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Sternberg's pattern approach to diagnosis

Topic Completed: 1 October 2011

Revised: 20 February 2019

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

PubMed search: uterus diagnosis WITH Sternberg

Nat Pernick, M.D.
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Table of Contents
Definition / general
Cite this page: Pernick N. Sternberg's pattern approach to diagnosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uteruspatternapproach.html. Accessed August 24th, 2019.
Definition / general

Gland to stroma ratio:
  • 1:1 associated with normal cycling endometrium, dysfunctional uterine bleeding and infertility
  • Glands > stroma associated with menstruation, late secretory phase, hyperplasia and carcinoma
  • Glands < stroma associated with normal decidua, atrophy and monophasic stromal proliferations

Glandular features:
  • Must evaluate cytologic features and architecture of glands to determine if atrophy, weakly proliferative endometrium, proliferative endometrium, presence of cytologic atypia, secretory endometrium (early, mid-, late), Arias-Stella reaction, disintegrating glands / shedding and budding or branching of glands

Stromal features:
  • Usual stroma in proliferative phase has minimal cytoplasm and spindled or oval nuclei; in secretory phase or pregnancy, has decidual changes of abundant eosinophilic or clear cytoplasm, large round / oval nucleus

  • In proliferative phase, vessels are delicate branching network throughout stroma
  • Secretory phase vessels have thicker walls, are coiled (aka spiral arteries)
  • Thick walled vessels in fibrotic stroma are characteristic of endometrial polyps

Pattern uniformity:
  • Cycling endometrium has uniform pattern throughout, except for lower uterine segment / isthmus (spindled stromal cells separated by collagen, hybrid endocervical-endometrial glands) and stratum basalis layer (unresponsive to hormones, appears weakly proliferative throughout menstrual cycle)

  • Pattern 2: biphasic proliferations of glands and abundant (possibly neoplastic) stroma
  • Includes endometrial polyps, atypical polypoid adenomyoma, MMMT, adenosarcoma, sarcoma, endometrial stromal neoplasms and adenomatoid tumor

  • Pattern 3: predominantly monophasic spindle cell proliferations
  • Includes smooth muscle neoplasms, endometrial stromal tumors, spindled epithelial neoplasms, pure heterologous uterine sarcomas and undifferentiated sarcoma
  • Epithelial neoplasms typically express CD10, EMA, keratin
  • Smooth muscle neoplasms express smooth muscle actin, desmin and h-caldesmon

  • Pattern 4: sheetlike proliferations of large, round undifferentiated cells
  • Includes undifferentiated malignancies such as high grade adenocarcinoma, MMMT, undifferentiated sarcomas, extension of cervical primary, metastatic carcinoma, melanoma, leukemia and lymphoma
  • Lobular carcinoma of breast looks deceptively bland

  • Pattern 5: extensive necrosis, inflammation and disintegration
  • Necrosis suggests malignancy; also cervical stenosis, pyometra and xanthomatous endometritis
  • Inflammatory cells common in post-partum endometrium; also bacterial infection
  • Disintegration associated with menstruation, hyperplasia; may mimic carcinoma due to stromal collapse

  • Pattern 6: scanty samples that raise question of sampling adequacy
  • May be due to atrophy or obstructing lesion that shields endometrium from sampling
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