Endometritis

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	+/-post-partum, +/-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:

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

Notes:

Neutrophils are normal in the context of menses.

DDx:

Menstrual endometrium - less neutrophils. (???)

Image:

Acute endometritis (stonybrook.edu).

Chronic endometritis

Features:^[1]

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.^[2]

Other findings:^[1]

+/-Necrosis.
Edema - common.
Hemorrhage.

Notes:

One plasma cell is not enough to call it.

DDx:

Menstrual endometrium - endometrial stromal condensation.

Images

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

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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.

References

↑ ^1.0 ^1.1 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/.
↑ 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.

[pmid18476109-1] 1.0 ^1.1 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/.

[pmid19801162-2] 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.

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