Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Endometrial pathology in the postmenopausal woman a an. However, a minority 20% of eecs have atrophic background endometrium, which was shown to be a marker of a worse prognosis. 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 most other mammals, the endometrium is reabsorbed in the estrous. In a recent study in which histology of the endometrium was compared with hysteroscopy and transvaginal ultrasound, the majority of patients with an. For many years the meaning of these changes remained puzzling and obscure. The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial. 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. Hormonal pathology of the endometrium modern pathology nature. The histopathological findings in the endometrium of women with abnormal uterine bleeding are shown in table 2. All the atrophic endometrium reported by histopathology had et 12mm, 16% between 912mm and in 49% of them et 12mm and 58mm in 14. Histologic features and differential diagnosis of endometrial polyps. Atrophic, unsatisfactory, chronic endometritis, polyp.
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. Proliferative activity in postmenopausal endometrium. Assessment of endometrial morphology and histology in postmenopausal women. 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. Normal postmenopausal endometrium the histological appearance of the endometrium is dependent on the last hormonal pattern before the menopause.
Endometrioid endometrial carcinoma with atrophic endometrium. Most txtreated patients had no pathologic endometrial changes. Due to atrophy of the endometrium and diminution of its blood supply, ascending infection. 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 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. Types of atrophic endometrium with pmb and serum concentration of sex steroid hormones in each type during and between episodes. The interpretation of the relevance of an unassessable specimen or scant specimen rests with the clinician. Uterus, endometrium metaplasia, squamous nonneoplastic. The endometrium is not unique in that it too demonstrates a spectrum of metaplastic epithelia. It is also known as atrophy of the endometrium and endometrial atrophy. Pathology of the endometriumpathology of the endometrium. An introduction to the endometrium is found in the endometrium article. Histopathological study of endometrium 20 int j res med.
The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. 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. Unexplained uterine bleeding from atrophic endometrium. The endometrium is the lining of the uterus, an atrophic endometrium is an abnormal thin lining of the uterus. An overview of gynecologic pathology is in the gynecologic pathology article. 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. The endometrial tissue is a sensitive target for steroid sex hormones and is able to modify its structural characteristics with promptness and versatility. 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. Bleeding caused by atrophic endometrium is a curious phenomenon. There are several histologic types of endometrial carcinoma ec. Often the endometrium is so thin it is reflective of sound waves, such that it looks like a continuous line. Histopathological lesions of endometrium endometrium pattern number of cases percentage proliferative endometrium 44 29. The study comprised 84 disease free endometria from asymptomatic postmenopausal women who had undergone.
Histopathological pattern of endometrial samples in abnormal. Doshi hospital staff quarters, gondal road, rajkot. Cystic atrophy becomes apparent if irregular proliferation or cystic glandular. 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. Unexplained postmenopausal uterine bleeding from atrophic. At histopathologic examination, these protuberances are identified as cystic glandular dilatation 3, 4. The uterus of the treated animal right is atrophic compared with that of a control animal left. An atrophic endometrium measures less than 4 mm, but is more commonly 1 to 2 mm in width. Histopathological patterns of endometrium in women with. Atrophic endometrium hysteroscopy cystic polyps hyperplasia stenosis subendometrial. Study of histopathological pattern of endometrium in. Uterine atrophy must be differentiated from hypoplasia. Hormonal pathology of the endometrium modern pathology.
Simple atrophy alone cannot explain why bleeding occurs in some but not other patients. 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. Epidemiology, risk factors, and prevention, section on epidemiology. My approach to the interpretation of endometrial biopsies. As discussed, this is the norm with an atrophic endometrium and no focal.
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. Histopathological and hormonal studies article pdf available in middle east fertility society journal 664 june 2015 with 414 reads. Clinicopathologic study of endometrial histopathology in. Autoplay when autoplay is enabled, a suggested video will automatically play next. To learn about the models of care for different endometrial pathology. Endometrial cancer histopathology reporting guide version 3. Study of histopathological pattern of endometrium in abnormal. 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. Endometrial histopathologybasics linkedin slideshare. To study the histopathology of endometrium and the serum concentration of sex steroid hormones in different types of atrophic.
The endometrium was in the proliferative phase in five cases, in the secretory phase in one case and atrophic in six cases. Morphological changes in hysterectomies after endometrial. Amongst simple hyperplastic endometrium 36% showed et 12mm, same number. 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. The most common age group having complaint of aub was 4150 years 53. 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. Type ii, nonendometrioid carcinomas, arise in atrophic endometrium and have a poor prognosis. Uterus, endometrium metaplasia, squamous in a female sprague dawley rat from a chronic study higher magnification of figure 1. 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.
Nov 14, 2014 the histological appearance of the endometrium is dependent on the last hormonal pattern before the menopause. The endometrium is typically biopsied because of abnormal bleeding. Patients with endometrial polyps and cancer presented more often with abnormal vaginal bleeding than those with inactiveatrophic endometrium. At about the turn of the century some investi gators held the physiological fluctuations of the menstrual cycle to be inflamma tory changes. Atrophic endometrium was most common finding in postmenopausal bleeding 4cases 3.
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. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding. Endometrial hyperplasia and endometrial carcinoma are dealt with in separate articles. Atrophic endometrium is a common finding in prepubertal and postmenopausal women. Pdf unexplained uterine bleeding from atrophic endometrium. 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. Answers from experts on atrophic endometrial lining. While most patients are asymptomatic, endometrial atrophy is one of the commonest cause of postmenopausal bleeding, accounting for approximately 6075% of cases 1. 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. Assessment of endometrial morphology and histology in. Atrophic endometrium, also inactive endometrium, is the normal finding in postmenopausal women. Atrophic endometrium is a noncancerous change that occurs in the tissue lining the inside of the uterus.
Endometrial glands are fewer than normal, the stroma may be collapsed or hyalinized especially in aged rodents, and the myometrium is thin. Including normal phases of endometrium, irregular and atrophic endometrium, as well as decidual reaction. Endometrial polyp an overview sciencedirect topics. Atrophy can affect just one portion of the uterus, such as the endometrium or myometrium.
In postmenopausal women there can occasionally be a small amount of fluid in the cavity outlining a paperthin endometrial lining. Regression of endometrial hyperplasia after treatment with. Pathology of the endometriumpathology of the endometrium thomas c. Types of atrophic endometrium with pmb and serum concentration of sex steroid hormones in each type during and between episodes of. In contrast to simple atrophy and postatrophic hyperplasia, acini have a pale appearance and nuclei are more spaced apart. They identified 19 samples with simple endometrial hyperplasia without cytologic atypia 0. My approach to the interpretation of endometrial biopsies and. Figure 2 2 is a suggested algorithm for assessing the adequacy of an endometrial biopsy specimen.
Atrophy is also encountered in extremely malnourished animals. 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. Nov 25, 2015 uterus, endometrium metaplasia, squamous in a female sprague dawley rat from a chronic study higher magnification of figure 1. Tamoxifen for breast carcinoma has an estrogenagonist effect on the uterus in approximately 20% of. Common symptoms reported by people with atrophic endometrium. Histopathological interpretation of endometrium in. The endometrium differs from all other tissues of the body in that it rhythmically changes its structure and function. Others included atrophic and basal endometrium, each constituting 5. Epithelial metaplasia refers to the replacement of normal epithelium at a given site by mature benign epithelium inappropriate to that site. Atrophy may be associated with bleeding and therefore biopsied to ruleout hyperplasia and malignancy. 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. Endometrial atrophy is a response to a hypooestrogenic state. Endometrial sampling was done and submitted to histopathological study for 97 cases of atrophic endometrium.
Go to the post procedure follow up and discuss the next step with your gyn physician. Patients with endometrial polyps and cancer presented more often with abnormal vaginal bleeding than those with inactive atrophic endometrium. Disordered proliferative endometrium associated with. Atrophic endometrium was defined as shallow endometrium with a thin basalis and with a few tubular glands lined by inactive epithelium. Endometrial pathology in the postmenopausal woman an. Immunohistochemical and genetic profiles of endometrioid. If it occurs after menopause it can be more specifically termed postmenopausal endometrial atrophy. There is squamous metaplasia of the endometrium with cellular debris in the uterine lumen and a few associated inflammatory cells. Atrophy is a common agerelated change and can also be induced by agents that cause ovarian damage or alter steroid production from the ovary. Some of these cytoplasmic alterations are better termed changes as they are thought not to represent true metaplastic transformation of the endometrial.
On histopathology endometrial atrophy was the commonest cause, followed by various endometrial hyperplasias with or without atypia, proliferative endometrium, cervical carcinoma. Endometrial polyps are known to contain thickwalled. In many histopathology laboratories, endometrial specimens account for a major. Atrophic endometrial tissue is smaller than normal endometrial tissue and has lost some of its function. Endometrial pathology in the postmenopausal woman an evidence based approach to management. Endometrial histopathology in 700 patients treated with.
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