Saturday, May 07, 2005

Gynecological Pathology Endometrium




Clinical Features

Other Features

Proliferative Enodmetrium

· Straight glands

· Narrow lumens

· Pallisading nuclei

· Ovoid nuclei

· Mitoses

Early Secretory Endometrium

First manifestation of effect of ovulation on endometrium

· Glands remain straight

· Lumens remain narrow

· Subnuclear vacuoles appear

24-36 hours after ovulation

Mid Secretory Endometrium

· Glands become coiled

· Vacuoles no longer present in glands

· Secretory product appears in lumen

Postovulatory days 5-9

Late Secretory Endometrium

· Intralumenal secretions are spent

· Stromal predecidua appears

· First predecidua around spiral arteries

· Later predecidua beneath surface

Postovulatory days 10-14

Menstrual Endometrium

· Stromal collapse

· Fribrin thrombi and blood

· Glands are broken apart

· Glands have no secretions

Hyper-secretory Endometrium of Pregnancy

· Arias-Stella reaction

· large, hyperchromatic nuclei

· prominent cytoplasmic vacuolization

Atrophic endometrium

· short glands

· glandular cells – flat, without significant mitotic activity

Dysfunctional Uterine Bleeding

· anovulatory bleeding

· luteal phase defect

Unopposed Estrogen

· proliferative glands

· stromal breakdown

· fibrin thrombi

· wreathing of stroma by glandular cells


Combined oral agents

· mix of proliferative and secretory changes

· long use

· atrophic glands

· stromal predecidual pattern dominates


· unopposed progesterone


· inc risk of carcinoma

· inc incidence of polyps

· large, mucinous metaplasia, fibrotic

Endometrial Hyperplasia

· unopposed estrogen stimulation – exogenous, endogenous

· no progestational stimulation

· simple or complex architecture

· typical or atypical nuclei

Vaginal bleeding, 60s

Risk factors – obesity, diabetes, nulliparity, early menarche, late menopause

Complex atypical hyperplasia progresses to carcinoma – 1/3

T – hysterectomy, hormonal manipulation

Endometrial Carcinoma Type 1 Endometrioid

· PTEN gene mutation à cell growth and apoptosis

· squamous or mucinous

Grade determines prognosis

T – hysterectomy, good survival

Low grade – hormonal

Endometrial Carcinoma Type 2 Unfavorable Histology

· serous-p53 mutations

· clear cell

Early spread outside uterus long term survival uncertain

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