Carcinoma, Squamous Cell/pathology* ; Endometrial Hyperplasia/pathology* ; Endometrial Neoplasms/pathology* ; Endometrium/pathology* ; Female ; Humans ; Hyperplasia/pathology*

OBJECTIVE: To evaluate saline infusion sonohysterography (SIS) as an investigative modality in abnormal uterine bleeding of premenopausal and postmenopausal women. METHODS: Eighty eight patients, 74 premenopausal women and 14 postmenopausal women, with abnormal uterine bleeding were selected. After complete work-up, transvaginal examination were performed followed by SIS. The final surgical-pathologic findings were compared with the results obtained from transvaginal sonography (TVS) and SIS. The sensitivity, specificity, positive and negative predictive value were calculated for each procedure. RESULTS: The SIS was perfomed in 85 cases. It couldn't be done in one premenopausal woman and two postmenopausal women. The uterine cavity was normal in 28 women, 57 cases displayed abnormalities. Seventeen had endometrial polyp, 17 had submucosal myoma, 23 had irregular endometrium. We found that SIS missed five endometrial polyp and mislabeled 14 (38.9%) false positive endometrial growth. On comparing SIS, transvaginal sonography missed nine endometrial polyp and mislabeled 22 (55%) false positive endometrial growth. The sensitivity, specificity, positive predictive value and negative predictive value of TVS were 72.9%, 45%, 61.4% and 58.1%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of SIS were 87.8%, 61.1%, 75.4% and 78.6%, respectively. Sensitivtity and negative predictive value were significantly higher with SIS than TVS. CONCLUSION: The SIS is a safe, convenient, time conserving, cost effective, easily accessible and acceptable investigative modality. It definitely enhance the diagnostic potential of TVS in accessment of endometrium and intracavitary pathologies in women with abnormal uterine bleeding.
Endometrium ; Female ; Humans ; Myoma ; Pathology ; Polyps ; Sensitivity and Specificity ; Uterine Hemorrhage*

Age Factors ; Endometrial Hyperplasia ; pathology ; Endometrial Neoplasms ; pathology ; Endometrium ; cytology ; pathology ; Female ; Humans ; Menstrual Cycle ; Papanicolaou Test ; Postmenopause ; Vaginal Smears

Corded and hyalinized endometrioid carcinoma (CHEC) is a morphologic variant of endo-metrioid adenocarcinoma. The tumor exhibits a biphasic appearance with areas of traditional low-grade adenocarcinoma merging directly with areas of diffuse growth composed of epithelioid or spindled tumor cells forming cords, small clusters, or dispersed single cells. It is crucial to distinguish CHEC from its morphological mimics, such as malignant mixed mullerian tumor (MMMT), because CHECs are usually low stage, and are associated with a good post-hysterectomy prognosis in most cases while the latter portends a poor prognosis. The patient reported in this article was a 54-year-old woman who presented with postmenopausal vaginal bleeding for 2 months. The ultrasound image showed a thickened uneven echo endometrium of approximately 12.2 mm and a detectable blood flow signal. Magnetic resonance imaging revealed an abnormal endometrial signal, considered endometrial carcinoma (Stage Ⅰ B). On hysterectomy specimen, there was an exophytic mass in the uterine cavity with myometrium infiltrating. Microscopically, most component of the tumor was well to moderately differentiated endometrioid carcinoma. Some oval and spindle stromal cells proliferated on the superficial surface of the tumor with a bundle or sheet like growth pattern. In the endometrial curettage specimen, the proliferation of these stromal cells was more obvious, and some of the surrounding stroma was hyalinized and chondromyxoid, which made the stromal cells form a cord-like arrangement. Immunostains were done and both the endometrioid carcinoma and the proliferating stroma cells showed loss of expression of DNA mismatch repair protein MLH1/PMS2 and wild-type p53 protein. Molecular testing demonstrated that this patient had a microsatellite unstable (MSI) endometrial carcinoma. The patient was followed up for 6 months, and there was no recurrence. We diagnosed this case as CHEC, a variant of endometrioid carcinoma, although this case did not show specific β-catenin nuclear expression that was reported in previous researches. The striking low-grade biphasic appearance without TP53 mutation confirmed by immunohistochemistry and molecular testing supported the diagnosis of CHEC. This special morphology, which is usually distributed in the superficial part of the tumor, may result in differences between curettage and surgical specimens. Recent studies have documented an aggressive clinical course in a significant proportion of cases. More cases are needed to establish the clinical behaviors, pathologic features, and molecular profiles of CHECs. Recognition of the relevant characteristics is the prerequisite for pathologists to make correct diagnoses and acquire comprehensive interpretation.
Female ; Humans ; Middle Aged ; Carcinoma, Endometrioid/surgery* ; Endometrial Neoplasms/pathology* ; Endometrium/metabolism* ; Adenocarcinoma/pathology* ; Stromal Cells/pathology*

Eighty eight cases of the endometrial biopsy comprising 19 cases of proliferative phase, 21 cases of secretory phase, and 23 cases of menstrual phase from non-sterility patients, and 25 cases of the endometrium at the first day of menstruation from primary sterility patients were examined histochemically. Secretory substance in the epithelial cells of the endometrial glands during the secretory phase and menstrual phase was main1y glycogen. Therefore, it is essential to fix the endometrial tissue in a fixative which can preserve glycogen for the detection of secretory activity more accurately. Among 25 cases of primary sterility, 15 cases showed epithelial secretory vacuoles on hematoxylin and eosin stained sections, and no epithelial vacuolization was noted in the remaining 10 cases. However, PAS staining showed presence of PAS positive diastase sensitive substance in the majority of the later 10 cases except one in which no PAS positive substance was found, indicating that PAS staining is superior than routine hematoxylin and eosin staining for the detection of epithelial secretory substance. The absolute lack of secretory activity in the endometrial glands was infrequent, but a relative decrease of progesterone effect was rather common among the patients complaining primary sterility, and the decreased progesterone effect may not necessarily be due to the absence of ovulation.
Adult ; Endometrium/*cytology/*physiology ; Female ; Histocytochemistry ; Human ; Infertility, Female/pathology ; Ovulation/*physiology ; Progesterone/analysis ; Secretory Rate

OBJECTIVE: The aim of our study is to evaluate the clinical usefulness of transvaginal sonography (TVS) and saline infusion sonohysterography (SHG) in the evaluation of endometrial abnormality. METHODS: We retrospectively reviewed 370 patients with abnormal uterine bleeding or uterine cavity abnormalities confirmed by TVS. SHG was carried out by experienced gynecologist, on the same setting in an outpatient clinic after the performance of TVS. Two hundred nineteen patients aged between 23 and 69 years (mean age 41+/-8.2) had operative hysteroscopy (88.2%), hysterectomy (9.1%) and dilatation/curettage (2.7%) within 3 months which provided a detailed description of uterine cavity. Surgical-pathologic findings were compared with the results obtained from TVS and SHG. RESULTS: The sensitivity and specificity were 71.7% and 31.4% for TVS, and 98.4% and 67.6% for SHG respectively. The positive and negative predictive values were 84.6% and 17.5% for TVS, and 94.3% and 92.3% for SHG, respectively. Twenty one cases showed a discrepancy between the TVS and SHG, and 16 cases showed a discrepancy between SHG and the pathologic diagnosis. Fifty five cases (25%) in TVS were unconfirmed, but SHG showed 51 pathologic confirmed intracavitary lesion. CONCLUSION: SHG is a sensitive tool and is superior to TVS used alone for evaluation of endometrial abnormalities. SHG definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.
Ambulatory Care Facilities ; Diagnosis ; Endometrium ; Female ; Humans ; Hysterectomy ; Hysteroscopy ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Hemorrhage

OBJECTIVE: The aim of this study is to investigate the effect of tamoxifen on endometrial thickness in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer after chemotherapy. METHODS: Fifty-eight tamoxifen-treated postmenopausal breast cancer patients underwent periodically transvaginal ultrasonography twice a year for 2 years and then once a year. We analyzed the correlation between the sonographic endometrial thickness and the duration of tamoxifen therapy. RESULTS: The mean endometrial thickness of breast cancer patients before tamoxifen therapy was 4.68 mm. But the mean endometrial thickness increased to 5.03 mm at 6 months, 5.21 mm at 12 months, after which it slightly declined to 5.13 mm at 18 months. And then it increased to 5.15 mm at 24 months, and 5.24 mm at 36 months. There was a significant increase in endometrial thickness after tamoxifen therapy compared with before tamoxifen therapy (p<0.05). Overall, proliferative endometrium was the most common histopathologic finding (5/14) in tamoxifen-treated postmenopausal women who had endometrial thickness >or=5 mm. No cases of endometrial cancer were detected. CONCLUSION: Significant increase in endometrial thickness with the duration of tamoxifen therapy in postmenopausal tamoxifen-treated patients may be associated with a high risk of endometrial pathologies in these patients.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Pathology ; Tamoxifen ; Ultrasonography

BACKGROUNDEndometriosis (EM) is a benign gynecologic disease predominantly found in women of reproductive age. However, its pathogenesis is still poorly understood. Our experiment was designed to establish a stable and reliable cultural environment for coculture of endometrium and peritoneum, so as to observe the adhesion/invasion ability of endometrium from patients with or without EM.

METHODSEndometria of secretory phase and peritoneum were sampled from 6 women with endometriois during laparoscopy. Six with ovarian teratoma or simple ovarian cyst were taken as control. We cocultured endometrium and peritoneum into four groups (endometrium from EM cultured with peritoneum from EM, endometrium from control cultured with peritoneum from control, endometrium from EM cultured with peritoneum from non-EM and the endometrium from control cultured with peritoneum from EM) to observe the adhesion/invasion process in gas-liquid surface culture and in-medium culture. Specimens were collected at 1 hour, 6 hours, 12 hours, 24 hours, 2 days, 3 days, 4 days, 5 days, 6 days and 7 days for histology, immunofluorescence and immunohistochemical analysis on cytokeratin 8 (CK8) and CD10.

RESULTSThe gas-liquid surface culture was superior to in-medium culture for the maintenance of tissue morphology and survival of endometrium. CK8 immunoflurescence demonstrated no remarkable difference in adhesion process between patients with and without EM. CD10 immunochemistry manifested frequent invasion of endometrial stromal cells from EM patients into peritoneum of up to 3 days culture, while the endometriotic cells from non-EM patients did not invade into peritoneum.

CONCLUSIONSGas-liquid surface culture is a suitable model for observing the early events in EM lesion formation. Endometrium from patients with EM showed increased invasion capacity during coculture, which might help to explain the etiology of endometriosis.

Cell Adhesion ; physiology ; Endometriosis ; pathology ; Endometrium ; cytology ; Female ; Humans ; Tissue Culture Techniques ; methods

Carcinoma, Endometrioid ; diagnosis ; Dilatation and Curettage ; methods ; Endometrial Neoplasms ; diagnosis ; Endometrium ; pathology ; Female ; Humans

OBJECTIVETo analyze the ultrastructural characteristics of ectopic endometrium in endometriosis.

METHODSEctopic endometria collected from patients with adenomyosis and ovarian endometriosis were examined under transmission electron microscope (TEM).

RESULTSIn comparison to normal human endometrium, the ectopic glandular epithelium of adenomyosis patients showed reduced and shortened microvilli covering the surface of the secretory cells, with obviously increased, elongated and irregularly aligned cilia of ciliated cells projecting into the lumen. Numerous microvilli and cilia broke off from the cell surface and shed into the lumen. The mitochondria were enlarged, and multiple polyribosomes were present on the surface of RER. The Golgi apparatus with electron-lucent vacuoles was seen frequently. The glandular cells contained many lysosomes, lipofuscins and myelinosomes, and the cell nuclei showed varying shape and size. The nuclear membrane of the epithelial cells was irregularity. Cytoplasm protrusion containing a few organelles occurred and shed into the lumen. Some ectopic epithelial cells showed characteristic features of necrosis. The basement membrane became markedly tortuous and focal lysis of the extracellular matrix was seen. Ultrastructurally, the ectopic glandular epithelium in ovarian endometriosis showed short and sparse microvilli on the free surface of the secretory cells. Some microvilli broke off from the surface. The short cilia of the ciliated cells were seldom seen. The mitochondria were enlarged. The glandular cells contained small amounts of RER, many free ribosomes, Golgi apparatus, lipofuscins and myelinosomes. The nuclear membrane showed obvious irregularity. Some ectopic epithelial cells had giant nuclei. Cytoplasmic protrusions containing small amounts of organelles were observed in some ectopic epithelial cells. Apoptotic cell death occurred in some ectopic glandular epithelium cells. The basement membrane became markedly tortuous, and the decidual-like cells containing abundant short and club-shaped RER were observed. The number of macrophages was obviously increased.

CONCLUSIONThe ultrastructural change of the ectopic glandular epithelium in endometriosis promotes its transformation into endometriotic lesions.

Adult ; Endometriosis ; pathology ; Endometrium ; ultrastructure ; Female ; Humans ; Microscopy, Electron, Transmission ; Middle Aged