From the Guidelines
In a histopathology examination of the endometrium from a hysterectomy specimen of a 65-year-old woman with uterine prolapse, one should expect to find atrophic endometrium, characterized by thin, inactive endometrial glands with minimal or absent proliferative activity, surrounded by dense, fibrous stroma. This expectation is based on the post-menopausal state of the patient, where decreased estrogen levels lead to endometrial atrophy, as supported by the most recent guidelines and studies on endometrial cancer and uterine neoplasms 1. The endometrial thickness is typically reduced to 1-2 mm, with simplified glandular architecture and cuboidal to low columnar epithelium. The stroma often appears dense and fibrotic with decreased cellularity. Key points to consider in the examination include:
- Careful evaluation for any unexpected findings such as endometrial hyperplasia, polyps, or malignancy, as these can be incidental findings in post-menopausal women.
- Assessment of the myometrium for degenerative changes or fibroids, which are common in this age group and may contribute to prolapse. While uterine prolapse itself doesn't typically cause specific endometrial changes, chronic irritation from prolapse might occasionally lead to inflammatory changes or metaplasia in the endometrium, as noted in various studies on uterine neoplasms and endometrial cancer 1. However, the primary expectation remains that of atrophic endometrium due to the patient's post-menopausal status, as emphasized in the latest clinical practice guidelines 1.
From the Research
Expected Histopathology Examination of Endometrium
In a hysterectomy specimen of a 65-year-old woman with uterine prolapse, the expected histopathology examination of the endometrium may include:
- Atrophic endometrium, which is the most common endometrial pathology in postmenopausal women 2, 3
- Chronic cervicitis, which is a common incidental finding in hysterectomy specimens 2, 3
- Other possible findings include:
- Endometrial hyperplasia, which may be present in up to 20% of women with uterine prolapse 4
- Endometrial polyps, which may be found in up to 7% of women with uterine prolapse 4
- Adenomyosis, which may be present in up to 21% of women with uterine prolapse 3, 4
- Uterine fibroids, which may be found in up to 27% of women with uterine prolapse 4
- It is also important to note that grossly unremarkable specimens can have unsuspected histopathological lesions, which could be potential premalignant or malignant lesions 3
- Hysteroscopy can be used to evaluate the endometrial cavity and identify malignant or benign pathology, but it may have false-positive results and should be combined with biopsy to increase accuracy 5, 6
Importance of Histopathological Examination
Histopathological examination of the endometrium is important to: