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Abstract：
Benign proliferations that mimic malignancies are commonly encountered during the course of assessment of small and fragmented endometrial samples. Although benign, endometrial epithelial metaplasias often coexist with premalignant or malignant lesions causing diagnostic confusion. The difficulty with mucinous metaplasia lies in its distinction from atypical mucinous glandular proliferations and mucinous carcinomas, which are associated with significant interobserver variability. Papillary proliferation of the endometrium is commonly associated with hormonal drugs and endometrial polyps and is characterised by papillae with fibrovascular cores covered by epithelial cells without cytologic atypia. They are classified into simple or complex papillary proliferations depending on the architectural complexity and extent of proliferation. Complex papillary proliferations are associated with a high risk of concurrent or subsequent hyperplasia with atypia/carcinoma. Papillary proliferations may have coexisting epithelial metaplasias and, most commonly, mucinous metaplasia and syncytial papillary change. Those with striking mucinous metaplasia overlap morphologically with papillary mucinous metaplasia. The latter has been proposed as a precursor of endometrial mucinous carcinoma. Misinterpreting the Arias-Stella reaction as a malignant or premalignant lesion is more likely to occur if the pathologist is unaware that the patient is pregnant or on hormonal drugs. Endometrial hyperplasia with secretory changes may occasionally be difficult to distinguish from the torturous and crowded glands of a late secretory endometrium. Endometrial polyps may have abnormal features that can be misinterpreted as endometrial hyperplasia or Mullerian adenosarcoma. Awareness of these benign endometrial proliferations and their common association with hormonal medication or altered endogenous hormonal levels will help prevent the over-diagnosis of premalignant and malignant lesions.
摘要：
在评估小的和碎片化的子宫内膜样品的过程中，通常会遇到模拟恶性肿瘤的良性增殖。虽然是良性的，子宫内膜上皮化生常与癌前病变或恶性病变共存，导致诊断混乱。粘液性化生的困难在于它与非典型粘液性腺体增生和粘液性癌的区别，这与显著的观察者间变异性有关。子宫内膜的乳头状增生通常与激素药物和子宫内膜息肉有关，其特征是乳头的纤维血管核心被上皮细胞覆盖，无细胞学异型。根据结构的复杂性和增殖的程度，它们分为简单或复杂的乳头状增殖。复杂的乳头状增生与伴有异型性/癌的并发或后续增生的高风险相关。乳头状增生可能有共存的上皮化生，最常见的是,黏液化生和合胞体乳头状改变。具有明显粘液化生的人在形态上与乳头状粘液化生重叠。后者已被提议作为子宫内膜粘液性癌的前体。如果病理学家不知道患者怀孕或服用激素药物，则更有可能将Arias-Stella反应误解为恶性或癌前病变。伴有分泌变化的子宫内膜增生有时很难与晚期分泌性子宫内膜的曲折和拥挤的腺体区分开。子宫内膜息肉可能具有异常特征，可被误解为子宫内膜增生或苗勒腺肉瘤。意识到这些良性子宫内膜增殖及其与激素药物或内源性激素水平改变的共同关联将有助于防止癌前和恶性病变的过度诊断。
