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Uterus

Non tumor

Endometritis


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 9 November 2011, last major update November 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● 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 post-menopausal 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 yellow-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, micro image #1, #2
● 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
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● 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

Chronic endometritis

Clinical features
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● In women with pelvic inflammatory disease (PID), postpartum, post-abortion (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)

Micro description
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● 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 non-endometritis cases (Pathol Res Pract 2011 Oct 11 [Epub ahead of print]), including dysfunctional uterine bleeding and stromal breakdown (Hum Pathol 2007;38:581)

Micro images
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Chronic endometritis (various images)


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

       
CD138 (syndecan) staining

   
Tuberculous endometritis

           
Xanthogranulomatous endometritis (various images)

Positive stains
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● Plasma cells are usually positive for CD138/syndecan (Arch Pathol Lab Med 2004;128:1000)

End of Uterus > Non tumor > Endometritis


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