子宫内膜病变（0809210）

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

名称：图4
描述：图4

 谢谢楼主提供病史！

此前的宫内膜图像链接在哪？

手术切除标本，如果仅此病变，内膜和肌层交界正常，我觉得报小区复杂性增生。不知各位老师如何诊断？期待中。。。

 There are some glandular complexity with no significant cytologic atypia.  I would not be confident to make a diagnosis of complex hyperplasia in a premenopausal woman.  Consider physiologic process or endometrial polyp etc.  Will need to review all material and make a meaningul interpretation.  Thanks.  

 Agree c above. Generally it is difficult to make dx of em-bx by few online photos. I feel it is a benign process in low power. However last fig in high power looks different. The cells are nuiform and have low grade nuclei, but the glands have complex architectures and show no stroma between the glands. In the dx of em lesions gland structures are more important than nuclear atypia. Endometrial ca can have grade 1 nuclei.

I feel afraid to jump in any final dx based on the photos above if it were my true clinical case. 

 Hard to say.  I didn't get a feeling about this endometrial biopsy: too few fields to evaluate.  Photo 1 and 2 may represent complex hyperplasia if everywhere is like this.  Last photo has several atypical nuclei and looks like microacinar proliferation which is associated with higher risk of endometrial carcinoma concurrently or subsequently.  I don't see mitoses, not even sure this is proliferative endometrium or secretory endometrium.  Endomtrial hyperplasia or neoplasia should show proliferative glands. 

Is this endometrial biopsy?  Sometimes with EM biopsy,  i don't feel confident to call it atypical hyperplasia but worry about it.  Under such circumstances, i would suggest endometrial curettage which yields more tissue and represents the EM pathology better than biopsy.

 Dr. wy1992:

This is an interesting case, first, the endometrium looks like complex hyperplasia with cellular atypia, but patient is only in her early 40' pregnancy is possible. some reactive changes in normal pregnenay may show those endometrial changes. you need to be very careful to rule out pregnency first and then give the dx. Clinical information is vital important.

second, your photos didnot show the junctions between glands and stroma, so microinvasive endo-Ca cannot be excluded.

Hope this may help you dx, have a nice holiday.

 低倍镜下看无明显异型，息肉尚不除外，多看几个视野可能感觉更有谱一些；

高倍镜下看有点异型，但不明确，关系不清。

考虑复杂型增生伴局灶不典型；尚不全除外息肉。