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

Secretory phase endometrium, abbreviated SPE, is a common diagnosis is 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:

• 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:

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

Late secretory phase

Features - post-ovulatory day 9-12:

• 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.

Notes:

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

Images

• 

  Early secretory phase endometrium. (WC)

• 

  Early secretory phase endometrium. (WC)

• 

  Endometrial stromal condensation. (WC/Nephron)

• 

  SPE - low mag. (WC)

• 

  SPE - intermed. mag. (WC)

• 

  SPE - high mag. (WC)

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 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.

See also

• Endometrium.