Difference between revisions of "Secretory phase endometrium"

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'''Secretory phase endometrium''', abbreviated '''SPE''', is a common diagnosis is [[endometrium|endometrial]] specimens.
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Secretory phase endometrium -- intermed mag.jpg
| Width      =
| Caption    = Secretory phase. [[H&E stain]].
| Micro      = dependent on day post-ovulation - see microscopic
| Subtypes  =
| LMDDx      = [[endometrial hyperplasia with secretory changes]], [[endometrium with hormonal changes]],[[proliferative phase endometrium]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[endometrium]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      = normal finding
| ClinDDx    =
}}
'''Secretory phase endometrium''', abbreviated '''SPE''', is a common diagnosis in [[endometrium|endometrial]] specimens.


==General==
==General==
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===Premenstrual===
===Premenstrual===
*Stroma: [[neutrophil]]s, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
*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>
*Glands: [[apoptosis]] at the base of the gland.<ref>Colgan T. 22 June 2009.</ref>


Notes:  
Notes:  
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*[[Proliferative phase endometrium]] - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles ''or'' <50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref>
*[[Proliferative phase endometrium]] - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles ''or'' <50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref>


Image:
===Images===
<gallery>
<gallery>
Image: Early secretory phase endometrium -- intermed mag.jpg | Early SPE - intermed. mag. (WC)
Image: Early secretory phase endometrium -- high mag.jpg | Early SPE - high mag. (WC)
Image: Early secretory phase endometrium -- very high mag.jpg | Early SPE - very high mag. (WC)
</gallery>
<gallery>
Image: Secretory phase endometrium -- low mag.jpg | Late SPE - low mag. (WC)
Image: Secretory phase endometrium -- intermed mag.jpg | Late SPE - intermed. mag. (WC)
Image: Secretory phase endometrium -- high mag.jpg | Late SPE - high mag. (WC)
</gallery>
<gallery>
Image:Endometrium_Secretory-Type_Endometrium_10x1.JPG | Early secretory phase endometrium. (WC)
Image:Endometrium_Secretory_20x1.jpg | Early secretory phase endometrium. (WC)
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation. (WC/Nephron)
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation. (WC/Nephron)
</gallery>
</gallery>


===Sign out===
==Sign out==
<pre>
<pre>
ENDOMETRIUM, BIOPSY:  
ENDOMETRIUM, BIOPSY:  
- SECRETORY PHASE ENDOMETRIUM.
</pre>
<pre>
ENDOMETRIUM, ASPIRATION:
- SECRETORY PHASE ENDOMETRIUM.
- SECRETORY PHASE ENDOMETRIUM.
</pre>
</pre>
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- SECRETORY PHASE ENDOMETRIUM, EARLY.
- SECRETORY PHASE ENDOMETRIUM, EARLY.
</pre>
</pre>
====With additional stuff====
===With additional stuff===
<pre>
<pre>
ENDOMETRIUM, BIOPSY:  
ENDOMETRIUM, BIOPSY:  
Line 87: Line 133:
</pre>
</pre>


====Micro====
===Evidence of shedding===
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.
<pre>
ENDOMETRIUM, CURETTAGE:
- SECRETORY PHASE ENDOMETRIUM WITH FINDINGS SUGGESTIVE OF SHEDDING (EPITHELIAL
  APOPTOSIS, INFLAMMATORY CELLS - ESPECIALLY NEUTROPHILS).
- BENIGN EXOCERVICAL AND ENDOCERVICAL MUCOSA.
</pre>
 
===Micro===
The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucus within them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent.


==See also==
==See also==

Latest revision as of 12:37, 13 February 2019

Secretory phase endometrium
Diagnosis in short

Secretory phase. H&E stain.

LM dependent on day post-ovulation - see microscopic
LM DDx endometrial hyperplasia with secretory changes, endometrium with hormonal changes,proliferative phase endometrium
Site endometrium

Other normal finding

Secretory phase endometrium, abbreviated SPE, is a common diagnosis in endometrial specimens.

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:[1]

  • 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:[1]

  • Glands: Mucus in glands.
  • Stroma: Edema (empty space around the glands).

Late secretory phase

Features - post-ovulatory day 9-12:[1]

  • Stroma:
    • Spiral arterioles.
    • Predecidual changes -- mnemonic NEW:
      1. Nucleus central.
      2. Eosinophilic cytoplasm key feature (may be subtle to the novice).
      3. Well-defined cell borders.

Premenstrual

  • Stroma: neutrophils, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
  • Glands: apoptosis at the base of the gland.[2]

Notes:

  • Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.[3]
  • Gland-to-stroma ratio is increased in late secretory phase and menstruation.[4]
  • 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:

Images

Sign out

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, ASPIRATION:
- SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, CURETTAGE: 
- SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM, EARLY.

With additional stuff

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
- SCANT ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. 
ENDOMETRIUM, BIOPSY:
- SECRETORY PHASE ENDOMETRIUM.
- BENIGN SUPERFICIAL EXOCERVICAL EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL EPITHELIUM.

Evidence of shedding

ENDOMETRIUM, CURETTAGE:
- SECRETORY PHASE ENDOMETRIUM WITH FINDINGS SUGGESTIVE OF SHEDDING (EPITHELIAL
  APOPTOSIS, INFLAMMATORY CELLS - ESPECIALLY NEUTROPHILS).
- BENIGN EXOCERVICAL AND ENDOCERVICAL MUCOSA.

Micro

The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucus within them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent.

See also

References

  1. 1.0 1.1 1.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.
  2. Colgan T. 22 June 2009.
  3. GAG. 6 Oct 2009.
  4. URL: http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed on: 6 December 2012.
  5. Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.