Difference between revisions of "Endometrium"

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Endometrium (view source)

Revision as of 01:11, 1 May 2014

4,485 bytes removed ,  01:11, 1 May 2014
→‎Disordered proliferative endometrium: split out
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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===
*Association: anovulation.
*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>
 
Treatment:
*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>
 
Image:
*[http://www.jabfm.org/content/19/6/590/F8.expansion.html Treatment algorithim based on endometrial biopsy results (jabfm.org)].<ref name=pmid17090792/>
 
===Microscopic===
Features:<ref name=Ref_PBoD1080>{{Ref PBoD|1080 and 1082}}</ref>
*Proliferative type endometrium with:
**Cystic dilation of glands focally that do not have (glandular) secretions - '''key feature'''.
***Glands >2x normal size - usually 3-4x normal.
***Irregular shape, e.g. gland contour has inflection points.
***Greater than fours glands involved (dilated).
*+/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium).
 
Notes:
*Dilated glands often have tubal metaplasia.{{fact}}
*Eosinophilic syncytial metaplasia - common.
**Features: abundant eosinophilic cytoplasm, mild nuclear atypia +/-loss of nuclear stratification, no mitoses).
 
DDx:
*[[Proliferative phase endometrium]].
**Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, no vacuolation, no mucus secretion, abundant mitoses.
**Stroma: cellular, stroma (spindle cells), mitoses.
*[[Simple endometrial hyperplasia]] without atypia - architectural atypia diffuse.
*[[Benign endometrial polyp]].
 
====Images====
www:
*[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig15 DPE (sciencedirect.com)].
*[http://www.sciencedirect.com/science/article/pii/S0740257010000997#fig18 DPE (sciencedirect.com)].
*[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)].
<gallery>
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation - high mag. (WC/Nephron)
</gallery>
===Sign out===
<pre>
ENDOMETRIUM, BIOPSY:
- DISORDERED PROLIFERATIVE ENDOMETRIUM.
</pre>
 
=====With endocervix=====
<pre>
ENDOMETRIUM, BIOPSY:
- DISORDERED PROLIFERATIVE ENDOMETRIUM.
- BENIGN ENDOCERVICAL MUCOSA.
</pre>
 
=====Waffle a bit=====
<pre>
ENDOMETRIUM, BIOPSY:
- COMPATIBLE WITH DISORDERED PROLIFERATIVE ENDOMETRIUM (FRAGMENTS OF PROLIFERATIVE
  ENDOMETRIUM WITH EVIDENCE OF SHEDDING AND VERY RARE GLAND DILATION).
- VERY SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHOUT APPARENT PATHOLOGY.
- NEGATIVE FOR ENDOMETRIAL HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
ENDOMETRIUM, CURETTAGE:
- PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH GLAND DILATION AND SMALL BLOOD
  VESSELS, SEE COMMENT.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
 
COMMENT:
A fibrotic stroma is not present. The findings may represent a remnant of the previously
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
glands and stroma. Irregular, moderately enlarged glands are seen (only) in one of several
fragments; most of the endometrial glands are round, regular and small.
 
No stromal condensation is apparent. No secretions are in the glands.
 
There are no back-to-back glands. No nuclear atypia is apparent. No thick-walled blood
vessels are apparent.


==Endometrium with changes due to exogenous hormones==
==Endometrium with changes due to exogenous hormones==
Michael
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