Anovulatory endometrium

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Anovulatory endometrium, abbreviated AE, is common perimenopausal finding. It is a diagnosis that is inferred from the clinical context.

General

  • Individuals usually perimenopausal.

Relation to disordered proliferative endometrium

Some consider disordered proliferative endometrium (DPE) a synonym for anovulatory endometrium.[1]

Libre Pathology separates the two. DPE has prominent gland dilation (reminiscent of simple endometrial hyperplasia) and may not have shedding. AE has shedding without gland dilation.

Microscopic

Features:

  • Shedding:
    • Stromal condensation.
    • Apoptotic endometrial epithelium.
  • Weakly proliferative glands or non-proliferative glands.

DDx:

Sign out

ENDOMETRIUM, CURETTAGE:
- FRAGMENTED PROLIFERATIVE ENDOMETRIUM WITH EVIDENCE OF SHEDDING, WITHOUT ABUNDANT
  NEUTROPHILS, SEE COMMENT.
- NO EVIDENCE OF HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
The changes are compatible with anovulatory bleeding.
ENDOMETRIUM, CURETTAGE:
- PROLIFERATIVE ENDOMETRIUM WITH SMALL ROUND GLANDS AND SHEDDING, SEE COMMENT.
- BENIGN ENDOCERVICAL MUCOSA.
- NEGATIVE FOR HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
The changes are suggestive of anovulatory bleeding.
ENDOMETRIUM, BIOPSY:
- BENIGN ENDOCERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION, AND EVIDENCE
  SUGGESTIVE OF EROSIONS (SIDEROPHAGES, INCREASED BLOOD VESSEL DENSITY).
- SMALL NONPROLIFERATIVE ENDOMETRIAL GLANDS WITH RARE NEUTROPHILS AND RARE
  APOPTOTIC CELLS, WITH BALLS OF CONDENSED ENDOMETRIAL STROMA, SEE COMMENT.
- NEGATIVE FOR ENDOMETRIAL HYPERPLASIA AND NEGATIVE FOR DYSPLASIA.

COMMENT:
The changes are suggestive of anovulatory bleeding.
ENDOMETRIUM, ASPIRATION:
- PSEUDOSTRATIFIED ENDOMETRIAL EPITHELIUM WITHOUT APPARENT PROLIFERATION, WITH
  APOPTOTIC CELLS AND LIMITED STROMA WITH RARE (STROMAL) CONDENSATION -- COMPATIBLE
  WITH SHEDDING.
- MINUTE FRAGMENTS OF BENIGN ENDOCERVICAL EPITHELIUM.
- NO EVIDENCE OF HYPERPLASIA.

See also

References

  1. URL: http://www.surgpath4u.com/caseviewer.php?case_no=382. Accessed on: 9 May 2013.
  2. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.