FIGURES AND TABLES

FIGURE 1.

Simple hyperplasia. Glands and stroma both are active, glands are irregularly distributed, and some are cystically dilated. Note uniformly distributed blood vessels in stroma.

FIGURE 2.

Simple hyperplasia. Balance between proliferation of glands and stroma is again noted. Most of the glands illustrated here are round, although some are cystically dilated. All are lined by proliferative-looking endometrium. Small blood vessels are uniformly distributed in the cellular stroma.

FIGURE 3.

Endometrial polyp in hysterectomy specimen. This specimen clearly demonstrates a polypoid projection protruding from the endometrial surface, which is covered on three surfaces by endometrial epithelium. Note dilated glands, fibrotic stroma, and scattered dilated thick-walled blood vessels.

FIGURE 4.

Endometrial polyp. At the center of this figure appear several profiles of dilated thick-walled blood vessels, characteristic of endometrial polyps. In this field, stromal fibrosis is slight compared with Figure 3, and the endometrial glands appear proliferative.

FIGURE 5.

Curettage specimen from a perimenopausal patient with abnormal bleeding. Stroma is largely hemorrhagic and necrotic, leading to close approximation of endometrial glandular epithelium, simulating a hyperplasia or carcinoma. This specimen is probably from an anovulatory cycle and is thus lacking in secretory changes, further complicating the correct interpretation of this specimen as totally benign.

FIGURE 6.

Proliferative endometrium, showing extensive "telescoping" artifact, producing numerous double-barreled lumina, simulating complex hyperplasia. This was a focal finding in what was otherwise typical proliferative phase endometrium.

FIGURE 7.

Complex hyperplasia. The glands in this field are crowded and architecturally irregular, with angular contours and numerous side buds. Nuclear atypia was lacking at higher power observation.

FIGURE 8.

Atypical polypoid adenomyoma. Largely unoriented glands are separated by a stroma composed of intersecting and swirling fascicles of smooth muscle. A large squamoid morule with central necrosis is seen in the upper left-hand corner.

FIGURE 9.

Atypical complex hyperplasia. High-power photomicrograph shows atypical glands with dyspolaric cells containing eosinophilic cytoplasm and enlarged, rounded nuclei with prominent nucleoli. In the center of the figure and at upper right are two hyperplastic but nonatypical glands for comparison.

FIGURE 10.

Atypical simple hyperplasia. Although the simple versus complex architecture of this illustration and Figure 9 cannot be ascertained from the high-power illustrations used, this figure again contrasts the epithelium of an atypical gland (left) with that of an adjacent hyperplastic gland lacking atypia (right).

FIGURE 11.

Hyperplastic endometrium with ciliary change (tubal metaplasia). Even at this magnification, the resemblance of the lining cells to tubal epithelium is evident. The nuclei lack the features of cytologic atypia seen in Figures 9 and 10.

FIGURE 12.

Surface syncytial change. In this specimen, it is apparent that the syncytial and papillary proliferation is growing largely on the endometrial surface, with involvement of a superficially located gland. Numerous neutrophils are seen within the microglandular and micropapillary epithelium.

FIGURE 13.

Higher-power view of surface syncytial change, in which the orientation of this curettage specimen makes it difficult to appreciate that the syncytial proliferation is on the surface. Note the lack of nuclear atypia in these cells, as well as a gland with ciliary change (tubal metaplasia), illustrating that different patterns of metaplastic and related changes often occur together.

FIGURE 14.

Cribriform pattern of well-differentiated endometrioid adenocarcinoma, in which stroma between glands has disappeared as the glands have grown together.

FIGURE 15.

Well-differentiated endometrioid adenocarcinoma. Another case in which glands have become confluent by replacing the stroma that originally existed between them in several islands. The growth pattern is somewhat villoglandular.

FIGURE 16.

Well-differentiated endometrioid adenocarcinoma with prominent desmoplastic stroma separating glands and masses of glands. A confluent pattern is also seen focally.

FIGURE 17.

Well-differentiated endometrioid adenocarcinoma with malignant glands separated by masses of neutrophils (stromal necrosis).

FIGURE 18.

Well-differentiated adenocarcinoma in which the intervening stroma between glands has been converted to lipid-laden foam cells. Elsewhere in the specimen, a more typical desmoplastic stroma was present. Note that some of the malignant glands in this field reveal mucinous degeneration, but the foam cell change is a good indicator that the tumor is primary in the endometrium rather than in the endocervix.

FIGURE 19.

Endometrioid adenocarcinoma with squamous differentiation, adenoacanthoma type. There is a squamoid morule that appears cytologically benign in the center of the photomicrograph. Note the confluent nature of the surrounding glands and the desmoplastic stroma, indicating that this is indeed a carcinoma. The glandular component throughout this tumor, as in this field, was well differentiated (FIGO Grade 1).

FIGURE 20.

Endometrioid adenocarcinoma with squamous differentiation, mixed adenosquamous carcinoma type. In this tumor, the squamous epithelium present appears cytologically malignant and is in direct apposition to the adjacent desmoplastic stroma. Many of the apparent glands in this figure actually represent microcystic foci of necrosis within the squamous or poorly differentiated glandular component.

FIGURE 21.

High-grade endometrioid adenocarcinoma with squamous differentiation, mixed adenosquamous carcinoma type. Distinction between the solid adenocarcinomatous component seen in the lower left and the malignant squamous elements seen at the top and right is difficult, but the squamous components show sheet-like growth, sharp cell margins, eosinophilic and glassy cytoplasm, and increased amounts of cytoplasm (thus, a lower nuclear:cytoplasmic ratio) compared with the malignant glandular component. In this field, only the glandular component would be graded, and this would be considered FIGO Grade 3.

FIGURE 22.

Mixed glandular and solid (FIGO Grade 2), apparently endometrioid adenocarcinoma with foci (upper half) of large, bizarre nuclei. Rather than just upgrading this tumor to Grade 3, consideration should be given to the possibility that this represents a serous carcinoma with a predominantly nonpapillary architecture.

FIGURE 23.

Focus of well-differentiated endometrioid adenocarcinoma within a nest of adenomyosis deep in the myometrium. Note the rounded border of the tumor, the absence of intervening reactive stroma between the malignant glands and surrounding myometrium, and the single, residual benign basalis-type gland at 3 o'clock in the tumor nest.

FIGURE 24.

Endometrioid adenocarcinoma with true myoinvasion. Note the angulated contours of the carcinomatous glands and their separation from smooth muscle seen at lower left by reactive desmoplastic stroma.

TABLE 1 - Epithelial Metaplastic and Related Changes.