Technical Remarks
A complete curettage is the ideal method for optimal diagnostic evaluation of the endometrium. A fractionated curettage has additional advantages; it helps to localize the site and extent of malignancy and assists in evaluating endocervical changes that d
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2.1 Procedures for Obtaining Endometrial Tissue A complete curettage is the ideal method for optimal diagnostic evaluation of the endometrium. A fractionated curettage has additional advantages; it helps to localize the site and extent of malignancy and assists in evaluating endocervical changes that develop during hormonal therapy. For functional diagnosis in infertile patients, endometrial biopsies will usually suffice if properly taken with a single-stroke biopsy from the uterine fundus, and they offer the advantage that they can be repeated within the same menstrual cycle. Interpreting biopsies taken by brush or aspiration may prove quite difficult and inaccurate, except for advanced carcinomas.
2.2 Selection of the Proper Time for Curettage In order to obtain optimal diagnostic results, the time for curettage must be carefully selected. In infertile patients, differential diagnosis of the various causes of sterility is best made shortly before the onset of menstruation. Only at this late time can the failure in endometrial differentiation be completely surveyed. In menorrhagia possibly due to irregular shedding, the best time for curettage is 5–10 days after the onset of menstruation, in order to recognize remnants of nonlysed mucosa. In metrorrhagia, curettage is best done without delay when much of the endometrium is still available for examination. With amenorrhea in a patient of reproductive age, pregnancy must be excluded before curettage is performed. Clinical information is equally important to the pathologist, mainly about the patient’s age, menstrual history, any hormone therapy, contraceptive device, endocrinologic disorders, and size and cavity of the uterus, including sonographic and/or hysteroscopic reports.
G. Dallenbach-Hellweg et al., Atlas of Endometrial Histopathology, DOI: 10.1007/978-3-642-01541-0_2, © Springer-Verlag Berlin Heidelberg 2010
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2 Technical Remarks
2.3 Preparation of the Endometrial Specimen For fixation, a 4% neutral solution of formaldehyde is commonly used and is ideal for most of the diagnostic procedures involved in endometrial examination. Routine staining of all specimens should include hematoxylin-eosin (H & E) and a connective tissue stain, for instance van Gieson’s solution. The latter is particularly important for recognizing endometrial polyps, or portions of them, and hyalinized placental villi. An additional periodic acid-Schiff (PAS) reaction may be helpful in detecting small amounts of glycogen or mucopolysaccharides in glandular epithelial cells. A reticulin impregnation can be useful for verifying tissue lysis or for distinguishing between various types of tumors. These four staining methods suffice for most questions arising in routine examination of the endometrial biopsy. For subclassification of endometrial carcinomas, sarcomas, carcinosarcomas and other nonepithelial and nonmesenchymal tumors such as neuroectodermal tumors or lymphomas, immunohistochemical stainings may be helpful or needed. Among these, monoclonal antibodies against variou
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