PAPILLARY PROLIFERATION OF THE ENDOMETRIUM: A BENIGN LESION SIMULATING ADENOCARCINOMA.

Transcription

1 PAPILLARY PROLIFERATION OF THE ENDOMETRIUM: A BENIGN LESION SIMULATING ADENOCARCINOMA. Teresa Pusiol, Maria Grazia Zorzi, Doriana Morichetti U.O. Anatomia Patologica Ospedale S. Maria del Carmine Rovereto TN

2 Background: Papillary proliferation of the endometrium (PPE) consisted of papillary fibrovascular core, that are devoid of cytologic atypia. The lesion was first described by Silverberg and Kurman in Tumors of the uterine corpus aand gestational trophoblastic disease. Atlas of tumors pathology, 3 sseries, Fascicle 3. Washington, DC: Armed Forces Institute of Pathology, 1992

3 Lehman and Hart in 2001 have described the clinicopathologic features in nine cases. These authors have identified two sub-groups: simple PPE and complex PPE. Lehman MB, Hart WR. Simple and complex hyperplastic papillary proliferations of the endometrium: a clinicopathologic study of nine cases of apparently localized papillary lesions with fibrovascular stromal cores and epithelial metaplasia. Am J Surg Pathol Nov;25(11):

4 In recent a study of 59 cases Ip PP et al (2013) have classified the PPE in two groups. Ip PP, Irving JA, McCluggage WG, Clement PB, Young RH. Papillary proliferation of the endometrium: a clinicopathologic study of 59 cases of simple and complex papillae without cytologic atypia. Am J Surg Pathol Feb;37(2):

5 The group 1 consisted of lesions with localized simple papillae. The group 2 was composed by complex or elongated papillae or diffuse intracystic proliferation. The PPE doesn t include the group of endometrial hyperplasias of WHO classification.

6 A, Simple papillae involving part of an endometrial polyp. B, Simple papillae extensively involving a polyp. C, Simple papillae with fibrovascular stromal cores and with occasional branching and covered by epithelial cells with bland nuclear features. D, Complex papillae with broad fibrovascular cores with frequent secondary and tertiary branching.

7 E, The epithelial cells covering the papillae have preserved nuclear polarity, little or no variation in nuclear size and shape, uniform nuclear chromatin, and absence of prominent nucleoli. Mucinous metaplasia is often prominent. F, Simple and complex papillae (left) abutting nonatypical complex hyperplasia (right). G, Simple and complex papillae (left) abutting atypical complex hyperplasia (right). H, Simple papillae involving adenomyosis.

8 PPE is commonly seen in postmenopausal women. It frequently involves endometrial polyp and it is associated with one or more types of epithelial metaplasia. In the endometrial stromal localization the lesion may simulate endometrioid adenocarcinoma with papillary pattern especially in the small fragments of the endometrium.

9 Methods: The computerized files of the Institute of Anatomic Pathology of the Rovereto Hospital were searched for examples of PPE in the period January 1993 June Examples of syncytial surface change were excluded. Only 1 case of PPE has been found.

10 Results: A 55-year-old woman presented with postmenopausal bleeding. The operative hysteroscopy revealed stromal PPE composed by simple papillae, with short stalk, covered by epithelial cells with bland nuclear features.

11 The diagnosis of simple hyperplastic PPE was performed. In the histological material were present two endometrial polips with focal simple PPE and mucinous, hobnail metaplasia. Hysterectomy was performed and revealed diffuse simple cystic hyperplasia of the endometrium.

12 Conclusion: PPE is very unusual finding and mimics well differentiated adenocarcinoma. The report of a single case may be useful for the knowledge of this lesion published in few papers.

13 MANY TANKS.

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