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| ==Indications for endometrial biopsy== | | ==Indications for endometrial biopsy== |
| Abnormal bleeding: | | Abnormal bleeding: |
| *Abnormal uterine bleeding (AUB). | | *[[Abnormal uterine bleeding]] (AUB). |
| **[[Dysfunctional uterine bleeding]], abbreviated ''DUB'', is diagnosed if other causes of bleeding are excluded. | | **[[Dysfunctional uterine bleeding]], abbreviated ''DUB'', is diagnosed if other causes of bleeding are excluded. |
| **''DUB'' may get a 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'' may get a 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> |
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| *[[Products of conception]] - dealt with in a separate article. | | *[[Products of conception]] - dealt with in a separate article. |
| *Dating of endometrium - infertility work-up. | | *Dating of endometrium - infertility work-up. |
| | |
| | ===Endometrial thickness on ultrasound=== |
| | *A thin endometrium on ultrasound has a very low risk of malignancy.<ref name=pmid15283934>{{Cite journal | last1 = Gambacciani | first1 = M. | last2 = Monteleone | first2 = P. | last3 = Ciaponi | first3 = M. | last4 = Sacco | first4 = A. | last5 = Genazzani | first5 = AR. | title = Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. | journal = Maturitas | volume = 48 | issue = 4 | pages = 421-4 | month = Aug | year = 2004 | doi = 10.1016/j.maturitas.2003.10.006 | PMID = 15283934 }}</ref> |
|
| |
|
| =Normal microscopic findings= | | =Normal microscopic findings= |
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| *[http://jcp.bmjjournals.com/content/59/8/801/F3.large.jpg Telescoping (bmjjournals.com)].<ref name=pmid16873562/> | | *[http://jcp.bmjjournals.com/content/59/8/801/F3.large.jpg Telescoping (bmjjournals.com)].<ref name=pmid16873562/> |
|
| |
|
| ==Endocervical epithelium verus endometrial epithelium== | | ==Endometrial gland compression artifact== |
| | :[[AKA]] ''compression artifact''. |
| | *Gland moulding. |
| | *Tearing of tissue around the compressed glands - '''key feature'''. |
| | *Usually at the edge of a tissue fragment. |
| | |
| | DDx: |
| | *Focal [[complex endometrial hyperplasia]]. |
| | |
| | ===Image=== |
| | *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/figure/fig4/ Gland compression (bmjjournals.com)].<ref name=pmid16873562/> |
| | |
| | ===Micro=== |
| | An increased gland density is seen focally, at the edge of one tissue fragment, in association with tearing of the stroma (compression artifact). |
| | |
| | ===See also=== |
| | *[[Endometrial gland coiling]]. |
| | |
| | ==Endocervical epithelium versus endometrial epithelium== |
| ===Table=== | | ===Table=== |
| {| class="wikitable sortable" | | {| class="wikitable sortable" |
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| | hyperchromatic | | | hyperchromatic |
| |- | | |- |
| | Nuclear-to-cytoplasm ratio | | | [[Nucleus-to-cytoplasm ratio]] |
| | moderate to high (1:2) | | | moderate to high (1:2) |
| | low (often 1:3) | | | low (often 1:3) |
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| *More hyperchromatic. | | *More hyperchromatic. |
| *Nuclei columnar. | | *Nuclei columnar. |
| | |
| | ===Images=== |
| | <gallery> |
| | Image:Endometrial and endocervical epithelium - low mag.jpg | Endocervical and endometrial epithelium - low mag. (WC) |
| | Image:Endometrial and endocervical epithelium - high mag.jpg | Endocervical and endometrial epithelium - high mag. (WC) |
| | </gallery> |
| | |
| | ==Metaplasias of the endometrium== |
| | The big table of metaplasias - adapted from Nicolae ''et al.'':<ref name=pmid21126963>{{Cite journal | last1 = Nicolae | first1 = A. | last2 = Preda | first2 = O. | last3 = Nogales | first3 = FF. | title = Endometrial metaplasias and reactive changes: a spectrum of altered differentiation. | journal = J Clin Pathol | volume = 64 | issue = 2 | pages = 97-106 | month = Feb | year = 2011 | doi = 10.1136/jcp.2010.085555 | PMID = 21126963 }}</ref> |
| | {| class="wikitable sortable" |
| | ! Metaplasia |
| | ! Subtypes |
| | ! Microscopic |
| | ! Notes |
| | ! Risk of malignancy |
| | ! Image |
| | |- |
| | | [[Endometrium with squamous morules|Morules]] |
| | | - |
| | | |
| | | |
| | | nearly always |
| | | [[Image:Squamous morule 2 - endometrium -- very high mag.jpg|150px|SM. (WC)]] |
| | |- |
| | | Ciliary |
| | | - |
| | | ciliated cells |
| | | usu. lumped together with ''tubal'', unopposed estrogen, [[endometriosis]] |
| | | frequent - [[endometrial hyperplasia]] (complex and simple), adenocarcinoma |
| | | |
| | |- |
| | | Tubal |
| | | complex, simple |
| | | ciliated cells, secretory cell, intercallary cells |
| | | usu. lumped together with ''ciliary'', unopposed estrogen, seen in [[endometriosis]] |
| | | frequent (complex only) - [[endometrial hyperplasia]] (complex and simple), adenocarcinoma |
| | | |
| | |- |
| | | Mucinous |
| | | complex, simple |
| | | |
| | | |
| | | frequent (complex only) |
| | | |
| | |- |
| | | Squamous |
| | | - |
| | | |
| | | |
| | | rare |
| | | |
| | |- |
| | | Papillary syncytial change (surface) |
| | | - |
| | | |
| | | |
| | | rare |
| | | |
| | |- |
| | | Eosinophilic, oxyphilic, oncocytic |
| | | |
| | | |
| | | |
| | | not known |
| | | |
| | |- |
| | | Clear cell (secretory) |
| | | - |
| | | |
| | | |
| | | not reported |
| | | |
| | |- |
| | | Stromal metaplasia |
| | | osseous, cartilaginous, adipose, smooth muscle, myoid, sex-cord like |
| | | |
| | | |
| | | not reported |
| | | |
| | |} |
|
| |
|
| =Tamoxifen effects= | | =Tamoxifen effects= |
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| - FRAGMENTS OF DETACHED SQUAMOUS EPITHELIUM, ENDOCERVICAL EPITHELIUM AND FOCALLY PROLIFERATIVE ENDOMETRIAL GLANDS. | | - FRAGMENTS OF DETACHED SQUAMOUS EPITHELIUM, ENDOCERVICAL EPITHELIUM AND FOCALLY PROLIFERATIVE ENDOMETRIAL GLANDS. |
| - ASSESSMENT LIMITED AS NO DEFINITE ENDOMETRIAL STROMA IS PRESENT. | | - ASSESSMENT LIMITED AS NO DEFINITE ENDOMETRIAL STROMA IS PRESENT. |
| | </pre> |
| | |
| | ===Possible endometrium - insufficient=== |
| | <pre> |
| | ENDOMETRIUM, ASPIRATION: |
| | - ONE MINUTE STRIP OF POSSIBLE NONPROLIFERATIVE ENDOMETRIAL EPITHELIUM, INSUFFICIENT |
| | FOR ADEQUATE DIAGNOSTIC ASSESSMENT. |
| | - VERY SCANT BENIGN STRIPPED ENDOCERVICAL EPITHELIUM. |
| | - VERY SCANT METAPLASTIC SQUAMOUS EPITHELIUM. |
| | |
| | COMMENT: |
| | Re-biopsy is advised. |
| | </pre> |
| | |
| | <pre> |
| | ENDOMETRIUM, BIOPSY: |
| | - BENIGN STRIPPED ENDOCERVICAL EPITHELIUM AND BENIGN INFLAMED ENDOCERVICAL MUCOSA. |
| | - NO DEFINITE ENDOMETRIUM WITH STROMA, INADEQUATE SPECIMEN. |
| </pre> | | </pre> |
|
| |
|
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| - SPECIMEN INADEQUATE; NO ENDOMETRIUM IDENTIFIED. | | - SPECIMEN INADEQUATE; NO ENDOMETRIUM IDENTIFIED. |
| - ONE VERY TINY FRAGMENT OF ENDOCERVICAL MUCOSA WITHOUT APPARENT PATHOLOGY. | | - ONE VERY TINY FRAGMENT OF ENDOCERVICAL MUCOSA WITHOUT APPARENT PATHOLOGY. |
| | </pre> |
| | |
| | <pre> |
| | ENDOMETRIUM, BIOPSY: |
| | - ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. |
| | - MICROGLANDULAR HYPERPLASIA AND FOCAL SQUAMOUS METAPLASIA. |
| | - NO DEFINITE ENDOMETRIUM IDENTIFIED, SUGGEST RE-BIOPSY. |
| </pre> | | </pre> |
|
| |
|
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| | round spaced pseudostratified glands | | | round spaced pseudostratified glands |
| | mitoses in glands and stroma | | | mitoses in glands and stroma |
| | [[disordered proliferative phase]], [[simple endometrial hyperplasia]], [[complex endometrial hyperplasia]] | | | [[disordered proliferative phase]], [[simple endometrial hyperplasia]], [[complex endometrial hyperplasia]], early [[secretory phase endometrium]] |
| | normal | | | normal |
| | Image | | | [[Image:Proliferative endometrium - very high mag.jpg|thumb|150px|center|Proliferative endometrium. (WC)]] |
| |- | | |- |
| | [[Secretory phase endometrium]] | | | [[Secretory phase endometrium]] |
| | irregular glands with secretions ''or'' simple glands with vacuoles | | | irregular glands with secretions ''or'' simple glands with vacuoles |
| | decidual changes (nucleus central, eosinophilic cytoplasm, well-defined cell borders) | | | decidual changes (nucleus central, eosinophilic cytoplasm, well-defined cell borders) |
| | | | | [[endometrial hyperplasia with secretory changes]], late [[proliferative phase endometrium]] |
| | | normal |
| | | [[Image:Secretory phase endometrium -- high mag.jpg|thumb|120px|center|Secretory phase endometrium. (WC)]] |
| | |- |
| | | [[Menstrual endometrium]] |
| | | stromal condensation |
| | | nonproliferative glands, stromal/epithelial neutrophils, glandular cell apoptosis |
| | | [[disordered proliferative phase]] |
| | normal | | | normal |
| | Image <!-- | | | Image |
| | |- |
| | | [[Benign endometrial polyp]] |
| | | fibrous stroma, muscular blood vessels |
| | | polypoid shape (epithelium on 3 sides), +/-gland dilation |
| | | [[disordered proliferative endometrium]] (DPE), [[simple endometrial hyperplasia]] (SEH) |
| | | DPE and SEH do ''not'' occur in polyps |
| | | [[Image:Benign endometrial polyp -- low mag.jpg|thumb|150px|center|Benign endometrial polyp. (WC)]] |
| |- | | |- |
| | Diagnosis | | | [[Endometrium with changes due to exogenous hormones]] |
| | | decidualized stroma (nucleus central, eosinophilic cytoplasm, well-defined cell borders) |
| | | inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses) |
| | | [[secretory phase endometrium]], [[endometrial hyperplasia with secretory changes]] |
| | | variant of normal |
| | | [[Image:Endometrium with hormone effect -- high mag.jpg|thumb|150px|center|Endometrium with changes due to exogenous hormones. (WC)]] |
| | |- |
| | | [[Atrophic endometrium]] |
| | | nonproliferative glands |
| | | no nuclear atypia, often without appreciable stroma |
| | | [[serous endometrial carcinoma]] |
| | | normal postmenopausal finding |
| | | [[Image:Nonproliferative endometrial epithelium - alt -- high mag.jpg|thumb|150px|center|Inactive endometrium. (WC)]] |
| | |- |
| | | [[Disordered proliferative endometrium]] |
| | | proliferative focally dilated & irregular glands (usu. with tubal metaplasia) |
| | | no nuclear atypia, +/-evidence of shedding (stromal condensation) |
| | | [[simple endometrial hyperplasia]], [[proliferative phase endometrium]] |
| | | can be thought of a [[waffle diagnosis]] |
| | | [[Image:Disordered proliferative endometrium -- low mag.jpg|thumb|150px|center|Disordered proliferative endometrium. (WC)]] |
| | |- <!-- |
| | | Diagnosis |
| | Key feature | | | Key feature |
| | Additional features | | | Additional features |
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| =Normal endometrium= | | =Normal endometrium= |
| ==Proliferative phase endometrium== | | ==Proliferative phase endometrium== |
| *Abbreviated ''PPE''.
| | {{Main|Proliferative phase endometrium}} |
| ===General===
| |
| *Day 1-13 in the protypical menstrual cycle of 28 days.
| |
| **May be ''day 5-13'' - if the menstruation is not included.
| |
| **"Exodus" pattern is a term used to describe exfoliation of endometrial cells during the proliferative phase.
| |
| ***On [[pap test]]s this is associated with the classic double contoured balls of endometrial epithelium and stroma.
| |
| | |
| Note:
| |
| *Proliferative phase = follicular phase.
| |
| **Gynecologists prefer the ovarian descriptor, i.e. ''follicular phase''; pathologists go by what they see, i.e. ''proliferative'' endometrium.
| |
| *When the patient is >40 years, some advocate the use of the term ''proliferative type endometrium'' (instead of the term ''proliferative endometrium'').<ref>GAG. January 2009.</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=pmid16873562/>
| |
| *Glands:
| |
| **Straight, tubular, composed of tall pseudostratified columnar cells - '''key feature'''.
| |
| **Mitotic figures - '''key feature'''. †
| |
| *Stroma:
| |
| **Cellular stroma (spindle cells).
| |
| **Mitoses.
| |
| ***Usually harder to find than in the glands.
| |
| | |
| Notes:
| |
| * † McCluggage says one shouldn't call ''PPE'' without mitoses, as some pseudostratification can be seen in [[atrophic endometrium]].<ref name=pmid16873562>{{Cite journal | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
| |
| ** There is no guidance on how hard one should look. VL suggests searching ~ 10 mm^2 with the 20x objective. This represents approximately ~ 10 fields of view with a microscope that has a 22 mm eye piece.
| |
| * Significant negatives:
| |
| ** No vacuolation.
| |
| ** No mucus secretion.
| |
| * Inflammation (neutrophils, rare plasma cell) & stromal breakdown common early in the proliferative phase.<ref name=Ref_GP197>{{Ref GP|197}}</ref>
| |
| | |
| DDx:
| |
| *[[Endometrial polyp]].
| |
| *[[Disordered proliferative endometrium]].
| |
| *[[Endometrial hyperplasia]]:
| |
| **[[Simple endometrial hyperplasia]].
| |
| **[[Complex endometrial hyperplasia]].
| |
| *[[Secretory phase endometrium]], early - >=50% of gland have subnuclear vacuoles ''and'' >=50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref>
| |
| | |
| | |
| Images:
| |
| *[http://library.med.utah.edu/WebPath/FEMHTML/FEM017.html Proliferative phase endometrium (utah.edu)].
| |
| *[http://www.cytochemistry.net/microanatomy/medical_lectures/028%20-%2019_16f.jpg Proliferative phase endometrium (cytochemistry.net)].<ref>URL: [http://www.cytochemistry.net/microanatomy/medical_lectures/oviduct_and_uterus.htm http://www.cytochemistry.net/microanatomy/medical_lectures/oviduct_and_uterus.htm]. Accessed on: 23 October 2012.</ref>
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - PROLIFERATIVE PHASE ENDOMETRIUM.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - PROLIFERATIVE PHASE ENDOMETRIUM.
| |
| - ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH A FIBROTIC STROMA.
| |
| - BENIGN STRIPPED ENDOCERVICAL EPITHELIUM.
| |
| - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
| | |
| ====Not quite normal====
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - EARLY SECRETORY PHASE ENDOMETRIUM.
| |
| - FOCUS OF CROWDED PROLIFERATIVE GLANDS, SEE COMMENT.
| |
| | |
| COMMENT:
| |
| There is a small focus of crowded and irregular proliferative glands
| |
| without cytologic atypia. The possibility of a polyp is considered but the vessels and
| |
| polyp-type stroma are lacking. Suggest clincal follow up with a consideration of a repeat
| |
| biopsy in 3 to 6 months to rule out a hyperplastic lesion.
| |
| </pre>
| |
| | |
| ====Post-menopausal====
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - PROLIFERATIVE TYPE ENDOMETRIUM.
| |
| -- NEGATIVE FOR HYPERPLASIA.
| |
| -- NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
| | |
| =====Micro=====
| |
| The sections show endometrium with proliferative glands without significant dilation or irregularity of shape. The gland-to-stroma ratio is within normal limits. Mitotic activity is mild. No nuclear atypia is apparent.
| |
|
| |
|
| ==Secretory phase endometrium== | | ==Secretory phase endometrium== |
| *Abbreviated ''SPE''.
| | {{Main|Secretory phase endometrium}} |
| ===General===
| |
| *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.
| |
| | |
| ===Gross===
| |
| *Thickened endometrium.
| |
| | |
| ===Microscopic===
| |
| ====Early secretory phase====
| |
| Features - post-ovulatory day 1-5:<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref>
| |
| *Glands: secretory vacuoles.
| |
| **First basal to the epithelial nuclei (infranuclear vacuoles).
| |
| **Then apical to the epithelial nuclei (supranuclear vacuoles).
| |
| *Mitoses may be present - common when vacuoles are subnuclear.
| |
| | |
| ====Mid secretory phase====
| |
| Features - post-ovulatory day 6-8:<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref>
| |
| *Glands: Mucus in glands.
| |
| *Stroma: Edema (empty space around the glands).
| |
| | |
| ====Late secretory phase====
| |
| Features - post-ovulatory day 9-12:<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref>
| |
| *Stroma:
| |
| **Spiral arterioles.
| |
| **Predecidual changes -- mnemonic ''NEW'':
| |
| **#Nucleus central.
| |
| **#Eosinophilic cytoplasm '''key feature''' (may be subtle to the novice).
| |
| **#Well-defined cell borders.
| |
| | |
| ====Premenstrual====
| |
| *Stroma: [[neutrophil]]s, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
| |
| *Glands: [[apoptosis]] at the base of the gland.<ref>TC. 22 June 2009.</ref>
| |
| | |
| Notes:
| |
| *Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.<ref>GAG. 6 Oct 2009.</ref>
| |
| *Gland-to-stroma ratio is increased in late secretory phase and menstruation.<ref>URL: [http://www.pathologyoutlines.com/topic/uteruspatternapproach.html http://www.pathologyoutlines.com/topic/uteruspatternapproach.html]. Accessed on: 6 December 2012.</ref>
| |
| *Endocervical epithelium (ECE) has a morphology similar to the epithelium of secretory phase endometrium (SPE):
| |
| **ECE - grey foamy appearing cytoplasm.
| |
| **SPE - eosinophilic cytoplasm.
| |
| ***Most useful feature to differentiate ECE and SPE is the accompanying stroma.
| |
| | |
| DDx:
| |
| *[[Endometrial hyperplasia with secretory changes]].
| |
| *[[Endometrium with hormonal changes]].
| |
| *[[Proliferative phase endometrium]] - may have some changes of secretory endometrium; <50% of gland have subnuclear vacuoles ''or'' <50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref>
| |
| | |
| Image:
| |
| <gallery>
| |
| Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation. (WC/Nephron)
| |
| </gallery>
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - SECRETORY PHASE ENDOMETRIUM.
| |
| </pre>
| |
| | |
| ====With additional stuff====
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - SECRETORY PHASE ENDOMETRIUM.
| |
| - SCANT ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - SECRETORY PHASE ENDOMETRIUM.
| |
| - ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - SECRETORY PHASE ENDOMETRIUM.
| |
| - BENIGN SUPERFICIAL EXOCERVICAL EPITHELIUM.
| |
| - SCANT BENIGN ENDOCERVICAL EPITHELIUM.
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucous with in them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent.
| |
|
| |
|
| ==Menstrual endometrium== | | ==Menstrual endometrium== |
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Non-proliferative endometrium. | | *Proliferative endometrium (mitoses).<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref> |
| **Apoptotic cells common.<ref name=pmid8744416>{{Cite journal | last1 = Spencer | first1 = SJ. | last2 = Cataldo | first2 = NA. | last3 = Jaffe | first3 = RB. | title = Apoptosis in the human female reproductive tract. | journal = Obstet Gynecol Surv | volume = 51 | issue = 5 | pages = 314-23 | month = May | year = 1996 | doi = | PMID = 8744416 }}</ref>
| | *Apoptotic cells common.<ref name=pmid8744416>{{Cite journal | last1 = Spencer | first1 = SJ. | last2 = Cataldo | first2 = NA. | last3 = Jaffe | first3 = RB. | title = Apoptosis in the human female reproductive tract. | journal = Obstet Gynecol Surv | volume = 51 | issue = 5 | pages = 314-23 | month = May | year = 1996 | doi = | PMID = 8744416 }}</ref> |
| *Tightly packed cellular balls of stromal cells with nuclear moulding. | | *Tightly packed cellular balls of stromal cells with nuclear moulding. |
| **Known as "blue balls". | | **Known as "blue balls". |
| **Tightly packed cellular stromal cells known as "stromal condensation". | | **Tightly packed cellular stromal cells known as "stromal condensation". |
| *Inflammation, esp. [[neutrophil]]s. | | *Inflammation, especially abundant [[neutrophil]]s. |
|
| |
|
| DDx: | | DDx: |
| *[[Small cell carcinoma]]. | | *[[Small cell carcinoma]] - proliferative activity in the moulded (stromal condensation-like) cells. |
| | *[[Anovulatory endometrium]] - less neutrophils. |
|
| |
|
| ====Images==== | | ====Images==== |
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|
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|
| ===Sign out=== | | ===Sign out=== |
| | <pre> |
| | Endometrium, Biopsy: |
| | - Consistent with menstrual endometrium. |
| | -- Weakly proliferative endometrial glands with apoptosis, fragmented. |
| | -- Abundant balls of condensed non-proliferative endometrial stroma and blood. |
| | </pre> |
| | |
| | ====Block letters==== |
| <pre> | | <pre> |
| ENDOMETRIUM, BIOPSY: | | ENDOMETRIUM, BIOPSY: |
| - CONSISTENT WITH MENSTRUAL ENDOMETRIUM: | | - CONSISTENT WITH MENSTRUAL ENDOMETRIUM: |
| -- STRIPPED NON-PROLIFERATIVE ENDOMETRIAL GLANDS. | | -- STRIPPED WEAKLY PROLIFERATIVE ENDOMETRIAL GLANDS. |
| -- BALLS OF CONDENSED ENDOMETRIAL STROMA. | | -- BALLS OF CONDENSED ENDOMETRIAL STROMA. |
| -- ABUNDANT NEUTROPHILS AND BLOOD. | | -- ABUNDANT NEUTROPHILS AND BLOOD. |
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| ENDOMETRIUM, BIOPSY: | | ENDOMETRIUM, BIOPSY: |
| - CONSISTENT WITH MENSTRUAL PHASE ENDOMETRIUM: | | - CONSISTENT WITH MENSTRUAL PHASE ENDOMETRIUM: |
| -- NON-PROLIFERATIVE ENDOMETRIAL GLANDS WITH NEUTROPHILS AND APOPTOSIS. | | -- WEAKLY PROLIFERATIVE ENDOMETRIAL GLANDS WITH NEUTROPHILS AND APOPTOSIS. |
| -- BALLS OF CONDENSED ENDOMETRIAL STROMA. | | -- BALLS OF CONDENSED ENDOMETRIAL STROMA. |
| -- BLOOD. | | -- BLOOD. |
| </pre> | | </pre> |
|
| |
|
| =Specific entities/abnormalities=
| |
| ==Arias-Stella reaction==
| |
| {{Main|Arias-Stella reaction}}
| |
| *Benign atypical endometrial changes associated with chorionic tissue -- may be seen in a completely normal pregnancy and misdiagnosed as a malignancy.<ref name=pmid11756756>{{Cite journal | last1 = Arias-Stella | first1 = J. | title = The Arias-Stella reaction: facts and fancies four decades after. | journal = Adv Anat Pathol | volume = 9 | issue = 1 | pages = 12-23 | month = Jan | year = 2002 | doi = | PMID = 11756756 }}</ref>
| |
|
| |
| ==Endometritis==
| |
| ===General===
| |
| *Usually post-delivery or post-instrumentation, e.g. previous biopsy.
| |
| *May be spontaneous, e.g. tuberculous endometritis.
| |
|
| |
| ===Microscopic===
| |
| ====Acute endometritis====
| |
| Features:
| |
| *Neutrophils clusters (>5 PMNs) in the:
| |
| **Endometrial stroma.
| |
| **Within uterine glands.
| |
|
| |
| Notes:
| |
| *Neutrophils are normal in the context of menses.
| |
|
| |
| Image:
| |
| *[http://www.hsc.stonybrook.edu/gyn-atlas/UT53.10.1.htm Acute endometritis (stonybrook.edu)].
| |
|
| |
| ====Chronic endometritis====
| |
| Features:<ref name=pmid18476109>{{Cite journal | last1 = Tawfik | first1 = O. | last2 = Venuti | first2 = S. | last3 = Brown | first3 = S. | last4 = Collins | first4 = J. | title = Immunohistochemical characterization of leukocytic subpopulations in chronic endometritis. | journal = Infect Dis Obstet Gynecol | volume = 4 | issue = 5 | pages = 287-93 | month = | year = 1996 | doi = 10.1155/S1064744996000555 | PMID = 18476109 | PMC = 2364507 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364507/}}</ref>
| |
| *Plasma cells with in the endometrial stroma - '''key feature'''.
| |
| **Usually superficial/close to the luminal aspect.
| |
| *Lymphocytic infiltrate - usu. marked.
| |
| **May form lymphoid aggregates - '''low power''' finding.
| |
|
| |
| Other findings:<ref name=pmid18476109/>
| |
| *+/-Necrosis.
| |
| *Edema - common.
| |
| *Hemorrhage.
| |
|
| |
| Notes:
| |
| *One [[plasma cell]] is not enough to call it.
| |
|
| |
| DDx:
| |
| *Mentrual endometrium - endometrial stromal condensation.
| |
|
| |
| ====Images====
| |
| <gallery>
| |
| Image:Endometritis_-_2_-_high_mag.jpg | Endometritis - high mag. (WC/Nephron)
| |
| Image:Endometritis_-_2_-_cropped_-_very_high_mag.jpg | Endometritis - very high mag. (WC/Nephron)
| |
| </gallery>
| |
| www:
| |
| *[http://www.webpathology.com/image.asp?n=2&Case=565 Chronic endometritis (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?n=3&Case=565 Chronic endometritis (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?n=6&Case=565 Tuberculous endometritis (webpathology.com)].
| |
|
| |
| ===Sign out===
| |
| <pre> | | <pre> |
| ENDOMETRIUM, BIOPSY: | | ENDOMETRIUM, BIOPSY: |
| - CHRONIC ENDOMETRITIS. | | - VERY WEAKLY PROLIFERATIVE ENDOMETRIAL GLANDS WITH NEUTROPHILS AND APOPTOSIS. |
| | - BALLS OF CONDENSED ENDOMETRIAL STROMA AND BLOOD. |
| | - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. |
| </pre> | | </pre> |
|
| |
|
| ====Not definite endometritis==== | | ====Consistent with menstrual endometrium==== |
| <pre> | | <pre> |
| ENDOMETRIUM, ASPIRATION: | | ENDOMETRIUM, ASPIRATION: |
| - PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE AND VERY RARE | | - CONSISTENT WITH MENSTRUAL ENDOMETRIUM (FRAGMENTED ENDOMETRIUM WITH PSEUDOSTRATIFIED |
| PLASMA CELLS, SEE COMMENT. | | GLANDS WITH APOPTOTIC CELLS, ABUNDANT NEUTROPHILS, CONDENSED ENDOMETRIAL STROMA |
| - NEGATIVE FOR HYPERPLASIA. | | AND BLOOD). |
| | | - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. |
| COMMENT:
| |
| The lymphocytic infiltrate and plasma cells raise the possibility of a mild chronic
| |
| endometritis; clinical correlation is suggested.
| |
| </pre> | | </pre> |
|
| |
| ====Nonspecific lymphocytic infiltrate====
| |
| If not more than one plasma cell is apparent after searching.
| |
| <pre> | | <pre> |
| ENDOMETRIUM, ASPIRATION: | | ENDOMETRIUM, ASPIRATION: |
| - PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE. | | - CONSISTENT WITH MENSTRUAL ENDOMETRIUM (FRAGMENTED ENDOMETRIUM WITH SIMPLE |
| - SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
| | GLANDS WITH APOPTOTIC CELLS, ABUNDANT NEUTROPHILS, CONDENSED ENDOMETRIAL STROMA |
| - NEGATIVE FOR HYPERPLASIA.
| | (FOCAL) AND BLOOD). |
| </pre>
| |
| | |
| =====Micro=====
| |
| The section show proliferative endometrium with a normal gland-to-stroma ratio. Mitotic activity is seen in the glands and stroma. No cytologic atypia is apparent. A mild nonspecific lymphocytic infiltrate is present.
| |
| | |
| No lymphoid aggregates are apparent. No significant number of plasma cells is apparent.
| |
| | |
| ==Benign endometrial polyp==
| |
| :''Uterine polyp'' redirects here.
| |
| *Abbreviated ''BEP''.
| |
| *[[AKA]] ''endometrial polyp''.
| |
| | |
| ===General===
| |
| *Very common.
| |
| *May be a cause of [[menorrhagia]] (heavy & long menses).
| |
| | |
| ===Gross===
| |
| *Polypoid mass in the endometrial cavity.
| |
| | |
| Gross DDx:
| |
| *[[Secretory phase endometrium]].<ref name=pmid16873562/>
| |
| *Pedunculated [[uterine leiomyoma|leiomyoma]].
| |
| ===Microscopic===
| |
| Features - diagnostic criteria:<ref name=pmid16873562>{{Cite journal | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
| |
| #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.
| |
| | |
| Glandular changes common:<ref name=pmid16873562/>
| |
| *Endometrial glands may be out of phase with surrounding endometrium.
| |
| **Often proliferative.
| |
| *+/-Cystic dilation of glands/unusual shapes
| |
| **[[Simple endometrial hyperplasia]] should ''not'' be diagnosed in a polyp!
| |
| *+/-Focal gland crowding.
| |
| | |
| Notes:
| |
| #Apparently benign polyps should be examined closely at the surface for in situ & invasive malignancies.
| |
| #Stroma often cellular.
| |
| | |
| DDx:
| |
| *[[Adenofibroma]].
| |
| *[[Cervical polyp]] - have endocervical mucosa.
| |
| *Lower uterine segment - have endocervical epithelium and lack the thick-walled blood vessels.<ref name=pmid16873562/>
| |
| *[[Endometrial carcinoma]] - esp. [[serous carcinoma of the endometrium]].
| |
| | |
| ===Sign out===
| |
| ====Non-proliferative====
| |
| <pre>
| |
| ENDOMETRIUM, CURETTAGE:
| |
| - BENIGN ENDOMETRIAL POLYP.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM ("POLYPS"), REMOVAL:
| |
| - BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
| |
| WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
| |
| </pre>
| |
| | |
| =====Suggestive of polyp=====
| |
| <pre>
| |
| ENDOMETRIUM, CURETTAGE:
| |
| - POLYPOID NONPROLIFERATIVE ENDOMETRIUM WITH FOCALLY PROMINENT SMALL BLOOD VESSELS AND
| |
| FIBROUS STROMA, SUGGESTIVE OF BENIGN POLYP.
| |
| - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. | | - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. |
| </pre>
| |
|
| |
|
| ====Proliferative====
| |
| <pre>
| |
| ENDOMETRIUM, CURETTAGE:
| |
| - BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE ACTIVITY.
| |
| </pre> | | </pre> |
|
| |
|
| Note:
| | ====Late menses==== |
| *It is useful to comment on whether non-polypoid endometrium is proliferative (if present), esp. in menopausal women.<ref name=pmid16873562/>
| |
| | |
| ====Polyp with disordered proliferative phase in the background==== | |
| <pre> | | <pre> |
| ENDOMETRIUM, BIOPSY: | | ENDOMETRIUM, ASPIRATION: |
| - BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE GLANDS AND FOCAL GLAND DILATION. | | - ENDOMETRIAL GLANDS WITH APOPTOTIC CELLS, INFILTRATING NEUTROPHILS, |
| - SUSPICIOUS FOR A BACKGROUND OF DISORDERED PROLIFERATIVE | | AND GLANDULAR PROLIFERATIVE ACTIVITY. |
| PHASE ENDOMETRIUM, SEE COMMENT.
| | - BALLS OF CONDENSED ENDOMETRIAL STROMA. |
| - STRIPPED BENIGN ENDOCERVICAL EPITHELIUM. | | - SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. |
| | - NEGATIVE FOR HYPERPLASIA. |
|
| |
|
| COMMENT: | | COMMENT: |
| The endometrium sampled is proliferative with focal gland dilation throughout. The | | The findings are most in keeping with late menstrual endometrium. |
| features of a polyp (large muscular blood vessels, fibrous stroma and polypoid fragments of
| |
| endometrium) are only focally present, suggesting there is a background of disordered
| |
| proliferative phase endometrium. Clinical correlation is suggested.
| |
| </pre> | | </pre> |
|
| |
|
| ==Anovulatory endometrium== | | =Specific entities/abnormalities= |
| | ==Adipose tissue on endometrial biopsy== |
| | *[[AKA]] ''fat on endometrial biopsy''. |
| ===General=== | | ===General=== |
| *May be used as a synonym for ''[[disordered proliferative phase]]''.<ref>URL: [http://www.surgpath4u.com/caseviewer.php?case_no=382 http://www.surgpath4u.com/caseviewer.php?case_no=382]. Accessed on: 9 May 2013.</ref> | | *Benign. |
| | | *Raises the possibility of perforation - should prompt a phone call to the clinician. |
| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Shedding: | | *Adipose tissue, benign - '''key finding'''. |
| **Stromal condensation.
| | *Definite endometrium. |
| **Apoptotic endometrial epithelium. | |
| *Non-proliferative glands.
| |
|
| |
|
| DDx: | | DDx: |
| *[[Disordered proliferative phase]]. | | *Extraneous tissue. |
| *[[Simple endometrial hyperplasia]]. | | **[[Tissue floater]]. |
| *[[Menstrual endometrium]]. | | **Pick-up. |
|
| |
|
| ===Sign out===
| | ====Images==== |
| <pre>
| |
| ENDOMETRIUM, CURETTAGE:
| |
| - NON-PROLIFERATIVE ENDOMETRIUM WITH SMALL ROUND GLANDS AND SHEDDING, SEE COMMENT.
| |
| - BENIGN ENDOCERVICAL MUCOSA.
| |
| - NEGATIVE FOR HYPERPLASIA.
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| | |
| COMMENT:
| |
| The changes are suggestive of anovulatory bleeding.
| |
| </pre>
| |
| | |
| ==Disordered proliferative endometrium==
| |
| *Abbreviated ''DPE''.
| |
| *[[AKA]] ''endometrium with disordered proliferative phase''.
| |
| *[[AKA]] ''disordered proliferative phase''.
| |
| | |
| ===General===
| |
| *Association: anovulation.
| |
| *Benign - can be grouped with ''normal''.<ref name=pmid18580308>{{Cite journal | last1 = Sherman | first1 = ME. | last2 = Ronnett | first2 = BM. | last3 = Ioffe | first3 = OB. | last4 = Richesson | first4 = DA. | last5 = Rush | first5 = BB. | last6 = Glass | first6 = AG. | last7 = Chatterjee | first7 = N. | last8 = Duggan | first8 = MA. | last9 = Lacey | first9 = JV. | title = Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification. | journal = Int J Gynecol Pathol | volume = 27 | issue = 3 | pages = 318-25 | month = Jul | year = 2008 | doi = 10.1097/PGP.0b013e3181659167 | PMID = 18580308 }}</ref>
| |
| | |
| Treatment:
| |
| *Progesterone<ref name=pmid16873562/> versus observation.<ref name=pmid17090792>{{Cite journal | last1 = Ely | first1 = JW. | last2 = Kennedy | first2 = CM. | last3 = Clark | first3 = EC. | last4 = Bowdler | first4 = NC. | title = Abnormal uterine bleeding: a management algorithm. | journal = J Am Board Fam Med | volume = 19 | issue = 6 | pages = 590-602 | month = | year = | doi = | PMID = 17090792 | url = http://www.jabfm.org/content/19/6/590.full }}</ref>
| |
| | |
| Image:
| |
| *[http://www.jabfm.org/content/19/6/590/F8.expansion.html Treatment algorithim based on endometrial biopsy results (jabfm.org)].<ref name=pmid17090792/>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_PBoD1080>{{Ref PBoD|1080 and 1082}}</ref>
| |
| *Proliferative type endometrium with:
| |
| **Cystic dilation of glands focally that do not have (glandular) secretions - '''key feature'''.
| |
| ***Glands >2x normal size - usually 3-4x normal.
| |
| ***Irregular shape, e.g. gland contour has inflection points.
| |
| ***Greater than fours glands involved (dilated).
| |
| *+/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium).
| |
| | |
| Notes:
| |
| *Dilated glands often have tubal metaplasia.{{fact}}
| |
| *Eosinophilic syncytial metaplasia - common.
| |
| **Features: abundant eosinophilic cytoplasm, mild nuclear atypia +/-loss of nuclear stratification, no mitoses).
| |
| | |
| DDx:
| |
| *[[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.
| |
| *[[Simple endometrial hyperplasia]] without atypia - architectural atypia diffuse.
| |
| *[[Benign endometrial polyp]].
| |
| | |
| ====Images==== | |
| www:
| |
| *[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig15 DPE (sciencedirect.com)].
| |
| *[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig18 DPE (sciencedirect.com)].
| |
| *[http://www.glowm.com/resources/glowm/uploads/1225247516_03-50291-007_small.jpg DPE (glowm.com)].<ref name=glowm>URL: [http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235 http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235]. Accessed on: 11 December 2012.</ref>
| |
| *[http://www.hsc.stonybrook.edu/gyn-atlas/UT3431B.htm DPE (stonybrook.edu)].
| |
| <gallery> | | <gallery> |
| Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation - high mag. (WC/Nephron) | | Image: Endometrium and adipose tissue - alt -- intermed mag.jpg | EMB with fat - intermed. mag. |
| | Image: Endometrium and adipose tissue -- intermed mag.jpg | EMB with fat - intermed. mag. |
| | Image: Endometrium and adipose tissue -- high mag.jpg | EMB with fat - high mag. |
| </gallery> | | </gallery> |
| | |
| ===Sign out=== | | ===Sign out=== |
| <pre> | | <pre> |
| ENDOMETRIUM, BIOPSY: | | ENDOMETRIUM, BIOPSY: |
| - DISORDERED PROLIFERATIVE ENDOMETRIUM. | | - BENIGN ADIPOSE TISSUE, SEE COMMENT. |
| </pre>
| | - PROLIFERATIVE PHASE ENDOMETRIUM. |
|
| |
|
| =====With endocervix=====
| | COMMENT: |
| <pre>
| | The presence of adipose tissue raises the possibility of perforation. |
| ENDOMETRIUM, BIOPSY:
| |
| - DISORDERED PROLIFERATIVE ENDOMETRIUM.
| |
| - BENIGN ENDOCERVICAL MUCOSA.
| |
| </pre>
| |
|
| |
|
| =====Waffle a bit=====
| | The findings were briefly discussed with Dr. Brown on November 6, 2009. |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - COMPATIBLE WITH DISORDERED PROLIFERATIVE ENDOMETRIUM (FRAGMENTS OF PROLIFERATIVE
| |
| ENDOMETRIUM WITH EVIDENCE OF SHEDDING AND VERY RARE GLAND DILATION).
| |
| - VERY SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
| |
| - NEGATIVE FOR ENDOMETRIAL HYPERPLASIA.
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| </pre> | | </pre> |
|
| |
|
| ====Micro==== | | ==Arias-Stella reaction== |
| The sections show a well-sampled endometrium. Mitotic figures are identified within the | | {{Main|Arias-Stella reaction}} |
| glands and stroma. Irregular, moderately enlarged glands are seen (only) in one of several
| | *Benign atypical endometrial changes associated with chorionic tissue -- may be seen in a completely normal pregnancy and misdiagnosed as a malignancy.<ref name=pmid11756756>{{Cite journal | last1 = Arias-Stella | first1 = J. | title = The Arias-Stella reaction: facts and fancies four decades after. | journal = Adv Anat Pathol | volume = 9 | issue = 1 | pages = 12-23 | month = Jan | year = 2002 | doi = | PMID = 11756756 }}</ref> |
| fragments; most of the endometrial glands are round, regular and small.
| |
|
| |
|
| No stromal condensation is apparent. No secretions are in the glands.
| | ==Endometritis== |
| | {{Main|Endometritis}} |
|
| |
|
| There are no back-to-back glands. No nuclear atypia is apparent. No thick-walled blood
| | ==Benign endometrial polyp== |
| vessels are apparent.
| | {{Main|Benign endometrial polyp}} |
|
| |
|
| ==Endometrial changes of oral contraception== | | ==Anovulatory endometrium== |
| {{ Infobox external links
| | {{Main|Anovulatory endometrium}} |
| | Name = Endometrial changes of oral contraception
| |
| | EHVSC = 10170
| |
| | pathprotocols =
| |
| | wikipedia =
| |
| | pathoutlines =
| |
| }}
| |
| {{Main|Oral contraceptive pill}} | |
| :''Endometrium with hormonal changes'' and ''OCP endometrium'' redirect here.
| |
| *[[AKA]] ''oral contraceptive effect''.
| |
| ===General===
| |
| *Very common.
| |
| *Most pills a mix of progesterone and estrogen.
| |
| **The progesterone is what generates the characteristic appearance -- that is similar to pregnancy.
| |
|
| |
|
| ===Microscopic=== | | ==Disordered proliferative endometrium== |
| Features:<ref name=Ref_PBoD1082>{{Ref PBoD|1082}}</ref>
| | *Abbreviated ''DPE''. |
| *Inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses). | | *[[AKA]] ''endometrium with disordered proliferative phase''. |
| *Stroma decidualized -- mnemonic ''NEW'': | | *[[AKA]] ''disordered proliferative phase''. |
| **Nucleus central.
| | {{Main|Disordered proliferative endometrium}} |
| **Eosinophilic cytoplasm. | |
| **Well-defined cell borders.
| |
|
| |
|
| DDx:
| | ==Endometrium with changes due to exogenous hormones== |
| *[[Endometrial hyperplasia with secretory changes]] - proliferative activity.
| | {{Main|Endometrium with changes due to exogenous hormones}} |
| *[[Secretory phase endometrium]] - glandular changes of the secretory phase (cytoplasmic vacuolization), secretions in the glands.
| |
| | |
| ====Image====
| |
| <gallery>
| |
| Image:Endometrium_ocp_use3.jpg | Endometrium of woman on an OCP. (WC/Nephron)
| |
| </gallery>
| |
| ===Sign out===
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - NON-PROLIFERATIVE ENDOMETRIAL GLANDS WITH STROMAL DECIDUALIZATION, CONSISTENT
| |
| WITH EXOGENOUS HORMONES.
| |
| </pre>
| |
| | |
| ====OCP effect and shedding endometrium====
| |
| <pre>
| |
| ENDOMETRIUM, ASPIRATION:
| |
| - ENDOMETRIUM WITH NONPROLIFERATIVE ENDOMETRIAL GLANDS AND
| |
| STROMAL DECIDUALIZATION, COMPATIBLE WITH EXOGENOUS HORMONES.
| |
| - EVIDENCE OF ENDOMETRIAL SHEDDING (BALLS OF CONDENSED STROMA
| |
| ASSOCIATED NEUTROPHILS, AND BLOOD).
| |
| - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
|
| |
|
| ==Atrophic endometrium== | | ==Atrophic endometrium== |
| :''Inactive endometrium'' redirect here.
| |
| *[[AKA]] ''atrophy of the endometrium''. | | *[[AKA]] ''atrophy of the endometrium''. |
| *[[AKA]] ''endometrial atrophy''. | | *[[AKA]] ''endometrial atrophy''. |
| ===General===
| | {{Main|Inactive endometrium}} |
| *Endometrium of normal postmenopausal women.
| |
| **Menopause typically happens at around 50 years old.
| |
| *Very common diagnosis.
| |
| **Atrophy may be associated with bleeding and therefore biopsied to rule-out hyperplasia and malignancy.
| |
| | |
| ===Gross===
| |
| *Thin endometrium.
| |
|
| |
|
| ===Microscopic=== | | ==Ablated endometrium== |
| Features:
| | {{Main|Ablated endometrium}} |
| *Glands - small columnar cells:
| |
| **Moderate quantity of eosinophilic cytoplasm.
| |
| **Ovoid (palisaded) nuclei +/- nuclear pseudostratification.<ref name=pmid16873562>{{Cite journal | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
| |
| **Eosinophilic cytoplasm.
| |
| **No mitoses.
| |
| *Architecture:
| |
| **+/-Cystic dilation.
| |
|
| |
|
| Notes:
| | ==Endometrium with squamous morules== |
| *If a woman is truly postmenopausal, mitoses in the glandular epithelium is pathologic until demonstrated otherwise.
| | {{Main|Endometrium with squamous morules}} |
| **The exceptions are [[benign endometrial polyp]], [[uterine prolapse]], and possibly inflammation (e.g. the person has had several biopsy attempts and was seeded with pathogens).
| |
| | |
| DDx:
| |
| *[[Proliferative phase endometrium]] - esp. if there is pseudostratification.
| |
| *[[Serous carcinoma of the endometrium]].
| |
| | |
| Images:
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/figure/fig1/ Atrophic endometrium (nih.gov)].<ref name=pmid16873562/>
| |
| | |
| ===Sign out===
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - NON-PROLIFERATIVE ENDOMETRIUM.
| |
| - BENIGN SQUAMOUS EPITHELIUM WITH METAPLASTIC CHANGE.
| |
| - SCANT ENDOCERVICAL MUCOSA WITH REACTIVE CHANGES.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - NON-PROLIFERATIVE ENDOMETRIUM.
| |
| - BENIGN STRIPPED ENDOCERVICAL EPITHELIUM.
| |
| - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
| | |
| =====Micro=====
| |
| The sections show small fragments of endometrium. The gland-to-stroma ratio is normal. The glands are small and round, and have a pseudostratified epithelium.
| |
| | |
| Mitotic figures are not identified within the glands or stroma. No stromal condensation is apparent. No secretions are in the glands. No nuclear atypia is apparent.
| |
| | |
| Scant benign endocervical tissue (stripped epithelium and mucosa) is present.
| |
| | |
| ====Limited stroma====
| |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - STRIPPED NONPROLIFERATIVE ENDOMETRIAL EPITHELIUM; NO APPRECIABLE STROMA PRESENT.
| |
| - SCANT ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
| |
| - MINUTE FRAGMENTS OF SQUAMOUS EPITHELIUM WITHOUT APPARENT PATHOLOGY.
| |
| </pre>
| |
| | |
| <pre>
| |
| ENDOMETRIUM, BIOPSY:
| |
| - SCANT STRIPPED NON-PROLIFERATIVE ENDOMETRIAL EPITHELIUM.
| |
| - VERY SMALL FRAGMENT OF ENDOMETRIAL STROMA.
| |
| - TUBAL METAPLASTIC EPITHELIUM.
| |
| </pre>
| |
|
| |
|
| =====Micro===== | | ==Endometrium with psammoma bodies== |
| The sections show stripped endometrial epithelium and stripped tubal-type epithelium.
| | {{Main|Endometrium with psammoma bodies}} |
| No mitotic activity is identified. No nuclear atypia is apparent. A small fragment of
| |
| definite endometrial stroma is present. The gland-to-stroma ratio cannot be assessed due
| |
| to the limited stroma.
| |
|
| |
|
| ==Endometrial hyperplasia== | | ==Endometrial hyperplasia== |
Line 839: |
Line 555: |
| *[[Uterine tumours]]. | | *[[Uterine tumours]]. |
| *[[Gynecologic pathology]]. | | *[[Gynecologic pathology]]. |
| | *[[Psammoma bodies]]. |
|
| |
|
| =References= | | =References= |
Line 844: |
Line 561: |
|
| |
|
| [[Category:Gynecologic pathology]] | | [[Category:Gynecologic pathology]] |
| | [[Category:Endometrium]] |