Uterus

Nontumor

Endometritis


Editorial Board Member: Gulisa Turashvili, M.D., Ph.D.
Deputy Editor-in-Chief: Jennifer A. Bennett, M.D.
Stephanie L. Skala, M.D.

Topic Completed: 3 August 2021

Minor changes: 3 August 2021

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PubMed search: Endometritis[TI] uterus[TIAB] pathology

Stephanie L. Skala, M.D.
Page views in 2020: 15,185
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Cite this page: Skala SL. Endometritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/uterusendometritis.html. Accessed December 3rd, 2021.
Definition / general
  • Inflammatory process involving the endometrium
Essential features
  • Endometrial stromal plasma cells required for the diagnosis of chronic endometritis
  • Chronic endometritis is implicated in infertility and recurrent pregnancy loss
  • Acute endometritis typically represents ascending infection from lower genital tract
  • Xanthogranulomatous endometritis usually associated with cervical stenosis
ICD coding
  • ICD-10:
    • N71.1 - chronic inflammatory disease of uterus
    • N71.9 - inflammatory disease of uterus, unspecified
Epidemiology
  • Typically premenopausal women
Sites
  • Endometrium
Pathophysiology
  • Unknown
Etiology
Clinical features
Diagnosis
  • Microscopic examination is the gold standard
  • Hysteroscopic scoring systems have been proposed (J Minim Invasive Gynecol 2020;27:1127)
    • Features: endometrial hyperemia (focal or diffuse), hemorrhagic spots, dilated endometrial vessels, micropolyps, endometrial polyp
Prognostic factors
Case reports
Treatment
Microscopic (histologic) description
  • Chronic endometritis
  • Acute endometritis
    • Neutrophils infiltrating and destroying endometrial epithelium
    • Neutrophils filling gland lumina
    • With or without microabscess formation
  • Granulomatous endometritis
    • Clusters of epithelioid histiocytes rimmed by lymphocytes
    • Cytopathic effects if viral etiology (herpes simplex virus, cytomegalovirus)
    • Tuberculosis: necrotizing granulomas with multinucleated giant cells, usually in superficial functional endometrium (Am J Obstet Gynecol 2020;223:737.e1)
    • Sarcoidosis: nonnecrotizing granulomatous inflammation, more commonly in myometrium
  • Xanthogranulomatous endometritis
    • Abundant foamy histiocytes, siderophages, neutrophils, plasma cells, lymphocytes
    • With or without fibrosis, calcification
Microscopic (histologic) images

Contributed by Stephanie L. Skala, M.D. and Yuri Tachibana, M.D.

Chronic endometritis
Spindled endometrial stroma

Spindled endometrial stroma

Endometrial stromal plasma cells

Endometrial stromal plasma cells

Eosinophils and plasma cells

Eosinophils and plasma cells

Plasma cells

Plasma cells

CD138

CD138

MUM1 highlights plasma cells

MUM1 highlights plasma cells


Xanthogranulomatous endometritis
Foamy histiocytes and eosinophils

Foamy histiocytes and eosinophils

Lymphoid follicles and histiocytes

Lymphoid follicles and histiocytes

 
Acute endometritis
Prominent intraluminal neutrophils

Prominent intraluminal neutrophils

Positive stains
Sample pathology report
  • Endometrium, biopsy:
    • Chronic endometritis
Differential diagnosis
Board review style question #1

What clinical scenario is most likely associated with the endometrial biopsy findings shown above?

  1. Cervical stenosis
  2. Chlamydia
  3. Tuberculosis
  4. Use of intrauterine device
Board review style answer #1
A. Cervical stenosis

Comment Here

Reference: Endometritis
Board review style question #2
Which of the following conditions is thought to be associated with infertility and recurrent pregnancy loss?

  1. Acute endometritis
  2. Chronic endometritis
  3. Granulomatous endometritis
  4. Xanthogranulomatous endometritis
Board review style answer #2
B. Chronic endometritis

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Reference: Endometritis
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