play romantic dating games - Endometrial dating histology

The secretory phase was definitely shorter in the biopsied than control cycle, suggesting that biopsy does accelerate the onset of flow.However, further analysis showed that biopsy does not interfere with length of flow or succeeding menstrual rhythm.



age, indication, LMP & menopausal status, hormonal therapy etc.

Considerable disagreement among gynecological pathologists: Inadequate if no endometrial tissue is present “Unassessable” if suboptimal endometrial tissue is present 8 Six morphological patterns Proliferations composed of glands & supportive non neoplastic stroma Biphasic proliferations composed of glands & abundant (possible neoplastic) stroma Predominantly monophasic spindle cell proliferation Sheet like proliferations composed of large, round undifferentiated cells Sample that feature extensive necrosis, inflammation, or disintegration Scanty samples that raise the question of sampling adequacy 14 Endometrial metaplasias Epithelial Mullerian: -Squamous -Tubal -Mucinous -Secretory Non Mullerian -Eosinophilic -Papillary syncytial -Micropapillary hobnail -Clear cell Non epithelial Osteoid Endometrial extamedullary hemopoiesis 32 Endometrial polyp Pathological diagnosis is straightforward if the gynecologist is aware of this & has conveyed this information to the pathologist & has removed polyp intact Possibility of polyp should always be considered in abnormal uterine bleeding Mixture of polypoidal & non polypoidal endometrium helpful in difficult cases Carcinoma, EIN or EIC can arise in or involve endometrial polyp 37 Endometrial hyperplasia (WHO 1994 & 2003) Non-atypical hyperplasias Simple hyperplasia Complex hyperplasia without atypia (adenomatous without atypia) Atypical hyperplasias Simple atypical hyperplasia Complex atypical hyperplasia (adenomatous with atypia) : Problems and alternative approaches Problems with this classification Definition of atypia Reproducibility of atypia Reproducibility of carcinoma Alternative approaches and concepts Simplified Classification for Biopsies Molecular and morphometric studies and EIN concept(Mutter, Baak et al.

2000) 47 Caveat: Sampling Problems in Endometrial Precursor lesion Focal nature of the lesion Problems of possible underdiagnosing due to incomplete sampling, particularly, in scanty fragmented specimens Hysteroscopy may assist in targeting focal lesions 58 Endometrial cancer: WHO classification Epithelial Endometrioid adenocarcinoma & it’s variants Mucinous adenocarcinoma Serous adenocarcinoma Clear cell adenocarcinoma Mixed carcinoma Squamous cell carcinoma Transitional cell carcinoma Small cell carcinoma Undifferentiated carcinoma Stromal Endometrial stromal sarcoma; low grade Endometrial stromal nodule Undifferentiated stroma sarcoma 61 Dualistic model of endometrial carcinoma; WHO2002 Type I;estrogen-related Endometrial hyperplasia/EIN Younger age History of estrogen use Increased body mass index Serum estrone increased ER / PR positive (80%) Favorable prognosis Endometrioid carcinoma mucinous carcinoma Key genes: K-RAS, PTEN, B-catenin; MSI, HNPCC Type II; estrogen-not related EIC Higher age No history of estrogen use Body mass index normal Serum estrone normal ER / PR negative (90%) unfavorable prognosis Serous carcinoma, clear cell carcinoma Key genes: p53 62 50% solid tumor* *Squamous metaplasia does not increase the grade NUCLEAR GRADE Size, shape , staining and chromatin, variability, prominent nucleoli.

The endometrium is typically biopsied because of abnormal bleeding.

Of the 40 patients who had adequate temperature records, 31 (78%) ovulated as predicted allowing a or- 1 day error, indicating that dating is a better gauge of duration of progesterone effect than predictor of onset of menses.

To determine whether biopsy caused early menstruation, the secretory phases of the 25 patients who had recorded temperatures in at least 2 cycles in addition to that in which the biopsy was taken were examined.

-- Weakly proliferative endometrial glands with apoptosis, fragmented.

-- Abundant balls of condensed non-proliferative endometrial stroma and blood.

Absence of organic endometrial disease and availability of accurate menstrual history were the only selection criteria. 42 of the 300 patients (14%) menstruated on the day predicted, 36 (12%) menstruated later, and 222 (74%) menstruated earlier.

Tags: , ,