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Uterus

Epithelial tumors - benign

Endometrial polyp with atypical (bizarre) stromal cells


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 20 February 2012, last major update February 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● Usually an incidental finding
● Mean age 56 years (range 45-82 years); patients present with post-menopausal bleeding
● Benign behavior; not associated with endometrial carcinoma
● Atypia probably represents degenerative change

Micro description
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● Moderate to severe nuclear atypia due to large, hyperchromatic nuclei and occasional multinucleation
● Hyperchromasia due to “smudging”, as with symplastic leiomyomas
● No prominent nucleoli
● No mitotic activity
● Giant cells often within loose fibrous background
● Atypical cells scattered throughout the polyp
● May also be associated with a leiomyoma (Int J Gynecol Pathol 2005;24:352)

Micro images
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Endometrial polyp with pseudosarcomatous stromal atypia: lesion is polypoid; large, often multinucleated cells with large hyperchromatic nuclei are present. These findings were limited to this polyp in a hysterectomy specimen, and mitotic figures were absent. The lesion never became more cellular than in this field. No densely cellular cuffs were noted around endometrial glands.

Positive stains
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For atypical cells: vimentin, ER, PR, androgen receptor and CD10 (38%)

Differential diagnosis
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Adenosarcoma: stromal hypercellularity, periglandular stromal cuffing, cambium layer, polypoid or leaf-like projections into glandular lumina and >3 mitoses/10 high power fields
MMMT: malignant appearing epithelial component, stromal component has mitotic figures
Endometrial stromal sarcoma: tan to yellow, tightly packed spindled cells without significant glandular elements, smaller capillary type vessels distributed evenly; infiltrates into myometrium; usually no atypical cells

Additional references
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Am J Surg Pathol 2002;26:505

End of Uterus > Epithelial tumors-benign > Endometrial polyp with atypical (bizarre) stromal cells


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