Foam Cells on Endometrial Biopsies/Curettings – An Indication for Additional Sampling or Not?
Melissa Holland, Abha Goyal. Cleveland Clinic Foundation, Cleveland, OH
Background: Endometrial stromal foam cells are often noted in association with atypical hyperplasias, endometrioid adenocarcinomas and stromal neoplasms. Though these cells resemble histiocytes, they reveal ultrastructural features of endometrial stromal cells. In this study, we examine whether the finding of foam cells in benign endometrium, anovulatory enometrium or in hyperplasias without atypia warrants additional sampling of the endometrium or not.
Design: A retrospective database search was conducted for “foam cells” in endometrial biopsy/curettings specimens accessioned at our institution from January 1990 to August 2012. For cases with benign endometrium, anovulatory pattern endometrium and endometrial hyperplasia without atypia, clinicopathologic data including histologic follow-up was recorded.
Results: In total, 65 cases were retrieved; 14 cases with complex hyperplasia with atypia and 2 cases with endometrioid FIGO Grade 1 adenocarcinoma at initial diagnosis were excluded from further analysis. For the remaining 49 cases - mean age was 52.8 years (range 32-89 years), diagnoses included disordered proliferative endometrium (10), simple hyperplasia without atypia (8), complex hyperplasia without atypia (12), proliferative endometrium (7), endometrial polyp (4), benign superficial endometrium (7) and abnormal secretory phase endometrium (1). Stromal breakdown was present in 23 (46.9%) cases and morular squamous metaplasia in 3 (6.1%) cases. Six patients underwent treatment with progestins. Of 23 cases with histologic follow-up (follow-up interval of 1-98.5 months, mean 16.5 months), only 1 patient developed complex hyperplasia with atypia (index biopsy with proliferative endometrium, interval from index biopsy of 8.2 years). None of the patients were found to have carcinoma on follow-up. Of the rest of 26 patients, clinical follow-up information was available for 12 and was unremarkable.
Conclusions: Our study suggests that foam cells may not be harbingers of endometrial carcinoma or atypical hyperplasia and may simply be a manifestation of chronic bleeding and stromal breakdown. Their presence should prompt a careful scrutiny by the pathologist but may not necessitate additional endometrial sampling.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 127, Tuesday Morning