Recommended
More Related Content
What's hot
What's hot (20)
Similar to ENDOMETRIAL DATING.pptx
Similar to ENDOMETRIAL DATING.pptx (20)
More from Tamil Mahizhenthi
More from Tamil Mahizhenthi (14)
Recently uploaded
Recently uploaded (20)
ENDOMETRIAL DATING.pptx
- 1. ENDOMETRIAL DATING Dr TAMIL NILA POST GRADUATE
- 2. NORMAL MENSTRUAL PHASES NAME OF THE PHASE AVERAGE DURATION RANGE MENSES 5 DAYS 1 – 7 DAYS PROLIFERATIVE PHASE 10 DAYS 9 – 20 DAYS SECRETORY PHASE 14 DAYS 14 DAYS (CONSTANT) MORPHOLOGICAL DATE CHRONOLOGICAL DATE VS
- 3. GLAND STROMAL RATIO (UNDER 10X) 1:1 MORE GLANDS MORE STROMA NORMAL CYCLING ENDOMETRIUM LATE SECRETORY ENDOMETRIA DECIDUA DYSFUNCTIONAL UTERINE BLEEDING MENSTRUATION ATROPHY INFERTILITY ENDOMETRIAL HYPERPLASIA CARCINOMAS MONOPHASIC SPINDLE CELL PROLIFERATIONS - SMOOTH MUSCLE NEOPLASMS - ENDOMETRIAL STROMAL NEOPLASM - SPINDLED EPITHELIAL NEOPLASM - UTERINE SARCOMAS
- 4. NORMAL PROLIFERATIVE ENDOMETRIUM • EPITHELIUM • PSEUDOSTRATIFIED • MITOTICALLY ACTIVE • ELONGATED CELLS • STRATUM FUNCTIONALIS • NON BRANCHING • NON BUDDING • SIMILAR SHAPED & EVENLY DISTRIBUTED GLANDS • STROMA • MITOTICALLY ACTIVE • MONOMORPHOUS • UNDIFFERENTIATED STROMAL CELLS • SCANT CYTOPLASM • INDISTINCT CELL MARGINS • VASCULATURE • UNIFORM, ARBORIZING AND THIN WALLED VESSELS
- 6. MID PROLIFERATIVE PHASE • GLANDS • DENSE, ELONGATED • PSEUDO STRATIFIED NUCLEUS • STROMA - EDEMA • CONFUSION WITH PREDECIDUAL PATTERN • GLAND CELLS’ NUCLEAR DETAILS • STROMAL CELLS’ CYTOPLASMIC MARGINS
- 7. INTERVAL ENDOMETRIUM • GLANDS • COILED • <50% OF EPITHELIAL CELLS WITH SUB NUCLEAR VACUOLATION • EVIDENCE OF SECRETION • EVIDENCE OF OVULATION • APPEARANCE OF DISTINCTIVE NUCLEOLAR CHANNEL SYSTEM • POD 1 & 2 ALSO SHOW THESE FINDINGS
- 8. EARLY SECRETORY PHASE (POD 2 – 5) • GLANDS • COILED • >50% CELLS WITH LARGE SUBNUCLEAR CYTOPLASMIC VACUOLES • MITOTIC FIGURES PRESENT • STROMA • NON PREDECIDUATED • CLINICOPATH CORRELATION • H/O MID CYCLE SPOTTING • MITTELSCHMERZ
- 9. MID SECRETORY PHASE (POD 6 – 8) • GLANDS • FULLY COILED • NO CYTOPLASMIC VACUOLATION • VESICULAR ROUND NUCLEUS • STROMA • STROMAL EDEMA • NO PREDECIDUA • LUMINAL SECRETIONS PRESENT • CLINICAL CORRELATION • IMPLANTATION
- 10. LATE SECRETORY (POD 9 – 10) • PROMINENT SPIRAL ARTERIOLES (UNDER LOW POWER) • VESSEL WALL THICKENING • STROMAL CELL CUFFING • STROMA • PREDECIDUATION BEGIN • AROUND ARTERIES -> ISLANDS -> CONFLUENT
- 11. LATE SECRETORY PHASE POD 12 -13 • GLANDS • TIGHTLY COILED • NON VACUOLATED SECRETORY EPITHELIUM • STROMA • EXTENSIVELY PREDECIDUATED • PATCHY FASHION • STROMAL GRANULOCYTES • NATURAL KILLER CELLS • BEAN SHAPED, DENSE NUCLEI • CYTOPLASMIC GRANULES
- 13. MENSTRUATION • DISINTEGRATING FRAGMENTS OF SECRETORY ENDOMETRIUM • GLANDS • APOPTOSIS • LINED BY DILATED & FLAT CELLS – SECRETORY EXHAUSTION • CELLS LOSE COHESION • THIN STRIPS • STROMA • FULLY PREDECIDUALISED • CRUMBLED • FIBRIN THROMBI
- 16. TYPE OF GLANDS PROLIFERATIVE SECRETORY VACUOLATED SECRETORY NON- VACUOLATED
- 17. PROLIFERATIVE SHAPE STRAIGHT-EP COILED – MP, LP, INTERVAL STROMAL EDEMA YES – MP NO – LP, INTERVAL SNV NO - LP <50% - INTERVAL
- 18. SECRETORY GLAND VACUOLATED POD 2 UNIFORM SNV >50% NUCLEAR PSEUDOSTRATIFICATION MITOTIC FIGURES POD 3 POD 4 LUMINAL POSITION OF VACUOLES RARE MITOTIC FIGURES POD 5 SECRETIONS VACUOLES INFREQUENT
- 19. SECRETORY NON VACUOLATED NON DECIDUALISED STROMA POD 6 PROMINENT SECRETION POD 7 STROMAL EDEMA + POD 8 STROMAL EDEMA +++ PRE DECIDUAL LATE SECRETORY, MENSTRUAL
- 20. SECRETORY NON VACUOLATED NO CRUMBLING OF STROMA POD 9 SPIRAL ARTERIES + POD 10 PERIARTERIAL CUFFS + POD 11 PREDECIDUA ISLANDS POD 12 COALESCENCE OF ISLANDS POD 13 STROMAL GRANULOCYTES + POD 14 RBC IN STROMA CRUMBLED STROMA MENSTRUATION
- 23. ESTROGENS • PROMOTE THE GROWTH OF A NON SECRETORY ENDOMETRIUM • ENDOGENOUS – CHRONIC ANOVULATION • EXOGENOUS – HORMONE REPLACEMENT THERAPY • PREDISPOSES TO • ENDOMETRIAL HYPERPLASIA • ENDOMETRIAL CARCINOMA (2-15 FOLD INCREASED RISK) – WELL DIFFERENTIATED AND SUPERFICIAL WITH GOOD PROGNOSIS
- 24. PROGESTATIONAL AGENTS • THERAPEUTIC & CONTRACEPTIVE PURPOSES • CHANGES SEEN MAINLY IN STROMA – PSEUDODECIDUAL CHANGES • GLANDS • SMALL • WIDELY SEPARATED • ATROPHIC • TAKES WEEKS TO RETURN TO NORMAL PATTERN ON DISCONTINUATION • ARIAS STELLA REACTION
- 25. ARIAS STELLA REACTION • CAN BE FOCAL, EXTRA ENDOMETRIAL • GLANDS • HYPERSECRETORY • LARGE CELLS • CYTOPLASM – EOSINOPHILIC, ABUNDANT • NUCLEI – IRREGULAR LARGE, SMUDGED, PLEOMORPHIC
- 26. SYNTHETIC PROGESTERONE RECEPTOR MODULATORS • INDICATION • ENDOMETRIOSIS • UTERINE LEIOMYOMAS • GLANDS • ATROPHIC OR INACTIVE EPITHELIUM • CYSTIC DILATED • DYSSYNCHRONY BETWEEN GLANDS AND STROMA • THICK WALLED CORDED VESSELS CLOSE TO SURFACE EPITHELIUM • CILIARY METAPLASIA IS COMMON
- 27. TAMOXIFEN • SYNTHETIC ANTI-ESTROGEN • INDICATION : PROPHYLAXIS OF BREAST CARCINOMA • PARADOXICAL ESTROGENIC EFFECT IN THE ABSENCE OF OVARIAN OESTROGEN • CAUSES • HYPERPLASIAS • POLYPS • MALIGNANT TUMOURS • ENDOMETRIAL CARCINOMA WITH BAD PROGNOSIS
- 28. GESTATIONAL ENDOMETRIUM • EARLY • COINCIDENCE OF • GLANDULAR LUMINAL SECRETION • PRE DECIDUALISATION • STROMAL EDEMA • FULLY DEVELOPED • GLANDS • FLATTENED OR CUBOIDAL LINING • NUCLEAR INCLUSIONS – BIOTIN ACCUMULATION • SURROUNDED BY SHEETS OF DECIDUA • ASSOCIATED FINDINGS – CHORIONIC VILLI, PLACENTA, FETAL PARTS ETC
- 30. ACUTE ENDOMETRITIS • INFLAMMATORY CELLS ARE NORMALLY PRESENT ON DAYS 26,27,28 • ACUTE ENDOMETRITIS • ABORTION • POSTPARTUM STATE • INSTRUMENTATION • INFILTRATION & DESTRUCTION OF GLANDS BY PMNs
- 31. CHRONIC ENDOMETRITIS • INFILTRATION BY LYMPHOCYTES, PLASMA CELLS & EOSINOPHILS • CAUSES • PREGNANCY • ABORTION • SUBMUCOSAL FIBROID • IUD/ CERVICITIS • SYMPTOMS • INFERTILITY • BLEEDING PV • PELVIC PAIN • ASYMPTOMATIC IUD • FOCAL OR EXTENSIVE • NECROSIS • SQUAMOUS METAPLASIA
- 32. ACTINOMYCES • CENTRAL BRANCHING FILAMENTS • DIPHETHEROID FORMS • DEVELOPS FOLLOWING INSERTION OF IUD HEMATOMETRA • CERVICAL OCCLUSION • MICROSCOPY • DISAPPEARANCE OF MUCOSA • LIPID CONTAINING HISTIOCYTIC CELSS – XANTHOGRANULOMATOUS ENDOMETRITIS • YELLOWISH-BROWN CYTOPLASMIC PIGMENT – CEROID CONTAINING HISTIOCYTIC GRANULOMA
- 33. ENDOMETRIAL TUBERCULOSIS • SYMPTOMS • MENSTRUAL ABNORMALITY • INFERTILITY • AFB IN TUBERCLES/CULTURE • GRANULOMAS CONCENTRATE IN SUPERFICIAL LAYERS • TAKE EM BX DURING LATE SECRETORY PHASE
- 34. OTHERS • CHLAMYDIA – IHC OF ANTIGENS OR PCR, PLASMA CELLS • VIRAL INFECTIONS – CMV, HPV – GRANULOMATOUS • COCCIDIODOMYCOSIS – FROM LUNG INFECTION • POSTOPERATIVE GRANULOMAS – ENDOMETRIAL ABLATION • SARCOIDOSIS • GRANULOMATOUS REACTION SPREADS TO MYOMETRIUM
- 35. HOW TO AVOID OVERDIAGNOSIS? • ABNORMAL CYCLIC PATTERN • FOCAL MONONUCLEAR INFILTRATE • INFLAMMATORY CELLS IN THE GLANDULAR LUMINA • DENSE STROMA • A STELLATE STROMAL PATTERN OF PROLIFERATION • FOCI OF NECROSIS OR CALCIFICATION
- 36. METAPLASIA - SQUAMOUS • MOST COMMON – PRE MENOPAUSAL, PCOS • FRANK KERATINIZATION – ICTHYOSIS UTERI • NON KERATINISED SQUAMOID CELLS • DIFFUSE – ADENOACANTHOSIS • AGGREGATES - MORULES • MORULAR METAPLASIA • FUNCTIONALY INERT • NO SEX HORMONE RECEPTORS • LOW PROLIFERATION RATE • CDX2 – INTESTINAL TRANSCRIPTION FACTOR +VE
- 37. METAPLASIA – CILIATED (TUBAL) • SCATTERED CILIATED CELLS ARE NORMAL IN THE ENDOMETRIUM • MARKEDLY INCREASED – METAPLASIA • COMMON IN ATROPHIC ENDOMETRIUM • NOT A SIGNIFICANT RISK FACTOR FOR ADENO CARCINOMA
- 38. METAPLASIA - PAPILLARY • SYNCTITIAL TO PAPILLARY AGGREGATES OF EOSINOPHILIC CELLS • ENDOMETRIAL BREAKDOWN
- 39. MUCINOUS METAPLASIA • MORPHOLOGICALLY, HISTOCHEMICALLY & ULTRASTRUCTURALLY SIMILAR TO ENDOCERVICAL MUCOSA • COMMON IN ENDOMETRIAL POLYPS EOSINOPHILIC METAPLASIA • CELLS WITH ABUNDANT EOSINOPHILIC CYTOPLASM HOBNAIL & CLEAR CELL METAPLASIA • EPITHELIUM – CLEAR, TALL CELLS WITH APICALLY LOCATED NUCLEI
- 40. ADENOMYOSIS • PRESENCE OF ISLANDS OF ENDOMETRIAL GLANDS AND STROMA DEEP WITHIN THE MYOMETRIUM • NON FUNCTIONAL – BASAL LAYER OF ENDOMETRIUM • LESS PROLIFERATIVE RATE • FOUND IN PROLIFERATIVE PHASE ENDOMETRIOSIS • OCCURRENCE OF ENDOMETRIAL TISSUE OUTSIDE THE UTERUS • FUNCTIONAL LAYERS OF THE ENDOMETRIUM • MORE PROLIFERATIVE RATE • PHASE CHANGES OCCORDING TO CYCLE
- 41. ADENOMYOSIS & ENDOMETRIOSIS THEORIES • CONGENITAL MULLERIAN OR WOLFFIAN RESTS • IMPLANTATION OF ENDOMETRIUM • LYMPHATIC OR HEMATOGENOUS SPREAD • SEROSAL METAPLASIA SYMPTOMS • PELVIC PAIN – VARIES WITH THE MENSTRUAL PERIOD • INFERTILITY • RUPTURE AT THE TIME OF PREGNANCY
- 42. ADENOMYOSIS - GROSS • ENLARGED & GLOBULAR UTERUS • MYOMETRIAL HYPERTROPHY – ASYMMETRICAL • DEPRESSED SMALL CYSTIC LESIONS • NODULES - ADENOMYOMA
- 43. ENDOMETRIOSIS GROSS • BLUISH CYSTIC NODULES SURROUNDED BY FIBROSIS • MULTIPLE POLYPOIDAL MASSES – ENDOMETRIOTIC POLYPOSIS OVARIES UTERINE LIGAMENT RECTOVAGINAL SEPTUM CUL DE SAC PELVIC PERITONEUM LARGE AND SMALL BOWEL AND APPENDIX, MUCOSA -CERVIX, VAGINA, & FALLOPIAN TUBES LAPAROTOMY SCARS
- 44. MICROSCOPY - ADENOMYOSIS • ENDOMETRIAL GLANDS & STROMA ARE SEEN IN THE MYOMETRIUM AT A DISTANCE OF AT LEAST OF 1 LOW POWER (10X) FIELD FROM THE EM-MM JUNCTION • ALWAYS IN PROLIFERATIVE PHASE • STROMA PREDOMINANT – STROMAL ADENOMYOSIS
- 45. MICROSCOPY - ENDOMETRIOSIS • ENDOMETRIAL GLANDS AND STROMA IN DENSE FIBROUS MASS WITH FRESH AND OLD HEMORRHAGE • STROMAL COMPONENT – SMOOTH MUSCLE METAPLASIA
- 46. ENDOMETRIAL ATROPHY • MITOTICALLY INACTIVE • CYSTIC ATROPHY • CYSTICALLY DILATED GLANDS • CUBOIDAL OR FLATTENED LINING
- 47. WEAKLY PROLIFERATIVE ENDOMETRIUM • TUBULAR GLANDS – CELLS WITH PSEUDOSTRATIFIED NUCLEI • MITOTIC FIGURES – ABSENT • COMMON & NORMAL PATTERN • PERIMENOPAUSAL • POSTMENOPAUSAL
- 48. DISORDERLY PROLIFERATIVE ENDOMETRIUM • ABSENCE OF UNIFORM GLANDULAR DEVELOPMENT • DYSSYNCHRONOUS GROWTH OF THE FUNCTIONALIS • NORMAL G:S RATIO • IDENTICAL TO LATE PROLIFERATIVE PHASE • NORMAL IN PERIMENARCHAL AND PERIMENOPAUSAL AGE GROUP • ANOVULATORY CYCLES • EXOGENOUS ESTROGEN THERAPY
- 49. ENDOMETRIAL HYPERPLASIA • PROLIFERATING ENDOMETRIUM – GLANDULAR CROWDING • INCREASED GLAND STROMAL RATIO = 2:1 OR 3:1 • CLASSIFICATION (WHO 2014) • ENDOMETRIAL HYPERPLASIA WITHOUT ATYPIA • ATYPICAL HYPERPLASIA
- 50. HYPERPLASIA WITHOUT ATYPIA • GLANDS • CYSTIC DILATION • MINIMAL BUDDING • LINING EPITHELIUM – NORMAL LP • NO CYTOLOGICAL ATYPIA • STROMA • COMPRESSED
- 51. HYPERPLASIA WITHOUT ATYPIA • GLANDS • MORE BUDDING • NO CYTOLOGICAL ATYPIA • STROMA • VERY MINIMAL
- 52. ATYPICAL HYPERPLASIA • GLANDS • BUDDING • CYTOLOGICAL ATYPIA • CRITERIA FOR ATYPIA • NUCLEAR ENLARGEMENT • NUCLEAR PLEOMORPHISM • LOSS OF NUCLEAR POLARITY • INCREASED N:C RATIO • EXTENSIVE NUCLEAR STRATIFICATION • MITOTIC FIGURES + • STROMA • VERY MINIMAL
- 53. ENDOMETRIAL POLYP • GROSS : PEDUNCULATED LESION • MICROSCOPY • GLANDS • CYSTICALLY DILATED CROWDED • LINING – ATROPHIC/WEAKLY PROLIFERATIVE GLANDS • STROMA • COLLAGENATED FIBROUS TISSUE, NUCLEAR ATYPIA, INCREASED MITOTIC ACTIVITY • HYPERPLASIA, CARCINOMA – FOCAL • CENTRAL – LARGE, THICK WALLED BLOOD VESSELS
- 54. • FUNCTIONAL POLYP – CYCLING ENDOMETRIUM • ADENOMYOMA – SMOOTH MUSCLE STROMA • ATYPICAL POLYPOID ADENOMYOMA – SMOOTH MUSCLE STROMA + ATYPICAL ENDOMETRIAL GLANDS
- 55. REFERENCES • ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE • DIFIORE’S ATLAS OF HISTOLOGY WITH FUNCTIONAL CORRELATION • STERNBERG’S DIAGNOSITIC SURGICAL PATHOLOGY • ROSAI AND ACKERMAN’S SURGICAL PATHOLOGY
- 56. THANK YOU