Adaptation: endometrial hyperplasia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Pathology · Adaptation: endometrial hyperplasia

Sample item

A 50-year-old obese woman with anovulatory cycles has prolonged heavy bleeding. Endometrial biopsy shows crowded glands with a high gland-to-stroma ratio and nuclear atypia. Which statement about the mechanism and risk is correct?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Unopposed oestrogen drives glandular proliferation, and atypical hyperplasia can progress to endometrioid carcinoma

Obesity increases peripheral aromatisation of androgens to oestrone, and anovulation removes progesterone, so oestrogen acts unopposed on the endometrium. This is pathological hyperplasia, a hormone-driven adaptation that reverses when the stimulus is removed. When cytological atypia is present the lesion is a precursor of endometrioid adenocarcinoma, often with PTEN mutations.

Option by option

  • A. It is physiological hypertrophy of endometrial cells that never progresses once the stimulus is removed

    Hyperplasia involves increased cell number, not only hypertrophy, and atypical forms do carry malignant potential.

  • B. Excess progesterone causes stromal decidualisation, which is the premalignant lesion for endometrial cancer

    Progesterone opposes oestrogen and causes secretory change or decidualisation, which is not a precursor of cancer.

  • C. Unopposed oestrogen drives glandular proliferation, and atypical hyperplasia can progress to endometrioid carcinoma (correct)

    Correct. Unopposed oestrogen and atypia explain the risk of endometrioid carcinoma.

  • D. It arises from TP53 loss in atrophic endometrium and usually progresses to serous carcinoma

    TP53-driven serous carcinoma arises from atrophic endometrium through serous intraepithelial carcinoma and is not oestrogen related.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Unopposed oestrogen drives glandular proliferation, and atypical hyperplasia can progress to endometrioid carcinoma. Obesity increases peripheral aromatisation of androgens to oestrone, and anovulation removes progesterone, so oestrogen acts unopposed on the endometrium.

Why is "It is physiological hypertrophy of endometrial cells that never progr…" not the answer?

Hyperplasia involves increased cell number, not only hypertrophy, and atypical forms do carry malignant potential.

Why is "Excess progesterone causes stromal decidualisation, which is the prem…" not the answer?

Progesterone opposes oestrogen and causes secretory change or decidualisation, which is not a precursor of cancer.

Why is "It arises from TP53 loss in atrophic endometrium and usually progress…" not the answer?

TP53-driven serous carcinoma arises from atrophic endometrium through serous intraepithelial carcinoma and is not oestrogen related.

What concept does this question test?

It tests Adaptation: endometrial hyperplasia in Pathology. This is pathological hyperplasia, a hormone-driven adaptation that reverses when the stimulus is removed. When cytological atypia is present the lesion is a precursor of endometrioid adenocarcinoma, often with PTEN mutations.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Adaptation: endometrial hyperplasia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.