A 29-year-old female presents with severe pain during menstruation (dysmenorrhea). During workup, an endometrial biopsy is obtained. The pathology repo from this specimen makes the diagnosis of chronic endometritis. Based on this pathology repo, which one of the following was present in the biopsy sample of the endometrium?
) The endometrium and myometrium are relatively resistant to infections. Therefore, inflammation of the endometrium (endometritis) is rare. The diagnosis of endometritis depends on finding inflammatory cells within the endometrium that are not present during the normal menstrual cycle. Polymorphonuclear leukocytes (neutrophils) are normally present during menstruation, while a stromal lymphocytic infiltrate can be seen at other times during the menstrual cycle. Lymphoid aggregates and lymphoid follicles may also be seen in normal endometrium. Therefore the presence of any of these types of leukocytes is not diagnostic of endometritis. Acute endometritis is usually caused by bacterial infection following delivery or miscarriage and is characterized by the presence of neutrophils in endometrial tissue that is not menstrual endometrium. The histologic diagnosis of chronic endometritis depends on finding plasma cells within the endometrium. All it takes is one plasma cell to make the diagnosis. Chronic endometritis may be seen in patients with intrauterine devices (IUDs), pelvic inflammatory disease (PID), retained products of conception (postpaum), or tuberculosis. The latter is characterized histologically by the presence of caseating granulomas with Langhans giant cells. These are secondary causes of chronic endometritis. In a significant number of cases, no underlying cause is found. Decidualized stromal cells are the result of the effects of progesterone and are seen normally in the late secretory phase or in patients who are pregnant. Histologically, these stromal cells contain abundant eosinophilic cytoplasm. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
Neutrophils
Lymphocytes
Lymphoid follicles
Plasma cells
miscellaneous