Histologic features and differential diagnosis of endometrial polyps. As discussed, this is the norm with an atrophic endometrium and no focal. Correlation between cytological and histopathological. Pathology of the endometriumpathology of the endometrium thomas c. In a recent study in which histology of the endometrium was compared with hysteroscopy and transvaginal ultrasound, the majority of patients with an unassessable biopsy had a thin, regular endometrium on hysteroscopy with an endometrial thickness not exceed ing 7 ram. Histopathological patterns of endometrium in women with. However, approximately 20% of cases do not fit within this dualistic model and include endometrioid carcinomas associated with recurrence and. Amongst simple hyperplastic endometrium 36% showed et 12mm, same number. Disordered proliferative endometrium associated with. There is squamous metaplasia of the endometrium with cellular debris in the uterine lumen and a few associated inflammatory cells.
The endometrium is not unique in that it too demonstrates a spectrum of metaplastic epithelia. An overview of gynecologic pathology is in the gynecologic pathology article. Atrophy may be associated with bleeding and therefore biopsied to ruleout hyperplasia and malignancy. Endometrial polyp an overview sciencedirect topics. Histopathological interpretation of endometrium in. Bleeding caused by atrophic endometrium is a curious phenomenon. Wright columbia university, new york, ny changes in the uterus th h t lifthoughout life there are marked changes in the size of the uterus. Cystic atrophy becomes apparent if irregular proliferation or cystic glandular. Endometrioid histology is the most common, and this typically presents at an early stage with abnormal uterine bleeding, and is most common in postmenopausal women. To study the histopathology of endometrium and the serum concentration of sex steroid hormones in different types of atrophic. Study of histopathological pattern of endometrium in abnormal. If it occurs after menopause it can be more specifically termed postmenopausal endometrial atrophy.
As discussed, this is the norm with an atrophic endometrium and no focal lesion on ultrasound scan, but not a reason for repeating the biopsy. In the present study, 70 cases were placed in this category on cytology, out of which 62 cases proved to be benign, 3 cases were of hyperplasia and rest. On histopathology endometrial atrophy was the commonest cause, followed by various endometrial hyperplasias with or without atypia, proliferative endometrium, cervical carcinoma. Patients with endometrial polyps and cancer presented more often with abnormal vaginal bleeding than those with inactiveatrophic endometrium. Types of atrophic endometrium with pmb and serum concentration of sex steroid hormones in each type during and between episodes. To study the histopathology of endometrium and the serum concentration of sex steroid hormones in different types of atrophic endometrium associated with postmenopausal uterine bleeding pmb. Atrophic endometrium, also inactive endometrium, is the normal finding in postmenopausal women. Endometrial hyperplasia and endometrial carcinoma are dealt with in separate articles.
All the atrophic endometrium reported by histopathology had et endometrium showed proliferative phase, 25% showed et12mm, 16% between 912mm and in 49% of them et endometrium showed thickness of 912mm in 71%, 12mm and 58mm in 14. Type i endometrial carcinomas are characterized by endometrioid histology, develop from hyperplastic endometrium, and have a good prognosis. Go to the post procedure follow up and discuss the next step with your gyn physician. In many histopathology laboratories, endometrial specimens account for a major. Hormonal pathology of the endometrium modern pathology nature.
The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial. Atrophic endometrium was most common finding in postmenopausal bleeding 4cases 3. Some of these cytoplasmic alterations are better termed changes as they are thought not to represent true metaplastic transformation of the endometrial. Endometrial polyps are known to contain thickwalled. At histopathologic examination, these protuberances are identified as cystic glandular dilatation 3, 4. My approach to the interpretation of endometrial biopsies. This may suggest that unexplained pmb from atrophic endometrium may be due to the fluctuation of serum levels of the estrogens e 1, and e 2. Unexplained uterine bleeding from atrophic endometrium. The endometrium is typically biopsied because of abnormal bleeding. Figure 2 2 is a suggested algorithm for assessing the adequacy of an endometrial biopsy specimen.
Autoplay when autoplay is enabled, a suggested video will automatically play next. The egfr is an important mediator of cell proliferation, 20 22 both in normally cycling 23 25 and atrophic endometria, 26 whereas a high mib1 proliferation index is the defining feature of intense proliferative activity. In postmenopausal women there can occasionally be a small amount of fluid in the cavity outlining a paperthin endometrial lining. In the present study, 70 cases were placed in this category on cytology, out of which 62 cases proved to be benign, 3 cases were of hyperplasia and rest of the 5 cases had inadequate material on histopathology. We examined endometrial samples from 65 women who had undergone hysterectomy and categorized them based on histopathology into benign atrophic endometrium n, proliferative endometrium n. The endometrium is the lining of the uterus, an atrophic endometrium is an abnormal thin lining of the uterus. The endometrium was in the proliferative phase in five cases, in the secretory phase in one case and atrophic in six cases. Epidemiology, risk factors, and prevention, section on epidemiology. Hormone replacement therapy hrt is used to treat vasomotor symptoms and conditions such as atrophic vaginitis in perimenopausal and postmenopausal women, and its long term use also has a role in reducing the incidence of osteoporosis and ischaemic heart disease in postmenopausal women. Atrophic endometrium hysteroscopy cystic polyps hyperplasia stenosis subendometrial. The endometrial tissue is a sensitive target for steroid sex hormones and is able to modify its structural characteristics with promptness and versatility. Answers from experts on atrophic endometrial lining. Four patients had endometrial hyperplasia two atypical, one of them complex and two nonatypical, one of them complex, six had adenomyosis, three had myomas, four had endometrial polyps and one had an endometrioid. Endometrial carcinomas are divided into type i endometrioid endometrial carcinomas eecs, thought to arise from hyperplastic endometrium, and type ii nonendometrioid endometrial carcinomas, thought to arise from atrophic endometrium.
Atrophic endometrium is a common finding in prepubertal and postmenopausal women. Unexplained postmenopausal uterine bleeding from atrophic. Study of histopathological pattern of endometrium in. Clinicopathologic study of endometrial histopathology in. Epithelial metaplasia refers to the replacement of normal epithelium at a given site by mature benign epithelium inappropriate to that site. The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial aspiration and. When the last cycle ends in deficient proliferation or secretion, simple atrophy will appear as sparse, narrow glands lined by atrophic epithelium within a dense, fibrous stroma. However, a minority 20% of eecs have atrophic background endometrium, which was shown to be a marker of a worse prognosis. Histopathological and hormonal studies article pdf available in middle east fertility society journal 664 june 2015 with 414 reads. There are several histologic types of endometrial carcinoma ec.
Types of atrophic endometrium with pmb and serum concentration of sex steroid hormones in each type during and between episodes of. To learn about the models of care for different endometrial pathology. Often the endometrium is so thin it is reflective of sound waves, such that it looks like a continuous line. Including normal phases of endometrium, irregular and atrophic endometrium, as well as decidual reaction.
The endometrium differs from all other tissues of the body in that it rhythmically changes its structure and function. Glut1 and glut8 in endometrium and endometrial adenocarcinoma. An introduction to the endometrium is found in the endometrium article. In most other mammals, the endometrium is reabsorbed in the estrous. Morphological changes in hysterectomies after endometrial. Tamoxifen for breast carcinoma has an estrogenagonist effect on the uterus in approximately 20% of. An atrophic endometrium measures less than 4 mm, but is more commonly 1 to 2 mm in width. Assessment of endometrial morphology and histology in postmenopausal women. For many years the meaning of these changes remained puzzling and obscure. The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. Endometrial histopathology in 700 patients treated with. Histopathological lesions of endometrium endometrium pattern number of cases percentage proliferative endometrium 44 29.
My approach to the interpretation of endometrial biopsies and. Endometrial cancer histopathology reporting guide version 3. All the atrophic endometrium reported by histopathology had et 12mm, 16% between 912mm and in 49% of them et 12mm and 58mm in 14. For subsequent comparison of endometrial histopathology, the sign test was used to evaluate possible differences within groups, and the 2 or fishers exact test was used for. Doshi hospital staff quarters, gondal road, rajkot. Atrophy is a common agerelated change and can also be induced by agents that cause ovarian damage or alter steroid production from the ovary. Distribution of study subjects according to histological diagnosis histopathology number of cases percentage % atrophic endometrium 97 37,59 chronic hypotrophic endometritis 11 4,26 simple hyperplasia 18 6,97. Due to atrophy of the endometrium and diminution of its blood supply, ascending infection. Nov 25, 2015 uterus, endometrium metaplasia, squamous in a female sprague dawley rat from a chronic study higher magnification of figure 1. Endometrial glands are fewer than normal, the stroma may be collapsed or hyalinized especially in aged rodents, and the myometrium is thin.
Histopathological examination of endometrium should be done generously in women presenting with abnormal uterine bleeding especially after the age of 40 years to rule out malignant pathology. Atrophic endometrium was defined as shallow endometrium with a thin basalis and with a few tubular glands lined by inactive epithelium. Uterus, endometrium metaplasia, squamous in a female sprague dawley rat from a chronic study higher magnification of figure 1. Histopathological study of endometrium 20 int j res med. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding. Hormone replacement therapy and the endometrium journal. While most patients are asymptomatic, endometrial atrophy is one of the commonest cause of postmenopausal bleeding, accounting for approximately 6075% of cases 1. Immunohistochemical and genetic profiles of endometrioid.
Type ii, nonendometrioid carcinomas, arise in atrophic endometrium and have a poor prognosis. The ultrasound features of an endometrial polyp include a hyperechogenic area within the endometrial cavity, with or without regular small cysts, surrounded by a bright edge fig. Atrophic, unsatisfactory, chronic endometritis, polyp. Hormonal pathology of the endometrium modern pathology. Most txtreated patients had no pathologic endometrial changes. Atrophic endometrium is a noncancerous change that occurs in the tissue lining the inside of the uterus. Others included atrophic and basal endometrium, each constituting 5. They identified 19 samples with simple endometrial hyperplasia without cytologic atypia 0. Normal postmenopausal endometrium the histological appearance of the endometrium is dependent on the last hormonal pattern before the menopause. Atrophy is also encountered in extremely malnourished animals. In a recent study in which histology of the endometrium was compared with hysteroscopy and transvaginal ultrasound, the majority of patients with an.
The uterus of the treated animal right is atrophic compared with that of a control animal left. At about the turn of the century some investi gators held the physiological fluctuations of the menstrual cycle to be inflamma tory changes. Assessment of endometrial morphology and histology in. Endometrial pathology in the postmenopausal woman an evidence based approach to management. Proliferative activity in postmenopausal endometrium. Endometrial pathology in the postmenopausal woman an evidence based approach to management mohamed otify msc mrcog,a, joanna fuller mrcog,a jackie ross frcog,b hizbullah shaikh,c jemma johns md mrcog d aclinical research fellow, suite 8, golden jubilee wing, kings college hospital, denmark hill, london se5 9rs, uk bconsultant gynaecologist, suite 8, golden jubilee wing, kings. Simple atrophy alone cannot explain why bleeding occurs in some but not other patients. To investigate proliferation in disease free postmenopausal endometrium and that harbouring endometrial adenocarcinomais there a dynamic, yet lurking, potential for atrophic endometrium to give rise to endometrial adenocarcinoma.
The interpretation of the relevance of an unassessable specimen or scant specimen rests with the clinician. Atrophy can affect just one portion of the uterus, such as the endometrium or myometrium. Pathology of the endometriumpathology of the endometrium. Common symptoms reported by people with atrophic endometrium. Regression of endometrial hyperplasia after treatment with. Uterus, endometrium metaplasia, squamous nonneoplastic. Histopathological pattern of endometrial samples in abnormal.
Patients with endometrial polyps and cancer presented more often with abnormal vaginal bleeding than those with inactive atrophic endometrium. Atrophic endometrial tissue is smaller than normal endometrial tissue and has lost some of its function. Endometrioid endometrial carcinoma with atrophic endometrium. Pdf unexplained uterine bleeding from atrophic endometrium. Endometrial pathology in the postmenopausal woman a an. It is also known as atrophy of the endometrium and endometrial atrophy. Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Embryology the endometrium and the myometrium are of mesodermal origin and are formed secondary to fusion of the mullerian paramesonephric ducts between the 8th and 9th postovulatory weeks. Uterine atrophy must be differentiated from hypoplasia. In contrast to simple atrophy and postatrophic hyperplasia, acini have a pale appearance and nuclei are more spaced apart. Endometrial histopathologybasics linkedin slideshare. The study comprised 84 disease free endometria from asymptomatic postmenopausal women who had undergone. The histopathological findings in the endometrium of women with abnormal uterine bleeding are shown in table 2. Endometrial atrophy is a response to a hypooestrogenic state.
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