Arias-Stella reaction
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The Arias-Stella reaction is a benign change.
General
- Benign atypical endometrial changes associated with chorionic tissue.[1]
- May be seen in a normal pregnancy, hydatidiform moles, others.
- Historically it was diagnosed as endometrial cancer.
- Usually in premenopausal women - pregnant or recently pregnant; however, it may be seen postmenopausal women.[2]
Note:
- To the novice... the nuclei look really scary, i.e. they look like cancer.
Microscopic
Features:[1]
- Epithelial component of endometrium with large nuclei - key feature.
- +/-Nuclear hyperchromasia, i.e. dark nuclei.
- +/-Irregular nuclear membrane.
- +/-Nuclear clearing.[3]
- +/-Nuclear pseudoinclusions.
- NC ratio is preserved.[3]
- Usually a focal change.
- +/-Mitoses - uncommon.
Notes:
- No decidual reaction in the stroma.
DDx:
- Choriocarcinoma.
- Herpetic endometritis.
- Clear cell endometrial carcinoma.
- Serous endometrial carcinoma.[4]
Images:
Subtypes
There are five subtypes:[1]
- Minimal atypia.
- Usually early gestation.
- Early secretory pattern.
- Mimics secretory endometrium: cytoplasmic vacuoles, central nucleus, palisading architecture.
- Secretory or hypersecretory pattern.
- Regenerative, proliferative or nonsecretory pattern.
- Monstrous cell pattern.
See also
References
- ↑ 1.0 1.1 1.2 Arias-Stella, J. (Jan 2002). "The Arias-Stella reaction: facts and fancies four decades after.". Adv Anat Pathol 9 (1): 12-23. PMID 11756756.
- ↑ Offman, SL.; Longacre, TA. (Sep 2012). "Clear cell carcinoma of the female genital tract (not everything is as clear as it seems).". Adv Anat Pathol 19 (5): 296-312. doi:10.1097/PAP.0b013e31826663b1. PMID 22885379.
- ↑ 3.0 3.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 236-7. ISBN 978-0470519035.
. Cite error: Invalid
<ref>tag; name "Ref_DCHH236-7" defined multiple times with different content - ↑ Félix, A.; Nogales, FF.; Arias-Stella, J. (Mar 2010). "Polypoid endometriosis of the uterine cervix with Arias-Stella reaction in a patient taking phytoestrogens.". Int J Gynecol Pathol 29 (2): 185-8. doi:10.1097/PGP.0b013e3181b7015e. PMID 20173505.