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Proliferative phase endometrium (view source)
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'''Proliferative phase endometrium''', abbreviated '''PPE''', is a very common [[diagnosis]] in [[endometrium|endometrial]] specimens. | '''Proliferative phase endometrium''', abbreviated '''PPE''', is a very common [[diagnosis]] in [[endometrium|endometrial]] specimens. | ||
It is also known as '''proliferative endometrium'''. | |||
==General== | ==General== | ||
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**"Exodus" pattern is a term used to describe exfoliation of endometrial cells during the proliferative phase. | **"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. | ***On [[pap test]]s this is associated with the classic double contoured balls of endometrial epithelium and stroma. | ||
*Proliferative activity is relatively common in postmenopausal women ~25% and probably associated with a small increased risk of malignancy.<ref name=pmid15280405>{{Cite journal | last1 = Sivridis | first1 = E. | last2 = Giatromanolaki | first2 = A. | title = Proliferative activity in postmenopausal endometrium: the lurking potential for giving rise to an endometrial adenocarcinoma. | journal = J Clin Pathol | volume = 57 | issue = 8 | pages = 840-4 | month = Aug | year = 2004 | doi = 10.1136/jcp.2003.014399 | PMID = 15280405 }}</ref> | |||
**~17% of asymptomatic (unselected) postmenopausal women have proliferative endometrium.<ref name=pmid1872332>{{Cite journal | last1 = Archer | first1 = DF. | last2 = McIntyre-Seltman | first2 = K. | last3 = Wilborn | first3 = WW. | last4 = Dowling | first4 = EA. | last5 = Cone | first5 = F. | last6 = Creasy | first6 = GW. | last7 = Kafrissen | first7 = ME. | title = Endometrial morphology in asymptomatic postmenopausal women. | journal = Am J Obstet Gynecol | volume = 165 | issue = 2 | pages = 317-20; discussion 320-2 | month = Aug | year = 1991 | doi = | PMID = 1872332 }}</ref> | |||
Note: | Note: | ||
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Notes: | 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> | * † 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. | ** There is no guidance on how hard one should look. Perhaps ~ 10 mm<sup>2</sup> with the 20x objective? Ten millimetres squared represents approximately ~ 10 fields of view with a microscope that has a 22 mm eye piece. | ||
* Significant negatives: | * Significant negatives: | ||
** No vacuolation. | ** No vacuolation. | ||
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===Images=== | ===Images=== | ||
====Case 1==== | |||
<gallery> | <gallery> | ||
Image: Proliferative phase endometrium -- very low mag.jpg | PPE - very low mag. (WC) | Image: Proliferative phase endometrium -- very low mag.jpg | PPE - very low mag. (WC) | ||
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Image: Proliferative phase endometrium -- high mag.jpg | PPE - high mag. (WC) | Image: Proliferative phase endometrium -- high mag.jpg | PPE - high mag. (WC) | ||
</gallery> | </gallery> | ||
====Case 2==== | |||
<gallery> | <gallery> | ||
Image:Endometrial epithelium with proliferation - intermed mag.jpg | Proliferative endometrial epithelium - intermed. mag. (WC) | Image:Endometrial epithelium with proliferation - intermed mag.jpg | Proliferative endometrial epithelium - intermed. mag. (WC) | ||
Image:Endometrial epithelium with proliferation - high mag.jpg | Proliferative endometrial epithelium - high mag. (WC) | Image:Endometrial epithelium with proliferation - high mag.jpg | Proliferative endometrial epithelium - high mag. (WC) | ||
</gallery> | </gallery> | ||
www | ====Case 3==== | ||
<gallery> | |||
Image: Coiled endometrium -- low mag.jpg | [[Coiled endometrium|Coiled proliferative endometrium]] - low mag. (WC) | |||
Image: Coiled endometrium -- intermed mag.jpg | Coiled proliferative endometrium - intermed. mag. (WC) | |||
Image: Coiled endometrium - alt -- intermed mag.jpg | Coiled proliferative endometrium - intermed. mag. (WC) | |||
Image: Coiled endometrium -- high mag.jpg | Coiled proliferative endometrium - intermed. mag. (WC) | |||
</gallery> | |||
====www==== | |||
*[http://library.med.utah.edu/WebPath/FEMHTML/FEM017.html Proliferative phase endometrium (utah.edu)]. | *[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> | *[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== | ==Sign out== | ||
<pre> | |||
Endometrium, Curettage: | |||
- Proliferative endometrium. | |||
- Scant benign endocervical mucosa present. | |||
- NEGATIVE for hyperplasia and NEGATIVE for malignancy. | |||
</pre> | |||
<pre> | <pre> | ||
ENDOMETRIUM, BIOPSY: | ENDOMETRIUM, BIOPSY: | ||
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- PROLIFERATIVE-TYPE ENDOMETRIUM, LIMITED STROMA PRESENT. | - PROLIFERATIVE-TYPE ENDOMETRIUM, LIMITED STROMA PRESENT. | ||
- STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. | - STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. | ||
- NO EVIDENCE OF HYPERPLASIA. | |||
</pre> | |||
====Mostly atrophic==== | |||
<pre> | |||
ENDOMETRIUM, ASPIRATION: | |||
- FRAGMENTS OF PREDOMINANT INACTIVE, VERY WEAKLY PROLIFERATIVE ENDOMETRIAL EPITHELIUM | |||
ATTACHED TO A VERY SMALL AMOUNT OF UNREMARKABLE STROMA. | |||
- AMOUNT OF STROMA NOT SUFFICIENT TO ASSESS GLAND-TO-STROMA RATIO. | |||
- NO EVIDENCE OF HYPERPLASIA. | - NO EVIDENCE OF HYPERPLASIA. | ||
</pre> | </pre> | ||
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=====Compression artifact present===== | =====Compression artifact present===== | ||
The sections show endometrium with proliferative glands without significant dilation or irregularity of shape. An increased gland density is seen focally, at the edge of one tissue fragment, in association with tearing of the stroma (compression artifact). The gland-to-stroma ratio is otherwise within normal limits. Mitotic activity is present. No nuclear atypia is apparent. Benign endocervical epithelium is present. | The sections show endometrium with proliferative glands without significant dilation or irregularity of shape. An increased gland density is seen focally, at the edge of one tissue fragment, in association with tearing of the stroma (compression artifact). The gland-to-stroma ratio is otherwise within normal limits. Mitotic activity is present. No nuclear atypia is apparent. Benign endocervical epithelium is present. | ||
=====Minimal dilation and irregularity===== | |||
:''Used when it is a bit funny looking but '''not''' enough for [[disordered proliferative endometrium]]''. | |||
The sections show endometrium with proliferative glands. Rare mildly dilated glands (~2x surrounding) with minimal irregularity of shape are present. The gland-to-stroma ratio is within normal limits. Mitotic activity is present. No nuclear atypia is apparent. | |||
==See also== | ==See also== | ||