Difference between revisions of "Endometrium"

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Endometrium (view source)

Revision as of 01:39, 3 November 2013

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→‎Proliferative phase endometrium
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=Normal endometrium=
=Normal endometrium=
==Proliferative phase endometrium==
==Proliferative phase endometrium==
*Abbreviated ''PPE''.
{{Main|Proliferative phase endometrium}}
===General===
*Day 1-13 in the protypical menstrual cycle of 28 days.
**May be ''day 5-13'' - if the menstruation is not included.
**"Exodus" pattern is a term used to describe exfoliation of endometrial cells during the proliferative phase.
***On [[pap test]]s this is associated with the classic double contoured balls of endometrial epithelium and stroma.
 
Note:
*Proliferative phase = follicular phase.
**Gynecologists prefer the ovarian descriptor, i.e. ''follicular phase''; pathologists go by what they see, i.e. ''proliferative'' endometrium.
*When the patient is >40 years, some advocate the use of the term ''proliferative type endometrium'' (instead of the term ''proliferative endometrium'').<ref>GAG. January 2009.</ref>
 
===Microscopic===
Features:<ref name=pmid16873562/>
*Glands:
**Straight, tubular, composed of tall pseudostratified columnar cells - '''key feature'''.
**Mitotic figures - '''key feature'''. †
*Stroma:
**Cellular stroma (spindle cells).
**Mitoses.
***Usually harder to find than in the glands.
 
Notes:
* † McCluggage says one shouldn't call ''PPE'' without mitoses, as some pseudostratification can be seen in [[atrophic endometrium]].<ref name=pmid16873562>{{Cite journal  | last1 = McCluggage | first1 = WG. | title = My approach to the interpretation of endometrial biopsies and curettings. | journal = J Clin Pathol | volume = 59 | issue = 8 | pages = 801-12 | month = Aug | year = 2006 | doi = 10.1136/jcp.2005.029702 | PMID = 16873562 | PMC = 1860448 }}</ref>
** There is no guidance on how hard one should look. VL suggests searching ~ 10 mm^2 with the 20x objective. This represents approximately ~ 10 fields of view with a microscope that has a 22 mm eye piece.
* Significant negatives:
** No vacuolation.
** No mucus secretion.
* Inflammation (neutrophils, rare plasma cell) & stromal breakdown common early in the proliferative phase.<ref name=Ref_GP197>{{Ref GP|197}}</ref>
 
DDx:
*[[Endometrial polyp]].
*[[Disordered proliferative endometrium]].
*[[Endometrial hyperplasia]]:
**[[Simple endometrial hyperplasia]].
**[[Complex endometrial hyperplasia]].
*[[Secretory phase endometrium]], early - >=50% of gland have subnuclear vacuoles ''and'' >=50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref>
 
 
Images:
*[http://library.med.utah.edu/WebPath/FEMHTML/FEM017.html Proliferative phase endometrium (utah.edu)].
*[http://www.cytochemistry.net/microanatomy/medical_lectures/028%20-%2019_16f.jpg Proliferative phase endometrium (cytochemistry.net)].<ref>URL: [http://www.cytochemistry.net/microanatomy/medical_lectures/oviduct_and_uterus.htm http://www.cytochemistry.net/microanatomy/medical_lectures/oviduct_and_uterus.htm]. Accessed on: 23 October 2012.</ref>
 
===Sign out===
<pre>
ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE PHASE ENDOMETRIUM.
</pre>
 
<pre>
ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE PHASE ENDOMETRIUM.
- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
</pre>
 
<pre>
ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE ENDOMETRIUM, FOCALLY WITH A FIBROTIC STROMA.
- BENIGN STRIPPED ENDOCERVICAL EPITHELIUM.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
ENDOMETRIUM, ASPIRATION:
- EARLY PROLIFERATIVE PHASE ENDOMETRIUM WITH SOME SHEDDING (APOPTOTIC CELLS,
  INFILTRATING NEUTROPHILS, BALLS OF CONDENSED ENDOMETRIAL STROMA).
- SCANT STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
- NEGATIVE FOR HYPERPLASIA.
</pre>
 
====Not quite normal====
<pre>
ENDOMETRIUM, BIOPSY:
- EARLY SECRETORY PHASE ENDOMETRIUM.
- FOCUS OF CROWDED PROLIFERATIVE GLANDS, SEE COMMENT.
 
COMMENT: 
There is a small focus of crowded and irregular proliferative glands
without cytologic atypia.  The possibility of a polyp is considered but the vessels and
polyp-type stroma are lacking.  Suggest clincal follow up with a consideration of a repeat
biopsy in 3 to 6 months to rule out a hyperplastic lesion.
</pre>
 
====Post-menopausal====
<pre>
ENDOMETRIUM, BIOPSY:
- PROLIFERATIVE TYPE ENDOMETRIUM.
-- NEGATIVE FOR HYPERPLASIA.
-- NEGATIVE FOR MALIGNANCY.
</pre>
 
=====Micro=====
The sections show endometrium with proliferative glands without significant dilation or irregularity of shape. The gland-to-stroma ratio is within normal limits. Mitotic activity is mild. No nuclear atypia is apparent.


==Secretory phase endometrium==
==Secretory phase endometrium==
Michael
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