A 52-year-old nulliparous woman with a history of diabetes complains that her menstrual blood fl ow is more abundant than usual. During the last two menstrual cycles, she noticed spotting throughout the entire cycle. The patient is obese (BMI = 32 kg/m2), and her blood pressure is 160/100 mm Hg. An ultrasound examination reveals a thickened endometrial stripe with a polypoid mass in the uterine fundus. The patient undergoes a hysterectomy. The uterus is opened to reveal a partially necrotic mass (shown in the image). A biopsy of the mass shows moderately differentiated adenocarcinoma. Which of the following represents the most likely precursor of this patient’s malignant disease?
- Adenomyosis
- Atypical hyperplasia
- Chronic endometritis
- Complex hyperplasia
- Glandular metaplasia