Difference between revisions of "Endometrium"
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The '''endometrium''' is typically biopsied because of abnormal bleeding. | The '''endometrium''' is typically biopsied because of abnormal bleeding. | ||
===Indications=== | |||
Biopsies done for bleeding: | Biopsies done for bleeding: | ||
*Too much bleeding (if premenopausal) - ''AUB'' = abnormal uterine bleeding. | *Too much bleeding (if premenopausal) - ''AUB'' = abnormal uterine bleeding. | ||
*Post-menopausal bleeding. | *Post-menopausal bleeding. | ||
*Dysfunctional uterine bleeding | *Dysfunctional uterine bleeding [[AKA]] ''DUB'' - may get D&C if they fail medical management.<ref>URL: [http://emedicine.medscape.com/article/257007-treatment http://emedicine.medscape.com/article/257007-treatment]. Accessed on: 15 July 2010.</ref> | ||
**DUB is diagnosed if other causes of bleeding are excluded | **DUB is diagnosed if other causes of bleeding are excluded. | ||
===Normal microscopic findings=== | |||
*Endocervical glands are commonly seen, as is endocervical mucous. | *Endocervical glands are commonly seen, as is endocervical mucous. | ||
**This is 'cause the gynecologist scrapes some off on the way in or out. | **This is 'cause the gynecologist scrapes some off on the way in or out. | ||
| Line 29: | Line 30: | ||
#Glands round? | #Glands round? | ||
#*Round is normal. | #*Round is normal. | ||
#*Irregular - may be seen in menses, endometrial hyperplasia | #*Irregular - may be seen in menses, endometrial hyperplasia, disordered proliferative endometrium. | ||
#Glands pseudostratified? | #Glands pseudostratified? | ||
#* | #*Pseudostratified glands are normal in the proliferative phase. | ||
===High power=== | ===High power=== | ||
| Line 62: | Line 63: | ||
==Dating endometrium== | ==Dating endometrium== | ||
===Proliferative phase=== | ===Proliferative phase=== | ||
* | *Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, NO vacuolation, NO mucus secretion. | ||
**Key features: pseudostratification, mitoses. | **Key features: pseudostratification, mitoses. | ||
* | *Stroma: cellular stroma (spindle cells), mitoses. | ||
Note: | Note: | ||
| Line 72: | Line 73: | ||
===Secretory phase=== | ===Secretory phase=== | ||
*Early secretory phase - post-ovulatory day 1-5: | *Early secretory phase - post-ovulatory day 1-5: | ||
** | **Glands: secretory vacuoles. | ||
***First basal to the epithelial nuclei (infranuclear vacuoles). | ***First basal to the epithelial nuclei (infranuclear vacuoles). | ||
***Then apical to the epithelial nuclei (supranuclear vacuoles). | ***Then apical to the epithelial nuclei (supranuclear vacuoles). | ||
| Line 80: | Line 81: | ||
**Stroma: Edema (empty space around the glands). | **Stroma: Edema (empty space around the glands). | ||
*Late secretory phase ( | *Late secretory phase (beginning) - post-ovulatory day 9-12: | ||
**Stroma: | **Stroma: | ||
***Spiral arterioles. | ***Spiral arterioles. | ||
| Line 132: | Line 133: | ||
==Endometrial carcinoma== | ==Endometrial carcinoma== | ||
{{main|Endometrial carcinoma}} | {{main|Endometrial carcinoma}} | ||
Most common gynecologic malignancy.<ref name=pmid19332248>{{cite journal |author=Lu KH |title=Management of early-stage endometrial cancer |journal=Semin. Oncol. |volume=36 |issue=2 |pages=137–44 |year=2009 |month=April |pmid=19332248 |doi=10.1053/j.seminoncol.2008.12.005 |url=}}</ref> | |||
==See also== | ==See also== | ||
Revision as of 15:28, 15 July 2010
The endometrium is typically biopsied because of abnormal bleeding.
Indications
Biopsies done for bleeding:
- Too much bleeding (if premenopausal) - AUB = abnormal uterine bleeding.
- Post-menopausal bleeding.
- Dysfunctional uterine bleeding AKA DUB - may get D&C if they fail medical management.[1]
- DUB is diagnosed if other causes of bleeding are excluded.
Normal microscopic findings
- Endocervical glands are commonly seen, as is endocervical mucous.
- This is 'cause the gynecologist scrapes some off on the way in or out.
Endocervical glands vs. Endometrial glands
Endocervical
- Less hyperchromatic.
- Nuclei round & small.
- Cell borders usually well-defined.
Endometrial
- More hyperchromatic.
- Nuclei columnar.
A simple approach
Low power
- Decide whether you're look at endometrium.
- Gland-to-stroma ratio normal?
- 1:3 is normal.
- If gland-to-stroma ratio is increased... think endometrial hyperplasia.
- If glands are fused to one another or cribriform... think endometrial carcinoma.
- Glands round?
- Round is normal.
- Irregular - may be seen in menses, endometrial hyperplasia, disordered proliferative endometrium.
- Glands pseudostratified?
- Pseudostratified glands are normal in the proliferative phase.
High power
- Mitoses present in the glands?
- Present in the proliferative phase, hyperplasias, malignancies.
- Mitoses present in the stroma?
- Present in the proliferative phase, hyperplasias, malignancies.
- Mucous present in the glands?
- Present in the secretory phase.
- Inflammatory cells present?
- Some are normal during menses.
Endometrial polyp
Epidemiology
- Very common.
Microscopy
Features:[2]
- Large blood vessels (muscular) - key feature.
- Fibrotic stroma - key feature.
- Polypoid shape - epithelium on three sides.
- May not be seen... as polyp is fragmented on removal.
Notes:
- Endometrial glands may be out of phase with surrounding endometrium.
- Often proliferative.
- +/-Cystic dilation of glands.
- Cellular stroma.
Dating endometrium
Proliferative phase
- Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, NO vacuolation, NO mucus secretion.
- Key features: pseudostratification, mitoses.
- Stroma: cellular stroma (spindle cells), mitoses.
Note:
- Proliferative phase = folicular phase.
- Gynecologists prefer the ovarian descriptor, i.e. follicular phase; pathologists go by what they see, i.e. proliferative endometrium.
Secretory phase
- Early secretory phase - post-ovulatory day 1-5:
- Glands: secretory vacuoles.
- First basal to the epithelial nuclei (infranuclear vacuoles).
- Then apical to the epithelial nuclei (supranuclear vacuoles).
- Glands: secretory vacuoles.
- Mid secretory phase - post-ovulatory day 6-8:
- Glands: Mucus in glands.
- Stroma: Edema (empty space around the glands).
- Late secretory phase (beginning) - post-ovulatory day 9-12:
- Stroma:
- Spiral arterioles.
- Predecidual changes -- mnemonic NEW:
- Nucleus central.
- Eosinophilic cytoplasm key feature (may be subtle to the novice).
- Well-defined cell borders.
- Stroma:
- Premenstrual
- Stroma: Neutrophils, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation" (Image: Endometrial stromal condensation (WC)).
- Glands: Apoptosis at the base of the gland.[3]
Notes:
- Secretory phase = luteal phase.
- Gynecologists prefer the ovarian descriptor, i.e. luteal phase; pathologists go by what they see, i.e. Secretions in the (endometrial) glands.
- When the patient is >40 years, some advocate the use of the term proliferative type endometrium (instead of the term proliferative endometrium).[6]
- Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.[7]
Abnormalities of endometrium
Disordered proliferative phase
- Association: anovulation.
Features:[8]
- Proliferative type endometrium with:
- Cystic dilation of glands without secretions.
- +/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium).
Notes:
- Proliferative phase endometrium:
- Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, NO vacuolation, NO mucus secretion, abundant mitoses.
- Stroma: cellular, stroma (spindle cells), mitoses.
Endometrium of a woman taking OCP
Features:[9]
- Inactive glands.
- Stroma decidualized -- mnemonic NEW:
- Nucleus central.
- Eosinophilic cytoplasm.
- Well-defined cell borders.
Postmenopausal women
- If a woman is truly postmenopausal, mitoses in the glandular epithelium is pretty much always pathologic.
- Exception is inflammation... e.g. the person has had several biopsy attempts and was seeded with pathogens.
Endometrial hyperplasia
Main article: Endometrial hyperplasia
Can be thought of as a precursor lesion for endometrial carcinoma.
Endometrial carcinoma
Main article: Endometrial carcinoma
Most common gynecologic malignancy.[10]
See also
References
- ↑ URL: http://emedicine.medscape.com/article/257007-treatment. Accessed on: 15 July 2010.
- ↑ URL: http://www.pathologyoutlines.com/uterus.html#endopolyp.
- ↑ TC. 22 June 2009.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1081. ISBN 0-7216-0187-1.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.
- ↑ GAG. Jan 2009
- ↑ GAG. 6 Oct 2009.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1080 and 1082. ISBN 0-7216-0187-1.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1082. ISBN 0-7216-0187-1.
- ↑ Lu KH (April 2009). "Management of early-stage endometrial cancer". Semin. Oncol. 36 (2): 137–44. doi:10.1053/j.seminoncol.2008.12.005. PMID 19332248.