Difference between revisions of "Endometrium with squamous morules"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Squamous morule b - endometrium -- high mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Squamous morule. [[H&E stain]].
| Micro      =
| Micro      = well-circumscribed ball of squamoid cells -- cells have a whorled arrangement, moderate eosinophilic cytoplasm and a bland nucleus
| Subtypes  =
| Subtypes  =
| LMDDx      = [[endometrial hyperplasia]], [[endometrial carcinoma]] - esp. [[endometrioid endometrial carcinoma]], [[uterine leiomyoma]]  
| LMDDx      = [[endometrial hyperplasia]], [[endometrial carcinoma]] - esp. [[endometrioid endometrial carcinoma]], [[uterine leiomyoma]], [[atypical polypoid adenomyoma]]
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  = benign
| Prognosis  = benign in itself, strong assoc. with malignancy
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =
}}
}}
:''Squamous morules'' redirects here.
'''Endometrium with squamous morules''' is important to recognize as squamous morules are strongly associated with [[malignancy]].
'''Endometrium with squamous morules''' is important to recognize as squamous morules are strongly associated with [[malignancy]].


==General==
==General==
*Benign finding in itself.
*Benign finding in itself.
*Strong association of with malignancy.<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>
*Strong association with malignancy.<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>
**Associated with glandular lesions, i.e. endometrial hyperplasia and adenocarcinoma, ''not'' neoplastic squamous lesions.<ref>{{Cite journal  | last1 = Lin | first1 = MC. | last2 = Lomo | first2 = L. | last3 = Baak | first3 = JP. | last4 = Eng | first4 = C. | last5 = Ince | first5 = TA. | last6 = Crum | first6 = CP. | last7 = Mutter | first7 = GL. | title = Squamous morules are functionally inert elements of premalignant endometrial neoplasia. | journal = Mod Pathol | volume = 22 | issue = 2 | pages = 167-74 | month = Feb | year = 2009 | doi = 10.1038/modpathol.2008.146 | PMID = 19180120 }}</ref>
**Associated with glandular lesions, i.e. endometrial hyperplasia and adenocarcinoma, ''not'' neoplastic squamous lesions.<ref name=pmid19180120>{{Cite journal  | last1 = Lin | first1 = MC. | last2 = Lomo | first2 = L. | last3 = Baak | first3 = JP. | last4 = Eng | first4 = C. | last5 = Ince | first5 = TA. | last6 = Crum | first6 = CP. | last7 = Mutter | first7 = GL. | title = Squamous morules are functionally inert elements of premalignant endometrial neoplasia. | journal = Mod Pathol | volume = 22 | issue = 2 | pages = 167-74 | month = Feb | year = 2009 | doi = 10.1038/modpathol.2008.146 | PMID = 19180120 }}</ref>


==Microscopic==
==Microscopic==
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*Well-circumscribed ball of squamoid cells:
*Well-circumscribed ball of squamoid cells:
**Cells have a whorled arrangement.
**Cells have a whorled arrangement.
**Moderate cytoplasm.
**Moderate eosinophilic cytoplasm.
**Bland nucleus.
**Bland nucleus.
***Smooth nuclear membrane.
***Pale nuclear staining.
***Fine chromatin pattern.


DDx:
DDx:
Line 46: Line 50:
*[[Endometrioid endometrial carcinoma]].
*[[Endometrioid endometrial carcinoma]].
*[[Uterine leiomyoma]].
*[[Uterine leiomyoma]].
*[[Atypical polypoid adenomyoma]] - squamous morules ''and'' proliferation of smooth muscle.


===Images===
===Images===
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Image: Squamous morule 2 - endometrium -- extremely high mag.jpg | SM - extremely high mag.
Image: Squamous morule 2 - endometrium -- extremely high mag.jpg | SM - extremely high mag.
</gallery>
</gallery>
www:
*[http://www.nature.com/modpathol/journal/v22/n2/fig_tab/modpathol2008146f1.html Squamous morules - several (nature.com)].
*[http://www.nature.com/modpathol/journal/v22/n2/fig_tab/modpathol2008146f2.html Squamous morule and IHC stains (nature.com)].<ref name=pmid19180120>{{Cite journal  | last1 = Lin | first1 = MC. | last2 = Lomo | first2 = L. | last3 = Baak | first3 = JP. | last4 = Eng | first4 = C. | last5 = Ince | first5 = TA. | last6 = Crum | first6 = CP. | last7 = Mutter | first7 = GL. | title = Squamous morules are functionally inert elements of premalignant endometrial neoplasia. | journal = Mod Pathol | volume = 22 | issue = 2 | pages = 167-74 | month = Feb | year = 2009 | doi = 10.1038/modpathol.2008.146 | PMID = 19180120 }}</ref>
==IHC==
Features:<ref name=pmid19180120>{{Cite journal  | last1 = Lin | first1 = MC. | last2 = Lomo | first2 = L. | last3 = Baak | first3 = JP. | last4 = Eng | first4 = C. | last5 = Ince | first5 = TA. | last6 = Crum | first6 = CP. | last7 = Mutter | first7 = GL. | title = Squamous morules are functionally inert elements of premalignant endometrial neoplasia. | journal = Mod Pathol | volume = 22 | issue = 2 | pages = 167-74 | month = Feb | year = 2009 | doi = 10.1038/modpathol.2008.146 | PMID = 19180120 }}</ref>
*ER -ve.
*PR -ve.
*Ki-67 low.
==Sign out==
<pre>
ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A FOCUS OF SQUAMOUS MORULES, SEE COMMENT.
COMMENT:
There is no evidence of hyperplasia or malignancy in this biopsy; however, squamous morules
are associated with hyperplasia and malignancy.  Close follow-up and a re-biopsy (when
clinically indicated) are recommended.
</pre>
<pre>
ENDOMETRIUM, BIOPSY:
- EXTENSIVELY FRAGMENTED ENDOMETRIUM WITH ABUNDANT SQUAMOUS MORULES, SEE COMMENT.
- FOCAL STROMAL CONDENSATION SUGGESTIVE OF SHEDDING.
COMMENT:
The fragmentation makes it difficult to assess for hyperplasia. The squamous morules have
degenerative changes centrally. There is no evidence of malignancy in this biopsy.
Squamous morules are associated with hyperplasia and malignancy.  Close follow-up and a
re-biopsy (when clinically indicated) are recommended.
</pre>


==See also==
==See also==
*[[Endometrium]].
*[[Endometrium]].
*[[Endometrial hyperplasia]].
*[[Endometrial hyperplasia]].
*[[Metaplasias of the endometrium]].
*[[Endometrium with psammoma bodies]].


==References==
==References==

Latest revision as of 12:35, 18 June 2014

Endometrium with squamous morules
Diagnosis in short

Squamous morule. H&E stain.
LM well-circumscribed ball of squamoid cells -- cells have a whorled arrangement, moderate eosinophilic cytoplasm and a bland nucleus
LM DDx endometrial hyperplasia, endometrial carcinoma - esp. endometrioid endometrial carcinoma, uterine leiomyoma, atypical polypoid adenomyoma
Gross +/-endometrial thickening
Site endometrium
Associated Dx endometrial hyperplasia, endometrial carcinoma - esp. endometrioid endometrial carcinoma
Prognosis benign in itself, strong assoc. with malignancy
Squamous morules redirects here.

Endometrium with squamous morules is important to recognize as squamous morules are strongly associated with malignancy.

General

  • Benign finding in itself.
  • Strong association with malignancy.[1]
    • Associated with glandular lesions, i.e. endometrial hyperplasia and adenocarcinoma, not neoplastic squamous lesions.[2]

Microscopic

Features:

  • Well-circumscribed ball of squamoid cells:
    • Cells have a whorled arrangement.
    • Moderate eosinophilic cytoplasm.
    • Bland nucleus.
      • Smooth nuclear membrane.
      • Pale nuclear staining.
      • Fine chromatin pattern.

DDx:

Images

  • SM - intermed. mag.

  • SM - high mag.

  • SM - high mag.

  • SM - high mag.

  • SM - very high mag.

  • SM - extremely high mag.

www:

IHC

Features:[2]

  • ER -ve.
  • PR -ve.
  • Ki-67 low.

Sign out

ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A FOCUS OF SQUAMOUS MORULES, SEE COMMENT.

COMMENT:
There is no evidence of hyperplasia or malignancy in this biopsy; however, squamous morules
are associated with hyperplasia and malignancy.  Close follow-up and a re-biopsy (when
clinically indicated) are recommended. 

ENDOMETRIUM, BIOPSY:
- EXTENSIVELY FRAGMENTED ENDOMETRIUM WITH ABUNDANT SQUAMOUS MORULES, SEE COMMENT.
- FOCAL STROMAL CONDENSATION SUGGESTIVE OF SHEDDING.

COMMENT:
The fragmentation makes it difficult to assess for hyperplasia. The squamous morules have
degenerative changes centrally. There is no evidence of malignancy in this biopsy.

Squamous morules are associated with hyperplasia and malignancy.  Close follow-up and a
re-biopsy (when clinically indicated) are recommended.

See also

References

  1. ↑ Nicolae, A.; Preda, O.; Nogales, FF. (Feb 2011). "Endometrial metaplasias and reactive changes: a spectrum of altered differentiation.". J Clin Pathol 64 (2): 97-106. doi:10.1136/jcp.2010.085555. PMID 21126963.
  2. ↑ 2.0 2.1 2.2 Lin, MC.; Lomo, L.; Baak, JP.; Eng, C.; Ince, TA.; Crum, CP.; Mutter, GL. (Feb 2009). "Squamous morules are functionally inert elements of premalignant endometrial neoplasia.". Mod Pathol 22 (2): 167-74. doi:10.1038/modpathol.2008.146. PMID 19180120.
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