Reasons to biopsy:

abnormal bleeding:

• post occult spontaneous abortion: may find some POC as multinucleate trophoblasts or villi; may see a few stromal plasma cells along with stromal fibrin plaques.

• chronic endometritis or endometriopathy: positive for stromal eosinophiles or plasma cells [LMC-05-2084] by H&E.

• polyps: may be simple polyps with low glands:stroma ratio or adenomatous with increased ratio.

• pseudopolyp: residual non-functionalis island of post-ablation endometrium [L08-13096].

• submucous leiomyomata: [LMC-02-3578]...may not stop with Provera. A hard DX to make due to insufficient sampling in D&C or BX unless happen to skim off a bit of the myoma.

• dysfunctional uterine bleeding (DUB), NOS: preumptive DX until biopsy clarifies the basis or after biopsy gives no clue to why bleeding. Might include medication effect causing bleeding, coagulopathy, or corpus luteum insufficiency.

• perimenopausal hypoestrogenic weakly proliferative endometrium: gland functionalis area has penciform nuclear shapes rather than plumply oval nuclei of normal proliferative.

• perimenopausal disordered (menstrual series has a lot of anovulatory cycles) proliferative endometrium: when D&C has a large quantity of tissue, it is what old terminolgy had as non-adenomatous, noncomplex, "simple hyperplasia" [L06-8378]). Star shaped gland cross-sectional profiles or other irregularities but without a glands:stroma ratio greater than 1.0 (unity).

• corpus luteum insufficiency: insufficiently thickened endometrium & weak, non-robust, secretory effect. A hard DX to make due to insufficient sampling in D&C or BX but one that can be in a DDX when don't see a specific DX.

• hyperplasia/malignancy: increased glands:stroma ration makes hyperplasia & cyto-histological atypia makes cancer.

• medications (aspirin): there may be stromal bleeding in any type of pattern. A hard DX to make due to insufficient sampling in D&C or BX but one that can be in a DDX when don't see a specific DX.

• medication (pill/progestational): the stroma can be plump due to progestational effect, but can sometimes have a pseudodecidual reaction so florrid that it resembles true decidua & can slough as a cast ("membranous dysmenorrhea" [L09-12181]).

• coagulation disorders: there may be stromal bleeding in any type of pattern. A hard DX to make due to insufficient sampling in D&C or BX but one that can be in a DDX when don't see a specific DX.

• pelvic pain: we look for eosinophiles &/or plasma cells reflective of endometritis.

• uterine enlargement: adenomyosis, myometrial hypertrophy, myomata, endometrial hyperplasia, endometrial cancer.

• endometrial lining thickening by U/S: rule out hyperplasia & cancer.

• patient on carcinogenic medications: as in breast cancer...may induce endometrial hyperplasia or cancer.

References:

1. Hendrickson & Kempson, Surgical Pathology of the Uterine Corpus, 1980.

(posted May 2002; latest addition 3 March 2010)