Difference between revisions of "Endometrium"

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Endometrium (view source)

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The '''endometrium''' is typically biopsied because of abnormal bleeding.
The '''endometrium''' is typically biopsied because of abnormal bleeding.


===Indications===
==Indications for endometrial biopsy==
Biopsies done for bleeding:  
Biopsies done for bleeding:  
*Too much bleeding (if premenopausal) - ''AUB'' = abnormal uterine bleeding.
*Too much bleeding (if premenopausal) - ''AUB'' = abnormal uterine bleeding.
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**DUB is diagnosed if other causes of bleeding are excluded.
**DUB is diagnosed if other causes of bleeding are excluded.


===Normal microscopic findings===
=Normal microscopic findings=
==General==
*Endocervical glands are commonly seen, as is endocervical mucous.
*Endocervical glands are commonly seen, as is endocervical mucous.
**This is 'cause the gynecologist scrapes some off on the way in or out.
**This is 'cause the gynecologist scrapes some off on the way in or out.
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*Nuclei columnar.
*Nuclei columnar.


==A simple approach==
=A simple approach=
===Low power===
==Low power==
#Decide whether you're look at endometrium.
#Decide whether you're look at endometrium.
#Gland-to-stroma ratio normal?
#Gland-to-stroma ratio normal?
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#*Pink - consider leiomyoma, squamous morules (associated with endometrial hyperplasia).
#*Pink - consider leiomyoma, squamous morules (associated with endometrial hyperplasia).


===High power===
==High power==
#Mitoses present in the glands?
#Mitoses present in the glands?
#*Present in the proliferative phase, hyperplasias, malignancies.
#*Present in the proliferative phase, hyperplasias, malignancies.
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#*Some are normal during menses.
#*Some are normal during menses.


==Endometrial polyp==
=Dating endometrium=
===Epidemiology===
==Proliferative phase==
*Very common.
 
===Microscopy===
Features:<ref>URL: [http://www.pathologyoutlines.com/uterus.html#endopolyp http://www.pathologyoutlines.com/uterus.html#endopolyp].</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.
 
Notes:
*Endometrial glands may be out of phase with surrounding endometrium.
**Often proliferative.
*+/-Cystic dilation of glands.
*Cellular stroma.
 
==Dating endometrium==
===Proliferative phase===
*Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, NO vacuolation, NO mucus secretion.
*Glands: straight, tubular, tall pseudostratified columnar cells, mitotic figures, NO vacuolation, NO mucus secretion.
**Key features: pseudostratification, mitoses.
**Key features: pseudostratification, mitoses.
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**Gynecologists prefer the ovarian descriptor, i.e. ''follicular phase''; pathologists go by what they see, i.e. ''proliferative'' endometrium.
**Gynecologists prefer the ovarian descriptor, i.e. ''follicular phase''; pathologists go by what they see, i.e. ''proliferative'' endometrium.


===Secretory phase===
==Secretory phase==
*Early secretory phase - post-ovulatory day 1-5:
*Early secretory phase - post-ovulatory day 1-5:
**Glands: secretory vacuoles.
**Glands: secretory vacuoles.
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*Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.<ref>GAG. 6 Oct 2009.</ref>
*Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.<ref>GAG. 6 Oct 2009.</ref>


==Abnormalities of endometrium==
=Specific entities/abnormalities=
===Disordered proliferative phase===
==Endometrial polyp==
===Epidemiology===
*Very common.
*May be a cause of menorrhagia (heavy & long menses).
 
===Microscopic===
Features:<ref>URL: [http://www.pathologyoutlines.com/uterus.html#endopolyp http://www.pathologyoutlines.com/uterus.html#endopolyp].</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.
 
Notes:
*Endometrial glands may be out of phase with surrounding endometrium.
**Often proliferative.
*+/-Cystic dilation of glands.
*Cellular stroma.
 
==Disordered proliferative phase==
===General===
*Association: anovulation.
*Association: anovulation.


Features:<ref>{{Ref PBoD|1080 and 1082}}</ref>
===Microscopic===
Features:<ref name=Ref_PBoD1080>{{Ref PBoD|1080 and 1082}}</ref>
*Proliferative type endometrium with:
*Proliferative type endometrium with:
**Cystic dilation of glands without secretions.
**Cystic dilation of glands without secretions.
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Image: [http://upload.wikimedia.org/wikipedia/commons/a/ab/Endometrial_stromal_condensation_high_mag.jpg Endometrial stromal condensation - high mag. (WC)].
Image: [http://upload.wikimedia.org/wikipedia/commons/a/ab/Endometrial_stromal_condensation_high_mag.jpg Endometrial stromal condensation - high mag. (WC)].


===Endometrium of a woman taking [[OCP]]===
==Oral contraceptive effect==
===General===
*Very common.
*Most pills a mix of progesterone and estrogen.
**The progesterone is what generates the characteristic appearance -- that is similar to pregnancy.
 
===Microscopic===
Features:<ref name=Ref_PBoD1082>{{Ref PBoD|1082}}</ref>
Features:<ref name=Ref_PBoD1082>{{Ref PBoD|1082}}</ref>
*Inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses).
*Inactive glands (round/ovoid glands, simple cuboidal epithelium, no mitoses).
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Image: [http://commons.wikimedia.org/wiki/File:Endometrium_ocp_use3.jpg Endometrium of woman on an OCP (WC)].
Image: [http://commons.wikimedia.org/wiki/File:Endometrium_ocp_use3.jpg Endometrium of woman on an OCP (WC)].


===Postmenopausal women===
==Postmenopausal women==
===General===
*Menopause happens at around 50 years old.
 
===Microscopic===
Features:
*Atrophy glands.
*Thin endometrium.
 
Notes:
*If a woman is truly postmenopausal, mitoses in the glandular epithelium is pretty much always pathologic.
*If a woman is truly postmenopausal, mitoses in the glandular epithelium is pretty much always pathologic.
**Exception is inflammation... e.g. the person has had several biopsy attempts and was seeded with pathogens.
**Exception is inflammation... e.g. the person has had several biopsy attempts and was seeded with pathogens.
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{{main|Endometrial hyperplasia}}
{{main|Endometrial hyperplasia}}
Can be thought of as a precursor lesion for endometrial carcinoma.
Can be thought of as a precursor lesion for endometrial carcinoma.
It comes in two main flavours:
#Simple.
#Complex.
Each flavour may or may not have nuclear atypia.


==Endometrial carcinoma==
==Endometrial carcinoma==
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Endometrial cancer is the common gynecologic malignancy (in the USA).<ref name=pmid19332248>{{cite journal |author=Lu KH |title=Management of early-stage endometrial cancer |journal=Semin. Oncol. |volume=36 |issue=2 |pages=137–44 |year=2009 |month=April |pmid=19332248 |doi=10.1053/j.seminoncol.2008.12.005 |url=}}</ref>
Endometrial cancer is the common gynecologic malignancy (in the USA).<ref name=pmid19332248>{{cite journal |author=Lu KH |title=Management of early-stage endometrial cancer |journal=Semin. Oncol. |volume=36 |issue=2 |pages=137–44 |year=2009 |month=April |pmid=19332248 |doi=10.1053/j.seminoncol.2008.12.005 |url=}}</ref>


==See also==
=See also=
*[[Uterine tumours]].
*[[Uterine tumours]].
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
Michael
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