Atlas of Endometrial Histopathology (eBook)

Preface to the Third Edition 5
Contents 6
1: Introduction to the First Edition 9
2: Technical Remarks 10
2.1 Procedures for Obtaining Endometrial Tissue 10
2.2 Selection of the Proper Time for Curettage 10
2.3 Preparation of the Endometrial Specimen 11
2.4 Interpretation of Endometrial Specimens 11
3: Normal Endometrium 13
3.1 Normal Menstrual Cycle 13
3.1.1 Proliferative Phase 13
Early Proliferative Phase 13
Midproliferative Phase 15
Late Proliferative Phase 17
3.1.2 Secretory Phase 18
3.1.3 Menstruation 41
3.1.4 Regeneration 44
3.2 Physiologic Variations in the Climacterium 44
3.2.1 Proliferative Phase 44
3.2.2 Secretory Phase 47
3.3 Normal Postmenopausal Endometrium 47
3.4 Isthmus Mucosa 49
4: Metaplastic Changes 51
4.1 Epithelial Metaplasia 51
4.1.1 Squamous Metaplasia and Ichthyosis 51
4.1.2 Mucinous Metaplasia 53
4.1.3 Papillary (Syncytial) Metaplasia 55
4.1.4 Tubal (Ciliated Cell) Metaplasia 55
4.1.5 Rare Forms of Metaplasia of Endometrial Glandular Epithelium 56
4.2 Stromal Metaplasia 58
5: Circulatory Disturbances 59
5.1 Pathologic Edema 59
5.2 Lymphatic Cysts 60
5.3 Apoplexia Uteri 61
6: Functional Disturbances 64
6.1 Anovulatory Disturbances 64
6.1.1 Atrophy 64
Diffuse Atrophy 64
Focal Pressure Atrophy 67
6.1.2 Resting Endometrium 68
6.1.3 Deficient Proliferation 68
6.1.4 Irregular (Disordered) Proliferation 70
6.1.4.1 Deficient or Irregular Proliferation with Focal Abortive Secretion 72
6.1.5 Anovulatory Withdrawal Bleeding 73
6.2 Endometrial Hyperplasia 75
6.2.1 Nonatypical Hyperplasia 75
6.2.1.1 Simple Hyperplasia 75
6.2.1.2 Complex (Adenomatous) Hyperplasia 82
6.2.2 Atypical Hyperplasia 89
6.2.6 Hyperplasia of Glands and Stroma 90
6.2.7 Focal Hyperplasia 90
6.2.8 Basal Hyperplasia 93
6.2.9 Endometrial Polyps 93
6.3 Ovulatory Disturbances 98
6.3.1 Deficient Secretory Phase 98
6.3.2 Irregular Shedding 103
6.3.3 Abnormal Decidual Shedding 110
6.4 Functional Endogenous Changes During the Perimenopausal Period 110
6.4.1 Secretory Hypertrophy 110
7: Iatrogenic Changes 114
7.1 After Hormone Therapy 114
7.1.1 Estrogen-Induced Hyperplasia 115
7.1.2 Gestagen Therapy 118
7.1.2.1 Arrested Secretion 118
7.1.2.2 Fibrous Atrophy 118
7.1.3 Gestagen Therapy of Atypical Hyperplasia or Adenocarcinoma 121
7.1.4 Combination Therapy 122
7.1.4.1 Abortive Secretion 122
7.1.4.2 Irregular Atrophy 128
7.1.4.3 Breakthrough Bleeding 128
7.1.4.4 Irregular Regeneration 128
7.1.4.5 Focal Stromal Hyperplasia 129
7.1.4.6 Pseudomelanosis 129
7.1.4.7 Focal Complex Hyperplasia 129
7.1.5 Hormones for Inducing Ovulation 129
7.1.5.2 Therapy with Clomiphen 130
7.1.6 Therapy with Tamoxifen 130
7.2 After Intrauterine Contraceptive Devices 130
7.2.1 Mechanical Decidualization 130
7.2.2 Perifocal Arrested Secretion 132
7.2.3 Surface Reaction Following Copper Devices 134
7.2.4 Endometritis 136
7.3 After Intrauterine Instillation 136
7.3.1 Histiocytic Storage Reaction 137
8: Endometritis 139
8.1 Acute Endometritis 139
8.2 Chronic Endometritis 141
8.3 Tuberculous Endometritis 143
8.4 Sarcoidosis 144
8.5 Actinomycosis 144
8.6 Foreign Body Granuloma 146
9: Neoplasms 149
9.1 Carcinomas 149
9.1.1 Adenocarcinomas of the Endometrioid Type 151
9.1.1.1 Early Adenocarcinoma 151
9.1.1.2 Well-Differentiated Adenocarcinoma 153
9.1.1.3 Dedifferentiated Adenocarcinoma 155
9.1.1.4 Secretory Adenocarcinoma 158
9.1.1.5 Estrogen Type of Adenocarcinoma 160
9.1.1.6 Sertoliform Variant of Adenocarcinoma 160
9.1.1.7 Adenocarcinoma with Squamous Differentiation 160
Well differentiated (Adenoacanthoma) 160
Poorly Differentiated (Adenosquamous Carcinoma) 162
9.1.2 Carcinomas of the Nonendometrioid Müllerian Type 163
9.1.2.1 Mucinous Adenocarcinoma 164
9.1.2.2 Mucinous Adenocarcinoma with Squamous Differentiation (Mucoepidermoid Adenocarcinoma) 168
9.1.2.3 Clear Cell Adenocarcinoma 169
9.1.2.4 Serous Adenocarcinoma 172
9.1.2.5 Squamous Cell Carcinoma 175
9.1.2.6 Small Cell Neuroendocrine Carcinomas of the Endometrium 175
9.1.2.7 Mixed Carcinomas 177
9.1.2.8 Undifferentiated Carcinoma 177
9.2 Stromal Tumors 177
9.2.1 Endometrial Stromal Nodule 177
9.2.2 Endometrial Stromal Sarcoma, Low Grade 178
9.2.3 Undifferentiated Endometrial Sarcoma 182
9.2.4 Malignant Mixed Mesenchymal Tumors 182
9.3 Mesodermal Mixed Tumors 184
9.3.1 Adenofibroma 184
9.3.2 Atypical Polypoid Adenomyoma 184
9.3.3 Adenosarcoma 186
9.3.4 Carcinofibroma 190
9.3.5 Carcinosarcoma (Malignant Müllerian Mixed Tumor), Homologous Type 191
9.3.6 Carcinosarcoma (Malignant Müllerian Mixed Tumor), Heterologous Type 194
9.4 Primitive Neuroectodermal Tumor (PNET) 197
9.6 Leiomyomas as Components of Endometrial Specimens 207
9.7 Secondary Tumors 207
9.7.1 Metastases from Primary Breast Carcinoma 210
9.7.3 Endometrial Involvement from Primary Carcinoma of the Cervix 212
10: Gestational Changes 213
10.1 Normal Trophoblast 213
10.2 Spontaneous Abortion 213
10.3 Partial Hydatidiform Mole 217
10.4 Complete Hydatidiform Mole 219
10.5 Invasive Mole 221
10.6 Choriocarcinoma 222
10.7 Placental Site Trophoblastic Tumor (PSTT) 225
10.8 Epithelioid Trophoblastic Tumor (ETT) 229
10.9 Placental Site Nodule (PSN) 230
References 231
Index 242