Hyperplasia and Carcinoma, with or without Secretory Changes, in Secretory Endometrium: A Diagnostic Challenge
AM Truskinovsky, B Lifschitz-Mercer, B Czernobilsky. University of Minnesota, Minneapolis, MN; Tel Aviv Medical Center, Tel Aviv, Israel; Patho-Lab Diagnostics, Ness Ziona, Israel
Background: The diagnosis of endometrial hyperplasia or carcinoma in a background of secretory endometrium can be difficult. We attempt to establish the diagnostic criteria to be used in such cases.
Design: We examined 80 cases of endometrial hyperplasia, carcinoma and other conditions with glandular crowding arising in secretory endometrium, analyzed their morphologic features, assessed the volume percentage stroma (VPS) in each case and performed Ki67 immunostains on six cases. Thirteen cases each of secretory and gestational endometrium served as controls.
Results: The mean patient age was 45 years. The nonneoplastic diseases included simple hyperplasia without atypia (56%), endometrial polyps (12.5%) and chronic endometritis with glandular crowding (3%), while neoplastic diseases included complex hyperplasia without atypia (10%), atypical hyperplasia (12.5%) and endometrioid carcinoma (6%). The secretory changes were usually less advanced in the hyperplastic glands than in the background endometrium. The morphologic features that best distinguished hyperplasia or carcinoma from secretory endometrium included glandular crowding that stood out from the background; architectural disorder (the long axes of the glands pointing in different directions or parallel to the endometrial surface); dilated, irregular-shaped glands, including budding or branching glands and staghorn-shaped glands; stroma of a polyp; cribriform or confluent glands in cases of carcinoma; nuclear atypia in cases of atypical hyperplasia and carcinoma; and crowded nonsecretory glands. The VPS of neoplastic lesions was less than that of nonneoplastic ones (37% vs. 61%, p<0.000001) and that of secretory endometrium (37% vs. 68%, p=0.000006). Nonneoplastic lesions did not have more crowded glands than secretory endometrium (VPS 61% vs. 68%, p=0.11). Gestational endometrium had more crowded glands than nonneoplastic lesions (VPS 39% vs. 61%, p=0.000004), approximately equal VPS with complex hyperplasia (both close to 39%, p=0.53), and less crowded glands than endometrioid carcinoma (VPS 39% vs. 30%, p=0.0266). The Ki67 index was higher in hyperplasia and carcinoma than in the background secretory endometrium (mitoses per gland cross-section, 1.76 vs. 0.19, p=0.02).
Conclusions: Hyperplasia and carcinoma in secretory endometrium can be diagnosed based on increased glandular crowding, architectural irregularity, nuclear atypia and increased Ki67 index.
Tuesday, March 10, 2009 8:00 AM
Platform Session: Section D, Tuesday Morning