Anatomic Pathology: Gynecologic Pathology

495) An endometrial biopsy specimen shows secretory endometrium and evidence of cells similar to the ones noted in the image. Which of the following statements is TRUE?

• Definitions of chronic endometritis differ based on the study performed. However, it seems to be generally accepted that the presence of a single plasma cell is sufficient for the diagnosis of chronic endometritis.

• Several studies have shown associations between chronic endometritis and pelvic inflammatory disease (PID), IUD placement, and intermenstrual bleeding.

• In most cases, chronic endometritis is characterized microscopically by endometrial inflammation rich in plasma cells with or without the presence of neutrophils or lymphocytes. Lymphocytes and neutrophils are normally seen in the endometrial stroma, and their numbers increase as the patient nears menses. However, the numbers of lymphocytes are often markedly increased in the presence of chronic endometritis.

• Other morphologic changes often seen in the presence of chronic endometritis include superficial mucosal stromal edema, stromal breakdown, disturbances in normal growth and maturation, and spindle cell alteration of the stroma.

• Endometrial dating is not recommended on chronic endometritis specimens at the present time because the endometrium is thought to be altered, and so dating is unreliable.

Mount S, Mead P, Cooper K: Chlamydia trachomatis in the endometrium: can surgical pathologists identify plasma cells? Adv Anat Pathol 2001;8(6):327-329.

Rotterdam H: Chronic endometritis. A clinicopathologic study. Pathol Annu 1978;13(Pt 2):209-231.

Smith M, Hagerty KA, Skipper B, et al: Chronic endometritis: a combined histopathologic and clinical review of cases from 2002-2007. Int J Gynecol Pathol 2009;29(1):44-50.

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