Secretory phase endometrium

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Secretory phase endometrium
Diagnosis in short

Secretory phase. H&E stain.

LM dependent on day post-ovulation - see microscopic
LM DDx endometrial hyperplasia with secretory changes, endometrium with hormonal changes,proliferative phase endometrium
Site endometrium

Other normal finding

Secretory phase endometrium, abbreviated SPE, is a common diagnosis in endometrial specimens.

General

  • Secretory phase = luteal phase.
    • Gynecologists prefer the ovarian descriptor, i.e. luteal phase; pathologists go by what they see, i.e. Secretions in the (endometrial) glands.

Gross

  • Thickened endometrium.

Microscopic

Early secretory phase

Features - post-ovulatory day 1-5:[1]

  • Glands: secretory vacuoles.
    • First basal to the epithelial nuclei (infranuclear vacuoles).
    • Then apical to the epithelial nuclei (supranuclear vacuoles).
  • Mitoses may be present - common when vacuoles are subnuclear.

Mid secretory phase

Features - post-ovulatory day 6-8:[1]

  • Glands: Mucus in glands.
  • Stroma: Edema (empty space around the glands).

Late secretory phase

Features - post-ovulatory day 9-12:[1]

  • Stroma:
    • Spiral arterioles.
    • Predecidual changes -- mnemonic NEW:
      1. Nucleus central.
      2. Eosinophilic cytoplasm key feature (may be subtle to the novice).
      3. Well-defined cell borders.

Premenstrual

  • Stroma: neutrophils, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
  • Glands: apoptosis at the base of the gland.[2]

Notes:

  • Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.[3]
  • Gland-to-stroma ratio is increased in late secretory phase and menstruation.[4]
  • Endocervical epithelium (ECE) has a morphology similar to the epithelium of secretory phase endometrium (SPE):
    • ECE - grey foamy appearing cytoplasm.
    • SPE - eosinophilic cytoplasm.
      • Most useful feature to differentiate ECE and SPE is the accompanying stroma.

DDx:

Images

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ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, ASPIRATION:
- SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, CURETTAGE: 
- SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM, EARLY.

With additional stuff

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
- SCANT ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. 
ENDOMETRIUM, BIOPSY:
- SECRETORY PHASE ENDOMETRIUM.
- BENIGN SUPERFICIAL EXOCERVICAL EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL EPITHELIUM.

Evidence of shedding

ENDOMETRIUM, CURETTAGE:
- SECRETORY PHASE ENDOMETRIUM WITH FINDINGS SUGGESTIVE OF SHEDDING (EPITHELIAL
  APOPTOSIS, INFLAMMATORY CELLS - ESPECIALLY NEUTROPHILS).
- BENIGN EXOCERVICAL AND ENDOCERVICAL MUCOSA.

Micro

The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucous with in them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent.

See also

References

  1. 1.0 1.1 1.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.
  2. Colgan T. 22 June 2009.
  3. GAG. 6 Oct 2009.
  4. URL: http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed on: 6 December 2012.
  5. Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.