Case report
Endometrial atypical hyperplasia with clear cell change spreading throughout the endometrium

https://doi.org/10.1016/j.anndiagpath.2003.09.009Get rights and content

Abstract

An unusually rare case of atypical endometrial hyperplasia with clear cell change (metaplasia) spreading through almost the whole endometrium of a 37-year-old woman with infertility and abnormal bleeding is reported.

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Material and methods

Cytologic examinations by Papanicolaou staining were performed. The specimens from the uterus and the both ovaries were fixed in 10% buffered formalin, and the whole uterus was impregnated into 42 paraffin blocks. Thin sections were stained with hematoxylin-eosin, including periodic acid-Schiff (PAS), d-PAS, AB/PAS, and Giemsa stain.

After about 30 days’ fixation in formalin, a stick was taken from the endometrium for electron microscopic examinations. The tissue was fixed with glutaraldehyde.

Case report

A 37-year-old infertile woman had abnormal bleeding for 30 to 90 days. Menarche began at 10 years of age. Human menopausal gonadotropin (hMG) has been used to treat infertility. On August 27, 2001 she consulted her primary care physician for gastrointestinal distress. The occult blood test of feces was positive, and fluoroscopic examination of the large intestine revealed a compression of the sigmoid colon. She then consulted a gynecologic clinic (Sept 12) where a physical examination showed a

Discussion

The case under study poses the problem of how to diagnose cytologically atypical clear cells and histologically crowded clear cell glands lined by moderately atypical cells. It is probably necessary to differentiate clear cell metaplasia, endometrial hyperplasia, endometrioid adenocarcinoma of secretory type, and clear cell carcinoma.

From the cytologic appearance of nuclear atypia with prominent nucleoli in the present case, we strongly suspected the possibility of carcinoma. Histologically,

Acknowledgements

The authors wish to express their sincere thanks to Hiroko Sato, Yukiko Sugie, Kazuko Matsuba, and Kenichi Yoshida for their technical help. They also would like to express their gratitude to Dr Xu JinLan (our laboratory) and Dr Keiko Ishii (Shinshu University School of Medicine, Matsumoto, Japan) for their insightful opinions.

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