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The '''endometrium''' is typically biopsied because of abnormal bleeding. | The '''endometrium''' is typically biopsied because of abnormal bleeding. [[Endometrial hyperplasia]] and [[endometrial carcinoma]] are dealt with in separate articles. An overview of gynecologic pathology is in the ''[[gynecologic pathology]]'' article. | ||
==Indications for endometrial biopsy== | ==Indications for endometrial biopsy== | ||
Abnormal bleeding: | |||
* | *[[Abnormal uterine bleeding]] (AUB). | ||
* | **[[Dysfunctional uterine bleeding]], abbreviated ''DUB'', is diagnosed if other causes of bleeding are excluded. | ||
* | **''DUB'' may get a D&C if they fail medical management.<ref>URL: [http://emedicine.medscape.com/article/257007-treatment http://emedicine.medscape.com/article/257007-treatment]. Accessed on: 15 July 2010.</ref> | ||
** | **Post-menopausal bleeding. | ||
Other indications:<ref>{{Ref EMB|1}}</ref> | |||
*[[Products of conception]] - dealt with in a separate article. | |||
*Dating of endometrium - infertility work-up. | |||
===Endometrial thickness on ultrasound=== | |||
*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> | |||
=Normal microscopic findings= | =Normal microscopic findings= | ||
Endometrium - consists of: | |||
#Epithelium (endometrial glands). | |||
#Stroma (endometrial stroma). | |||
In endometrial biopsies: | |||
*Endocervical glands are commonly seen, as is endocervical mucous. | *Endocervical glands are commonly seen, as is endocervical mucous. | ||
**This is 'cause the gynecologist scrapes some off on the way in or out. | **This is 'cause the gynecologist scrapes some off on the way in or out. | ||
== | ==Glandular telescoping== | ||
===Endocervical=== | :[[AKA]] ''gland-within-a-gland''. | ||
:[[AKA]] ''gland intussusception''. | |||
:[[AKA]] ''telescoping''. | |||
*Considered an artifact of tissue processing, i.e. normal.<ref name=pmid16873562>{{Cite journal | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 }}</ref> | |||
Image: | |||
*[http://jcp.bmjjournals.com/content/59/8/801/F3.large.jpg Telescoping (bmjjournals.com)].<ref name=pmid16873562/> | |||
==Endometrial gland compression artifact== | |||
:[[AKA]] ''compression artifact''. | |||
*Gland moulding. | |||
*Tearing of tissue around the compressed glands - '''key feature'''. | |||
*Usually at the edge of a tissue fragment. | |||
DDx: | |||
*Focal [[complex endometrial hyperplasia]]. | |||
===Image=== | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860448/figure/fig4/ Gland compression (bmjjournals.com)].<ref name=pmid16873562/> | |||
===Micro=== | |||
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]]. | |||
==Endocervical epithelium versus endometrial epithelium== | |||
===Table=== | |||
{| class="wikitable sortable" | |||
! Feature | |||
! Endometrial | |||
! Endocervical | |||
! Tubal metaplasia | |||
|- | |||
| Cytoplasmic staining | |||
| usu. hyperchromatic +/-vacuoles | |||
| clear or light eosinophilic | |||
| hyperchromatic | |||
|- | |||
| [[Nucleus-to-cytoplasm ratio]] | |||
| moderate to high (1:2) | |||
| low (often 1:3) | |||
| high (1:1) | |||
|- | |||
| Surface features | |||
| | |||
| | |||
| villi | |||
|- | |||
| Associated stroma | |||
| cellular, hyperchromatic | |||
| inflamed, less cellular | |||
| variable | |||
|} | |||
===List=== | |||
Endocervical: | |||
*Less hyperchromatic. | *Less hyperchromatic. | ||
*Nuclei round & small. | *Nuclei round & small. | ||
*Cell borders usually well-defined. | *Cell borders usually well-defined. | ||
Endometrial: | |||
*More hyperchromatic. | *More hyperchromatic. | ||
*Nuclei columnar. | *Nuclei columnar. | ||
=A simple approach= | ===Images=== | ||
==Low power== | <gallery> | ||
#Decide whether you | Image:Endometrial and endocervical epithelium - low mag.jpg | Endocervical and endometrial epithelium - low mag. (WC) | ||
# | Image:Endometrial and endocervical epithelium - high mag.jpg | Endocervical and endometrial epithelium - high mag. (WC) | ||
</gallery> | |||
==Metaplasias of the endometrium== | |||
The big table of metaplasias - adapted from Nicolae ''et al.'':<ref name=pmid21126963>{{Cite journal | last1 = Nicolae | first1 = A. | last2 = Preda | first2 = O. | last3 = Nogales | first3 = FF. | title = Endometrial metaplasias and reactive changes: a spectrum of altered differentiation. | journal = J Clin Pathol | volume = 64 | issue = 2 | pages = 97-106 | month = Feb | year = 2011 | doi = 10.1136/jcp.2010.085555 | PMID = 21126963 }}</ref> | |||
{| class="wikitable sortable" | |||
! Metaplasia | |||
! Subtypes | |||
! Microscopic | |||
! Notes | |||
! Risk of malignancy | |||
! Image | |||
|- | |||
| [[Endometrium with squamous morules|Morules]] | |||
| - | |||
| | |||
| | |||
| nearly always | |||
| [[Image:Squamous morule 2 - endometrium -- very high mag.jpg|150px|SM. (WC)]] | |||
|- | |||
| Ciliary | |||
| - | |||
| ciliated cells | |||
| usu. lumped together with ''tubal'', unopposed estrogen, [[endometriosis]] | |||
| frequent - [[endometrial hyperplasia]] (complex and simple), adenocarcinoma | |||
| | |||
|- | |||
| Tubal | |||
| complex, simple | |||
| ciliated cells, secretory cell, intercallary cells | |||
| usu. lumped together with ''ciliary'', unopposed estrogen, seen in [[endometriosis]] | |||
| frequent (complex only) - [[endometrial hyperplasia]] (complex and simple), adenocarcinoma | |||
| | |||
|- | |||
| Mucinous | |||
| complex, simple | |||
| | |||
| | |||
| frequent (complex only) | |||
| | |||
|- | |||
| Squamous | |||
| - | |||
| | |||
| | |||
| rare | |||
| | |||
|- | |||
| Papillary syncytial change (surface) | |||
| - | |||
| | |||
| | |||
| rare | |||
| | |||
|- | |||
| Eosinophilic, oxyphilic, oncocytic | |||
| | |||
| | |||
| | |||
| not known | |||
| | |||
|- | |||
| Clear cell (secretory) | |||
| - | |||
| | |||
| | |||
| not reported | |||
| | |||
|- | |||
| Stromal metaplasia | |||
| osseous, cartilaginous, adipose, smooth muscle, myoid, sex-cord like | |||
| | |||
| | |||
| not reported | |||
| | |||
|} | |||
=Tamoxifen effects= | |||
*[[Endometrial hyperplasia]]. | |||
*[[Endometrial cancer]]. | |||
*[[Endometrial polyps]]. | |||
*[[Endometrial atrophy|Atrophy]]. | |||
=Inadequate endometrial biopsy= | |||
*Endometrial biopsies often have scant tissue. | |||
**This is normal in post-menopausal women. | |||
*Ideally, the biopsy should have some endometrial stroma. | |||
**Without stroma it is ''not'' possible to assess the gland-to-stroma ratio. | |||
==Sign out== | |||
===No stroma=== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- VERY SCANT STRIPPED NON-PROLIFERATIVE COLUMNAR EPITHELIUM, PROBABLY FROM THE LOWER UTERINE SEGMENT. | |||
- NO DEFINITE ENDOMETRIAL STROMA, SEE COMMENT. | |||
- STRIPPED ENDOCERVICAL EPITHELIUM AND ENODOCERVICAL MUCOSA WITHIN NORMAL LIMITS. | |||
- MUCOUS. | |||
COMMENT: | |||
A re-biopsy should be considered within the clinical context. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- VERY SCANT STRIPPED EPITHELIUM PROBABLY FROM THE LOWER UTERINE SEGMENT. | |||
- NO DEFINITE ENDOMETRIAL STROMA. | |||
- SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. | |||
- SMALL FRAGMENTS OF DETACHED BENIGN SQUAMOUS EPITHELIUM. | |||
COMMENT: | |||
A re-biopsy should be considered within the clinical context. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- FRAGMENTS OF DETACHED SQUAMOUS EPITHELIUM AND DETACHED NON-PROLIFERATIVE ENDOMETRIAL GLANDS. | |||
- ASSESSMENT LIMITED AS VERY SCANT ENDOMETRIAL STROMA IS PRESENT. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- ENDOMETRIUM: STRIPS OF EPITHELIUM, NON-PROLIFERATIVE. | |||
- ENDOCERVIX: SCANT BENIGN EPITHELIUM. | |||
- EXOCERVIX: SCANT BENIGN EPITHELIUM. | |||
- OTHER: TUBAL METAPLASIA. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- STRIPS OF NON-PROLIFERATIVE ENDOMETRIUM. | |||
- SCANT BENIGN ENDOCERVICAL EPITHELIUM. | |||
- SCANT BENIGN SQUAMOUS EPITHELIUM. | |||
- TUBAL METAPLASIA. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- STRIPS OF BENIGN ENDOMETRIAL EPITHELIUM/TUBAL METAPLASIA, NON-PROLIFERATIVE. | |||
- SCANT BENIGN ENDOCERVICAL EPITHELIUM. | |||
- RARE SQUAMOUS METAPLASTIC CELLS. | |||
</pre> | |||
===Proliferative without definite stroma=== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- FRAGMENTS OF DETACHED SQUAMOUS EPITHELIUM, ENDOCERVICAL EPITHELIUM AND FOCALLY PROLIFERATIVE ENDOMETRIAL GLANDS. | |||
- ASSESSMENT LIMITED AS NO DEFINITE ENDOMETRIAL STROMA IS PRESENT. | |||
</pre> | |||
===Possible endometrium - insufficient=== | |||
<pre> | |||
ENDOMETRIUM, ASPIRATION: | |||
- ONE MINUTE STRIP OF POSSIBLE NONPROLIFERATIVE ENDOMETRIAL EPITHELIUM, INSUFFICIENT | |||
FOR ADEQUATE DIAGNOSTIC ASSESSMENT. | |||
- VERY SCANT BENIGN STRIPPED ENDOCERVICAL EPITHELIUM. | |||
- VERY SCANT METAPLASTIC SQUAMOUS EPITHELIUM. | |||
COMMENT: | |||
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> | |||
===No endometrium=== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- SPECIMEN INADEQUATE; NO ENDOMETRIUM IDENTIFIED. | |||
- ONE VERY TINY FRAGMENT OF ENDOCERVICAL MUCOSA WITHOUT APPARENT PATHOLOGY. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. | |||
- MICROGLANDULAR HYPERPLASIA AND FOCAL SQUAMOUS METAPLASIA. | |||
- NO DEFINITE ENDOMETRIUM IDENTIFIED, SUGGEST RE-BIOPSY. | |||
</pre> | |||
===No tissue=== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- NO TISSUE IDENTIFIED ON MICROSCOPY. | |||
</pre> | |||
=Overview= | |||
==A simple approach== | |||
===Low power=== | |||
#Decide whether you are looking at endometrium. | |||
#Is the gland-to-stroma ratio normal? | |||
#*1:3 is normal. | #*1:3 is normal. | ||
#*If gland-to-stroma ratio is increased... think ''[[endometrial hyperplasia]]''. | #*If the gland-to-stroma ratio is increased... think ''[[complex endometrial hyperplasia]]''. | ||
#*If glands are fused to one another or [[cribriform]]... think ''[[endometrial carcinoma]]''. | #*If the glands are fused to one another or [[cribriform]]... think ''[[endometrial carcinoma]]''. | ||
#Glands round? | #Glands round? | ||
#*Round is normal. | #*Round is normal. | ||
#*Irregular - may be seen in menses, | #*Irregular - may be seen in [[secretory phase endometrium]], menses, [[disordered proliferative endometrium]] (focal), [[simple endometrial hyperplasia]] (diffuse). | ||
#Glands pseudostratified? | #Glands pseudostratified? | ||
#*Pseudostratified glands are normal in the proliferative phase, hyperplasias, malignancy. | #*Pseudostratified glands are normal in the [[proliferative phase endometrium]], hyperplasias, malignancy. | ||
#Balls of cells? | #Balls of cells? | ||
#*Blue - likely menstrual (stromal condensation). | #*Blue - likely menstrual (stromal condensation). | ||
#*Pink - consider leiomyoma, squamous morules (associated with endometrial hyperplasia). | #*Pink - consider [[uterine leiomyoma|leiomyoma]], squamous morules (associated with [[endometrial hyperplasia]], [[endometrioid endometrial carcinoma]], may be benign). | ||
==High power== | ===High power=== | ||
#Mitoses present in the glands? | #Mitoses present in the glands? | ||
#*Present in the proliferative phase, hyperplasias, malignancies. | #*Present in the proliferative phase, hyperplasias, malignancies. | ||
Line 48: | Line 307: | ||
#*Some are normal during menses. | #*Some are normal during menses. | ||
= | ==Tabular summary== | ||
= | {| class="wikitable sortable" | ||
! Diagnosis | |||
! Key feature (low power) | |||
! Additional features | |||
! DDx | |||
! Other | |||
! Image | |||
|- | |||
| [[Proliferative phase endometrium]] | |||
| round spaced pseudostratified glands | |||
| mitoses in glands and stroma | |||
| [[disordered proliferative phase]], [[simple endometrial hyperplasia]], [[complex endometrial hyperplasia]], early [[secretory phase endometrium]] | |||
| normal | |||
| [[Image:Proliferative endometrium - very high mag.jpg|thumb|150px|center|Proliferative endometrium. (WC)]] | |||
|- | |||
| [[Secretory phase endometrium]] | |||
| irregular glands with secretions ''or'' simple glands with vacuoles | |||
| decidual changes (nucleus central, eosinophilic cytoplasm, well-defined cell borders) | |||
| [[endometrial hyperplasia with secretory changes]], late [[proliferative phase endometrium]] | |||
| normal | |||
| [[Image:Secretory phase endometrium -- high mag.jpg|thumb|120px|center|Secretory phase endometrium. (WC)]] | |||
|- | |||
| [[Menstrual endometrium]] | |||
| stromal condensation | |||
| nonproliferative glands, stromal/epithelial neutrophils, glandular cell apoptosis | |||
| [[disordered proliferative phase]] | |||
| normal | |||
| Image | |||
|- | |||
| [[Benign endometrial polyp]] | |||
| fibrous stroma, muscular blood vessels | |||
| polypoid shape (epithelium on 3 sides), +/-gland dilation | |||
| [[disordered proliferative endometrium]] (DPE), [[simple endometrial hyperplasia]] (SEH) | |||
| DPE and SEH do ''not'' occur in polyps | |||
| [[Image:Benign endometrial polyp -- low mag.jpg|thumb|150px|center|Benign endometrial polyp. (WC)]] | |||
|- | |||
| [[Endometrium with changes due to exogenous hormones]] | |||
| decidualized stroma (nucleus central, eosinophilic cytoplasm, well-defined cell borders) | |||
| inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses) | |||
| [[secretory phase endometrium]], [[endometrial hyperplasia with secretory changes]] | |||
| variant of normal | |||
| [[Image:Endometrium with hormone effect -- high mag.jpg|thumb|150px|center|Endometrium with changes due to exogenous hormones. (WC)]] | |||
|- | |||
| [[Atrophic endometrium]] | |||
| nonproliferative glands | |||
| no nuclear atypia, often without appreciable stroma | |||
| [[serous endometrial carcinoma]] | |||
| normal postmenopausal finding | |||
| [[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 | |||
| Key feature | |||
| Additional features | |||
| DDx | |||
| Other | |||
| Image --> | |||
|} | |||
=Normal endometrium= | |||
==Proliferative phase endometrium== | |||
{{Main|Proliferative phase endometrium}} | |||
==Secretory phase endometrium== | |||
{{Main|Secretory phase endometrium}} | |||
==Menstrual endometrium== | |||
===General=== | |||
* | *Technically part of the ''proliferative phase'' or ''follicular phase''. | ||
== | ===Microscopic=== | ||
Features: | |||
** | *Proliferative endometrium (mitoses).<ref name=Ref_DCHH237>{{Ref DCHH|237}}</ref> | ||
*** | *Apoptotic cells common.<ref name=pmid8744416>{{Cite journal | last1 = Spencer | first1 = SJ. | last2 = Cataldo | first2 = NA. | last3 = Jaffe | first3 = RB. | title = Apoptosis in the human female reproductive tract. | journal = Obstet Gynecol Surv | volume = 51 | issue = 5 | pages = 314-23 | month = May | year = 1996 | doi = | PMID = 8744416 }}</ref> | ||
*** | *Tightly packed cellular balls of stromal cells with nuclear moulding. | ||
**Known as "blue balls". | |||
**Tightly packed cellular stromal cells known as "stromal condensation". | |||
*Inflammation, especially abundant [[neutrophil]]s. | |||
DDx: | |||
* | *[[Small cell carcinoma]] - proliferative activity in the moulded (stromal condensation-like) cells. | ||
* | *[[Anovulatory endometrium]] - less neutrophils. | ||
====Images==== | |||
* | <gallery> | ||
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation - high mag. (WC/Nephron) | |||
</gallery> | |||
www: | |||
*[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=5&cat2=26&cat3=0&cat4=3&stype=n Menstrual endometrium - several images (gfmer.ch)]. | |||
* | *[http://www.hsc.stonybrook.edu/gyn-atlas/UT3415B.htm Menstrual phase endometrium (stonybrook.edu)]. | ||
===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> | |||
ENDOMETRIUM, BIOPSY: | |||
- CONSISTENT WITH MENSTRUAL ENDOMETRIUM: | |||
-- STRIPPED WEAKLY PROLIFERATIVE ENDOMETRIAL GLANDS. | |||
-- BALLS OF CONDENSED ENDOMETRIAL STROMA. | |||
-- ABUNDANT NEUTROPHILS AND BLOOD. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- CONSISTENT WITH MENSTRUAL PHASE ENDOMETRIUM: | |||
-- WEAKLY PROLIFERATIVE ENDOMETRIAL GLANDS WITH NEUTROPHILS AND APOPTOSIS. | |||
-- BALLS OF CONDENSED ENDOMETRIAL STROMA. | |||
-- BLOOD. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- VERY WEAKLY PROLIFERATIVE ENDOMETRIAL GLANDS WITH NEUTROPHILS AND APOPTOSIS. | |||
- BALLS OF CONDENSED ENDOMETRIAL STROMA AND BLOOD. | |||
- 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> | |||
====Late menses==== | |||
<pre> | |||
ENDOMETRIUM, ASPIRATION: | |||
- ENDOMETRIAL GLANDS WITH APOPTOTIC CELLS, INFILTRATING NEUTROPHILS, | |||
AND GLANDULAR PROLIFERATIVE ACTIVITY. | |||
- BALLS OF CONDENSED ENDOMETRIAL STROMA. | |||
- SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. | |||
- NEGATIVE FOR HYPERPLASIA. | |||
COMMENT: | |||
The findings are most in keeping with late menstrual endometrium. | |||
</pre> | |||
==== | =Specific entities/abnormalities= | ||
==Adipose tissue on endometrial biopsy== | |||
*[[AKA]] ''fat on endometrial biopsy''. | |||
===General=== | |||
*Benign. | |||
*Raises the possibility of perforation - should prompt a phone call to the clinician. | |||
===Microscopic=== | |||
Features: | Features: | ||
* | *Adipose tissue, benign - '''key finding'''. | ||
*Definite endometrium. | |||
DDx: | |||
* | *Extraneous tissue. | ||
**[[Tissue floater]]. | |||
**Pick-up. | |||
Images | ====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> | |||
== | ===Sign out=== | ||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- BENIGN ADIPOSE TISSUE, SEE COMMENT. | |||
- PROLIFERATIVE PHASE ENDOMETRIUM. | |||
COMMENT: | |||
The presence of adipose tissue raises the possibility of perforation. | |||
The findings were briefly discussed with Dr. Brown on November 6, 2009. | |||
</pre> | |||
== | ==Arias-Stella reaction== | ||
=== | {{Main|Arias-Stella reaction}} | ||
*Benign atypical endometrial changes associated with chorionic tissue -- may be seen in a completely normal pregnancy and misdiagnosed as a malignancy.<ref name=pmid11756756>{{Cite journal | last1 = Arias-Stella | first1 = J. | title = The Arias-Stella reaction: facts and fancies four decades after. | journal = Adv Anat Pathol | volume = 9 | issue = 1 | pages = 12-23 | month = Jan | year = 2002 | doi = | PMID = 11756756 }}</ref> | |||
== | ==Endometritis== | ||
{{Main|Endometritis}} | |||
==Benign endometrial polyp== | |||
{{Main|Benign endometrial polyp}} | |||
==Anovulatory endometrium== | |||
{{Main|Anovulatory endometrium}} | |||
== | ==Disordered proliferative endometrium== | ||
*Abbreviated ''DPE''. | |||
* | *[[AKA]] ''endometrium with disordered proliferative phase''. | ||
* | *[[AKA]] ''disordered proliferative phase''. | ||
* | {{Main|Disordered proliferative endometrium}} | ||
== | ==Endometrium with changes due to exogenous hormones== | ||
{{Main|Endometrium with changes due to exogenous hormones}} | |||
==Atrophic endometrium== | |||
*[[AKA]] ''atrophy of the endometrium''. | |||
*[[AKA]] ''endometrial atrophy''. | |||
{{Main|Inactive endometrium}} | |||
== | ==Ablated endometrium== | ||
{{Main|Ablated endometrium}} | |||
=== | ==Endometrium with squamous morules== | ||
{{Main|Endometrium with squamous morules}} | |||
==Endometrium with psammoma bodies== | |||
{{Main|Endometrium with psammoma bodies}} | |||
==Endometrial hyperplasia== | ==Endometrial hyperplasia== | ||
Line 204: | Line 555: | ||
*[[Uterine tumours]]. | *[[Uterine tumours]]. | ||
*[[Gynecologic pathology]]. | *[[Gynecologic pathology]]. | ||
*[[Psammoma bodies]]. | |||
=References= | =References= | ||
Line 209: | Line 561: | ||
[[Category:Gynecologic pathology]] | [[Category:Gynecologic pathology]] | ||
[[Category:Endometrium]] |
edits