Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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Endometrium Pathology

Reasons to biopsy:

  1. abnormal bleeding:
    1. post occult spontaneous abortion: may find some POC as multinucleate trophoblasts or villi; may see a few stromal plasma cells along with stromal fibrin plaques.
    2. chronic endometritis or endometriopathy: positive for stromal eosinophiles or plasma cells [LMC-05-2084] by H&E.
    3. IUD-related changes: These devices can induce a granulomatous reaction of histiocytes & polys (greatest with copper devices) [HP13-1431]. The progesterone-releasing devices induce a decidual reaction and dilated, thin-walled vesicles associated with thinning of surface epithelium.
    4. polyps: may be simple polyps with low glands:stroma ratio or adenomatous with increased ratio.
    5. pseudopolyp: residual non-functionalis island of post-ablation endometrium [L08-13096].
    6. submucous leiomyomata: [LMC-02-3578]...may not stop with Provera. A hard DX to make due to insufficient sampling in D&C or BX unless happen to skim off a bit of the myoma.
    7. dysfunctional uterine bleeding (DUB), NOS: preumptive DX until biopsy clarifies the basis or after biopsy gives no clue to why bleeding. Might include medication effect causing bleeding, coagulopathy, or corpus luteum insufficiency.
    8. perimenopausal hypoestrogenic weakly proliferative endometrium: gland functionalis area has penciform nuclear shapes rather than plumply oval nuclei of normal proliferative.
    9. perimenopausal disordered (menstrual series has a lot of anovulatory cycles) proliferative endometrium: when D&C has a large quantity of tissue, it is what old terminolgy had as non-adenomatous, noncomplex, "simple hyperplasia" [L06-8378]). Star shaped gland cross-sectional profiles or other irregularities but without a glands:stroma ratio greater than 1.0 (unity).
    10. corpus luteum insufficiency: insufficiently thickened endometrium & weak, non-robust, secretory effect. A hard DX to make due to insufficient sampling in D&C or BX but one that can be in a DDX when don't see a specific DX.
    11. hyperplasia/malignancy: increased glands:stroma ration makes hyperplasia & cyto-histological atypia makes cancer.
    12. medications (aspirin): there may be stromal bleeding in any type of pattern. A hard DX to make due to insufficient sampling in D&C or BX but one that can be in a DDX when don't see a specific DX.
    13. medication (pill/progestational): the stroma can be plump due to progestational effect, but can sometimes have a pseudodecidual reaction so florrid that it resembles true decidua & can slough as a cast ("membranous dysmenorrhea" [L09-12181]).
  2. coagulation disorders: there may be stromal bleeding in any type of pattern. A hard DX to make due to insufficient sampling in D&C or BX but one that can be in a DDX when don't see a specific DX.
  3. pelvic pain: we look for eosinophiles &/or plasma cells reflective of endometritis.
  4. uterine enlargement: adenomyosis, myometrial hypertrophy, myomata, endometrial hyperplasia, endometrial cancer.
  5. endometrial lining thickening by U/S: rule out hyperplasia & cancer.
  6. patient on carcinogenic medications: as in breast cancer...may induce endometrial hyperplasia or cancer. So, biopsy prior to beginning treatments and periodically as clinically indicated.
Volume as a diagnostic Aid
Scant Intermediate Plentiful
atrophy cycling disordered proliferative
inactive endometritis hyperplasia
HRT effect HRT effect HRT effect
oral contraceptive effect early hyperplasia gestation
adenomatous "change"1, typical or atypical [LMC-02-6383] polypoid cystic atrophy [LMC-04-9410] carcinoma
post thermal- or cryo- ablation   polyp
Lupron therapy (medical menopause induction)   polypoid cystic atrophy [LMC-04-9410]

Glands:stroma ratio

<1:1 no > than 1:1 >1:1
early proliferative mid proliferative mid secretory
inactive late proliferative early secretory
atrophy...even polypoid cystic atrophy [LMC-04-9410] mid secretory hyperplasia
progestin therapy disordered proliferative gestation
>day 20 secretory   carcinoma
oral contraception effect    
post-ablation post-ablation  
disordered proliferative [S-04-13194]    

References:

  1. Hendrickson & Kempson, Surgical Pathology of the Uterine Corpus, 1980.

(posted May 2002; latest addition 1 January 2015)

 
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