Dysfunctional Uterine Bleeding

Richard K. Cochran, M.D.

Specimen Type:

Uterus

History:

A 41 year old woman presented with dysfunctional uterine bleding. A TruTest® endometrial biopsy was performed using a Tao Brush® to sample the endometrium. Ample tissue fragments were received and were separated from the endometrial sample by filtration and submitted for histology and hematoxylin and eosin (H&E) staining. The remaining endometrial cytology material was processed by selective cellular enhancement technique and the slides were stained with Papanicolaou (Pap) and acid hematoxylin (AH) methods.

Pathologic Features:

In the cytologic preparations, numerous proliferative type glands were present. Many of these structures were tubular and were composed of cells with ovoid nuclei with smooth nuclear concurs (Fig. 1 AH). Nuclear crowding due to pseudostratification was present and mitotic figures were seen (Fig. 2 AH). Other glands showed cystic dilatation and a few sheets of proliferative endometrium with rolled-up or folded edges were present (Fig. 3, Pap and Fig. 4, AH).

The cell block contained numerous tissue fragments composed of proliferative type glands of variable size and shape with a moderate amount of intervening stroma. All the tissue fragments showed similar changes. Many of these glands were dilated and had infoldings and outpouchings (Fig. 5 & 6, H&E). These glands were lined by cells with ovoid nuclei that were pseudostratified and had smooth nuclear contours Fig. 7, H&E).

Differential Diagnosis:

  • Simple Hyperplasia without Atypia
  • Disordered Proliferative Endometrium

Diagnosis:

Simple Hyperplasia without Atypia

In simple endometrial hyperplasia, the abnormalities are diffuse throughout the endometrium. In disordered proliferative endometrium the dilated and irregularly shaped glands are present only focally with intervening areas of normal appearing proliferative endometrium.

References:

  1. Maksem, J, Meiers, I, and Robboy, A primer of Endometrial Cytology with Histologic Correlation, Diagnostic Cytology, 2007: 35: 817-844.
  2. Maksem, J, Sager, F and Bender, R, Endometrial Collection and Interpretation Using the Tao Brush and the CytoRich Fixative System: A Feasibility Study, Diagnostic Cytopathology, 1997;17:339-346.
  3. Mazur,MT, and Kurman, RJ, Diagnosis of Endometrial Biopsies and Curettings: A Practical Approach, 2nd ed. Springer, New York 2005. pp 112-113, 180-181.