Endometrium with squamous morules

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Endometrium with squamous morules
Diagnosis in short

Squamous morule. H&E stain.

LM well-circumscribed ball of squamoid cells -- cells have a whorled arrangement, moderate eosinophilic cytoplasm and a bland nucleus
LM DDx endometrial hyperplasia, endometrial carcinoma - esp. endometrioid endometrial carcinoma, uterine leiomyoma, atypical polypoid adenomyoma
Gross +/-endometrial thickening
Site endometrium

Associated Dx endometrial hyperplasia, endometrial carcinoma - esp. endometrioid endometrial carcinoma
Prognosis benign in itself, strong assoc. with malignancy
Squamous morules redirects here.

Endometrium with squamous morules is important to recognize as squamous morules are strongly associated with malignancy.

General

  • Benign finding in itself.
  • Strong association with malignancy.[1]
    • Associated with glandular lesions, i.e. endometrial hyperplasia and adenocarcinoma, not neoplastic squamous lesions.[2]

Microscopic

Features:

  • Well-circumscribed ball of squamoid cells:
    • Cells have a whorled arrangement.
    • Moderate eosinophilic cytoplasm.
    • Bland nucleus.
      • Smooth nuclear membrane.
      • Pale nuclear staining.
      • Fine chromatin pattern.

DDx:

Images

www:

IHC

Features:[2]

  • ER -ve.
  • PR -ve.
  • Ki-67 low.

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ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A FOCUS OF SQUAMOUS MORULES, SEE COMMENT.

COMMENT:
There is no evidence of hyperplasia or malignancy in this biopsy; however, squamous morules
are associated with hyperplasia and malignancy.  Close follow-up and a re-biopsy (when
clinically indicated) are recommended. 
ENDOMETRIUM, BIOPSY:
- EXTENSIVELY FRAGMENTED ENDOMETRIUM WITH ABUNDANT SQUAMOUS MORULES, SEE COMMENT.
- FOCAL STROMAL CONDENSATION SUGGESTIVE OF SHEDDING.

COMMENT:
The fragmentation makes it difficult to assess for hyperplasia. The squamous morules have
degenerative changes centrally. There is no evidence of malignancy in this biopsy.

Squamous morules are associated with hyperplasia and malignancy.  Close follow-up and a
re-biopsy (when clinically indicated) are recommended.

See also

References

  1. Nicolae, A.; Preda, O.; Nogales, FF. (Feb 2011). "Endometrial metaplasias and reactive changes: a spectrum of altered differentiation.". J Clin Pathol 64 (2): 97-106. doi:10.1136/jcp.2010.085555. PMID 21126963.
  2. 2.0 2.1 2.2 Lin, MC.; Lomo, L.; Baak, JP.; Eng, C.; Ince, TA.; Crum, CP.; Mutter, GL. (Feb 2009). "Squamous morules are functionally inert elements of premalignant endometrial neoplasia.". Mod Pathol 22 (2): 167-74. doi:10.1038/modpathol.2008.146. PMID 19180120.