Difference between revisions of "Disordered proliferative endometrium"

Disordered proliferative endometrium
	Diagnosis in short
	; Disordered proliferative endometrium. H&E stain.
LM	proliferative endometrial glands (pseudostratified nuclei + mitoses) with focally abnormal glands (glands >2x normal size; irregular shape -- typically with inflection points; >4 glands involved (dilated)), +/-stromal condensation, gland-to-stromal ratio normal, not within an endometrial polyp
LM DDx	proliferative phase endometrium,simple endometrial hyperplasia, benign endometrial polyp
Site	endometrium
Prognosis	benign
Treatment	followup - re-biopsy

Latest revision as of 12:41, 13 February 2019

Disordered proliferative endometrium, abbreviated DPE, is an abnormal endometrial finding with some features of simple endometrial hyperplasia.

General

Association: anovulation.
Benign - can be grouped with normal.^[1]

Treatment:

Progesterone^[2] versus observation.^[3]

Image:

Treatment algorithm based on endometrial biopsy results (jabfm.org).^[3]

Microscopic

Features:^[4]

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 four glands involved (dilated).
+/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium).

Notes:

Dilated glands often have tubal metaplasia.^{[citation needed]}
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 - may have gland dilation.
Anovulatory endometrium - some consider this a synonym, see relation to disordered proliferative endometrium.

Images

DPE - low mag.
DPE - intermed. mag.
DPE - intermed. mag.
DPE - high mag.
DPE - high mag.

Endometrial stromal condensation - high mag. (WC/Nephron)

www:

Sign out

ENDOMETRIUM, BIOPSY:
- DISORDERED PROLIFERATIVE ENDOMETRIUM.

With endocervix

ENDOMETRIUM, BIOPSY:
- DISORDERED PROLIFERATIVE ENDOMETRIUM.
- BENIGN ENDOCERVICAL MUCOSA.

Waffle a bit

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.

ENDOMETRIUM, CURETTAGE:
- PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH GLAND DILATION AND SMALL BLOOD
  VESSELS, SEE COMMENT.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
A fibrotic stroma is not present. The findings may represent a remnant of the previously
excised endometrial polyp or disordered proliferative endometrium. Follow-up is suggested.

Micro

The sections show a well-sampled endometrium. Mitotic figures are identified within the glands and stroma. Irregular, moderately enlarged glands are seen (only) in one of several fragments; most of the endometrial glands are round, regular and small.

No stromal condensation is apparent. No secretions are in the glands.

There are no back-to-back glands. No nuclear atypia is apparent. No thick-walled blood vessels are apparent.

References

↑ Sherman, ME.; Ronnett, BM.; Ioffe, OB.; Richesson, DA.; Rush, BB.; Glass, AG.; Chatterjee, N.; Duggan, MA. et al. (Jul 2008). "Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification.". Int J Gynecol Pathol 27 (3): 318-25. doi:10.1097/PGP.0b013e3181659167. PMID 18580308.
↑ McCluggage, WG. (Aug 2006). "My approach to the interpretation of endometrial biopsies and curettings.". J Clin Pathol 59 (8): 801-12. doi:10.1136/jcp.2005.029702. PMID 16873562.
↑ ^3.0 ^3.1 Ely, JW.; Kennedy, CM.; Clark, EC.; Bowdler, NC.. "Abnormal uterine bleeding: a management algorithm.". J Am Board Fam Med 19 (6): 590-602. PMID 17090792. http://www.jabfm.org/content/19/6/590.full.
↑ 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.
↑ URL: http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235. Accessed on: 11 December 2012.

[pmid18580308-1] Sherman, ME.; Ronnett, BM.; Ioffe, OB.; Richesson, DA.; Rush, BB.; Glass, AG.; Chatterjee, N.; Duggan, MA. et al. (Jul 2008). "Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification.". Int J Gynecol Pathol 27 (3): 318-25. doi:10.1097/PGP.0b013e3181659167. PMID 18580308.

[pmid16873562-2] McCluggage, WG. (Aug 2006). "My approach to the interpretation of endometrial biopsies and curettings.". J Clin Pathol 59 (8): 801-12. doi:10.1136/jcp.2005.029702. PMID 16873562.

[pmid17090792-3] 3.0 ^3.1 Ely, JW.; Kennedy, CM.; Clark, EC.; Bowdler, NC.. "Abnormal uterine bleeding: a management algorithm.". J Am Board Fam Med 19 (6): 590-602. PMID 17090792. http://www.jabfm.org/content/19/6/590.full.

[Ref_PBoD1080-4] 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.

[glowm-5] URL: http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235. Accessed on: 11 December 2012.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
-#redirect [[Endometrium#Disordered_proliferative_endometrium]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Disordered proliferative endometrium -- low mag.jpg
+| Width      =
+| Caption    = Disordered proliferative endometrium. [[H&E stain]].
+| Synonyms   =
+| Micro      = proliferative endometrial glands (pseudostratified nuclei + mitoses) with focally abnormal glands (glands >2x normal size; irregular shape -- typically with inflection points; >4 glands involved (dilated)), +/-stromal condensation, gland-to-stromal ratio normal, not within an endometrial polyp
+| Subtypes   =
+| LMDDx      = [[proliferative phase endometrium]],[[simple endometrial hyperplasia]], [[benign endometrial polyp]]
+| Stains     =
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      =
+| Grossing   =
+| Site       = [[endometrium]]
+| Assdx      =
+| Syndromes  =
+| Clinicalhx =
+| Signs      =
+| Symptoms   =
+| Prevalence =
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign
+| Other      =
+| ClinDDx    =
+| Tx         = followup - re-biopsy
+}}
+'''Disordered proliferative endometrium''', abbreviated '''DPE''', is an abnormal [[endometrium|endometrial]] finding with some features of [[simple endometrial hyperplasia]].
+==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>{{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 }}</ref> 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 algorithm 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 four 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]] - may have gland dilation.
+*[[Anovulatory endometrium]] - some consider this a synonym, see ''[[relation to disordered proliferative endometrium]]''.
+===Images===
+<gallery>
+Image: Disordered proliferative endometrium -- low mag.jpg | DPE - low mag.
+Image: Disordered proliferative endometrium -- intermed mag.jpg | DPE - intermed. mag.
+Image: Disordered proliferative endometrium - alt -- intermed mag.jpg | DPE - intermed. mag.
+Image: Disordered proliferative endometrium -- high mag.jpg | DPE - high mag.
+Image: Disordered proliferative endometrium - alt -- high mag.jpg | DPE - high mag.
+</gallery>
+<gallery>
+Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation - high mag. (WC/Nephron)
+</gallery>
+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)].
+==Sign out==
+<pre>
+ENDOMETRIUM, BIOPSY:
+- DISORDERED PROLIFERATIVE ENDOMETRIUM.
+</pre>
+====With endocervix====
+<pre>
+ENDOMETRIUM, BIOPSY:
+- DISORDERED PROLIFERATIVE ENDOMETRIUM.
+- BENIGN ENDOCERVICAL MUCOSA.
+</pre>
+====Waffle a bit====
+<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>
+ENDOMETRIUM, CURETTAGE:
+- PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH GLAND DILATION AND SMALL BLOOD
+  VESSELS, SEE COMMENT.
+- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
+COMMENT:
+A fibrotic stroma is not present. The findings may represent a remnant of the previously
+excised endometrial polyp or disordered proliferative endometrium. Follow-up is suggested.
+</pre>
+===Micro===
+The sections show a well-sampled endometrium. Mitotic figures are identified within the
+glands and stroma. Irregular, moderately enlarged glands are seen (only) in one of several
+fragments; most of the endometrial glands are round, regular and small.
+No stromal condensation is apparent. No secretions are in the glands.
+There are no back-to-back glands. No nuclear atypia is apparent. No thick-walled blood
+vessels are apparent.
+==See also==
+*[[Endometrium]].
+*[[Simple endometrial hyperplasia]].
+*[[Waffle diagnosis]].
+==References==
+{{Reflist|2}}
+[[Category:Endometrium]]
 [[Category:Diagnosis]]