Endometrium is the mucosa covering cavum uteri, which grows in one’s childhood. It changes periodically with menstrual cycle, endometrium’s falling off causes menses. There is a ovulation in every menstrual cycle, if the conception hasn’t occured, the next menses will come. the cycle of menses is adjusted by ovarian hormone, the disorder of which lead to disorder of menses, this way endometrium changes as well, showing endometrial thickening. Which present amenorrhea or dysfunctional uterine bleeding, and the latter is more common. Endometrial thickening may occur at any age, including adolescence, reproductive period, peri-menopausal period or postmenopause.
Patients with endometrial thickening are often accompanied by pelvic infection, pelvic hydrops and so on, which shows that the inflammation stimulus is an important cause of endometrial accrementition. The clinical manifestation is the disorder, abundant and abnormal endometrorrhagia, the sufferer may experience continual bleeding, or menses cycle shortened, menses period prolonged, and the bleeding time may be as long as 1 month, hemorrahgic shock may occur.
Endometral thickening includes simple accrementition, complex thickening, glandular thickening, when the latter two kinds of symptoms occur, the possibility of carcinogenesis increases, and active treatment shoud be given.
The pathological feature of endometral thickening:
endometrium is thickened, up to 0.5～1cm incrassation, with smooth and soft surface.
simple accrementition of endometrium: hyperplasias in both of endometrial gland and interstitial substance are present, and the glands increase obviously, varying in size and distribution. Occasionlly, the glands are seen enlarged to capsule, the glandular epithelium cells appear cylinder shape, lack of excretion, usually forming pseudostratified epithelium. The nuclear mitotic figures are common, and the interstitial cells arrange tightly.
Endometrial glands and bursas thickening:
the feature is that hyperplastic glands present apparent saccular dilatation. In typical cases, sporadic ostioles are visible in the thickening endometrium, so it is called Swiss-cheese hyperplasia.
Microscopically, the endometrial glands present different shapes and sizes. The size of the small is like inchoate hyperplasia gland, the diameter of the big is several times or dozens times that of the small. the glands of different sizes are lined by pseudostratified tall or cuical epithelium, and lack of secretion. The mesenchymal cells are affluent, less cytoplasm, hyperchromatic.
Endometrial adenomatoid thickening: characterized by glandular hyperplasia in a dense array and interstitial scarce, by comparison with the two types mentioned above , the glands’ quantity is larger and the structures of glands are more complex, the glandular epithelium present papillary hyperplasia towards glandular cavity inside or budding hyperplasia towards mesenschyma. the interstitial substances are scarce. Glandular epithelium cells present cylinder shape, pseudostratified epithelium, vesicular nucleus, common nuclear mitotic figures, but without apparent heteromophism.
Endometrial atypical thickening: the organization structure is similar to adenomatoid hyperplasia, jaming glands appear irregular shape, crowded branching or budding hyperplasia, and interstitial substances decrease significantly. the glandular epithelium cells appear apparent heteromorphism, with enlarged nucleus, thickening chromatin, sharp nucleolus, polyptychic epithelium, losed polarity, common nuclear mitotic figure. endometrial atypical thickening is sometimes difficult to identify with well-differentiated adenocarcinomas, and the main identifing point is interstitial infiltrates invisible in the former. Some people consider it is precancerous changes of endometrial adenocarcinoma.
Key words: endometroisis; endometrium thicken; endometrium thicken symptoms; endometrium thicken causes
