48,830
edits
Difference between revisions of "Proliferative phase endometrium"
Jump to navigation
Jump to search
Proliferative phase endometrium (view source)
Revision as of 01:40, 3 November 2013
, 01:40, 3 November 2013split-out
(redirect w/ cat.) |
(split-out) |
||
| Line 1: | Line 1: | ||
'''Proliferative phase endometrium''', abbreviated '''PPE''', is a very common [[diagnosis]] in [[endometrium|endometrial]] specimens. | |||
==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> | |||
==Gross== | |||
*Thickened endometrium. | |||
==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. | |||
==See also== | |||
*[[Endometrium]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Endometrium]] | |||