Difference between revisions of "Secretory phase endometrium"
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'''Secretory phase endometrium''', abbreviated '''SPE''', is a common diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Secretory phase endometrium -- intermed mag.jpg | |||
| Width = | |||
| Caption = Secretory phase. [[H&E stain]]. | |||
| Micro = dependent on day post-ovulation - see microscopic | |||
| Subtypes = | |||
| LMDDx = [[endometrial hyperplasia with secretory changes]], [[endometrium with hormonal changes]],[[proliferative phase endometrium]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[endometrium]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = normal finding | |||
| ClinDDx = | |||
}} | |||
'''Secretory phase endometrium''', abbreviated '''SPE''', is a common diagnosis in [[endometrium|endometrial]] specimens. | |||
==General== | ==General== | ||
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===Premenstrual=== | ===Premenstrual=== | ||
*Stroma: [[neutrophil]]s, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation". | *Stroma: [[neutrophil]]s, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation". | ||
*Glands: [[apoptosis]] at the base of the gland.<ref> | *Glands: [[apoptosis]] at the base of the gland.<ref>Colgan T. 22 June 2009.</ref> | ||
Notes: | Notes: | ||
| Line 47: | Line 76: | ||
*[[Proliferative phase endometrium]] - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles ''or'' <50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref> | *[[Proliferative phase endometrium]] - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles ''or'' <50% of cells in the glands have subnuclear vacuoles.<ref name=Ref_EMB14>{{Ref EMB|14}}</ref> | ||
===Images=== | |||
<gallery> | <gallery> | ||
Image: Early secretory phase endometrium -- intermed mag.jpg | Early SPE - intermed. mag. (WC) | |||
Image: Early secretory phase endometrium -- high mag.jpg | Early SPE - high mag. (WC) | |||
Image: Early secretory phase endometrium -- very high mag.jpg | Early SPE - very high mag. (WC) | |||
</gallery> | |||
<gallery> | |||
Image: Secretory phase endometrium -- low mag.jpg | Late SPE - low mag. (WC) | |||
Image: Secretory phase endometrium -- intermed mag.jpg | Late SPE - intermed. mag. (WC) | |||
Image: Secretory phase endometrium -- high mag.jpg | Late SPE - high mag. (WC) | |||
</gallery> | |||
<gallery> | |||
Image:Endometrium_Secretory-Type_Endometrium_10x1.JPG | Early secretory phase endometrium. (WC) | |||
Image:Endometrium_Secretory_20x1.jpg | Early secretory phase endometrium. (WC) | |||
Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation. (WC/Nephron) | Image:Endometrial_stromal_condensation_high_mag.jpg | Endometrial stromal condensation. (WC/Nephron) | ||
</gallery> | </gallery> | ||
==Sign out== | |||
<pre> | <pre> | ||
ENDOMETRIUM, BIOPSY: | ENDOMETRIUM, BIOPSY: | ||
- SECRETORY PHASE ENDOMETRIUM. | |||
</pre> | |||
<pre> | |||
ENDOMETRIUM, ASPIRATION: | |||
- SECRETORY PHASE ENDOMETRIUM. | - SECRETORY PHASE ENDOMETRIUM. | ||
</pre> | </pre> | ||
| Line 67: | Line 113: | ||
- SECRETORY PHASE ENDOMETRIUM, EARLY. | - SECRETORY PHASE ENDOMETRIUM, EARLY. | ||
</pre> | </pre> | ||
===With additional stuff=== | |||
<pre> | <pre> | ||
ENDOMETRIUM, BIOPSY: | ENDOMETRIUM, BIOPSY: | ||
| Line 87: | Line 133: | ||
</pre> | </pre> | ||
====Micro | ===Evidence of shedding=== | ||
The sections show endometrium with a normal gland-to-stroma ratio. | <pre> | ||
ENDOMETRIUM, CURETTAGE: | |||
- SECRETORY PHASE ENDOMETRIUM WITH FINDINGS SUGGESTIVE OF SHEDDING (EPITHELIAL | |||
APOPTOSIS, INFLAMMATORY CELLS - ESPECIALLY NEUTROPHILS). | |||
- BENIGN EXOCERVICAL AND ENDOCERVICAL MUCOSA. | |||
</pre> | |||
===Micro=== | |||
The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucus within them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent. | |||
==See also== | ==See also== | ||
Latest revision as of 12:37, 13 February 2019
| Secretory phase endometrium | |
|---|---|
| Diagnosis in short | |
 Secretory phase. H&E stain. | |
|
| |
| LM | dependent on day post-ovulation - see microscopic |
| LM DDx | endometrial hyperplasia with secretory changes, endometrium with hormonal changes,proliferative phase endometrium |
| Site | endometrium |
|
| |
| Other | normal finding |
Secretory phase endometrium, abbreviated SPE, is a common diagnosis in endometrial specimens.
General
- Secretory phase = luteal phase.
- Gynecologists prefer the ovarian descriptor, i.e. luteal phase; pathologists go by what they see, i.e. Secretions in the (endometrial) glands.
Gross
- Thickened endometrium.
Microscopic
Early secretory phase
Features - post-ovulatory day 1-5:[1]
- Glands: secretory vacuoles.
- First basal to the epithelial nuclei (infranuclear vacuoles).
- Then apical to the epithelial nuclei (supranuclear vacuoles).
- Mitoses may be present - common when vacuoles are subnuclear.
Mid secretory phase
Features - post-ovulatory day 6-8:[1]
- Glands: Mucus in glands.
- Stroma: Edema (empty space around the glands).
Late secretory phase
Features - post-ovulatory day 9-12:[1]
- Stroma:
- Spiral arterioles.
- Predecidual changes -- mnemonic NEW:
- Nucleus central.
- Eosinophilic cytoplasm key feature (may be subtle to the novice).
- Well-defined cell borders.
Premenstrual
- Stroma: neutrophils, scattered lymphocytes, stromal balls ("blue balls"); "stromal condensation".
- Glands: apoptosis at the base of the gland.[2]
Notes:
- Stromal condensation (stromal balls) - premenstrual - stromal cells tightly packed together; nuclei molded together like in small cell tumours.[3]
- Gland-to-stroma ratio is increased in late secretory phase and menstruation.[4]
- Endocervical epithelium (ECE) has a morphology similar to the epithelium of secretory phase endometrium (SPE):
- ECE - grey foamy appearing cytoplasm.
- SPE - eosinophilic cytoplasm.
- Most useful feature to differentiate ECE and SPE is the accompanying stroma.
DDx:
- Endometrial hyperplasia with secretory changes.
- Endometrium with hormonal changes.
- Proliferative phase endometrium - may have some changes of secretory endometrium; <50% of glands have subnuclear vacuoles or <50% of cells in the glands have subnuclear vacuoles.[5]
Images
Early SPE - intermed. mag. (WC)
Early SPE - high mag. (WC)
Early SPE - very high mag. (WC)
Late SPE - low mag. (WC)
Late SPE - intermed. mag. (WC)
Late SPE - high mag. (WC)
Early secretory phase endometrium. (WC)
Early secretory phase endometrium. (WC)
Endometrial stromal condensation. (WC/Nephron)
Sign out
ENDOMETRIUM, BIOPSY: - SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, ASPIRATION: - SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, CURETTAGE: - SECRETORY PHASE ENDOMETRIUM.
ENDOMETRIUM, BIOPSY: - SECRETORY PHASE ENDOMETRIUM, EARLY.
With additional stuff
ENDOMETRIUM, BIOPSY: - SECRETORY PHASE ENDOMETRIUM. - SCANT ENDOCERVICAL MUCOSA WITHIN NORMAL LIMITS.
ENDOMETRIUM, BIOPSY: - SECRETORY PHASE ENDOMETRIUM. - ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS.
ENDOMETRIUM, BIOPSY: - SECRETORY PHASE ENDOMETRIUM. - BENIGN SUPERFICIAL EXOCERVICAL EPITHELIUM. - SCANT BENIGN ENDOCERVICAL EPITHELIUM.
Evidence of shedding
ENDOMETRIUM, CURETTAGE: - SECRETORY PHASE ENDOMETRIUM WITH FINDINGS SUGGESTIVE OF SHEDDING (EPITHELIAL APOPTOSIS, INFLAMMATORY CELLS - ESPECIALLY NEUTROPHILS). - BENIGN EXOCERVICAL AND ENDOCERVICAL MUCOSA.
Micro
The sections show endometrium with a normal gland-to-stroma ratio. The glands are mildly dilated, tortuous and have mucus within them. The glandular epithelium is simple and non-pseudostratified. The stroma is edematous and has a decidual reaction. No mitotic activity is apparent.
See also
References
- ↑ 1.0 1.1 1.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 237. ISBN 978-0470519035.
- ↑ Colgan T. 22 June 2009.
- ↑ GAG. 6 Oct 2009.
- ↑ URL: http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed on: 6 December 2012.
- ↑ Mazur, Michael T.; Kurman, Robert J. (2005). Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach (2nd ed.). Springer. pp. 14. ISBN 978-0387986159.