Secretory phase endometrium

Secretory phase endometrium, abbreviated SPE, is a common diagnosis is endometrial specimens.

General

Secretory phase = luteal phase.
- Gynecologists prefer the ovarian descriptor, i.e. luteal phase; pathologists go by what they see, i.e. Secretions in the (endometrial) glands.

Gross

Thickened endometrium.

Microscopic

Early secretory phase

Features - post-ovulatory day 1-5:^[1]

Glands: secretory vacuoles.
- First basal to the epithelial nuclei (infranuclear vacuoles).
- Then apical to the epithelial nuclei (supranuclear vacuoles).
Mitoses may be present - common when vacuoles are subnuclear.

Mid secretory phase

Features - post-ovulatory day 6-8:^[1]

Glands: Mucus in glands.
Stroma: Edema (empty space around the glands).

Late secretory phase

Features - post-ovulatory day 9-12:^[1]

Stroma:
- Spiral arterioles.
- Predecidual changes -- mnemonic NEW:
  1. Nucleus central.
  2. Eosinophilic cytoplasm key feature (may be subtle to the novice).
  3. Well-defined cell borders.

Premenstrual

Stroma: neutrophils, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
Glands: apoptosis at the base of the gland.^[2]

Notes:

Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.^[3]
Gland-to-stroma ratio is increased in late secretory phase and menstruation.^[4]
Endocervical epithelium (ECE) has a morphology similar to the epithelium of secretory phase endometrium (SPE):
- ECE - grey foamy appearing cytoplasm.
- SPE - eosinophilic cytoplasm.
  - Most useful feature to differentiate ECE and SPE is the accompanying stroma.

DDx:

Endometrial hyperplasia with secretory changes.
Endometrium with hormonal changes.
Proliferative phase endometrium - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles or <50% of cells in the glands have subnuclear vacuoles.^[5]

Image:

Early secretory phase endometrium. (WC)
Endometrial stromal condensation. (WC/Nephron)

Sign out

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.

ENDOMETRIUM, CURETTAGE: 
- SECRETORY PHASE ENDOMETRIUM.

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM, EARLY.

With additional stuff

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
- SCANT ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.

ENDOMETRIUM, BIOPSY: 
- SECRETORY PHASE ENDOMETRIUM.
- ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.

ENDOMETRIUM, BIOPSY:
- SECRETORY PHASE ENDOMETRIUM.
- BENIGN SUPERFICIAL EXOCERVICAL EPITHELIUM.
- SCANT BENIGN ENDOCERVICAL EPITHELIUM.

Micro

The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucous with in them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent.

References

↑ ^1.0 ^1.1 ^1.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.
↑ TC. 22 June 2009.
↑ GAG. 6 Oct 2009.
↑ URL: http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed on: 6 December 2012.
↑ Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.

[Ref_DCHH237-1] 1.0 ^1.1 ^1.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.

[2] TC. 22 June 2009.

[3] GAG. 6 Oct 2009.

[4] URL: http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed on: 6 December 2012.

[Ref_EMB14-5] Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.

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