What is a glandular hyperplasia? An expert guide to causes, symptoms, and treatment

According to the National Cancer Institute, hyperplasia is a condition where there is an increase in the number of normal cells in a tissue or organ. Glandular hyperplasia, therefore, specifically refers to the abnormal increase in the number of glandular cells, which can occur in various parts of the body and range from benign to a precursor for more serious conditions.

Quick Summary

Glandular hyperplasia is the abnormal proliferation of glandular cells, a condition that can affect various organs throughout the body, including the endometrium, cervix, and prostate. While often benign, the condition can sometimes be a precursor to cancer, and accurate diagnosis is critical. Symptoms depend on the affected organ but commonly involve abnormal bleeding or urinary changes. Timely diagnosis through biopsy and imaging is crucial for effective management and can significantly reduce the risk of progression.

Key Points

• Cell Proliferation: Glandular hyperplasia is the overgrowth of glandular cells in a tissue or organ, a condition that can be either benign or a precursor to cancer.

• Location Matters: The type of glandular hyperplasia and its associated risks depend on where it occurs, with common sites including the endometrium, prostate, and cervix.

• Hormonal Imbalance: Many forms of glandular hyperplasia, particularly in the endometrium and prostate, are caused by hormonal fluctuations or prolonged hormonal stimulation.

• Diagnosis is Key: Accurate diagnosis relies on obtaining a tissue sample (biopsy) and examining it for cellular characteristics, including the presence of atypia.

• Treatment Varies: Treatment options range from medication and lifestyle changes for benign forms to surgery for atypical or precancerous conditions.

• Potential for Progression: Atypical hyperplasia, particularly in the endometrium and cervix, has a risk of progressing to cancer and requires careful management.

What is glandular hyperplasia?

At its core, glandular hyperplasia is the multiplication of glandular cells within an organ or tissue, resulting in an abnormal increase in cell number. Unlike cancerous cells, which are abnormal in appearance and arrangement, hyperplastic cells initially retain a normal appearance under a microscope. The significance of glandular hyperplasia lies in its location and whether the cell proliferation shows signs of atypia (abnormal cell structure). In some cases, this condition is a natural, physiological response, such as during pregnancy, while in others, it is a pathological condition driven by excessive hormonal stimulation or other factors.

Common types of glandular hyperplasia

Glandular hyperplasia is not a single disease but a descriptive term for cellular overgrowth. The manifestation and risk vary greatly depending on the affected organ. Some of the most common types include:

• Endometrial Glandular Hyperplasia: This is perhaps one of the most well-known types, involving the inner lining of the uterus, called the endometrium. It is primarily caused by prolonged, unopposed estrogenic stimulation without sufficient progesterone to counteract its effects. It is of particular clinical importance because certain subtypes, such as atypical endometrial hyperplasia (also called Endometrial Intraepithelial Neoplasia or EIN), are considered precancerous lesions for endometrial cancer.
• Benign Prostatic Hyperplasia (BPH): This is an extremely common condition in older men, characterized by the enlargement of the prostate gland. While benign, the enlarged gland can compress the urethra, causing significant urinary symptoms such as difficulty urinating, a weak stream, and increased frequency.
• Lobular Endocervical Glandular Hyperplasia (LEGH): A rare, benign condition affecting the cervix, LEGH is a proliferation of gastric-type glands. A more severe, atypical variant (ALEGH) is considered a precursor to a rare form of gastric-type cervical adenocarcinoma.

Causes and risk factors

The specific cause of glandular hyperplasia depends on its location. However, a common thread often involves hormonal imbalances or chronic inflammation.

Endometrial hyperplasia causes

• Unopposed Estrogen: This is the primary driver, leading to continuous growth of the uterine lining without proper shedding. This can occur due to chronic anovulation (e.g., in PCOS), obesity (where fat tissue converts androgens to estrogen), and estrogen-only hormone replacement therapy.
• Tamoxifen: A medication used in breast cancer treatment, Tamoxifen can have estrogen-like effects on the uterus, increasing the risk of endometrial hyperplasia.

Benign Prostatic Hyperplasia causes

• Age: The risk of BPH increases with age, with continued prostate growth being a natural part of the aging process for many men.
• Hormonal Changes: While the exact mechanism is not fully understood, changes in the balance of sex hormones as men age likely play a significant role.

Lobular Endocervical Glandular Hyperplasia causes

• Genetic Factors: LEGH has been associated with specific genetic conditions like Peutz–Jeghers syndrome, which involves mutations in the STK11 gene.

Symptoms of glandular hyperplasia

Symptoms are highly dependent on the affected organ and the extent of the hyperplasia. For example, some hyperplasias, like those in the breast, may not cause any symptoms at all and are found incidentally.

Endometrial hyperplasia symptoms

• Abnormal uterine bleeding, including heavy or prolonged periods
• Bleeding between menstrual periods
• Postmenopausal bleeding

Benign Prostatic Hyperplasia (BPH) symptoms

• Weak urine stream or difficulty starting urination
• Frequent or urgent need to urinate, especially at night (nocturia)
• Incomplete emptying of the bladder

Lobular Endocervical Glandular Hyperplasia (LEGH) symptoms

• Excessive, watery vaginal discharge
• Presence of a cystic mass on the cervix

Diagnosis of glandular hyperplasia

Diagnosing glandular hyperplasia requires a histopathological assessment of tissue. The specific diagnostic procedure varies depending on the suspected location.

1. Endometrial Biopsy: For suspected endometrial hyperplasia, a small sample of the uterine lining is removed and examined under a microscope.
2. Hysteroscopy and D&C: In some cases, a hysteroscopy (using a camera to view the inside of the uterus) combined with dilation and curettage (D&C) is performed to obtain a more comprehensive tissue sample.
3. Transvaginal Ultrasound: This imaging technique can detect a thickened uterine lining, which may prompt a biopsy.
4. Urologic Examination: For BPH, a physical exam, patient symptom questionnaires, and sometimes a cystoscopy or ultrasound are used for diagnosis.

Treatment options

Treatment is tailored to the type, location, and severity of the hyperplasia. For benign cases without atypia, watchful waiting or hormone therapy may be sufficient. However, for atypical hyperplasia or symptoms that impact quality of life, more definitive action is often necessary.

Treatment for endometrial hyperplasia

• Hormonal Therapy: Progestin treatment, often in the form of oral medication, injections, or a progestin-releasing IUD, is a common approach to counteract the effects of estrogen and cause the endometrium to thin.
• Hysterectomy: Surgical removal of the uterus may be recommended for atypical hyperplasia, particularly in postmenopausal women or those who do not wish to preserve fertility, as it completely eliminates the risk of progression to cancer.
• Endometrial Ablation: This procedure destroys the uterine lining and is an option for certain cases, especially for women who have completed childbearing.

Treatment for BPH

• Medication: Medications can be used to relax the smooth muscles of the prostate (alpha-blockers) or shrink the prostate gland itself (5-alpha-reductase inhibitors).
• Minimally Invasive Procedures: Various procedures can be performed in-office to reduce the size of the prostate tissue.
• Surgery: Surgical options, such as transurethral resection of the prostate (TURP), are available for more severe cases.

Treatment for LEGH

• Watchful Waiting: For benign LEGH, surveillance may be an option, particularly if the lesion is small and asymptomatic.
• Hysterectomy: Due to the potential link to adenocarcinoma, hysterectomy is often recommended for atypical LEGH (ALEGH).

Comparison of glandular hyperplasias

Feature	Endometrial Hyperplasia	Benign Prostatic Hyperplasia (BPH)	Lobular Endocervical Glandular Hyperplasia (LEGH)
Affected Organ	Endometrium (uterine lining)	Prostate gland	Cervix
Primary Cause	Unopposed estrogen	Aging and hormonal shifts	Genetic predisposition (e.g., PJS), hormonal
Key Symptoms	Abnormal uterine bleeding, postmenopausal bleeding	Urinary frequency, weak stream, nocturia	Watery vaginal discharge
Link to Cancer?	Atypical form (EIN) is precancerous	No direct link, but can increase PSA	Atypical form (ALEGH) is precancerous
Common Treatment	Progestin therapy, hysterectomy	Medication, minimally invasive procedures	Surveillance or hysterectomy

Conclusion

Glandular hyperplasia is a condition characterized by an abnormal increase in glandular cells, which can occur in various organs like the uterus, prostate, and cervix. Its significance and treatment depend heavily on the specific type and whether the cells exhibit atypical features. While many forms are benign, some, particularly those classified as atypical, are considered precancerous and require close monitoring and appropriate medical intervention to prevent progression to cancer. Early and accurate diagnosis through procedures like biopsy is paramount for determining the correct course of action. Whether managed with medication, watchful waiting, or surgery, understanding the specifics of glandular hyperplasia is the first step toward effective health management. For more in-depth medical information and to determine the best path forward for your specific situation, it is important to consult a healthcare professional. For additional authoritative information on health topics, consider exploring the National Institutes of Health website at https://www.nih.gov.

Frequently Asked Questions

Is glandular hyperplasia a type of cancer?

No, glandular hyperplasia is not cancer, but it is an increase in the number of normal-looking glandular cells. However, certain types, especially those with atypia (abnormal cells), can be considered precancerous lesions and may increase the risk of developing cancer over time.

What is the most common cause of glandular hyperplasia?

For endometrial hyperplasia, the most common cause is unopposed estrogen, where the uterine lining is over-stimulated by estrogen without sufficient progesterone. In older men, benign prostatic hyperplasia (BPH) is commonly caused by age-related hormonal changes.

How is glandular hyperplasia diagnosed?

Diagnosis typically involves taking a biopsy, or tissue sample, from the affected area. This can be done through procedures like an endometrial biopsy, D&C, or surgical excision, and the tissue is then examined under a microscope.

Can glandular hyperplasia be treated with medication?

Yes, many forms of glandular hyperplasia, especially non-atypical types, can be treated with medication. For endometrial hyperplasia, progestin therapy is often used. For BPH, medications can help relax the prostate muscles or shrink the gland.

What are the treatment options if the hyperplasia is atypical?

Atypical hyperplasia carries a higher risk of developing into cancer. For conditions like atypical endometrial hyperplasia, a hysterectomy (removal of the uterus) may be recommended, particularly for postmenopausal women or those who have completed their family.

Is glandular hyperplasia painful?

Pain is not a universal symptom of glandular hyperplasia. For instance, endometrial hyperplasia may cause heavy or painful periods in some cases, but BPH typically causes urinary symptoms rather than pain. Other types may be asymptomatic.

How can one reduce the risk of glandular hyperplasia?

The risk can be managed by addressing underlying causes. For example, maintaining a healthy weight and, for postmenopausal women using hormone therapy, ensuring progestin is included with estrogen can help lower the risk of endometrial hyperplasia.