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Complex Hyperplasia
Etiology

associated with unopposed estrogen use
may be exogenous (non-cycled estrogens) but generally
endogenous due to peripheral aromatization of adrenal androgens by adipose in obese women
also associated with granulosa cell tumors and other estrogen producing ovarian tumors as well as polycystic ovary syndrome
Pathogenesis

estrogen drives continued proliferation of the endometrium
in the absence of progesterone maturation of the endometrium and spiral arteries never occurs, nor does regular menses,
Epidemiology

obese post-menopausal women
may also have diabetes and hypertension (classic triad)
General Gross Description

plush, thick, tan endometrium measuring up 1.0 cms
•Examples:
General Microscopic Description

glands exhibit crowding and often show budding
pseudostratified nuclei with mitotic activity
cells retain orientation to the lumen
cell nuclei have small nucleoli and normal chromatin
•Examples:
Complex Hyperplasia of Endometrium (Medium Power) Complex Hyperplasia of Endometrium (High Power)
Clinical Correlation

asymptomatic or post-menopausal bleeding
References

Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1057-8

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Complex Hyperplasia
Synopsis by: Melinda Sanders M.D. (T84000M72420)[18]
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