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| ===Endometrial thickness on ultrasound=== | | ===Endometrial thickness on ultrasound=== |
| *A thin endometrium on ultrasound has a very low risk of malignancy.<ref>15283934>{{Cite journal | last1 = Gambacciani | first1 = M. | last2 = Monteleone | first2 = P. | last3 = Ciaponi | first3 = M. | last4 = Sacco | first4 = A. | last5 = Genazzani | first5 = AR. | title = Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. | journal = Maturitas | volume = 48 | issue = 4 | pages = 421-4 | month = Aug | year = 2004 | doi = 10.1016/j.maturitas.2003.10.006 | PMID = 15283934 }}</ref> | | *A thin endometrium on ultrasound has a very low risk of malignancy.<ref name=pmid15283934>{{Cite journal | last1 = Gambacciani | first1 = M. | last2 = Monteleone | first2 = P. | last3 = Ciaponi | first3 = M. | last4 = Sacco | first4 = A. | last5 = Genazzani | first5 = AR. | title = Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. | journal = Maturitas | volume = 48 | issue = 4 | pages = 421-4 | month = Aug | year = 2004 | doi = 10.1016/j.maturitas.2003.10.006 | PMID = 15283934 }}</ref> |
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| =Normal microscopic findings= | | =Normal microscopic findings= |
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| *Focal [[complex endometrial hyperplasia]]. | | *Focal [[complex endometrial hyperplasia]]. |
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| Image: | | ===Image=== |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/figure/fig4/ Gland compression (bmjjournals.com)].<ref name=pmid16873562/> | | *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/figure/fig4/ Gland compression (bmjjournals.com)].<ref name=pmid16873562/> |
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| ===Micro=== | | ===Micro=== |
| An increased gland density is seen focally, at the edge of one tissue fragment, in association with tearing of the stroma (compression artifact). | | An increased gland density is seen focally, at the edge of one tissue fragment, in association with tearing of the stroma (compression artifact). |
| | |
| | ===See also=== |
| | *[[Endometrial gland coiling]]. |
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| ==Endocervical epithelium versus endometrial epithelium== | | ==Endocervical epithelium versus endometrial epithelium== |
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| | hyperchromatic | | | hyperchromatic |
| |- | | |- |
| | Nuclear-to-cytoplasm ratio | | | [[Nucleus-to-cytoplasm ratio]] |
| | moderate to high (1:2) | | | moderate to high (1:2) |
| | low (often 1:3) | | | low (often 1:3) |
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| COMMENT: | | COMMENT: |
| Re-biopsy is advised. | | Re-biopsy is advised. |
| | </pre> |
| | |
| | <pre> |
| | ENDOMETRIUM, BIOPSY: |
| | - BENIGN STRIPPED ENDOCERVICAL EPITHELIUM AND BENIGN INFLAMED ENDOCERVICAL MUCOSA. |
| | - NO DEFINITE ENDOMETRIUM WITH STROMA, INADEQUATE SPECIMEN. |
| </pre> | | </pre> |
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| | fibrous stroma, muscular blood vessels | | | fibrous stroma, muscular blood vessels |
| | polypoid shape (epithelium on 3 sides), +/-gland dilation | | | polypoid shape (epithelium on 3 sides), +/-gland dilation |
| | [[disordered proliferative phase]], [[simple endometrial hyperplasia]] | | | [[disordered proliferative endometrium]] (DPE), [[simple endometrial hyperplasia]] (SEH) |
| | Other | | | DPE and SEH do ''not'' occur in polyps |
| | Image | | | [[Image:Benign endometrial polyp -- low mag.jpg|thumb|150px|center|Benign endometrial polyp. (WC)]] |
| |- | | |- |
| | [[Endometrium with changes due to exogenous hormones]] | | | [[Endometrium with changes due to exogenous hormones]] |
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| | inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses) | | | inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses) |
| | [[secretory phase endometrium]], [[endometrial hyperplasia with secretory changes]] | | | [[secretory phase endometrium]], [[endometrial hyperplasia with secretory changes]] |
| | Other | | | variant of normal |
| | [[Image:Endometrium ocp use3.jpg|thumb|150px|center|Endometrium with OCP changes. (WC)]] | | | [[Image:Endometrium with hormone effect -- high mag.jpg|thumb|150px|center|Endometrium with changes due to exogenous hormones. (WC)]] |
| |- | | |- |
| | [[Atrophic endometrium]] | | | [[Atrophic endometrium]] |
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| | normal postmenopausal finding | | | normal postmenopausal finding |
| | [[Image:Nonproliferative endometrial epithelium - alt -- high mag.jpg|thumb|150px|center|Inactive endometrium. (WC)]] | | | [[Image:Nonproliferative endometrial epithelium - alt -- high mag.jpg|thumb|150px|center|Inactive endometrium. (WC)]] |
| | |- |
| | | [[Disordered proliferative endometrium]] |
| | | proliferative focally dilated & irregular glands (usu. with tubal metaplasia) |
| | | no nuclear atypia, +/-evidence of shedding (stromal condensation) |
| | | [[simple endometrial hyperplasia]], [[proliferative phase endometrium]] |
| | | can be thought of a [[waffle diagnosis]] |
| | | [[Image:Disordered proliferative endometrium -- low mag.jpg|thumb|150px|center|Disordered proliferative endometrium. (WC)]] |
| |- <!-- | | |- <!-- |
| | Diagnosis | | | Diagnosis |
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| DDx: | | DDx: |
| *[[Small cell carcinoma]]. | | *[[Small cell carcinoma]] - proliferative activity in the moulded (stromal condensation-like) cells. |
| *[[Anovulatory endometrium]] - less neutrophils. | | *[[Anovulatory endometrium]] - less neutrophils. |
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| ===Sign out=== | | ===Sign out=== |
| | <pre> |
| | Endometrium, Biopsy: |
| | - Consistent with menstrual endometrium. |
| | -- Weakly proliferative endometrial glands with apoptosis, fragmented. |
| | -- Abundant balls of condensed non-proliferative endometrial stroma and blood. |
| | </pre> |
| | |
| | ====Block letters==== |
| <pre> | | <pre> |
| ENDOMETRIUM, BIOPSY: | | ENDOMETRIUM, BIOPSY: |
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| - BALLS OF CONDENSED ENDOMETRIAL STROMA AND BLOOD. | | - BALLS OF CONDENSED ENDOMETRIAL STROMA AND BLOOD. |
| - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. | | - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. |
| | </pre> |
| | |
| | ====Consistent with menstrual endometrium==== |
| | <pre> |
| | ENDOMETRIUM, ASPIRATION: |
| | - CONSISTENT WITH MENSTRUAL ENDOMETRIUM (FRAGMENTED ENDOMETRIUM WITH PSEUDOSTRATIFIED |
| | GLANDS WITH APOPTOTIC CELLS, ABUNDANT NEUTROPHILS, CONDENSED ENDOMETRIAL STROMA |
| | AND BLOOD). |
| | - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. |
| | </pre> |
| | <pre> |
| | ENDOMETRIUM, ASPIRATION: |
| | - CONSISTENT WITH MENSTRUAL ENDOMETRIUM (FRAGMENTED ENDOMETRIUM WITH SIMPLE |
| | GLANDS WITH APOPTOTIC CELLS, ABUNDANT NEUTROPHILS, CONDENSED ENDOMETRIAL STROMA |
| | (FOCAL) AND BLOOD). |
| | - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY. |
| | |
| </pre> | | </pre> |
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| =Specific entities/abnormalities= | | =Specific entities/abnormalities= |
| ==Adipose tissue on endometrial biopsy== | | ==Adipose tissue on endometrial biopsy== |
| | *[[AKA]] ''fat on endometrial biopsy''. |
| ===General=== | | ===General=== |
| *Benign. | | *Benign. |
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| **[[Tissue floater]]. | | **[[Tissue floater]]. |
| **Pick-up. | | **Pick-up. |
| | |
| | ====Images==== |
| | <gallery> |
| | Image: Endometrium and adipose tissue - alt -- intermed mag.jpg | EMB with fat - intermed. mag. |
| | Image: Endometrium and adipose tissue -- intermed mag.jpg | EMB with fat - intermed. mag. |
| | Image: Endometrium and adipose tissue -- high mag.jpg | EMB with fat - high mag. |
| | </gallery> |
|
| |
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| ===Sign out=== | | ===Sign out=== |
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| The presence of adipose tissue raises the possibility of perforation. | | The presence of adipose tissue raises the possibility of perforation. |
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| The findings were briefly discussed with Dr. Brown on December 13, 2022. | | The findings were briefly discussed with Dr. Brown on November 6, 2009. |
| </pre> | | </pre> |
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| ==Endometritis== | | ==Endometritis== |
| ===General===
| | {{Main|Endometritis}} |
| *Usually post-delivery or post-instrumentation, e.g. previous biopsy.
| |
| *May be spontaneous, e.g. tuberculous endometritis.
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| | |
| ===Microscopic===
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| ====Acute endometritis====
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| Features:
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| *Neutrophils clusters (>5 PMNs) in the:
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| **Endometrial stroma.
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| **Within uterine glands.
| |
| | |
| Notes:
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| *Neutrophils are normal in the context of menses.
| |
| | |
| Image:
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| *[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'''.
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| **Usually superficial/close to the luminal aspect.
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| *Lymphocytic infiltrate - usually marked.
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| **May form lymphoid aggregates - '''low power''' finding.
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| *+/-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/>
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| *+/-Necrosis.
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| *Edema - common.
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| *Hemorrhage.
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| Notes:
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| *One [[plasma cell]] is not enough to call it.
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| DDx:
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| *Mentrual endometrium - endometrial stromal condensation.
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Endometritis_-_2_-_high_mag.jpg | Endometritis - high mag. (WC/Nephron)
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| Image:Endometritis_-_2_-_cropped_-_very_high_mag.jpg | Endometritis - very high mag. (WC/Nephron)
| |
| </gallery>
| |
| www:
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| *[http://www.webpathology.com/image.asp?n=2&Case=565 Chronic endometritis (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?n=3&Case=565 Chronic endometritis (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?n=6&Case=565 Tuberculous endometritis (webpathology.com)].
| |
| | |
| ===Sign out===
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| <pre>
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| ENDOMETRIUM, BIOPSY:
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| - CHRONIC ENDOMETRITIS.
| |
| </pre>
| |
| | |
| ====Not definite endometritis====
| |
| <pre>
| |
| ENDOMETRIUM, ASPIRATION:
| |
| - PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE AND VERY RARE
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| PLASMA CELLS, SEE COMMENT.
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| - NEGATIVE FOR HYPERPLASIA.
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| | |
| COMMENT:
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| The lymphocytic infiltrate and plasma cells raise the possibility of a mild chronic
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| endometritis; clinical correlation is suggested.
| |
| </pre>
| |
| | |
| ====Nonspecific lymphocytic infiltrate====
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| If not more than one plasma cell is apparent after searching.
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| <pre>
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| ENDOMETRIUM, ASPIRATION:
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| - PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE.
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| - SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
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| - NEGATIVE FOR HYPERPLASIA.
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| </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.
| |
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| No lymphoid aggregates are apparent. No eosinophils are apparent. No significant number of plasma cells is apparent.
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| ==Benign endometrial polyp== | | ==Benign endometrial polyp== |
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| ==Anovulatory endometrium== | | ==Anovulatory endometrium== |
| ===General===
| | {{Main|Anovulatory endometrium}} |
| *May be used as a synonym for ''[[disordered proliferative phase]]''.<ref>URL: [http://www.surgpath4u.com/caseviewer.php?case_no=382 http://www.surgpath4u.com/caseviewer.php?case_no=382]. Accessed on: 9 May 2013.</ref>
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| ===Microscopic===
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| Features:
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| *Shedding:
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| **Stromal condensation.
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| **Apoptotic endometrial epithelium.
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| *Nonproliferative glands.
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| DDx:
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| *[[Disordered proliferative phase]].
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| *[[Simple endometrial hyperplasia]].
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| *[[Menstrual endometrium]] - should have mitoses,<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref> abundant [[PMN]]s.
| |
| | |
| ===Sign out===
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| <pre>
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| ENDOMETRIUM, CURETTAGE:
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| - FRAGMENTED NONPROLIFERATIVE ENDOMETRIUM WITH EVIDENCE OF SHEDDING, WITHOUT ABUNDANT
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| NEUTROPHILS, SEE COMMENT.
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| - NO EVIDENCE OF HYPERPLASIA.
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| - NEGATIVE FOR MALIGNANCY.
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| COMMENT:
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| The changes are compatible with anovulatory bleeding.
| |
| </pre>
| |
| | |
| <pre>
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| ENDOMETRIUM, CURETTAGE:
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| - NON-PROLIFERATIVE ENDOMETRIUM WITH SMALL ROUND GLANDS AND SHEDDING, SEE COMMENT.
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| - BENIGN ENDOCERVICAL MUCOSA.
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| - NEGATIVE FOR HYPERPLASIA.
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| - NEGATIVE FOR MALIGNANCY.
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| | |
| COMMENT:
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| The changes are suggestive of anovulatory bleeding.
| |
| </pre>
| |
| | |
| <pre>
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| ENDOMETRIUM, BIOPSY:
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| - BENIGN ENDOCERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION, AND EVIDENCE
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| SUGGESTIVE OF EROSIONS (SIDEROPHAGES, INCREASED BLOOD VESSEL DENSITY).
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| - SMALL NONPROLIFERATIVE ENDOMETRIAL GLANDS WITH RARE NEUTROPHILS AND RARE
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| APOPTOTIC CELLS, WITH BALLS OF CONDENSED ENDOMETRIAL STROMA, SEE COMMENT.
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| - NEGATIVE FOR ENDOMETRIAL HYPERPLASIA AND NEGATIVE FOR DYSPLASIA.
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| COMMENT:
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| The changes are suggestive of anovulatory bleeding.
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| </pre>
| |
| | |
| <pre>
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| ENDOMETRIUM, ASPIRATION:
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| - PSEUDOSTRATIFIED ENDOMETRIAL EPITHELIUM WITHOUT APPARENT PROLIFERATION, WITH
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| APOPTOTIC CELLS AND LIMITED STROMA WITH RARE (STROMAL) CONDENSATION -- COMPATIBLE
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| WITH SHEDDING.
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| - MINUTE FRAGMENTS OF BENIGN ENDOCERVICAL EPITHELIUM.
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| - NO EVIDENCE OF HYPERPLASIA.
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| </pre>
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|
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| ==Disordered proliferative endometrium== | | ==Disordered proliferative endometrium== |
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| *[[AKA]] ''endometrium with disordered proliferative phase''. | | *[[AKA]] ''endometrium with disordered proliferative phase''. |
| *[[AKA]] ''disordered proliferative phase''. | | *[[AKA]] ''disordered proliferative phase''. |
| | | {{Main|Disordered proliferative endometrium}} |
| ===General===
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| *Association: anovulation.
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| *Benign - can be grouped with ''normal''.<ref name=pmid18580308>{{Cite journal | last1 = Sherman | first1 = ME. | last2 = Ronnett | first2 = BM. | last3 = Ioffe | first3 = OB. | last4 = Richesson | first4 = DA. | last5 = Rush | first5 = BB. | last6 = Glass | first6 = AG. | last7 = Chatterjee | first7 = N. | last8 = Duggan | first8 = MA. | last9 = Lacey | first9 = JV. | title = Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification. | journal = Int J Gynecol Pathol | volume = 27 | issue = 3 | pages = 318-25 | month = Jul | year = 2008 | doi = 10.1097/PGP.0b013e3181659167 | PMID = 18580308 }}</ref>
| |
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| Treatment:
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| *Progesterone<ref name=pmid16873562/> versus observation.<ref name=pmid17090792>{{Cite journal | last1 = Ely | first1 = JW. | last2 = Kennedy | first2 = CM. | last3 = Clark | first3 = EC. | last4 = Bowdler | first4 = NC. | title = Abnormal uterine bleeding: a management algorithm. | journal = J Am Board Fam Med | volume = 19 | issue = 6 | pages = 590-602 | month = | year = | doi = | PMID = 17090792 | url = http://www.jabfm.org/content/19/6/590.full }}</ref>
| |
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| Image:
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| *[http://www.jabfm.org/content/19/6/590/F8.expansion.html Treatment algorithim based on endometrial biopsy results (jabfm.org)].<ref name=pmid17090792/>
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| ===Microscopic===
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| Features:<ref name=Ref_PBoD1080>{{Ref PBoD|1080 and 1082}}</ref>
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| *Proliferative type endometrium with:
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| **Cystic dilation of glands focally that do not have (glandular) secretions - '''key feature'''.
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| ***Glands >2x normal size - usually 3-4x normal.
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| ***Irregular shape, e.g. gland contour has inflection points.
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| ***Greater than fours glands involved (dilated).
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| *+/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium).
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| Notes:
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| *Dilated glands often have tubal metaplasia.{{fact}}
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| *Eosinophilic syncytial metaplasia - common.
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| **Features: abundant eosinophilic cytoplasm, mild nuclear atypia +/-loss of nuclear stratification, no mitoses).
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| DDx:
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| *[[Proliferative phase endometrium]].
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| **Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, no vacuolation, no mucus secretion, abundant mitoses.
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| **Stroma: cellular, stroma (spindle cells), mitoses.
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| *[[Simple endometrial hyperplasia]] without atypia - architectural atypia diffuse.
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| *[[Benign endometrial polyp]].
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| ====Images====
| |
| www:
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| *[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig15 DPE (sciencedirect.com)].
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| *[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig18 DPE (sciencedirect.com)].
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| *[http://www.glowm.com/resources/glowm/uploads/1225247516_03-50291-007_small.jpg DPE (glowm.com)].<ref name=glowm>URL: [http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235 http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235]. Accessed on: 11 December 2012.</ref>
| |
| *[http://www.hsc.stonybrook.edu/gyn-atlas/UT3431B.htm DPE (stonybrook.edu)].
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| <gallery>
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| Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation - high mag. (WC/Nephron)
| |
| </gallery>
| |
| ===Sign out===
| |
| <pre>
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| ENDOMETRIUM, BIOPSY:
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| - DISORDERED PROLIFERATIVE ENDOMETRIUM.
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| </pre>
| |
| | |
| =====With endocervix=====
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| <pre>
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| ENDOMETRIUM, BIOPSY:
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| - DISORDERED PROLIFERATIVE ENDOMETRIUM.
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| - BENIGN ENDOCERVICAL MUCOSA.
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| </pre>
| |
| | |
| =====Waffle a bit=====
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| <pre>
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| ENDOMETRIUM, BIOPSY:
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| - COMPATIBLE WITH DISORDERED PROLIFERATIVE ENDOMETRIUM (FRAGMENTS OF PROLIFERATIVE
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| ENDOMETRIUM WITH EVIDENCE OF SHEDDING AND VERY RARE GLAND DILATION).
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| - VERY SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
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| - NEGATIVE FOR ENDOMETRIAL HYPERPLASIA.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
| |
| | |
| <pre>
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| ENDOMETRIUM, CURETTAGE:
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| - PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH GLAND DILATION AND SMALL BLOOD
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| VESSELS, SEE COMMENT.
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| - NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
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| COMMENT:
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| A fibrotic stroma is not present. The findings may represent a remnant of the previously
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| excised endometrial polyp or disordered proliferative endometrium. Follow-up is suggested.
| |
| </pre>
| |
| | |
| ====Micro====
| |
| The sections show a well-sampled endometrium. Mitotic figures are identified within the
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| glands and stroma. Irregular, moderately enlarged glands are seen (only) in one of several
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| fragments; most of the endometrial glands are round, regular and small.
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| | |
| No stromal condensation is apparent. No secretions are in the glands.
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| There are no back-to-back glands. No nuclear atypia is apparent. No thick-walled blood
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| vessels are apparent.
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|
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|
| ==Endometrium with changes due to exogenous hormones== | | ==Endometrium with changes due to exogenous hormones== |
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| *[[AKA]] ''endometrial atrophy''. | | *[[AKA]] ''endometrial atrophy''. |
| {{Main|Inactive endometrium}} | | {{Main|Inactive endometrium}} |
| | |
| | ==Ablated endometrium== |
| | {{Main|Ablated endometrium}} |
|
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|
| ==Endometrium with squamous morules== | | ==Endometrium with squamous morules== |
| {{Main|Endometrium with squamous morules}} | | {{Main|Endometrium with squamous morules}} |
| | |
| | ==Endometrium with psammoma bodies== |
| | {{Main|Endometrium with psammoma bodies}} |
|
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|
| ==Endometrial hyperplasia== | | ==Endometrial hyperplasia== |
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| *[[Uterine tumours]]. | | *[[Uterine tumours]]. |
| *[[Gynecologic pathology]]. | | *[[Gynecologic pathology]]. |
| | *[[Psammoma bodies]]. |
|
| |
|
| =References= | | =References= |