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Handbook of Endometrial Pathology
Debra S Heller
1:
Interpreting pathology results – the value of communication
Introduction
Some gynecology for the pathologist
Why is endometrial sampling performed?
How is endometrial sampling performed?
In-office endometrial biopsy
Endometrial curettage
Some pathology for the clinician
Why is a history so important?
How does the pathologist evaluate tissue?
Gross Evaluation
Microscopic examination
Pathology reports
Adequacy of specimen
2:
The normal endometrial cycle
Menstrual/early proliferative endometrium (day 1–5)
Mid- to late proliferative endometrium (days 6–14)
Interval endometrium (day 15–16, postovulatory day (POD) 2–3)
Secretory endometrium (day 17–28, POD 4–14)
Atrophic endometrium
Luteal phase defects
3:
Pregnancy-related findings in normal and abnormal pregnancies
First trimester intrauterine products of conception
Viable first trimester uterine contents
Arias-Stella reaction
Missed abortions
Endometrium associated with ectopic pregnancy
Third trimester endometrial findings
Retained placenta
Placenta accreta
Gestational trophoblastic neoplasia (GTN)
Hydatidiform mole
Complete hydatidiform mole
Partial hydatidiform mole
Ancillary testing
Invasive mole
Gestational choriocarcinoma
Placental site trophoblastic tumor (PSTT)
Epithelioid trophoblastic tumor (ETT)
Trophoblastic lesions that may be confused with GTN
Exaggerated placental site
Placental site nodules and plaques
Persistent gestational trophoblastic disease
4:
Organic lesions of the endometrium
Endometrial polyps
Usual endometrial polyps
Adenomyomatous polyps
Atypical polypoid adenomyoma (APA)
Endometritis
Acute endometritis
Chronic endometritis
Specific identifiable causes of endometritis
Leiomyomas
Adenomyosis
Atrophy
5:
Hormonally related abnormal uterine bleeding: dysfunctional uterine bleeding and exogenous hormone effects
Dysfunctional uterine bleeding
Exogenous hormonal causes of bleeding
Estrogen and hormone replacement therapy
Progesterone
Oral contraceptives
Gonadotropin releasing hormone agonist (luprolide acetate)
Ovulation induction drugs
Tamoxifen
Aromatase inhibitors
Progesterone receptor modulators
6:
Endometrial hyperplasia and preinvasive disease
Precursors of type 1 endometrioid adenocarcinoma
WHO terminology
Simple hyperplasia without atypia (simple hyperplasia)
Simple hyperplasia with atypia
Complex hyperplasia without atypia (complex hyperplasia)
Atypical hyperplasia (complex hyperplasia with atypia)
EIN (endometrial intraepithelial neoplasia) terminology
Benign hyperplasia
EIN
Precursors of type 2 uterine serous carcinoma
Endometrial intraepithelial carcinoma (EIC)
Superimposed therapeutic effects on endometrial hyperplasia
7:
Endometrial malignancies
Biologic and molecular classification
Histopathologic classification of endometrial carcinoma
Endometrioid adenocarcinoma
Variants of endometrioid adenocarcinoma
Villoglandular
Endometrioid carcinoma with squamous differentiation
Secretory adenocarcinoma
Ciliated adenocarcinoma
Nonendometrioid adenocarcinoma
Uterine serous carcinoma
Clear cell adenocarcinoma
Squamous cell carcinoma
Mucinous adenocarcinoma
Mixed carcinoma
Transitional cell carcinoma (TCC)
Small cell carcinoma
Undifferentiated carcinoma
Mixed epithelial and mesenchymal malignancies
Carcinosarcoma (malignant mixed müllerian or mesodermal tumor)
Müllerian adenosarcoma
Sarcomas of the uterus
Endometrial stromal tumors
Endometrial stromal sarcoma (low-grade endometrial stromal sarcoma, ESS)
Stromal nodule
Undifferentiated endometrial sarcoma
Metastatic carcinoma
Problems with artifacts
8:
Pitfalls in diagnosis
Artifacts
Telescoping
Artifactual crowding (squeeze artifact)
“Waffle” artifact
Retraction Artifact
Inactive Fragments
Basalis
Lower Uterine Segment
Artifactual “lymphvascular space” invasion
Lymphvascular space invasion mimicking histiocytes
Atypical stromal cells with bizarre nuclei
Non-endometrial tissue
Procedurally and therapeutically related artifacts
Metaplasias
Squamous metaplasia
Mucinous metaplasia
Tubal metaplasia
Eosinophilic metaplasia
Hobnail metaplasia
Clear cell metaplasia
Papillary syncytial change
Endometrial papillary proliferations devoid of malignant nuclear features
Osseous metaplasia
Stromal foam cells
Other Stromal metaplasias
Lack of history
9:
Molecular aspects of endometrial disease
Molecular mechanisms of endometrial disease
Mechanism of bleeding
Mechanisms of carcinogenesis
Endometrioid adenocarcinoma
Serous carcinoma
Clear cell adenocarcinoma
New diagnostic techniques
Immunohistochemistry
Glossary of terms
INDEX
TOC
Index
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