Uterus
Non tumor
Endometritis


Topic Completed: 1 November 2011

Revised: 4 October 2019

Copyright: 2002-2017, PathologyOutlines.com, Inc.

PubMed search: endometritis [title] NOT tumor


Nat Pernick, M.D.
Page views in 2018: 6,202
Page views in 2019 to date: 5,183
Cite this page: Pernick N. Endometritis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusendometritis.html. Accessed October 14th, 2019.
Definition / general
  • Endocervix normally forms barrier to ascending infection
  • Chlamydia: associated with severe acute / chronic inflammation
  • Coccidiomycosis: may be secondary to resolved primary lung infection
  • Giant cell arteritis: may involve uterus as isolated finding or part of generalized giant cell arteritis
  • Granulomas: due to sarcoid, tuberculosis, CMV (Am J Surg Pathol 1992;16:716) or post laser ablation for postmenopausal bleeding
  • Hematometra: blood within uterine cavity, usually due to cervical occlusion; endometrial mucosa is replaced by lipid laden histiocytes (xanthogranulomatous endometritis); called "ceroid containing histiocytic granuloma" if histiocytes contain yellowish brown cytoplasmic pigment
  • Intrauterine device (IUD): 65% have abnormal endometrium at biopsy; often focal or extensive chronic endometritis, necrosis and squamous metaplasia; may be associated with PID and tubo-ovarian abscesses; IUD infection rate is 13% - actinomyces common
  • Pneumopolycystic: one case reported to date, appears to resolve spontaneously (Am J Surg Pathol 2006;30:258)
  • Pyometra: pus in endometrial cavity; due to obstruction (benign cervical stricture) and infection; occasionally due to carcinoma
  • Sarcoidosis: granulomas usually spread to myometrium (in contrast to TB)
  • Tuberculosis: rare in US; common in other countries, where it causes infertility; plasma cells and white blood cells may be present due to secondary infection; acid fast bacilli present in tubercles or culture; granulomas tend to accumulate in superficial functional layers of endometrium, so biopsy during late secretory phase
  • Xanthogranulomatous endometritis: rare lesion of elderly with pyometra and cervical stenosis; replacement of endometrium by xanthogranulomatous inflammation composed of abundant foamy histiocytes, siderophages, giant cells, neutrophils, plasma cells and lymphocytes; also fibrosis, calcification (Infect Dis Obstet Gynecol 2007;2007:34763)
  • Acute endometritis:
    • Limited to post delivery or miscarriage, but presence of moderate to marked myometrial inflammation is not predictive of post cesarean section endometritis (Am J Clin Pathol 2003;120:217)
    • Due to retained products of conception or instrumentation
    • For diagnosis, must see microabscesses plus infiltration and destruction of glandular epithelium, as neutrophils are common in cycling endometrium
Clinical features - chronic endometritis
  • In women with pelvic inflammatory disease (PID), postpartum, postabortion (retained tissue), IUD, tuberculosis (miliary or TB salpingitis) and symptomatic bacterial vaginosis
  • 15% have unknown cause (may be chlamydia, give antibiotics)
  • Often asymptomatic (Am J Reprod Immunol 2011;66:410)
Microscopic (histologic) description - chronic endometritis
  • Spindly stroma with edema; focal early breakdown with surface neutrophils
  • Associated with weakly proliferative glands
  • Plasma cells are characteristic but one plasma cell is probably not enough; usually histiocytes, lymphocytes and lymphoid follicles are also present; glandular alterations usually make dating impossible
  • Also focal necrosis or focal calcification; myometrium usually spared unless inflammation is severe
  • Presence of eosinophils may suggest need to search for plasma cells, with CD138 if necessary (Hum Pathol 2010;41:33)
  • Note: lymphoid follicles are normal in functional layers of endometrial mucosa and do not constitute chronic endometritis
  • Note: plasma cells may occasionally be seen in nonendometritis cases (Pathol Res Pract 2011;207:680), including dysfunctional uterine bleeding and stromal breakdown (Hum Pathol 2007;38:581)
Microscopic (histologic) images

Chronic endometritis images
contributed by Yuri Tachibana, M.D., Nagasaki University

Plasma cells

CD138


 Chronic endometritis images
 AFIP

Chronic endometritis with reactive glandular proliferation:
the spindled stroma contains a massive lymphoplasmacytic
infiltrate; endometrial glands are irregularly distributed and variable
in size and shape but are also infiltrated by the inflammatory cells



Images hosted on other servers:

Endometrial tuberculosis



Chronic endometritis

Chronic endometritis (various images)


CD138 (syndecan) staining

Tuberculous endometritis


Xanthogranulomatous endometritis (various images)

Positive stains - chronic endometritis
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