Papillary Proliferation of the Endometrium: A Clinicopathologic Study of 56 Cases
Philip P Ip, Julie A Irving, Glenn W McCluggage, Robert H Young. University of Hong Kong, Queen Mary Hospital, Hksar, Hong Kong; Royal Jubilee Hospital, Victoria, BC, Canada; Belfast Health and Social Care Trust, Belfast, United Kingdom; Massachusetts General Hospital, Boston, MA
Background: Papillary proliferation of the endometrium (PPE) (Am J Surg Pathol 2001; 25:1347-1354) is uncommon and has been the subject of only a few studies. Histologically, it ranges from simple papillae with fibrovascular cores, typically involving endometrial polyps, to complex intracystic proliferations. Some consider the latter appearance nonatypical complex hyperplasia.
Design: To further characterize PPE, with emphasis on the risk of and features associated with underlying neoplasia, the clinicopathologic features of 56 cases of PPE without cytologic atypia were studied. The architectural complexity, extent of the proliferation, and any co-existent hyperplasia of conventional type (WHO classification) were recorded.
Results: The age of patients ranged from 23 to 82 years (median, 53); thirty-six (64%) were postmenopausal. The majority presented with abnormal bleeding. Thirteen patients (23%) were receiving hormonal preparations. The diagnosis of PPE was made in 47 biopsies and in 9 hysterectomies. In 46 cases (82%), there was an endometrial polyp. Fifty (89%) had epithelial metaplasias, most commonly mucinous (39 cases, 78%). Co-existent non-atypical and atypical hyperplasia was found in 8 and 5 cases, respectively. In 7 cases (12.5%) a low-grade endometrioid carcinoma was found either in the follow-up sample or hysterectomy specimen. In 4 of these, the neoplastic component was separate from the PPE. Features of PPE associated with a concurrent or subsequent atypical hyperplasia or carcinoma included complex or elongate papillae with frequent second and third degree branching, multifocality, and crowded intracystic papillae. Histologic features associated with uneventful outcome included simple papillae with absent or occasional second degree branching, detached or localized papillae confined to the surface of a polyp and a background of atrophic endometrium.
Conclusions: PPE most commonly occurs in postmenopausal women and is commonly associated with an endometrial polyp and epithelial metaplasias. Localized and simple lesions are usually associated with a benign outcome, and may be appropriately labeled as “benign papillary proliferation of the endometrium”. Architecturally complex papillae are likely to have an increased risk of carcinoma and should probably be regarded as analogous to complex hyperplasia. Patients with PPE should receive follow-up, including repeat sampling.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 127, Tuesday Afternoon