NORMAL ENDOMETRIUM & INFERTILITY EVALUATION.pptx

7/24/2019 NORMAL ENDOMETRIUM & INFERTILITY EVALUATION.pptx

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NORMAL ENDOMETRIUM AND

INFERTILITY EVALUATION

DR.M. Saraswathi MD (PATH).,

DGO.,


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NORMAL ENDOMETRIUM &INFERTILITY EVALUATION

HISTOLOGIAL FEATURES OF A NORMAL ENDOMETRIUM

HANGES !ITH A !OMAN"S AGE THROUGH PREMENARHAL,

REPRODUTIVE ,PERI MENOPAUSAL AND POST MENOPAUSAL

YEARS.

DURING REPRODUTIVE AGE GROUP THE YLIAL

HORMONAL HANGES IN THE MENSTRUAL YLE GIVES A

HANGING MORPHOLOGIAL PATTERN THAT IS NORMAL, SO

IN A #IOPSY SPEIMEN !ITH THESE HANGES AND !ITH

ARTIFATS AND LIMITED SAMPLING EVEN NORMAL PATTERNS

MAY #E DIFFIULT TO INTERPRET.


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SERETORY PHASE IS ONSTANT IN THE NORMAL

YLE LASTING $% DAYS FROM THE TIME OF

OVULATION TO THE ONSET OF MENSTRUATION.

VARIATION IN LENGTH OF THE YLE OURS

#EAUSE PROLIFERATIVE PHASE VARIES #ET!EEN

YLES AND #ET!EEN !OMEN.

#IOPSY IS TIMED IN THE MID TO LATE LUTEAL PHASE.


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HISTOLOGIALEVALUATION IDENTIFIATION OF THE SURFAE EPITHELIUM FOR

ORIENTING THE UNDERLYING GLANDS AND STROMAIS ESSENTIAL.

IN PROLIFERATIVE PHASE THE GLANDS AREREGULARLY PLAED IN A PERPENDIULARARRANGEMENT FROM #ASALIS TO SURFAEEPITHELIUM.

IN THE SERETORY PHASE THEY ARE TORTUOUS, #UTA THIN REGION #ENEATH THE SURFAE STRATUMOMPATUM !HERE THE STROMA IS DENSE AND THEGLANDS ARE NARRO! AND STRAIGHT


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STRATUM #ASALIS LOSE TO THE MYOMETRIUM

SHO!S IRREGULARLY SHAPED INATIVE GLANDS,

DENSE STROMA, AGGREGATES OF SPIRAL ARTERIES

!ITH THI'ER MUSULAR !ALLS

#IOPSY FROM LO!ER UTERINE SEGMENT SHO!S

SHORTER POORLY DEVELOPED INATIVE GLANDS

!ITH A FI#RO#LAST LI'E STROMAL ELLS !ITH

MORE A#UNDANT YTOPLASM THAN THE OVAL TO

ROUND STROMAL ELLS !ITH SANT YTOPLASM OF

ORPUS.


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SURFAE EPITHELIUM, A THIN LAYER #ENEATH THE

SURFAE EPITHELIUMSTRATUM OMPATUM,

STRATUM #ASALIS, #IOPSY FROM THE LO!ER

UTERINE SEGMENT ALL THESE ARE LESS RESPONSIVE

TO THE HORMONE HANGES.

SIGNIFIANE OF SURFAE EPITHELIUM DUE TO

ESTROGENI STIMULATION SHO!S A ILIATED

OLUMNAR EPITHELIUM !HIH IS MORE

PRONOUNED IN PATHOLOGIAL ONDITIONS LI'E

ENDOMETRIAL HYPERPLASIAMETAPLASIA.


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SERETORY PHASE

(LUTEALPOSTOVULATORY) OM#INED EFFET OFESTRADIOL &PROGESTERONE #Y

LUETINISEDGRANULOSA & THEAELLS OF L.

HISTOLOGIAL DATINGIS MORE PREISE IN

THE POST OVULATORYPHASE AS HANGESARE DISRETE IN IT


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KEY HISTOLOGICAL FEATURES

GLAND AND STROMA

GLANDULAR HANGES STROMAL HANGES

$. TORTUOSITY

. GLAND MITOSIS

*. ORIENTATION OF NULEI(PSEUDO STRATIFIATION

VS #ASAL)%. #ASAL SU#NULEAR

YTOPLASMI VAUOLES

+. LUMINAL SERETIONS!ITH SERETORYEHAUSTIONS.

$. EDEMA

. MITOSIS

*. PREDEIDUALHANGE

%. INFILTRATION OFGRANULAR

LYMPHOYTES


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PROLIFERATIVE PHASE EARLY ( %TH TO -TH DAY )

SURFAEEPITHELIUM THIN

GLANDS SMALL &TU#ULAR

EPITHELIAL MITOSIS

STROMA OMPAT& DENSE MITOSIS


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MID PROLIFERATIVE PHASE( /TH TO $0THDAY)

OLUMNARSURFAEEPITHELIUM

GLANDS 1 LONG &URVED

STROMAL EDEMA

MITOSIS


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LATE PROLIFERATIVE PHASE( $$THTO $%THDAY )

TORTUOUS GLANDS

PSEUDOSTRATIFIED NULEI

STROMAL MITOSIS

MODERATELY DENSESTROMA

REGULAR SPAING &UNIFORM SHAPE OF THE

GLANDS & ORIENTATION TOTHE SURFAE EPITHELIUMIS PERPENDIULAR ANDREGULAR.


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INTERVAL ENDOMETRIUM( $%THAND $+THDAY )

OILED ENDOMETRIALGLANDS

MITOTI FIGURES STILL

PRESENT INENDOMETRIAL GLANDS

SU#NULEAR VAUOLESIN 2+03 OF GLANDS

PRESENE OF VAUOLESIS DUE TO PRESENE OFGLYOGEN !HIH ISDISSOLVED DURING

TISSUE PROESSING


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SERETORY PHASEEARLY ( $4THTO 0THDAY ) GLANDULAR HANGES PREDOMINATE, MID TOLATE SERETORY PHASE ( $STTO -THDAY) STROMAL HANGESPREDOMINATE

$-TH

DAY 1 REGULARVAUOLATION 5 +03OF THE GLANDSSHO! SU#NULEARVAUOLATION.


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$/THDAYVAUOLESDEREASED INSI6E, EARLYLUMINALSERETIONSSEEN,#ASALLY

PLAEDNULEUS


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$7THDAY

FE! VAUOLES

REMAIN,INTRALUMINALSERETION ,NOPSUEDOSTRATIFIATION,NOMITOSIS


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0TH DAY PEA' OFINTRALUMINALSERETIONS


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$STDAY 1 MAR'ED

STROMAL EDEMA


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ND DAY 1 PEA'OF STROMALEDEMA ANDSTROMAL ELLSHAVE 8NA'EDNULEI9


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*RDDAY 1PERIARTERIOLARPREDEIDUAL

HANGE, SPIRALARTERIESPROMINENT


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%TH DAY 1 MOREPROMINENTPREDEIDUAL

HANGE , STROMALMITOSIS REUR


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+TH

DAY 1PREDEIDUALDIFFERENTIATION#EGINS UNDER THESURFAE

EPITHELIUM,INREASE IN NO. OFGRANULARLYMPHOYTES.


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4TH DAY 1PREDEIDUASTARTS TO #EOMEONFLUENT


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-THDAY 1NUMEROUSGRANULARLYMPHOYTES,ONFLUENT SHEETSOF PREDEIDUA,FOAL NEROSIS.


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%TH TO -TH DAY1 TORTOUS !ITHSA! TOOTHEDGLANDS

SERETORYEHAUSTION OF

THE GLANDS,RAGGED LUMINAL#ORDERS


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/THDAY 1

INITIAL EVIDENE OFSTROMAL

HEMORRHAGE

PROMINENT

STROMALGRANULOYTES

FOAL THROM#OSISIN ENDOMETRIAL

VESSELS PROMINENT

APOPTOSIS INENDOMETRIAL

GLANDS


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MENSTRUALENDOMETRIUMGLANDULAR & STROMAL #REA'DO!NFI#RIN THROM#I IN THE SMALL VESSELS

ONDENSED & OLLAPSED STROMA

NEROTI DE#RI

NEUTROPHILI INFILTRATE

THIS PHASE IS NOT GOOD FOR EVALUATIONOF STROMAL & GLANDULAR DEVELOPMENTIF THE #REA'DO!N IS ETENSIVE. IF AT ALL

YOU AN DO IT AT THE ONSET OF #LEEDING


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MENSTRUALENDOMETRIUM


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PITFALLS IN DATING

A#SENE OF SURFAE EPITHELIUMOMPROMISES THE INTERPRETATION

TISSUES FROM LO!ER UTERINE SEGMENTOR #ASALIS IS NOT SATISFATORY FORDATING

STRAIGHT TU#ULAR GLANDS #ENEATH THESURFAE ARE NORMAL AND NOT A SIGN OFIRREGULARITY IN MATURATION IN LATESERETORY PHASE

SATTERED SU#NULEAR VAUOLES NOTSUFFIIENT FOR EVIDENE OF OVULATION


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OMPAT PREDEIDUA !ITH SPINDLE SHAPED STROMAL

ELLS IS NOT A TRUE PREDEIDUAL REATION,

PREDEIDUA AROUND THE SPIRAL ARTERIOLES IS A MUST

LYMPHOYTES & GRANULAR LYMPHOYTES #EOME

PROMINENT IN THE LATE SERETORY PHASE ( IT IS NOT

INFLAMMATION)

IF TISSUE IS DIFFIULT TO DATE #EAUSE OF APPARENT

DISORDANE IT FEATURES POSSI#ILITY OF HRONI

ENDOMETRITIS OR POLYP

ENDOMETRIUM ANNOT #E DATED AURATELY !HEN

POLYPS, INFLAMMATION OR OTHER A#NORMALITIES ARE

PRESENT


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ARTIFATS & ONTAMINANTS

$. TISSUEFRAGMENTATION GLANDS GETDETAHED FROM STROMA AND ORIENTLOSE TO EAH OTHER

. ERVIAL EPITHELIUM IN LOSEOPPOSITION TO ENDOMETRIUM GIVES AONFUSING PATTERN (STROMA HELPS INDIFFERENTIATION


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TELESOPING OF GLANDS 1

GLAND IN GLAND, #OTH IN

PROLIFERATIVE & SERETORY

PHASE

ONTAMINATION FROM

ERVI STRIPS OF #LAND

S:UAMOUS OR MUINOUS

EPITHELIUM AND POOLS OF

MUIN & INFLAMMATORY

ELL OLLETIONS

FRAGMENTS OF ADIPOSE

TISSUE, OLONI MUOSA

PERFORATION OF THE

UTERUS


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LUTEAL PHASE DEFET & A#NORMALSERETORY PHASE PATTERNS

LPD IS A REOGNISED AUSE OFOVULATORY INFERTILITY 1 +3 OF ASES

IT AN #E A FATOR IN EARLY HA#ITUALSPONTANEOUS A#ORTION & IN A#NORMALUTERINE #LEEDING

IT IS THE RESULT OF HYPOTHALAMI ORPITUITARY DYSFUNTION THAT AUSESDEREASED FSH IN THE FOLLIULARPHASE.


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A#NORMAL LH SERETION & DEREASED LEVELS OFLH & FSH AT THE TIME OF OVULATION OR ELEVATED

PROLATIN LEVELS

HYPOTHYROIDISM AN ALSO LEAD TO LPD

MONITORING MID LUTEAL PHASE PROGESTERONELEVELS AN #E EFFETIVE

HISTOLOGIALY IT LAGS #Y MORE THAN DAYS FROMTHE ATUAL DATE IN ONSEUTIVE #IOPSIES

##T, TIME OF LH SURGE OR THE ONSET OF MENSESAFTER #IOPSY ESTA#LISHES THE DIAGNOSIS


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LPD AN AUSE DISORDANE IN THE DEVELOPMENT

OF GLANDS AND STROMA

IRREGULAR MATURATION PATTERN !ITH DIFFERENT

AREAS SHO!ING A MAR'ED VARIATION OF MORE THAN

% DAYS (PROLIFERATIVE STROMA !ITH SERETORY

GLANDS)

A#NORMAL SERETORY PHASE PATTERN SOME AREAS

SHO!ING EARLY SERETORY HANGES AND SOME

AREAS SHO!ING MIDSERETORY HANGES

DEFIIENT SERETORY PHASE 1ELONGATED,

HYPERHROMATI NULEI !ITH DEREASED

SERETORY ATIVITY AND POORLY DEVELOPED STROMA


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INFETIONSGRANULOMATOUS

INFLAMMATION OF THEENDOMETRIUM ISINFRE:UENT,USUALLYMYO#ATERIUM

TU#ERULOSIS IS

OMMONNON NEROTI6ING

GRANULOMAS IN LATESERETORY PHASE

GLAND DEVELOPMENT ISALTERED LA'ING ANAPPROPRIATESERETORY RESPONSE,PR ONFIRMS THE

DIAGNOSIS


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LINIAL :UERIES ANDREPORTING

IN ENDOMETRIAL #IOPSY OR URRETAGEFOR INFERTILITY !OR'UP, THEGYNAEOLOGIST SEE'S THE FOLLO!ING

INFORMATION$. HISTOLOGIAL EVIDENE OF OVULATION

. HISTOLOGIAL DATE OF THE SERETORYPHASE

*. PRESENE OR A#SENE OFENDOMETRIAL A#NORMALITIES THAT MAY#E RESPONSI#LE FOR INFERTILITY( INFLAMMATION AND POLYPS )


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DATING THE SERETORY PHASE IS SOME!HAT SU#;ETIVE

& NEITHER OMPLETELY EAT NOR REPRODUI#LE

REENTLY MORPHOMETRI ANALYSIS HAS #EEN ATTEMPTED

TO INREASE THE AURAY OF ENDOMETRIAL

HISTOLOGIAL DATING

MITOTI RATE IN THE GLAND ELLS

AMOUNT OF LUMINAL SERETIONS VOLUME FRATION OF THE GLAND THAT IS OUPIED #Y

THE GLAND ELLS

AMOUNT OF PSUEDOSTRATIFIATION OF GLAND ELLS

AMOUNT OF PREDEIDUAL REATION

SERETORY PRODUTS OF ENDOMETRIUM INTEGRINS HELPS

TO IDENTIFY LUTEAL PHASE DEFETS.


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AUSES OF UNDATA#LEENDOMETRIUM

$.HORMONAL

a) ANOVULATORY

) EOGENOUS HORMONES

?) PREGNANY


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. ORGANI LESIONS

a) POLYPS

) HYPERPLASIA

?) ARINOMA

@) ATROPHY

*. SAMPLING PRO#LEMS

) FRAGMENTATION

h) LA' OF SURFAE EPITHELIUM


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FORMAT

$. NAME B. AGE SE B

*. IP. NO B

%. LINIAL DIAGNOSIS B

+. PROEDURE B

4. MENSTRUAL HISTORY B

-. LMP B

/. DATE OF PROEDURE B7. HISTORY OF HORMONE INTA'E B


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NORMAL ENDOMETRIUM & INFERTILITY EVALUATION.pptx

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