Disordered proliferative endometrium

Disordered proliferative endometrium
Diagnosis in short
Disordered proliferative endometrium. H&E stain.
LM	proliferative endometrial glands (pseudostratified nuclei + mitoses) with focally abnormal glands (glands >2x normal size; irregular shape -- typically with inflection points; >4 glands involved (dilated)), +/-stromal condensation, gland-to-stromal ratio normal, not within an endometrial polyp
LM DDx	proliferative phase endometrium,simple endometrial hyperplasia, benign endometrial polyp
Site	endometrium
Prognosis	benign
Treatment	followup - re-biopsy

Disordered proliferative endometrium, abbreviated DPE, is an abnormal endometrial finding with some features of simple endometrial hyperplasia.

General

• Association: anovulation.
• Benign - can be grouped with normal.

Treatment:

• Progesterone versus observation.

Image:

• Treatment algorithm based on endometrial biopsy results (jabfm.org).

Microscopic

Features:

• 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 four glands involved (dilated).
• +/-Stromal condensation -- balls of stromal tissue, aka "blue balls" (due to breakdown of endometrium).

Notes:

• Dilated glands often have tubal metaplasia.^{[citation needed]}
• 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 - may have gland dilation.
• Anovulatory endometrium - some consider this a synonym, see relation to disordered proliferative endometrium.

Images

• 

  DPE - low mag.

• 

  DPE - intermed. mag.

• 

  DPE - intermed. mag.

• 

  DPE - high mag.

• 

  DPE - high mag.

• 

  Endometrial stromal condensation - high mag. (WC/Nephron)

www:

• DPE (sciencedirect.com).
• DPE (sciencedirect.com).
• DPE (glowm.com).
• DPE (stonybrook.edu).

Sign out

ENDOMETRIUM, BIOPSY:
- DISORDERED PROLIFERATIVE ENDOMETRIUM.

With endocervix

ENDOMETRIUM, BIOPSY:
- DISORDERED PROLIFERATIVE ENDOMETRIUM.
- BENIGN ENDOCERVICAL MUCOSA.

Waffle a bit

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.

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.

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.

See also

• Endometrium.
• Simple endometrial hyperplasia.
• Waffle diagnosis.