Endometrium with changes due to exogenous hormones

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Endometrium with changes due to exogenous hormones
Diagnosis in short

Endometrium with changes due to exogenous hormones. H&E stain.

LM inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses), decidualized stroma (nucleus central, eosinophilic cytoplasm, well-defined cell borders)
LM DDx endometrial hyperplasia with secretory changes, secretory phase endometrium
Site endometrium

Clinical history exogenous hormones (oral contraceptive pill or hormone releasing intrauterine device)
Prognosis benign
Endometrium with changes due to exogenous hormones
External resources
EHVSC 10170

Endometrium with changes due to exogenous hormones is relatively common in endometrial samples.

Endometrial changes of oral contraception, oral contraceptive effect, OCP endometrium, and endometrium with hormonal changes redirect here.

The oral contraceptive pill is dealt with in the article oral contraceptive pill.

General

  • Very common.
  • Most pills are a mix of progesterone and estrogen.
    • The progesterone is what generates the characteristic appearance -- that is similar to pregnancy.
  • Same appearance is seen with a levonorgestrel-releasing intrauterine device, e.g. Mirena.

Microscopic

Features:[1]

  • Inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses).
  • Stroma decidualized -- mnemonic NEW:
    • Nucleus central.
    • Eosinophilic cytoplasm.
    • Well-defined cell borders.

DDx:

Image

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Endometrium, Curettage:
- Endometrium with nonproliferative endometrial glands and stromal decidualization,
  consistent with exogenous hormones.

Block letters

ENDOMETRIUM, BIOPSY:
- NON-PROLIFERATIVE ENDOMETRIAL GLANDS WITH STROMAL DECIDUALIZATION, CONSISTENT 
  WITH EXOGENOUS HORMONES.

OCP effect and shedding endometrium

ENDOMETRIUM, ASPIRATION:
- ENDOMETRIUM WITH NONPROLIFERATIVE ENDOMETRIAL GLANDS AND
  STROMAL DECIDUALIZATION, COMPATIBLE WITH EXOGENOUS HORMONES.
- EVIDENCE OF ENDOMETRIAL SHEDDING (BALLS OF CONDENSED STROMA
  ASSOCIATED NEUTROPHILS, AND BLOOD).
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show endometrium with nonproliferative endometrial glands and stromal decidualization. The gland-to-stroma ratio is within normal limits.

See also

References

  1. 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. 1082. ISBN 0-7216-0187-1.