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endometrial epithelial anomalies

Tuesday 17 January 2017


-  metaplasia of the endometrium
- endometrial atrophy
- endometrial hyperplasia
- endometrial dysplasia

Evaluation of endometrium (Sternberg approach)

Reference : Mills, SE: Sternberg’s Diagnostic Surgical Pathology (4th Ed); Lippincott Williams & Wilkins, 2004

Based on low power microscopic appearance

- Pattern 1: proliferations composed of glands and supportive non-neoplastic endometrial stroma ; must evaluate gland to stroma ratio , glandular and stromal features , appearance of vessels and pattern uniformity

  • Gland to stroma ratio:
    • 1:1 associated with normal cycling endometrium , dysfunctional uterine bleeding and infertility
    • Glands > stroma associated with menstruation , late secretory phase , endometrial hyperplasia and endometrial carcinoma
    • Glands @<@ stroma associated with normal decidua , atrophy and monophasic stromal proliferations
  • endometrial stromal features:
  • Usual stroma in proliferative phase has minimal cytoplasm and spindled or oval nuclei ; in secretory phase or pregnancy , has decidual changes of abundant eosinophilic or clear cytoplasm , large round / oval nucleus
  • endometrial vasculature :
    • In proliferative phase , vessels are delicate branching network throughout endometrial stroma
    • secretory phase vessels have thicker walls, are coiled (aka spiral arteries )
    • thick walled vessels in fibrotic stroma are characteristic of endometrial polyp
  • Pattern uniformity:
    • cycling endometrium has uniform pattern throughout, except for lower uterine segment / isthmus (spindled stromal cells separated by collagen, hybrid endocervical-endometrial glands) and stratum basalis layer (unresponsive to hormones, appears weakly proliferative throughout menstrual cycle )

- Pattern 2: biphasic proliferations of glands and abundant stroma (possibly neoplastic stroma )

  • Includes endometrial polyp , atypical polypoid adenomyoma , MMMT, adenosarcoma , sarcoma , endometrial stromal neoplasms and adenomatoid tumor

- Pattern 3: predominantly endometrial monophasic spindle cell proliferations

- Pattern 4: sheetlike proliferations of large, round undifferentiated cells

- Pattern 5: extensive necrosis, inflammation and disintegration

  • Necrosis suggests malignancy ; also cervical stenosis , pyometra and xanthomatous endometritis
  • Inflammatory cells common in post-partum endometrium ; also bacterial infection
  • Disintegration associated with menstruation , hyperplasia ; may mimic carcinoma due to stromal collapse

- Pattern 6: scanty samples that raise question of sampling adequacy

  • May be due to atrophy or obstructing lesion that shields endometrium from sampling

See also

- uterine anomalies
- endometrium