasia without atypia 29 cases (23. AUB is frequently seen. 2 mm thick (mean, 2. 4. 5%) revealed secretory phase. Discussion 3. 1% cases in our study as compared to 32. 02. The 2024 edition of ICD-10-CM N85. Over ten years if not treated, this can raise the risk of uterine malignancy. Atrophic/weakly proliferative endometria were defined by the following criteria: (a) a shallow endometrium 2. Disordered proliferative endometrium was the most common histopathological finding followed by secretory. A range of conditions. Disordered proliferative endometrium with glandular and stromal breakdown. Noninflammatory disorders of female genital tract. N85. During the proliferative phase , the endometrium grows from about 0. A note from Cleveland Clinic. Patients with proliferative/secretory endometrium — Proliferative/secretory endometrium is not a form of endometrial hyperplasia but suggests active estradiol secretion (eg, by adipose tissue; an estrogen-producing tumor) or exposure to exogenous estrogens and should be evaluated further. Pregnancy outcome was poor when CD138 + cells/HPF ≥ 2 in the endometrium and may worsen with the increase in CD138 + cells. Cancer in situ of uterus; Cancer in situ, endometrium; Carcinoma in situ of uterus. A slightly disordered endometrium is a form of cancer. Also part of the differential diagnosis of simple hyperplasia are normal cycling endometrium, disordered proliferative phase, various compression artifacts, and. During this phase, the endometrial glands grow and become tortuous because of the active. 6 kg/m 2; P<. 2. 62% of our cases with the highest incidence in 40-49 years age group. 2%), disordered endometrium (19. Non-physiologic, in which the endometrium functionalis undergoes collapse, usually after cessation of exogenous hormonal therapy or intrinsic defects in normal follicle/corpus luteum progression (follicular/corpus luteum failure). A slightly disordered endometrium is a form of cancer. 1097/AOG. A proliferative endometrium is a normal part of healthy uterine function when it occurs during the first half of the menstrual cycle. Postmenopausal bleeding. 40, 41 The clue is, again, in the intact endometrium, which will show features of proliferative phase, early/mid. Fibrosis of uterus NOS. 6. , proliferative endometrium. Cystically dilated glands with outpouchings. read more. Absolutely not: Disordered proliferative endometrium solely describes endometrium that is in different phases of development of secretory glands at the same time. 38%). 1 Images;. [13 14] In our study we noted peak glandular positivity for Bcl-2 in cyclical PE, similar to the findings of Vaskivuo et al. Discrepancies between two benign diagnoses were upgraded to the more “abnormal” of the two in order to form the final diagnosis, e. Obstetrics and Gynecology 27 years experience. Among those women, 278 had a proliferative endometrium, and 684 had an atrophic endometrium. EMCs. Cases were reviewed by a second pathologist whenever necessary. 1 General; 6. A Verified Doctor answered. 2). Disordered proliferative endometrium in present study accounted for 7. Endometrial hyperplasia is a condition that causes. 25%. Furthermore, 962 women met the inclusion criteria. D & C report shows no malignancy is there. It is a. Proliferative endometrium is a very common non-cancerous change that develops in the tissue lining the inside of the uterus. In the present study, cytohistological concordance was 100% for proliferative phase. The endometrium is the fleshy tissue in the womb that becomes a rich bed of blood vessels that would support a pregnancy, building during the proliferative (growing) phase before later dissolving into menstrual flow when. Fifty endometrial biopsies were reviewed for presence of plasma cells on H and E and using IHC for syndecan- 1. Doctor of Medicine. N00-N99 - Diseases of the genitourinary system. Frequent, unpredictable periods whose lengths and heaviness vary. Increased progesterone concentrations eventually inhibit estrogen action to induce decidualization during the secretory phase. disordered proliferative endometrium. Later in the secretory phase, the cytoplasmic vacuoles are gone,. 8% , 46. More African American women had a proliferative. cystically dilated glands are predominantly detected in the atrophic endometrium of postmenopausal women and in disordered proliferative endometrium, which is also. We planned to include in the analysis only first‐phase data from cross‐over trials. 4% cases. Proliferative endometrium on the other hand was seen in only 6. 6,15 Disordered proliferative pattern lies at one end of theAdenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus. These could contribute to increased risk of menstrual bleeding abnormalities and create an a. 7%) followed by secretory phase (22. 6k views Reviewed Dec 27, 2022. Proliferative phase endometrium - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles or. The first phase of the menstrual cycle is the follicular or proliferative phase. The average age of menopause is 51 years old. 7 % of. Disordered proliferative endometrium is a non-cancerous change that develops in the tissue that lines the inside of the uterus. 00. In pre-menopausal women, this would mean unusual patterns of bleeding. During the proliferative phase, the endometrium responds to the endocrine environment to undergo extensive proliferation. be encountered in a disordered. Atrophy of uterus, acquired. Similar results of proliferative endometrium being the commonest were seen in Hoon CN et al,4 Muzaffar M et al,5 Maheshwari V et al,6 S. 1%), carcinoma (4. ASCs in endometrial fibroepithelial polyps tend to occur in older age compared with those observed in the cervix, vagina and, vulva,. The 2024 edition of ICD-10-CM N85. Can you please suggest is the D&C report normal or not. 1 Embryology and Normal Anatomy of the Uterine Corpus. Thus, an essentially normal proliferative phase endometrium with a few widely scattered cystic glands would better be called. e. Learn about the symptoms, causes, and diagnosis of this condition from Healthline. This is the microscopic appearance of normal proliferative endometrium in the menstrual cycle. Early diagnosis and treatment of EH (with or without atypia) can prevent progression to. . Out of these 36 cases, 24 (25%) showed proliferative endometrium and 11 (11. During the proliferative phase of the menstrual cycle,. Other significant pathologies included POCs 24%, chronic endometritis 10% and polyps 10%. Occasionally in the latter situation, when the proliferative phase is prolonged, there may be sufficient residual oestrogen secretion to give rise to a ‘disordered proliferative endometrium’, characterised by mild glandular architectural. Glands/cells identical to proliferative endometrium Abundant stroma Gland:Stroma ratio often 1:1, if becomes >2:1, then consider hyperplasia (see endometrial tumor notes) Often coinciding breakdown Endometrial glands and stroma outside of their usual endometrial cavity location→cause dysmenorrhea and/or menorrhagia AdenomyosisSPE - eosinophilic cytoplasm. e. Endometrial hyperplasia (EH) comprises a spectrum of changes in the endometrium ranging from a slightly disordered pattern that exaggerates the alterations seen in the late proliferative phase of the menstrual cycle to irregular, hyperchromatic lesions that are similar to endometrioid adenocarcinoma.