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Difference between revisions of "Endometritis"
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Endometritis_-_2_-_cropped_-_very_high_mag.jpg | |||
| Width = | |||
| Caption = Chronic endometritis. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = ''acute'': abundant [[neutrophils]], clusters >5 (in stroma & glands);<br> ''chronic'': plasma cells (key feature), often eosinophils, lymphoid aggregates | |||
| Subtypes = acute, chronic | |||
| LMDDx = [[menstrual endometrium]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[endometrium]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-postpartum, +/-recent instrumentation | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''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:{{fact}} | |||
*Neutrophils clusters (>5 [[PMN]]s) in the: | |||
**Endometrial stroma. | |||
**Within uterine glands. | |||
Notes: | |||
*Neutrophils are normal in the context of menses. | |||
DDx: | |||
*[[Menstrual endometrium]] - less neutrophils. (???) | |||
====Kiviat definition==== | |||
Kiviat ''et al.'' definition - requires both:<ref name=pmid2137304>{{cite journal |author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, ''et al.'' |title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis |journal=Am. J. Surg. Pathol. |volume=14 |issue=2 |pages=167–75 |year=1990 |month=February |pmid=2137304 |doi= |url=}}</ref> | |||
#>=5 [[PMN]]s in surface epithelium/400x magnification field of view. | |||
#>=1 [[plasma cell]] in the endometrial stroma/120x magnification field of view. | |||
Notes: | |||
*Above definition is considered "widely accepted".<ref name=pmid>{{cite journal |author=Ross JD |title=What is endometritis and does it require treatment? |journal=Sex Transm Infect |volume=80 |issue=4 |pages=252–3 |year=2004 |month=August |pmid=15295119 |pmc=1744883 |doi=10.1136/sti.2004.009548 |url=}}</ref> | |||
*Definition suffers from [[HPFitis]] and [[IPFitis]]. | |||
====Image==== | |||
*[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'''. | |||
**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.<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/> | |||
*+/-Necrosis. | |||
*Edema - common. | |||
*Hemorrhage. | |||
Notes: | |||
*One [[plasma cell]] is not enough to call it.<ref name=pmid21996319>{{cite journal |author=Vicetti Miguel RD, Chivukula M, Krishnamurti U, ''et al.'' |title=Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research |journal=Pathol. Res. Pract. |volume=207 |issue=11 |pages=680–5 |year=2011 |month=November |pmid=21996319 |pmc=3215901 |doi=10.1016/j.prp.2011.08.007 |url=}}</ref><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> | |||
DDx: | |||
*[[Menstrual endometrium]] - endometrial stromal condensation. | |||
===Images=== | |||
<gallery> | |||
Image:Endometritis_-_2_-_high_mag.jpg | Endometritis - high mag. (WC/Nephron) | |||
Image:Endometritis_-_2_-_cropped_-_very_high_mag.jpg | Endometritis - very high mag. (WC/Nephron) | |||
</gallery> | |||
www: | |||
*[http://www.webpathology.com/image.asp?n=2&Case=565 Chronic endometritis (webpathology.com)]. | |||
*[http://www.webpathology.com/image.asp?n=3&Case=565 Chronic endometritis (webpathology.com)]. | |||
*[http://www.webpathology.com/image.asp?n=6&Case=565 Tuberculous endometritis (webpathology.com)]. | |||
==Sign out== | |||
<pre> | |||
ENDOMETRIUM, BIOPSY: | |||
- CHRONIC ENDOMETRITIS. | |||
</pre> | |||
===Not definite endometritis=== | |||
<pre> | |||
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. | |||
</pre> | |||
===Nonspecific lymphocytic infiltrate=== | |||
If not more than one plasma cell is apparent after searching. | |||
<pre> | |||
ENDOMETRIUM, ASPIRATION: | |||
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE. | |||
- SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS. | |||
- NEGATIVE FOR HYPERPLASIA. | |||
</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. | |||
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. | |||
==See also== | |||
*[[Endometrium]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Endometrium]] | |||