It is against my rule to make diagnosis of EM lesion without seeing low magnification pictures. I would like to know if this is a diffuse or focal process, if endotrial glandular hyperplasia or metaplasia present, if there is chronic inflammation such as plasma cells, eosinophils and lymphocytes and if there is Michaelis-Gutmann body present.

Okay, let's focus on histiocytes in EM. Whenever you see histiocytes in endometrium, following DDx should be sought:

1. Complex or atypical complex hyperplasia or well diff adenocarcinoma. In up to 50% of CH, CAH or adenocarcinoma, you can find foamy microphages/histiocytes presence without inflammation. This situation is the most commonly seen in EM biopsy.

2. Reactive process, such as Endometrial malakoplakia. The cause is not ascertain, assuming related to infection, particularly chronic E. Coli infection. Usually you should be able to see plasma cells and lymphocyts associated with this process. Sometimes histiocytes accumulate large amount to form a "nodule", named 'nodular histiocyte hyperplasia".  This is rare event and not commonly seen.

3. Always rule out signet ring-like metastatic adenocarcinoma, such as from breast or GI source. This is a very rare situation, but I have seen one of such cases.

Now you understand why I ask so many questions at th begining in order to differentiate these entities. For this case, I cannot provide any further diagnosis without knowing th whole picture of this EM biopsy.

Thank you for sharing this case with us.

 试着翻译一下杨斌老师的讲解：

在子宫内膜病变的过程中，我们需要看到低倍镜下的图像。这个病变是局灶性的还是弥漫性的？是否存在内膜腺体的增生或者化生？是否有慢性炎症包括浆细胞，嗜酸性粒细胞，淋巴细胞的浸润？是否存在软斑小体？

好，那么我们看集中认识一下在子宫内膜中出现的组织细胞。当我们在子宫内膜中看到组织细胞时，下面的鉴别诊断就应该考虑到：

1，复合型增生，非典型复合型增生，高分化子宫内膜样腺癌。在大约50%的上述病变中，在没有炎症的背景下可以见到泡沫状的巨噬细胞/组织细胞。在子宫内膜活检中，这种情况是最常见的。

2，反应性的增生，比如子宫内膜软斑病。病因并不确定，被认为与感染，特别是慢性大肠杆菌感染有关。通常，我们能够在这种病变中看到浆细胞和淋巴细胞。有时，组织细胞大量聚集形成一个“结节”，称为“结节性组织细胞增生”。这种病变并不常见。 

3,通常需要排除从乳腺或胃肠道转移来的印戒样细胞腺癌。虽然这种情况非常罕见，但我曾见过一例。

现在你知道为什么我在上面会提出那么多的问题了。对这个子宫内膜活检的病例来说，在没有看到整个病变的图像的情况下，我无法提供更多的诊断意见了。

非常感谢你与我们一同分享这个病例。