Case 35

A 54-year-old female with a prior diagnosis of atypical hyperplasia/endometrial intraepithelial neoplasia and she was managed by progestin for 6 months, here is an follow-up biopsy:

1. How would you sign out the case?

   A: Benign weakly proliferative endometrium

   B: Residual hyperplasia

   C: Residual atypical hyperplasia

   D: Progestin effect, negative for hyperplasia or atypia

Answer

This is residual atypical hyperplasia. Progestin treatments are known to make the gland less crowded or no crowding, and more metaplastic changes. However, in this case, this is clearly cytologic demarcation and the gland in the stroma are crowded as three glands with rich cytoplasm, which would be atypical comparable to the adjacent inactive endometrium.

Case credit: UCSD Pathology

Author: Wangpan Jackson Shi, MD