Difference between revisions of "Endometritis"

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#redirect [[Endometrium#Endometritis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Endometritis_-_2_-_cropped_-_very_high_mag.jpg
| Width      =
| Caption    = Chronic endometritis. [[H&E stain]].
| Synonyms  =
| Micro      = ''acute'': abundant [[neutrophils]], clusters >5 (in stroma & glands);<br> ''chronic'': plasma cells (key feature), often eosinophils, lymphoid aggregates
| Subtypes  = acute, chronic
| LMDDx      = [[menstrual endometrium]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[endometrium]]
| Assdx      =
| Syndromes  =
| Clinicalhx = +/-postpartum, +/-recent instrumentation
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Endometritis''' is inflammation of the [[endometrium]]. It usually subdivided into ''acute'' and ''chronic''.
 
==General==
*Usually post-delivery or post-instrumentation, e.g. previous biopsy.
*May be spontaneous, e.g. tuberculous endometritis.
 
==Microscopic==
===Acute endometritis===
Features:{{fact}}
*Neutrophils clusters (>5 [[PMN]]s) in the:
**Endometrial stroma.
**Within uterine glands.
 
Notes:
*Neutrophils are normal in the context of menses.
 
DDx:
*[[Menstrual endometrium]] - less neutrophils. (???)
 
====Kiviat definition====
Kiviat ''et al.'' definition - requires both:<ref name=pmid2137304>{{cite journal |author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, ''et al.'' |title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis |journal=Am. J. Surg. Pathol. |volume=14 |issue=2 |pages=167–75 |year=1990 |month=February |pmid=2137304 |doi= |url=}}</ref>
#>=5 [[PMN]]s in surface epithelium/400x magnification field of view.
#>=1 [[plasma cell]] in the endometrial stroma/120x magnification field of view.
 
Notes:
*Above definition is considered "widely accepted".<ref name=pmid>{{cite journal |author=Ross JD |title=What is endometritis and does it require treatment? |journal=Sex Transm Infect |volume=80 |issue=4 |pages=252–3 |year=2004 |month=August |pmid=15295119 |pmc=1744883 |doi=10.1136/sti.2004.009548 |url=}}</ref>
*Definition suffers from [[HPFitis]] and [[IPFitis]].
 
====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 - usually marked.
**May form lymphoid aggregates - '''low power''' finding.
*+/-Eosinophils - presence should prompt a search for plasma cells.<ref name=pmid19801162>{{Cite journal  | last1 = Adegboyega | first1 = PA. | last2 = Pei | first2 = Y. | last3 = McLarty | first3 = J. | title = Relationship between eosinophils and chronic endometritis. | journal = Hum Pathol | volume = 41 | issue = 1 | pages = 33-7 | month = Jan | year = 2010 | doi = 10.1016/j.humpath.2009.07.008 | PMID = 19801162 }}</ref>
 
Other findings:<ref name=pmid18476109/>
*+/-Necrosis.
*Edema - common.
*Hemorrhage.
 
Notes:
*One [[plasma cell]] is not enough to call it.<ref name=pmid21996319>{{cite journal |author=Vicetti Miguel RD, Chivukula M, Krishnamurti U, ''et al.'' |title=Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research |journal=Pathol. Res. Pract. |volume=207 |issue=11 |pages=680–5 |year=2011 |month=November |pmid=21996319 |pmc=3215901 |doi=10.1016/j.prp.2011.08.007 |url=}}</ref><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>
 
DDx:
*[[Menstrual 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>
ENDOMETRIUM, BIOPSY:
- CHRONIC ENDOMETRITIS.
</pre>
 
===Not definite endometritis===
<pre>
ENDOMETRIUM, ASPIRATION:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE AND VERY RARE
  PLASMA CELLS, SEE COMMENT.
- NEGATIVE FOR HYPERPLASIA.
 
COMMENT:
The lymphocytic infiltrate and plasma cells raise the possibility of a mild chronic
endometritis; clinical correlation is suggested.
</pre>
 
===Nonspecific lymphocytic infiltrate===
If not more than one plasma cell is apparent after searching.
<pre>
ENDOMETRIUM, ASPIRATION:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE.
- SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR HYPERPLASIA.
</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 eosinophils are apparent. No significant number of plasma cells is apparent.
 
=====Alternate=====
The sections show a fragmented nonproliferative endometrium with stromal decidualization
and focal glandular dilation. The gland-to-stroma ratio is within normal limits. No
cytologic atypia is apparent.
 
Lymphoid aggregates are present. Focally, rare eosinophils are identified. No significant
number of plasma cells is apparent.
 
==See also==
*[[Endometrium]].
 
==References==
{{Reflist|2}}
 
[[Category:Endometrium]]

Latest revision as of 17:52, 3 July 2014

Endometritis
Diagnosis in short

Chronic endometritis. H&E stain.
LM acute: abundant neutrophils, clusters >5 (in stroma & glands);
chronic: plasma cells (key feature), often eosinophils, lymphoid aggregates
Subtypes acute, chronic
LM DDx menstrual endometrium
Site endometrium
Clinical history +/-postpartum, +/-recent instrumentation
Prevalence uncommon
Prognosis benign

Endometritis is inflammation of the endometrium. It usually subdivided into acute and chronic.

General

  • Usually post-delivery or post-instrumentation, e.g. previous biopsy.
  • May be spontaneous, e.g. tuberculous endometritis.

Microscopic

Acute endometritis

Features:[citation needed]

  • Neutrophils clusters (>5 PMNs) in the:
    • Endometrial stroma.
    • Within uterine glands.

Notes:

  • Neutrophils are normal in the context of menses.

DDx:

Kiviat definition

Kiviat et al. definition - requires both:[1]

  1. >=5 PMNs in surface epithelium/400x magnification field of view.
  2. >=1 plasma cell in the endometrial stroma/120x magnification field of view.

Notes:

  • Above definition is considered "widely accepted".[2]
  • Definition suffers from HPFitis and IPFitis.

Image

Chronic endometritis

Features:[3]

  • Plasma cells with in the endometrial stroma - key feature.
    • Usually superficial/close to the luminal aspect.
  • Lymphocytic infiltrate - usually marked.
    • May form lymphoid aggregates - low power finding.
  • +/-Eosinophils - presence should prompt a search for plasma cells.[4]

Other findings:[3]

  • +/-Necrosis.
  • Edema - common.
  • Hemorrhage.

Notes:

DDx:

Images

  • Endometritis - high mag. (WC/Nephron)

  • Endometritis - very high mag. (WC/Nephron)

www:

Sign out

ENDOMETRIUM, BIOPSY:
- CHRONIC ENDOMETRITIS.

Not definite endometritis

ENDOMETRIUM, ASPIRATION:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE AND VERY RARE
  PLASMA CELLS, SEE COMMENT.
- NEGATIVE FOR HYPERPLASIA.

COMMENT:
The lymphocytic infiltrate and plasma cells raise the possibility of a mild chronic
endometritis; clinical correlation is suggested.

Nonspecific lymphocytic infiltrate

If not more than one plasma cell is apparent after searching. 

ENDOMETRIUM, ASPIRATION:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE.
- SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR HYPERPLASIA.

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 eosinophils are apparent. No significant number of plasma cells is apparent.

Alternate

The sections show a fragmented nonproliferative endometrium with stromal decidualization and focal glandular dilation. The gland-to-stroma ratio is within normal limits. No cytologic atypia is apparent.

Lymphoid aggregates are present. Focally, rare eosinophils are identified. No significant number of plasma cells is apparent.

See also

References

  1. ↑ Kiviat NB, Wølner-Hanssen P, Eschenbach DA, et al. (February 1990). "Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis". Am. J. Surg. Pathol. 14 (2): 167–75. PMID 2137304.
  2. ↑ Ross JD (August 2004). "What is endometritis and does it require treatment?". Sex Transm Infect 80 (4): 252–3. doi:10.1136/sti.2004.009548. PMC 1744883. PMID 15295119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744883/.
  3. ↑ 3.0 3.1 Tawfik, O.; Venuti, S.; Brown, S.; Collins, J. (1996). "Immunohistochemical characterization of leukocytic subpopulations in chronic endometritis.". Infect Dis Obstet Gynecol 4 (5): 287-93. doi:10.1155/S1064744996000555. PMC 2364507. PMID 18476109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364507/.
  4. ↑ Adegboyega, PA.; Pei, Y.; McLarty, J. (Jan 2010). "Relationship between eosinophils and chronic endometritis.". Hum Pathol 41 (1): 33-7. doi:10.1016/j.humpath.2009.07.008. PMID 19801162.
  5. ↑ Vicetti Miguel RD, Chivukula M, Krishnamurti U, et al. (November 2011). "Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research". Pathol. Res. Pract. 207 (11): 680–5. doi:10.1016/j.prp.2011.08.007. PMC 3215901. PMID 21996319. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215901/.
  6. ↑ 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.
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