Difference between revisions of "Secretory phase endometrium"

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

Latest revision as of 12:37, 13 February 2019

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:

Endometrial hyperplasia with secretory changes.
Endometrium with hormonal changes.
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.^[5]

Images

Early SPE - intermed. mag. (WC)
Early SPE - high mag. (WC)
Early SPE - very high mag. (WC)

Late SPE - low mag. (WC)
Late SPE - intermed. mag. (WC)
Late SPE - high mag. (WC)

Early secretory phase endometrium. (WC)
Early secretory phase endometrium. (WC)
Endometrial stromal condensation. (WC/Nephron)

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.

References

↑ ^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.
↑ Colgan T. 22 June 2009.
↑ GAG. 6 Oct 2009.
↑ URL: http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed on: 6 December 2012.
↑ Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.

[Ref_DCHH237-1] 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.

[Ref_EMB14-5] Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
-#redirect [[Endometrium#Secretory_phase_endometrium]]
+{{ 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==
+*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:<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref>
+*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:<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref>
+*Glands: Mucus in glands.
+*Stroma: Edema (empty space around the glands).
+===Late secretory phase===
+Features - post-ovulatory day 9-12:<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref>
+*Stroma:
+**Spiral arterioles.
+**Predecidual changes -- mnemonic ''NEW'':
+**#Nucleus central.
+**#Eosinophilic cytoplasm '''key feature''' (may be subtle to the novice).
+**#Well-defined cell borders.
+===Premenstrual===
+*Stroma: [[neutrophil]]s, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
+*Glands: [[apoptosis]] at the base of the gland.<ref>Colgan T. 22 June 2009.</ref>
+Notes:
+*Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.<ref>GAG. 6 Oct 2009.</ref>
+*Gland-to-stroma ratio is increased in late secretory phase and menstruation.<ref>URL: [http://www.pathologyoutlines.com/topic/uteruspatternapproach.html http://www.pathologyoutlines.com/topic/uteruspatternapproach.html]. Accessed on: 6 December 2012.</ref>
+*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:
+*[[Endometrial hyperplasia with secretory changes]].
+*[[Endometrium with hormonal changes]].
+*[[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>
+===Images===
+<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)
+</gallery>
+==Sign out==
+<pre>
+ENDOMETRIUM, BIOPSY:
+- SECRETORY PHASE ENDOMETRIUM.
+</pre>
+<pre>
+ENDOMETRIUM, ASPIRATION:
+- SECRETORY PHASE ENDOMETRIUM.
+</pre>
+<pre>
+ENDOMETRIUM, CURETTAGE:
+- SECRETORY PHASE ENDOMETRIUM.
+</pre>
+<pre>
+ENDOMETRIUM, BIOPSY:
+- SECRETORY PHASE ENDOMETRIUM, EARLY.
+</pre>
+===With additional stuff===
+<pre>
+ENDOMETRIUM, BIOPSY:
+- SECRETORY PHASE ENDOMETRIUM.
+- SCANT ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
+</pre>
+<pre>
+ENDOMETRIUM, BIOPSY:
+- SECRETORY PHASE ENDOMETRIUM.
+- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
+</pre>
+<pre>
+ENDOMETRIUM, BIOPSY:
+- SECRETORY PHASE ENDOMETRIUM.
+- BENIGN SUPERFICIAL EXOCERVICAL EPITHELIUM.
+- SCANT BENIGN ENDOCERVICAL EPITHELIUM.
+</pre>
+===Evidence of shedding===
+<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==
+*[[Endometrium]].
+==References==
+{{Reflist|2}}
 [[Category:Diagnosis]]
+[[Category:Endometrium]]