Endometrial curettings
Author:
Mikael Häggström [note 1]
Contents
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross processing
- Generally submit all tissue for microscopy, even larger volumes.
- Look for products of conception if indicated from referral and/or history
Microscopic evaluation
Describe the anatomic/histologic type of epithelium.
Look mainly for:
- Endometrial hyperplasia, atypa and/or malignancy.
- Products of conception if indicated from referral and/or history
- If a polyp is mentioned in the history or referral, also evaluate as endometrial polyp.
Anatomic/histologic epithelium type
(Determine the type or phase of the endometrium:)
The most superficial layer of the endometrium usually consists of a simple columnar epithelium.
Postmenopausal (atrophic) endometrium: Thin epithelium, and scattered glands lined by columnar cells with small inactive nuclei, supported by a dense fibrous stroma of spindle cells. (H&E stain)
The phases of endometrium through the menstrual cycle:
Proliferative endometrium: long curving glands (G) and some stromal edema (H&E stain)
Secretory endometrium: Prominent glands (G), which have a dilated lumen and an irregular outer border stretching down into the basal compartment. In the luminal (functional) layer immune cells are readily detected (most of these are likely to be macrophages and uterine natural killer (uNK) cells), as are areas of decidualised fibroblasts (DEC) close to arterioles. (H&E stain)
If you want to specify the phase by day, then it's more accurate to state it as days past ovulation where applicable, since the follicular phase may vary substantially.
Hyperplasia, atypa and/or malignancy
- Look for signs of atypia or malignancy:
Endometrial hyperplasia: Cystically dilated endometrial glands lined by a single layer of columnar epithelium, without atypia.[1]
Endometrial intraepithelial neoplasia (EIN), has the following criteria:[2]
- Architectural gland crowding
- Altered cytology relative to background glands
- Minimum size of 1 mm
- Exclusion of adenocarcinoma
- Exclusion of mimics
Mitoses should also preferably be seen.
Endometrial adenocarcinoma[3], most commonly endometrioid, in which case low-grade carcinoma is distinguished from hyperplasia with atypia by the presence of glandular crowding with endometrial stromal exclusion, and significant cribriform, confluent glandular, labyrinthine, papillary/villoglandular, or non-squamous solid architecture.[4]
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Microscopy report
Example in a normal case:
| (Benign endometrium and endocervical mucosa without significant histopathologic changes.) Negative for neoplasia ((or viral cytopathic changes)). |
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Rao, Shalinee; Sundaram, Sandhya; Narasimhan, Raghavan (2009). "Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India
". Indian Journal of Medical and Paediatric Oncology 30 (4): 131. doi:. ISSN 0971-5851.
- Figure- available via license: Creative Commons Attribution 2.0 Generic - ↑ Owings, Richard A.; Quick, Charles M. (2014). "Endometrial Intraepithelial Neoplasia ". Archives of Pathology & Laboratory Medicine 138 (4): 484–491. doi:. ISSN 1543-2165.
- ↑ Stewart, Colin J.R.; Crum, Christopher P.; McCluggage, W. Glenn; Park, Kay J.; Rutgers, Joanne K.; Oliva, Esther; Malpica, Anais; Parkash, Vinita; et al. (2019). "Guidelines to Aid in the Distinction of Endometrial and Endocervical Carcinomas, and the Distinction of Independent Primary Carcinomas of the Endometrium and Adnexa From Metastatic Spread Between These and Other Sites
". International Journal of Gynecological Pathology 38: S75–S92. doi:. ISSN 0277-1691.
- "Figures - available via license: Creative Commons Attribution 4.0 International" - ↑ Rabban, Joseph T.; Gilks, C. Blake; Malpica, Anais; Matias-Guiu, Xavier; Mittal, Khush; Mutter, George L.; Oliva, Esther; Parkash, Vinita; et al. (2019). "Issues in the Differential Diagnosis of Uterine Low-grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas ". International Journal of Gynecological Pathology 38: S25–S39. doi:. ISSN 0277-1691.
Image sources
