Clinical Outcome in Diagnostically Ambiguous Foci of "Gland Crowding" in the Endometrium
EC Huang, GL Mutter, CP Crum, MR Nucci. Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Background: Premalignant endometrial lesions (Endometrial Intraepithelial Neoplasia or EIN) are clonal neoplasms that arise focally and can be diagnosed using specific criteria. We occasionally encounter localized groups of crowded endometrial glands which are subdiagnostic of EIN that are interpreted as ambiguous by the terms "focal gland crowding". The differential diagnosis includes artifacts or mimics, and tangentially or poorly sampled EIN lesions. It has been our practice to flag these in the pathology report by describing gland crowding, and requesting rebiopsy to resolve the issue. We here report clinical follow-up of these patients.
Design: We conducted a retrospective study in all gynecologic pathology reports since 2001 (introduction of EIN criteria). These reports were retrieved from our anatomic pathology information system using a free-text index search for the flag term "gland crowding" through the final anatomic diagnoses. The analysis included the age of the patients, number of subsequent specimens, the duration and the outcome of the follow-ups.
Results: Of the 71,579 gynecologic pathology reports searched, 206 (0.3%) had the term "gland crowding" within the primary diagnostic field or associated note. Of these, 69.4% (143/206 cases; age 18-80) had follow-up pathology reports. Among the cases with follow-up (number of subsequent biopsies: range=1 to 16, median=1, average=1.8), 33 (23.1%) had a subsequent diagnosis of EIN (27 cases; 18.9%; follow-up range=1 month to 7 years, median=1 year, average=1.5 year) or carcinoma (6 cases; 4.2%; follow-up range=1 month to 5 years, median=0.5 year, average=1.7 year). EIN cases that were diagnosed within the first year (14 cases, 42.4%) were presumed concurrent with the initial subdiagnostic biopsy. An additional 13 subsequent EIN cases occurred after one year and were interpreted as a later stage of disease or new events. Two of the EIN cases were subsequently diagnosed as carcinoma in the hysterectomy specimens.
Conclusions: The “crowded glands” in this study represent interpretively difficult samples rather than a discrete, or new, diagnostic class. It is worthwhile in these diagnostically ambiguous cases to consider the option of follow-up sampling to resolve the possibilities, as 23.1% of cases will be followed by a histologic outcome of neoplasia. The range of histologic changes falling into this category will be illustrated and contrasted with diagnostic (EIN) features.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 120, Wednesday Morning