Female Genital Tract
chapter
1 0
Endometrial Lesions, Unusual Tumors,
and Extrauterine Cancer
Terence J Colgan and C Meg McLachlin
Contents
In tro d u c tio n
T h e D e te c tio n o f E n d o m e tria l A b n o rm a litie s
E n d o m e t r ia l p h y s io lo g y
D e t e c t io n o f E n d o m e t r ia l D is e a s e b y C V C y t o lo g y
O v e rv ie w o f E n d o m e tria l C a rc in o m a
D e t e c t io n o f e n d o m e t r ia l D is e a s e b y D ir e c t e n d o m e t r ia l S a m p lin g
I n t r o d u c t io n
U n u su a l U te rin e T u m o rs
T y p e s I a n d II e n d o m e t r ia l A d e n o c a r c in o m a
S a r c o m a s o f t h e U te r u s
M o le c u la r p a t h o lo g y o f e n d o m e t r ia l a d e n o c a r c in o m a
L y m p h o m a s a n d L e u k e m ia s
C lin ic a l e p id e m io lo g y o f e n d o m e t r ia l a d e n o c a r c in o m a
M a lig n a n t M e la n o m a
p r e s e n t a t io n a n d S p re a d o f e n d o m e t r ia l a d e n o c a r c in o m a
T r o p h o b la s t ic N e o p la s ia
t h e H is t o p a t h o lo g y o f e n d o m e t r ia l a d e n o c a r c in o m a
E x tra u te rin e C a n c e r
S e n s itiv ity a n d S p e c ific ity o f S a m p lin g T e c h n iq u e s fo r E n d o m e tria l
D ise a s e
C a r c in o m a o f t h e F a llo p ia n T u b e
O v a r ia n a n d p e r ito n e a l C a rc in o m a s
C e r v ic o v a g in a l C y t o lo g y
C o n c lu d in g R e m a rk s
D ir e c t e n d o m e t r ia l S a m p lin g
N o r m a l-A p p e a r in g E n d o m e tria l C e lls a n d G e s ta tio n a l C h a n g e s
N o r m a l- a p p e a r in g e n d o m e t r ia l C e lls : C y t o m o r p h o lo g y , D if f e r e n t ia l D ia g n o s is , a n d
S ig n ific a n c e in C V C y t o lo g y
C y t o lo g ic F in d in g s d u r in g G e s ta tio n
C y t o m o r p h o lo g y o f D ir e c t e n d o m e t r ia l S a m p lin g
Introduction
Although the primary purpose of gynecologic exfoliative cytol-
ogy remains the detection of cervical carcinoma and its precur-
sor lesions, it may also detect significant endometrial disease.
Furthermore, direct endometrial cytology may be used to detect
endometrial neoplasia.
Both endometrial
and extrauterine
tumors may be detected using cervico-vaginal exfoliative cyto-
logic and direct endometrial sampling. Endometrial cytology
has a very limited role in assessing normal endometrial physi-
ologic and hormonal response. Interpretation of endometrium
in both exfoliative cytology and direct sampling requires an
understanding of the variable morphology of normal, physi-
ologic endometrium.
Endometrial Physiology
Reproductive Age
The endometrium, the lining of the body of the uterus, is com-
posed of numerous glands embedded within a supportive
stroma. During a woman's reproductive years the superficial
portion of the endometrium, the endometrium functionalis,
moves through cycles of proliferation and secretion, followed
by desquamation during the menstrual phase, in the absence
of any ovum implantation. All of these changes are dependent
upon a normally functioning pituitary-ovarian axis. The deeper
endometrium basalis, abutting the myometrium, lacks these
physiologic phases and serves to regenerate the endometrium
functionalis after each menses.
In the proliferative (or follicular) phase both the endome-
trial glands and stroma proliferate in response to the rising
estrogen levels of ovarian follicular origin. The thickness of
the endometrium increases. The glands become increasingly
tortuous, and are lined by a tall, pseudostratified columnar
epithelium (Fig. 10.1). The cytologic appearance of prolifera-
tive glands is very "active," and characterized by a moderately
high nuclear/cytoplasmic ratio, abundant mitotic activity,
and prominent nucleoli. The progesterone surge of ovulation
ends the proliferative phase, and the endometrium moves
into the secretory (or luteal phase) of development. Under
normal conditions the secretory phase is 14 days in length,
and the endometrium moves through an orderly sequence
of morphologic changes (Fig. 10.2). Under the influence of
local autocrine factors, the secretory endometrium disinte-
grates and collapses. The resultant menstrual endometrium
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