Difference between revisions of "Endometritis"

Revision as of 02:12, 3 April 2014

Endometritis is inflammation of the endometrium. It usually subdivided into acute and chronic.

General

Usually post-delivery or post-instrumentation, e.g. previous biopsy.
May be spontaneous, e.g. tuberculous endometritis.

Microscopic

Acute endometritis

Features:

Neutrophils clusters (>5 PMNs) in the:
- Endometrial stroma.
- Within uterine glands.

Notes:

Neutrophils are normal in the context of menses.

Image:

Acute endometritis (stonybrook.edu).

Chronic endometritis

Features:^[1]

Plasma cells with in the endometrial stroma - key feature.
- Usually superficial/close to the luminal aspect.
Lymphocytic infiltrate - usually marked.
- May form lymphoid aggregates - low power finding.
+/-Eosinophils - presence should prompt a search for plasma cells.^[2]

Other findings:^[1]

+/-Necrosis.
Edema - common.
Hemorrhage.

Notes:

One plasma cell is not enough to call it.

DDx:

Mentrual endometrium - endometrial stromal condensation.

Images

Endometritis - high mag. (WC/Nephron)
Endometritis - very high mag. (WC/Nephron)

www:

Sign out

ENDOMETRIUM, BIOPSY:
- CHRONIC ENDOMETRITIS.

Not definite endometritis

ENDOMETRIUM, ASPIRATION:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE AND VERY RARE
  PLASMA CELLS, SEE COMMENT.
- NEGATIVE FOR HYPERPLASIA.

COMMENT:
The lymphocytic infiltrate and plasma cells raise the possibility of a mild chronic
endometritis; clinical correlation is suggested.

Nonspecific lymphocytic infiltrate

If not more than one plasma cell is apparent after searching.

ENDOMETRIUM, ASPIRATION:
- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE.
- SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR HYPERPLASIA.

Micro

The section show proliferative endometrium with a normal gland-to-stroma ratio. Mitotic activity is seen in the glands and stroma. No cytologic atypia is apparent. A mild nonspecific lymphocytic infiltrate is present.

No lymphoid aggregates are apparent. No eosinophils are apparent. No significant number of plasma cells is apparent.

Alternate

The sections show a fragmented nonproliferative endometrium with stromal decidualization and focal glandular dilation. The gland-to-stroma ratio is within normal limits. No cytologic atypia is apparent.

Lymphoid aggregates are present. Focally, rare eosinophils are identified. No significant number of plasma cells is apparent.

References

↑ ^1.0 ^1.1 Tawfik, O.; Venuti, S.; Brown, S.; Collins, J. (1996). "Immunohistochemical characterization of leukocytic subpopulations in chronic endometritis.". Infect Dis Obstet Gynecol 4 (5): 287-93. doi:10.1155/S1064744996000555. PMC 2364507. PMID 18476109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364507/.
↑ Adegboyega, PA.; Pei, Y.; McLarty, J. (Jan 2010). "Relationship between eosinophils and chronic endometritis.". Hum Pathol 41 (1): 33-7. doi:10.1016/j.humpath.2009.07.008. PMID 19801162.

[pmid18476109-1] 1.0 ^1.1 Tawfik, O.; Venuti, S.; Brown, S.; Collins, J. (1996). "Immunohistochemical characterization of leukocytic subpopulations in chronic endometritis.". Infect Dis Obstet Gynecol 4 (5): 287-93. doi:10.1155/S1064744996000555. PMC 2364507. PMID 18476109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364507/.

[pmid19801162-2] Adegboyega, PA.; Pei, Y.; McLarty, J. (Jan 2010). "Relationship between eosinophils and chronic endometritis.". Hum Pathol 41 (1): 33-7. doi:10.1016/j.humpath.2009.07.008. PMID 19801162.

[1]

[2]

@@ Line 1: / Line 1: @@
-#redirect [[Endometrium#Endometritis]]
+'''Endometritis''' is inflammation of the [[endometrium]]. It usually subdivided into ''acute'' and ''chronic''.
+==General==
+*Usually post-delivery or post-instrumentation, e.g. previous biopsy.
+*May be spontaneous, e.g. tuberculous endometritis.
+==Microscopic==
+===Acute endometritis===
+Features:
+*Neutrophils clusters (>5 PMNs) in the:
+**Endometrial stroma.
+**Within uterine glands.
+Notes:
+*Neutrophils are normal in the context of menses.
+Image:
+*[http://www.hsc.stonybrook.edu/gyn-atlas/UT53.10.1.htm Acute endometritis (stonybrook.edu)].
+===Chronic endometritis===
+Features:<ref name=pmid18476109>{{Cite journal  | last1 = Tawfik | first1 = O. | last2 = Venuti | first2 = S. | last3 = Brown | first3 = S. | last4 = Collins | first4 = J. | title = Immunohistochemical characterization of leukocytic subpopulations in chronic endometritis. | journal = Infect Dis Obstet Gynecol | volume = 4 | issue = 5 | pages = 287-93 | month =  | year = 1996 | doi = 10.1155/S1064744996000555 | PMID = 18476109 | PMC = 2364507 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364507/}}</ref>
+*Plasma cells with in the endometrial stroma - '''key feature'''.
+**Usually superficial/close to the luminal aspect.
+*Lymphocytic infiltrate - usually marked.
+**May form lymphoid aggregates - '''low power''' finding.
+*+/-Eosinophils - presence should prompt a search for plasma cells.<ref name=pmid19801162>{{Cite journal  | last1 = Adegboyega | first1 = PA. | last2 = Pei | first2 = Y. | last3 = McLarty | first3 = J. | title = Relationship between eosinophils and chronic endometritis. | journal = Hum Pathol | volume = 41 | issue = 1 | pages = 33-7 | month = Jan | year = 2010 | doi = 10.1016/j.humpath.2009.07.008 | PMID = 19801162 }}</ref>
+Other findings:<ref name=pmid18476109/>
+*+/-Necrosis.
+*Edema - common.
+*Hemorrhage.
+Notes:
+*One [[plasma cell]] is not enough to call it.
+DDx:
+*Mentrual endometrium - endometrial stromal condensation.
+===Images===
+<gallery>
+Image:Endometritis_-_2_-_high_mag.jpg | Endometritis - high mag. (WC/Nephron)
+Image:Endometritis_-_2_-_cropped_-_very_high_mag.jpg | Endometritis - very high mag. (WC/Nephron)
+</gallery>
+www:
+*[http://www.webpathology.com/image.asp?n=2&Case=565 Chronic endometritis (webpathology.com)].
+*[http://www.webpathology.com/image.asp?n=3&Case=565 Chronic endometritis (webpathology.com)].
+*[http://www.webpathology.com/image.asp?n=6&Case=565 Tuberculous endometritis (webpathology.com)].
+==Sign out==
+<pre>
+ENDOMETRIUM, BIOPSY:
+- CHRONIC ENDOMETRITIS.
+</pre>
+===Not definite endometritis===
+<pre>
+ENDOMETRIUM, ASPIRATION:
+- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE AND VERY RARE
+  PLASMA CELLS, SEE COMMENT.
+- NEGATIVE FOR HYPERPLASIA.
+COMMENT:
+The lymphocytic infiltrate and plasma cells raise the possibility of a mild chronic
+endometritis; clinical correlation is suggested.
+</pre>
+===Nonspecific lymphocytic infiltrate===
+If not more than one plasma cell is apparent after searching.
+<pre>
+ENDOMETRIUM, ASPIRATION:
+- PROLIFERATIVE PHASE ENDOMETRIUM WITH A MILD LYMPHOCYTIC INFILTRATE.
+- SMALL FRAGMENT OF ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
+- NEGATIVE FOR HYPERPLASIA.
+</pre>
+====Micro====
+The section show proliferative endometrium with a normal gland-to-stroma ratio.  Mitotic activity is seen in the glands and stroma. No cytologic atypia is apparent. A mild nonspecific lymphocytic infiltrate is present.
+No lymphoid aggregates are apparent. No eosinophils are apparent. No significant number of plasma cells is apparent.
+=====Alternate=====
+The sections show a fragmented nonproliferative endometrium with stromal decidualization
+and focal glandular dilation. The gland-to-stroma ratio is within normal limits. No
+cytologic atypia is apparent.
+Lymphoid aggregates are present. Focally, rare eosinophils are identified. No significant
+number of plasma cells is apparent.
+==See also==
+*[[Endometrium]].
+==References==
+{{Reflist|2}}
+[[Category:Endometrium]]