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Endometrial Hyperplasia (EH) - Differential Diagnosis: Endometrial polyps can show focal glandular crowding and the glands may appear different from the native endometrium. Fragmented polyps are especially problematic and can be mistaken for EH because of altered and possibly crowded glands. A comparison of crowded and noncrowded glands within the polyp is helpful.

In an endometrial polyp, the crowded glands resemble the background noncrowded glands. If the crowded glands show nuclear enlargement, nuclear pseudostratification and loss of polarity, the diagnosis of atypical endometrial hyperplasia can be made.

Additional features favoring polyp include: polypoid configuration (if not fragmented), dilated thick-walled blood vessels, compact or fibrotic stroma, and glands oriented parallel to surface endometrium.

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