What is the histopathological hallmark of endometrial hyperplasia?

The histopathological hallmark of endometrial hyperplasia is an increased gland-to-stroma ratio. This condition results from an exaggerated response to estrogen, leading to the proliferation of endometrial glands relative to the supporting stroma. In endometrial hyperplasia, there is a noticeable increase in the number and size of the glands, which can become crowded and disorganized, while the stroma may appear relatively reduced in comparison.

The presence of inflammatory cells is not specific to endometrial hyperplasia and can be seen in various types of endometrial pathologies, including infections and other inflammatory conditions. The formation of papillary structures occurs in specific subtypes of endometrial lesions, such as endometrial adenocarcinoma, rather than as a hallmark feature of hyperplasia itself. Necrosis of glandular tissue is more commonly associated with malignancies or severe cases of other pathologies, rather than with hyperplasia. Therefore, focusing on the increased gland-to-stroma ratio provides a clear understanding of the underlying changes that characterize endometrial hyperplasia.