Focal Glandular Crowding in Endometrial Specimens: What Does It Mean?
AS Godambe, V Zayat, P Rajan, A Salhadar, C Ersahin. Loyola University Medical Center, Maywood, IL
Background: In the daily practice of gynecologic pathology, there are several instances where we find clusters of crowded glands without any atypia that do not fit into any diagnostic category. Many times in these instances, the pathologist makes a descriptive diagnosis of focal glandular crowding (FGC). This term is ambiguous, and leaves the gynecologist without any direction for decisive decision making. The significance of FGC is unknown.
Design: We performed an in-house search in endometrial biopsies or hysterectomy specimens with FGC in the final diagnosis. Sixty-two (n=62) such cases were found. We measured the cross sectional area and diameter of the glandular crowding. Since majority of FGC cases can be a feature of disordered proliferative endometrium (DPE) or simple hyperplasia (SH), the specimens were assessed for both DPE and SH. DPE usually shows focal cystic dilation of glands, and is diffuse in SH. In SH, ciliated cell change is common, while it is not a known feature of DPE. For each of the patients with a diagnosis of FGC, all subsequent gynecological specimens were reviewed.
Results: Out of the 62 cases, 10% of cases (6/62) showed progression in subsequent specimens, ranging from simple hyperplasia without atypia to adenocarcinoma. Retrospectively, SH without atypia is favored to DPE in initial biopsies. 34% (21/62) cases showed no progression to hyperplasia, and 56% (35/62) had no follow-up biopsies. Cystic dilation was focal (individual glands) in 30 cases, and more diffuse (with small to large variation in size) in 32 cases. Ciliated cell change was noted in 19 cases, and out of these 1 showed progression to simple hyperplasia. The surface area of FGC ranged from 0.16mm² to 4.97 mm², and the lesion diameter ranged from 0.12mm to 2.62mm.
Conclusions: Focal glandular crowding is a term used commonly by the pathologist, and interpreted widely by the gynecologist. FGC diagnosis alone cannot be interpreted as a marker of either benignity or malignancy. Pathologists should try to classify these lesions as DPE, SH or other. Diffuse cystic dilation of glands, ciliated cell change and larger lesions favor SH over DPE. Since significant number of FGC patients in our study received no follow-up biopsies, pathologists must clearly communicate with the clinician if SH is favored. The presence of subsequent hyperplasia and adenocarcinomas in 10% (6/62) of the patients with FGC stresses the need for clinical and histological follow-up on these patients.
Category: Gynecologic & Obstetrics
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 155, Monday Morning