Difference between revisions of "Endometrial thickening"

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{{Fixation - standard}}
 
{{Fixation - standard}}
 
{{Fixation - general notes}}
 
{{Fixation - general notes}}
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==Hysterectomy sampling==
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A '''[[Hysterectomy|regular hysterectomy grossing]]''' is performed, but with the following sampling:<ref>{{cite web|url=https://voices.uchicago.edu/grosspathology/gyne/uterus-endometrial-hyperplasia/|title=Gross Pathology Manual|website=The University of Chicago Department of Pathology|author=Nicole Cipriani|date=2020-06-22}}</ref>
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*2 longitudinal sections through ecto/endocervix (1 anterior and 1 posterior)
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*2 longitudinal sections through upper endocervix/lower uterine segment (1 anterior and 1 posterior), immediately adjacent to the sections taken from the cervix
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*4 full-thickness representative sections of endomyometrium (2 anterior and 2 posterior)
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*Transversely section the remaining anterior and posterior endomyometrium (~1 cm thick).  Submit the entire endometrium from the lower uterine segment to the fundus, maintaining orientation.
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*Submit entire fimbriae (longitudinally sectioned) and 2 representative cross-sections on each side.
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==Microscopic evaluation==
 
==Microscopic evaluation==
[[File:Endometrial histopathologies and cytopathologies.jpg|thumb|400px|Histopathologic and cytopathologic images.<br>(A) proliferative endometrium (Left: HE × 400) and proliferative endometrial cells (Right: HE × 100)<br>(B) secretory endometrium (Left: HE × 10) and secretory endometrial cells (Right: HE × 10)<br>(C) atrophic endometrium (Left: HE × 10) and atrophic endometrial cells (Right: HE × 10)<br>(D) mixed endometrium (Left: HE × 10) and mixed endometrial cells (Right: HE × 10)<br>(E): endometrial atypical hyperplasia (Left: HE × 10) and endometrial atypical cells (Right: HE × 200)<br>(F) endometrial carcinoma (Left: HE × 400) and endometrial cancer cells (Right: HE × 400).]]
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*Look for signs of atypia or malignancy:
*Look for signs of atypia or malignancy.
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{{Endometrial hyperplasia, atypia and/or malignancy}}
<gallery mode=packed>
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File:Histopathology of complex hyperplasia without atypia.jpg|'''Complex hyperplasia without atypia''': Cystically dilated endometrial glands lined by a single layer of columnar epithelium.<ref>{{cite journal|last1=Rao|first1=Shalinee|last2=Sundaram|first2=Sandhya|last3=Narasimhan|first3=Raghavan|title=Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India|journal=Indian Journal of Medical and Paediatric Oncology|volume=30|issue=4|year=2009|pages=131|issn=0971-5851|doi=10.4103/0971-5851.65335}}<br>- [https://www.researchgate.net/figure/Cystically-dilated-endometrial-glands-lined-by-a-single-layer-of-columnar-epithelium_fig1_46256480 Figure- available via license: Creative Commons Attribution 2.0 Generic]</ref>
 
File:Histopathology of complex hyperplasia with atypia.jpg|'''Complex hyperplasia with atypia''': Closely packed endometrial glands with sparse intervening stroma and stratification of the lining epithelium. Epithelial cells show cytological atypia with high nucleocytoplasmic ratio, irregular clumping of nuclear chromatin, and mitotic figures.<ref>{{cite journal|last1=Rao|first1=Shalinee|last2=Sundaram|first2=Sandhya|last3=Narasimhan|first3=Raghavan|title=Biological behavior of preneoplastic conditions of the endometrium: A retrospective 16-year study in south India|journal=Indian Journal of Medical and Paediatric Oncology|volume=30|issue=4|year=2009|pages=131|issn=0971-5851|doi=10.4103/0971-5851.65335}}<br>- [https://www.researchgate.net/figure/Closely-packed-endometrial-glands-with-sparse-intervening-stroma-and-stratification-of_fig2_46256480 Figure- available via license: Creative Commons Attribution 2.0 Generic]</ref>
 
</gallery>
 
 
==Reporting==
 
==Reporting==
 
Most importantly:
 
Most importantly:

Revision as of 14:16, 9 April 2022

Author: Mikael Häggström [note 1]

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Hysterectomy sampling

A regular hysterectomy grossing is performed, but with the following sampling:[1]

  • 2 longitudinal sections through ecto/endocervix (1 anterior and 1 posterior)
  • 2 longitudinal sections through upper endocervix/lower uterine segment (1 anterior and 1 posterior), immediately adjacent to the sections taken from the cervix
  • 4 full-thickness representative sections of endomyometrium (2 anterior and 2 posterior)
  • Transversely section the remaining anterior and posterior endomyometrium (~1 cm thick). Submit the entire endometrium from the lower uterine segment to the fundus, maintaining orientation.
  • Submit entire fimbriae (longitudinally sectioned) and 2 representative cross-sections on each side.

Microscopic evaluation

  • Look for signs of atypia or malignancy:

edit

Reporting

Most importantly:

  • Presence or absence of atypia.

  See also: General notes on reporting


Notes

  1. 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

  1. Nicole Cipriani (2020-06-22). Gross Pathology Manual. The University of Chicago Department of Pathology.
  2. 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:10.4103/0971-5851.65335. ISSN 0971-5851. 
    - Figure- available via license: Creative Commons Attribution 2.0 Generic
  3. Owings, Richard A.; Quick, Charles M. (2014). "Endometrial Intraepithelial Neoplasia ". Archives of Pathology & Laboratory Medicine 138 (4): 484–491. doi:10.5858/arpa.2012-0709-RA. ISSN 1543-2165. 
  4. 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:10.1097/PGP.0000000000000553. ISSN 0277-1691. 
    - "Figures - available via license: Creative Commons Attribution 4.0 International"
  5. 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:10.1097/PGP.0000000000000512. ISSN 0277-1691. 

Image sources