The pathologist is faced with making a decision on whether the biopsy specimen is adequate. Paradoxically, superficial endometrial biopsy specimens with scant tissue often take longer to assess than intact biopsy specimens with an appreciable amount of tissue. Most endometrial specimens are now taken at outpatients by pipelle or other techniques, with the result that many biopsy specimens contain scant, or even no, endometrial tissue. Previously, endometrial biopsy specimens were largely obtained by dilatation and curettage carried out under general anaesthesia. These hormonal compounds may alter the morphological appearance of the endometrium and a knowledge that these, and other relevant drugs such as tamoxifen, are being taken is of paramount importance to the pathologist.Ĭriteria for adequacy of endometrial biopsy specimens Other women may be taking hormone replacement therapy or contraceptives. Before biopsy, many women with abnormal uterine bleeding are already taking exogenous hormones, especially progestogenic compounds, to control the bleeding, and this information is not always conveyed to the pathologist. This results in the clinician and the patient assuming that the woman is postmenopausal. In many cases of postmenopausal bleeding, the patient is not actually postmenopausal but rather is perimenopausal, with a prolonged interval between periods. The menopausal status as well as the date of onset of the last menstrual period and the length of the menstrual cycle in premenopausal women should be provided. In evaluating an endometrial biopsy specimen, an adequate clinical history is important, including the age of the patient and the reason for the biopsy. 1 Similarly, pure mesenchymal lesions, benign or malignant, may be identified on endometrial biopsy and these will not be discussed further. In this review, dating of the endometrium will not be discussed, as this has been dealt with in detail recently. Endometrial biopsy specimens are now rarely taken to date the endometrium and to assess whether ovulation has occurred, as serum measurements of various hormones give equivalent or more information. In this review, I will outline my approach to the interpretation of endometrial biopsy specimens, especially concentrating on areas which, in my experience, create difficulties for pathologists. In some cases, a benign cause for abnormal uterine bleeding is identified, such as endometritis or endometrial polyp. Most specimens are taken because of abnormal uterine bleeding or other related symptoms, and the pathologist is expected to exclude an endometrial cancer or a precancerous lesion. In many histopathology laboratories, endometrial specimens account for a major proportion of the workload. The value of ancillary techniques, especially immunohistochemistry, is discussed where appropriate. Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens.
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