Sampling the endometrium
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng in Diagnostic Endometrial Pathology, 2019
Endometrial sampling is carried out periodically in order to rule out malignancy and premalignant changes in the endometrium of asymptomatic women receiving postmenopausal hormone replacement or tamoxifen for breast cancer. Monitoring of the endometrium is often performed as an outpatient or office procedure with endometrial aspirate sampling. Most instruments available for sampling the endometrium in an outpatient setting use a suction mechanism to sample the endometrial lining; these include the Vabra aspirator and Pipelle. Endometrial tumors localized to a polyp or to a small area of endometrium may go undetected using outpatient endometrial-biopsy methods. Among the many indications for sampling the endometrium, abnormal uterine bleeding is the commonest. Dilatation and curettage necessitates hospital admission and involves an anesthetic risk. The histological subtyping and grading of endometrial carcinoma, particularly the endometrioid subtype, can be discrepant between pre-hysterectomy specimens, whether obtained by formal cervical dilatation and curettage or by outpatient endometrial sampling, and hysterectomy specimens.
Tumors of the Uterine Cervix and Endometrium
Victor A. Bernstam in Pocket Guide to GENE LEVEL DIAGNOSTICS in Clinical Practice, 2019
The multitude of chromosome aberrations appears to suggest that several genetic changes are necessary for the development of uterine leiomyomas. Identification of high-grade cytogenetic instability in uterine smooth muscle tumors is likely to predict the aggressive clinical behavior of the tumor. The c-myc protooncogene is overexpressed in stage I and II squamous cell carcinomas of the uterine cervix, it is highly correlated with the eightfold higher incidence of early recurrences, and the 18-month relapse-free survival rates. Deoxyribonucleic acid (DNA) flow cytometry of hyperplastic endometrium, known to be the precursor of endometrial adenocarcinoma, showed a higher percentage of nondiploid cells (20%), comparable to that in well-differentiated adenocarcinoma (29%). DNA ploidy is suggested as an adjunct to other traditional modes of tumor assessment. The majority (57%) of endometrial carcinomas have no differences compared to the ploidy characteristics of benign endometrium. Triploidy carries an especially poor prognosis, being associated with an aggressive disease.
Basic science of endometriosis
Charles Koh in An Atlas of ENDOMETRIOSIS, 2020
Endometriosis is defined histologically as the presence of endometrial glands and stroma outside the uterine cavity. The use of the scanning microscope has altered the histological interpretation of endometriosis. Vasquez and colleagues described three different endometriotic implants. Laparoscopy does not distinguish between these three types, because only the sequelae of endometriosis are visible at laparoscopy: haemorrhage, adhesions, accumulation of fluid and inflammatory reaction. Oestrogen, progesterone and androgen receptors are all quantifiable in endometriotic tissue. Oestrogen receptors are at a lower level and do not have the pronounced cyclical changes that occur in endometrium. The endometrial fragments in menstrual effluent are composed of necrotic and living cells, which do not survive in ectopic locations because of programmed cell death. Changes have been observed in both humoral and cell-mediated immunity in women with endometriosis. Endometriosis is associated with chronic inflammation. Macrophage numbers are increased and more active in peritoneal fluid from women with endometriosis.
An overview of the main intrauterine pathologies in the postmenopausal period
Published in Climacteric, 2020
Hysteroscopy is the gold standard for evaluating the uterine cavity, diagnosing intrauterine pathology, and operative intervention for some causes of abnormal uterine bleeding. The American College of Obstetricians and Gynecologists concluded that, when the endometrium measures ≤4 mm with transvaginal ultrasonography, the likelihood that bleeding is secondary to endometrial carcinoma is less than 1% (negative predictive value 99%), and endometrial biopsy is not recommended. Endometrial sampling in this clinical scenario will likely result in insufficient tissue for evaluation and it is reasonable to consider initial management for atrophy. A thickened endometrium on transvaginal ultrasonography (>4 mm in a postmenopausal woman with postmenopausal bleeding) warrants additional evaluation with endometrial sampling. A negative tissue biopsy following ‘blind’ endometrial sampling in women with postmenopausal bleeding is not considered to be an endpoint, and further evaluation of the endometrial cavity with hysteroscopy to exclude focal disease is imperative.
Embryoscopic diagnostics of endometrial defects in missed abortion after IVF
Published in Gynecological Endocrinology, 2016
High incidence of missed abortion induces to search for its causes. Apart from genetic and anatomic uterine factors, the state of the decidual endometrium and implantation zone of chorionic structures of the gestational sac are of particular interest. Direct visualization of the intact decidual endometrium is possible with embryoscopy, however, there is lack of presented data of normal and pathological signs of the endometrium during pregnancy. This paper describes the changes of the endometrium in missed abortion obtained by hysteroscopy in 160 women with nonprogressive pregnancy after ART protocols. High incidence of vascular disorders is determined, namely perivascular hemorrhage (70%), thrombosis of small-caliber endometrial vessels (36.9%), necrosis of the decidual endometrium and areas of the endometrium ejection beyond the implantation zone as a source of vaginal bleeding (10%). In addition, a high incidence of capsular decidual membrane defects are detected, namely, dystrophy, thinning and necrosis (60.6%).
Progesterone, progestins and the endometrium in perimenopause and in menopausal hormone therapy
Published in Climacteric, 2018
It is well established that unopposed estrogen for hormone therapy in postmenopausal women (MHT) induces a dose-related stimulation of the endometrium associated with an increased risk of hyperplasia and endometrial cancer. Progesterone acts physiologically to counteract the proliferative effects of estradiol during the menstrual cycle. In MHT, progestogens protect the endometrium against the proliferative effects of estrogens in women with a uterus. Recent data suggest that, whereas micronized progesterone is apparently safer for the breast, it could be less efficient than synthetic progestin on the endometrium. An update on progestogen and endometrial safety in MHT is the subject of this review.