Difference between revisions of "Endometrium"

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Endometrium (view source)

Revision as of 01:56, 3 November 2013

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→‎Benign endometrial polyp: split-out
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==Benign endometrial polyp==
==Benign endometrial polyp==
:''Uterine polyp'' redirects here.
{{Main|Benign endometrial polyp}}
*Abbreviated ''BEP''.
*[[AKA]] ''endometrial polyp''.
 
===General===
*Very common.
*May be a cause of [[menorrhagia]] (heavy & long menses).
 
===Gross===
*Polypoid mass in the endometrial cavity.
 
Gross DDx:
*[[Secretory phase endometrium]].<ref name=pmid16873562/>
*Pedunculated [[uterine leiomyoma|leiomyoma]].
===Microscopic===
Features - diagnostic criteria:<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>
#Large blood vessels (muscular) - '''key feature'''.
#Fibrotic stroma - '''key feature'''.
#Polypoid shape - epithelium on three sides.
#*May not be seen... as polyp is fragmented on removal.
 
Glandular changes common:<ref name=pmid16873562/>
*Endometrial glands may be out of phase with surrounding endometrium.
**Often proliferative.
*+/-Cystic dilation of glands/unusual shapes
**[[Simple endometrial hyperplasia]] should ''not'' be diagnosed in a polyp!
*+/-Focal gland crowding.
 
Notes:
#Apparently benign polyps should be examined closely at the surface for in situ & invasive malignancies.
#Stroma often cellular.
 
DDx:
*[[Adenofibroma]].
*[[Cervical polyp]] - have endocervical mucosa.
*Lower uterine segment - have endocervical epithelium and lack the thick-walled blood vessels.<ref name=pmid16873562/>
*[[Endometrial carcinoma]] - esp. [[serous carcinoma of the endometrium]].
 
===Sign out===
====Non-proliferative====
<pre>
ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP.
</pre>
 
<pre>
ENDOMETRIUM ("POLYPS"), REMOVAL:
- BENIGN ENDOMETRIAL POLYPS WITH CYSTIC GLANDULAR DILATION AND
WITHOUT APPARENT PROLIFERATIVE ACTIVITY.
</pre>
 
=====Suggestive of polyp=====
<pre>
ENDOMETRIUM, CURETTAGE:
- POLYPOID NONPROLIFERATIVE ENDOMETRIUM WITH FOCALLY PROMINENT SMALL BLOOD VESSELS AND
  FIBROUS STROMA, SUGGESTIVE OF BENIGN POLYP.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Proliferative====
<pre>
ENDOMETRIUM, CURETTAGE:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE ACTIVITY.
</pre>
 
Note:
*It is useful to comment on whether non-polypoid endometrium is proliferative (if present), esp. in menopausal women.<ref name=pmid16873562/>
 
====Polyp with disordered proliferative phase in the background====
<pre>
ENDOMETRIUM, BIOPSY:
- BENIGN ENDOMETRIAL POLYP WITH PROLIFERATIVE GLANDS AND FOCAL GLAND DILATION.
- SUSPICIOUS FOR A BACKGROUND OF DISORDERED PROLIFERATIVE
  PHASE ENDOMETRIUM, SEE COMMENT.
- STRIPPED BENIGN ENDOCERVICAL EPITHELIUM.
 
COMMENT:
The endometrium sampled is proliferative with focal gland dilation throughout. The
features of a polyp (large muscular blood vessels, fibrous stroma and polypoid fragments of
endometrium) are only focally present, suggesting there is a background of disordered
proliferative phase endometrium.  Clinical correlation is suggested.
</pre>
 
====Clinically a polyp but not apparent on histology====
<pre>
UTERUS (POLYP), REMOVAL:
- LARGE FRAGMENT OF SECRETORY PHASE ENDOMETRIUM WITH LARGE BLOOD VESSELS, A
  NON-FIBROUS STROMA AND NO DISCERNIBLE SURFACE EPITHELIUM.
</pre>


==Anovulatory endometrium==
==Anovulatory endometrium==
Michael
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