The gross specimen of a bisected uterus shown above reveals a markedly thickened, irregular, and friable endometrial lining with areas of hemorrhage. The most likely diagnosis is:

Question

Accepted Answer

B. Endometrial hyperplasia. ## Image Findings
*   **Gross specimen of a bisected uterus** with attached adnexa (fallopian tube and ovary).
*   The **endometrial lining is markedly thickened**, appearing several times its normal thickness.
*   The endometrial surface is **irregular, nodular, and somewhat polypoid**, filling much of the uterine cavity.
*   The tissue appears **friable and congested**, with areas of reddish discoloration suggestive of hemorrhage.
*   The overall uterine size appears enlarged, and the endometrial growth measures several centimeters.

## Diagnosis
**Key Point:** The gross appearance of a markedly thickened, irregular, and friable endometrial lining is highly characteristic of **endometrial hyperplasia**.

Endometrial hyperplasia is a spectrum of proliferative disorders of the endometrial glands and stroma, resulting from prolonged unopposed estrogen stimulation. The image demonstrates a significant degree of endometrial proliferation, likely **complex or atypical hyperplasia**, given the marked thickening, irregularity, and friable nature of the tissue. These gross features distinguish it from normal endometrium and suggest a pathological process.

## Differential Diagnosis

## Clinical Relevance
**Clinical Pearl:** Endometrial hyperplasia, particularly atypical hyperplasia, is a **precursor lesion to endometrial adenocarcinoma**. Patients typically present with **abnormal uterine bleeding**, especially postmenopausal bleeding or heavy menstrual bleeding in premenopausal women.

## High-Yield for NEET PG
**High-Yield:** The most important risk factor for endometrial hyperplasia and carcinoma is **unopposed estrogen stimulation**. This can be endogenous (e.g., obesity, anovulation, estrogen-producing tumors) or exogenous (e.g., estrogen-only hormone replacement therapy).

**Key Point:** Endometrial hyperplasia is classified based on architectural complexity (simple vs. complex) and presence of cytological atypia (with vs. without atypia). **Atypical complex hyperplasia** carries the highest risk of progression to adenocarcinoma.

## Common Traps
**Warning:** On gross examination alone, it can be challenging to definitively distinguish severe atypical endometrial hyperplasia from early well-differentiated endometrial adenocarcinoma. Microscopic examination is essential for definitive diagnosis and grading.

## Reference
[cite:Robbins Basic Pathology, 10th Ed, Ch 22; Harrison's Principles of Internal Medicine, 20th Ed, Ch 119]

Answer

A. Endometrial polyp

Answer

C. Endometrial adenocarcinoma

Answer

D. Submucosal leiomyoma

The gross specimen of a bisected uterus shown above reveals a markedly thickened, irregular, and friable endometrial lining with areas of hemorrhage. The most likely diagnosis is:

Explanation

Image Findings

Diagnosis

Differential Diagnosis

Clinical Relevance

High-Yield for NEET PG

Common Traps

Reference

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Feature	Endometrial Hyperplasia (Atypical/Complex)	Endometrial Adenocarcinoma	Submucosal Leiomyoma	Endometrial Polyp
Gross Appearance	Markedly thickened, irregular, friable, often polypoid/nodular endometrium, diffuse.	Infiltrative mass, often with necrosis, ulceration, deep myometrial invasion. Can be exophytic.	Discrete, firm, whorled, well-circumscribed mass, often intramural or protruding into cavity.	Localized, often pedunculated or sessile growth, usually smooth or lobulated.
Location	Diffuse involvement of endometrial lining.	Originates from endometrium, often infiltrates myometrium.	Originates from myometrium.	Focal growth from endometrium.
Texture	Friable, soft.	Friable, often necrotic.	Firm, rubbery.	Soft to firm, depending on stromal content.
Hemorrhage	Common, especially with atypia.	Common, often with necrosis.	Less common, unless degenerating.	Can occur, especially with larger polyps.