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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.


● 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

● 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

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

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

Differential diagnosis

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

Am J Surg Pathol 2002;26:505

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

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