Diagnosis of Endometrial Biopsies and Curettings. A Practical Approach.pdf

Diagnosis of

Endometrial Biopsies

and Curettings

Second Edition

Michael T. Mazur, MD

Clinical Professor of Pathology, State University of New York, Upstate

Medical University, Syracuse, New York, and ClearPath Diagnostics,

Syracuse, New York

Robert J. Kurman, MD

Richard W. TeLinde Distinguished Professor, Departments of

Gynecology, Obstetrics and Pathology, The Johns Hopkins Hospital,

and The Johns Hopkins University School of Medicine, Baltimore,

Maryland

Diagnosis of

Endometrial Biopsies

and Curettings

A Practical Approach

Second Edition

With 230 Illustrations, 77 in Full Color

Michael T. Mazur, MD

Clinical Professor of Pathology

State University of New York

Upstate Medical University

Syracuse, NY 13210

and

ClearPath Diagnostics

Syracuse, NY 13202

USA

Robert J. Kurman, MD

Richard W. TeLinde Distinguished

Professor

Departments of Gynecology,

Obstetrics and Pathology

The Johns Hopkins Hospital

and

The Johns Hopkins University

School of Medicine

Baltimore, MD 21231

USA

Library of Congress Cataloging-in-Publication Data

Mazur, Michael T.

Diagnosis of endometrial biopsies and curettings : a practical approach / Michael

Mazur, Robert J. Kurman.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-387-98615-4 (h/c : alk. paper)

1. Endometrium—Biopsy. 2. Endometrium—Diseases—Cytodiagnosis. 3.

Endometrium—Cytopathology. I. Kurman, Robert J. II. Title.

[DNLM: 1. Uterine Diseases—diagnosis. 2. Biopsy—methods. 3. Dilatation

and Curettage—methods. 4. Endometrium—pathology. 5. Pregnancy

Complications—diagnosis. WP 440 M476d 2004]

RG316.M39 2004

618.1

42—dc22

2004046866

ISBN 0-387-98615-4

Printed on acid-free paper.

Business Media, Inc.

the written permission of the publisher (Springer Science

Business Media, Inc., 233 Spring

Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews

or scholarly analysis. Use in connection with any form of information storage and retrieval,

electronic adaptation, computer software, or by similar or dissimilar methodology now

known or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks, and similar terms,

even if they are not identiﬁed as such, is not to be taken as an expression of opinion as to

whether or not they are subject to proprietary rights.

While the advice and information in this book are believed to be true and accurate at the

date of going to press, neither the authors nor the editors nor the publisher can accept any

legal responsibility for any errors or omissions that may be made. The publisher makes no

warranty, express or implied, with respect to the material contained herein.

Printed in the United States of America.

(BS/WW)

987654321

SPIN 10689416

springeronline.com

Preface to the Second Edition

This second edition of Diagnosis of Endometrial Biopsies and Curettings:

A Practical Approach follows a number of favorable comments we

received about the ﬁrst edition. As before, this book is designed to offer

a practical reference for the everyday interpretation of endometrial

biopsies. This edition has been extensively updated to reﬂect the

advances in our understanding of the pathology and pathophysiology of

the endometrium over the past few years. In addition, a large number of

color illustrations have been added to help the reader understand the

morphologic changes described in the text.

Although the entire book has been revised, several areas received par-

ticular attention. Our knowledge of the utility of immunohistochemistry

in the interpretation of these specimens, especially trophoblastic disease

and endometrial neoplasia, has expanded considerably since the ﬁrst

edition. Accordingly, in this edition the problems, pitfalls, and utility of

this valuable diagnostic adjunct have received greater attention.

While immunohistochemistry is discussed in all the chapters, it is also

summarized in the ﬁnal chapter, which addresses methods of endome-

trial evaluation.

Expanded knowledge of newer entities, such as the epithelioid tro-

phoblastic tumor, endometrial intraepithelial carcinoma, and the effects

of tamoxifen on the endometrium have received increased emphasis in

this edition. Because hydatidiform mole is now commonly recognized at

an earlier stage of gestation, the features of these “early moles” are dis-

cussed in greater detail. The chapter on polyps was revised to further

clarify the terminology of these common lesions, as they demonstrate a

wide spectrum of morphologic features. Information about the distinc-

tion of endometrial carcinoma from endocervical adenocarcinoma also

was signiﬁcantly revised.

Most importantly, however, the text continues its focus on those

aspects of endometrial biopsy interpretation that can be especially

vexing, such as the diagnosis of atypical hyperplasia, grading of endome-

trial carcinoma, and the myriad of benign changes and artifacts that can

be confusing to the pathologist. In addition, a clear understanding of the

terminology that the pathologist uses to communicate diagnostic infor-

mation to the clinician is critically important. A diagnosis of carcinoma

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