Anovulatory endometrium

Anovulatory endometrium, abbreviated AE, is common perimenopausal finding. It is a diagnosis that is inferred from the clinical context.

General

• Individuals usually perimenopausal.

Relation to disordered proliferative endometrium

Some consider disordered proliferative endometrium (DPE) a synonym for anovulatory endometrium.

Libre Pathology separates the two. DPE has prominent gland dilation (reminiscent of simple endometrial hyperplasia) and may not have shedding. AE has shedding without gland dilation.

Microscopic

Features:

• Shedding:
  • Stromal condensation.
  • Apoptotic endometrial epithelium.
• Weakly proliferative glands or non-proliferative glands.

DDx:

• Disordered proliferative phase - gland dilation.
• Simple endometrial hyperplasia.
• Menstrual endometrium - should have mitoses, abundant PMNs.

Sign out

ENDOMETRIUM, CURETTAGE:
- FRAGMENTED PROLIFERATIVE ENDOMETRIUM WITH EVIDENCE OF SHEDDING, WITHOUT ABUNDANT
  NEUTROPHILS, SEE COMMENT.
- NO EVIDENCE OF HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
The changes are compatible with anovulatory bleeding.

ENDOMETRIUM, CURETTAGE:
- PROLIFERATIVE ENDOMETRIUM WITH SMALL ROUND GLANDS AND SHEDDING, SEE COMMENT.
- BENIGN ENDOCERVICAL MUCOSA.
- NEGATIVE FOR HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
The changes are suggestive of anovulatory bleeding.

ENDOMETRIUM, BIOPSY:
- BENIGN ENDOCERVICAL POLYP WITH ACUTE AND CHRONIC INFLAMMATION, AND EVIDENCE
  SUGGESTIVE OF EROSIONS (SIDEROPHAGES, INCREASED BLOOD VESSEL DENSITY).
- SMALL NONPROLIFERATIVE ENDOMETRIAL GLANDS WITH RARE NEUTROPHILS AND RARE
  APOPTOTIC CELLS, WITH BALLS OF CONDENSED ENDOMETRIAL STROMA, SEE COMMENT.
- NEGATIVE FOR ENDOMETRIAL HYPERPLASIA AND NEGATIVE FOR DYSPLASIA.

COMMENT:
The changes are suggestive of anovulatory bleeding.

ENDOMETRIUM, ASPIRATION:
- PSEUDOSTRATIFIED ENDOMETRIAL EPITHELIUM WITHOUT APPARENT PROLIFERATION, WITH
  APOPTOTIC CELLS AND LIMITED STROMA WITH RARE (STROMAL) CONDENSATION -- COMPATIBLE
  WITH SHEDDING.
- MINUTE FRAGMENTS OF BENIGN ENDOCERVICAL EPITHELIUM.
- NO EVIDENCE OF HYPERPLASIA.

See also

• Endometrium.
• Disordered proliferative endometrium.