Histopathology of the Endometrium

A. Methods of Obtaining, Preparing, and Interpreting the Endometrium.- 1. Indications for Curettage.- 2. Selection of the Proper Time for Curettage.- 3. Procedures for Obtaining Endometrial Tissue.- 4. Preparation of the Endometrial Specimen.- a) Fixation.- b) Embedding.- c) Orientation.- d) Staining.- e) Immunocytochemistry with Monoclonal Antibodies.- f) Quantitative and Experimental Methods.- 5. Components of Curettings and Their Diagnostic Value.- 6. Statistical Analysis of the Histological Results.- B. The Normal Histology of the Endometrium.- 1. The Individual Structures.- a) The Glandular Epithelium.- b) The Superficial Epithelium.- c) The Stromal Cells.- d) The Reticulum Fibers.- e) The Ground Substance.- f) The Vessels.- g) The Nerves.- 2. Histochemical Localization of Enzymes; the Reciprocal Action Between Enzymes and Hormones.- 3. Structural Changes Induced in the Endometrium by the Physiological Action of the Ovarian Hormones.- a) Molecular Biology of Steroid Hormones.- b) Endometrial Steroid Receptors.- c) Estrogen.- d) Progesterone.- e) Relaxin.- 4. Changes in Structures in the Endometrium During Nidation.- 5. The Endometrium Before Puberty.- 6. The Normal Menstrual Cycle and Its Possible Variations.- a) The Normal Proliferative Phase.- b) The Normal Secretory Phase.- c) Menstruation.- d) Regeneration.- e) Possible Variations in the Endometrium During the Normal Cycle.- 7. The Endometrium in the Climacterium and After the Menopause.- C. The Histopathology of the Endometrium.- 1. Morphological Effects of Circulatory and Coagulation Disturbances.- a) Edema.- b) Chronic Passive Hyperemia; Hemorrhage Caused by Extragenital Diseases.- 2. Functional Endogenous (Hormonal) Disturbances.- a) Atrophic Endometrium from Non-Functioning Ovaries.- b) Resting Endometrium Resulting from Inadequate Ovarian Function (Ovarian Insufficiency, Hypofolliculinism).- c) The Endometrium Associated with a Persistent Follicle.- ?) The Anovulatory Cycle.- ?) Glandular-Cystic Hyperplasia.- ?) Adenomatous Hyperplasia.- ?) Special Forms of Hyperplasia (Focal Hyperplasia, Polyps, Glandular, and Stromal Hyperplasias).- d) The Deficient Secretory Phase Associated with Deficiency or Premature Regression of the Corpus Luteum.- e) The Endometrium Associated with a Persistent Corpus Luteum.- ?) Irregular Shedding.- ?) Dysmenorrhea Membranacea.- ?) Secretory Hypertrophy.- f) The Endometrium Associated with Infertility.- g) Functional Disturbances During the Climacteric.- h) The Effect of Hormone-Producing Ovarian Tumors on the Endometrium.- i) The Functional Disturbances of the Endocervical Mucosa.- 3. Exogenous (latrogenic) Changes of the Endometrium.- a) After Hormonal Therapy.- ?) Estrogens.- ?) Gestagens.- ?) Both Hormones.- ?) Oral Contraceptive Agents.- ?) Gonadotropins.- ?) Clomiphene.- b) After Intrauterine Contraceptive Device.- c) After Intrauterine Instillation.- d) Regeneration after Curettage.- e) With In Vitro Fertilization.- 4. Endometritis.- a) Acute Endometritis.- b) Chronic Non-Specific Endometritis.- c) Tuberculous Endometritis.- d) Specific Endometritis Caused by Rare Microorganisms.- e) The Foreign Body Granuloma.- f) Endocervicitis.- 5. Metaplasias and Related Changes.- a) Epithelial Metaplasia.- ?) Squamous Metaplasia, Morules, and Ichthyosis.- ?) Mucinous (Endocervical) Metaplasia.- ?) Serous Papillary Metaplasia.- ?) Ciliated Cell Change.- ?) Clear Cell Change.- b) Stromal Metaplasia.- 6. Neoplasms.- a) Benign Tumors.- b) Carcinoma of the Endometrium.- ?) Carcinomas with Endometrial Differentiation.- ?) Carcinomas Which Originate from Pluripotent Müllerian Epithelium.- ?) Histochemical Results.- ?) Precursors of Endometrial Carcinoma.- ?) Etiological Concepts.- ?) Progesterone Treatment of Endometrial Carcinoma.- c) Sarcoma of the Endometrium.- d) Malignant Mixed Mesodermal Tumors.- e) Metastatic Tumors.- f) Primary Carcinomas of the Ecto- and Endocervix as Components of Curettings.- D. The Diagnosis of Normal and Pathologic Pregnancy from Curettings.- 1. The Early Intrauterine Pregnancy and Its Disturbances.- a) Therapeutic Abortion (Induced Abortion).- b) Spontaneous Abortion.- ?) Causes.- ?) Microscopic Changes.- c) Partial Hydatidiform Mole.- d) Complete Hydatidiform Mole, Invasive Mole, and Choriocarcinoma.- e) Placental Site Trophoblastic Tumor.- f) Late Endometrial Changes Following Intrauterine Abortion.- 2. The Endometrium Associated with Extrauterine Pregnancy.- 3. The Postpartum Endometrium.- References.