Disordered proliferative endometrium

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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.[1]

Treatment:

  • Progesterone[2] versus observation.[3]

Image:

Microscopic

Features:[4]

  • 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:

Images

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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

References

  1. Sherman, ME.; Ronnett, BM.; Ioffe, OB.; Richesson, DA.; Rush, BB.; Glass, AG.; Chatterjee, N.; Duggan, MA. et al. (Jul 2008). "Reproducibility of biopsy diagnoses of endometrial hyperplasia: evidence supporting a simplified classification.". Int J Gynecol Pathol 27 (3): 318-25. doi:10.1097/PGP.0b013e3181659167. PMID 18580308.
  2. McCluggage, WG. (Aug 2006). "My approach to the interpretation of endometrial biopsies and curettings.". J Clin Pathol 59 (8): 801-12. doi:10.1136/jcp.2005.029702. PMID 16873562.
  3. 3.0 3.1 Ely, JW.; Kennedy, CM.; Clark, EC.; Bowdler, NC.. "Abnormal uterine bleeding: a management algorithm.". J Am Board Fam Med 19 (6): 590-602. PMID 17090792. http://www.jabfm.org/content/19/6/590.full.
  4. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1080 and 1082. ISBN 0-7216-0187-1.
  5. URL: http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=235. Accessed on: 11 December 2012.