Difference between revisions of "Secretory phase endometrium"

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Secretory phase endometrium (view source)

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#redirect [[Endometrium#Secretory_phase_endometrium]]
'''Secretory phase endometrium''', abbreviated '''SPE''', is a common diagnosis is [[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>TC. 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>
 
Image:
<gallery>
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation. (WC/Nephron)
</gallery>
 
===Sign out===
<pre>
ENDOMETRIUM, BIOPSY:
- 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>
 
====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]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Endometrium]]
Michael
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