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Tubal Metaplasia

Classification, histopathology and clinical significance of the finding in endometrial specimens

Nicole Nikolic

on 24 July 2013

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Transcript of Tubal Metaplasia

Tubal Metaplasia Epithelial Metaplasias Estrogen Exposure Tubal metaplasia is not uncommon in normal proliferative endometrial tissue

Often considered an incidental physiologic finding

Most of women with endometrial metaplasia are postmenopausal and have been on estrogen replacement therapy Atypical Tubal Metaplasia vs Typical - 2011 study by the dept of pathology at Brown University done with immunostaining of 63 cases of atypical tubal metaplasia found the immunostaining patterns of typical tubal metaplasia of the endometrium was not significantly different from that of atypical tubal metaplasia

- 5% in atypical group had hyperplasia without atypia (vs 4% in the control)

- 3% in atypical group had atypical hyperplasia or carcinoma (vs 2% in control)

- Concluded that atypical metaplasia does not increase risk of developing endometrial hyperplasia or malignancy Neoplasm Occurs in 1/2 of endometrial adenocarcinomas

Also found in precancerous EIN (endometrial intraepithelial neoplasia) lesions

Can be found in atrophic uterus, suggesting that unopposed estrogen not necessary http://www.webpathology.com/slides/slides/Uterus_Endometrium_TubalMetaplasia.jpg http://resources.ama.uk.com/glowm_www/uploads/1215717109_Fig_10_EM.jpg Normal Fallopian Tube Tubal Metaplasia of Endometrium - Ciliated epithelium is normally found in the upper respiratory tract, fallopian tubes, and ependymal lining of ventricles and central canal of spinal cord Tubal (Ciliated Cell) Metaplasia Tubal (Ciliated)
Eosinophilic (Oncocytic)
Mucinous - Types:

- Significance depends on whether specimen appears benign, premalignant or malignant

- Benign:

- Malignant: local expansions Degenerative- local surface and stromal breakdown
Hormonally induced- diffuse changes Normal endometrial glands http://www.siumed.edu/~dking2/erg/RE017b.htm When found elsewhere in gynecologic tract (endometrial glands, endocervix) -> tubal metaplasia - Most common endometrial metaplasia (60%)

- Changes to tissue include: cilia, increased cytoplasm, and increased eosinophilic staining... but lacks atypia or mitotic activity

- Causes:
Estrogen exposure
Neoplastic Simon RA, Peng SL, Liu F, et al. Tubal metaplasia of the endometrium with cytologic atypia: analysis of p53, Ki-67, TERT and long-term follow-up. Mod Pathol. 2011 Sep;24(9):1254-61. p53
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