Endometrial Synovial-like Metaplasia Associated With Levonorgestrel-releasing Intrauterine System

Colin J R Stewart, Robyn Leake
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2015 · vol. 34(6) , pp. 570–575 · doi:10.1097/pgp.0000000000000183 · PMID:26447355 · W2414522822
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study describes a novel endometrial alteration resembling synovial metaplasia associated with levonorgestrel-releasing intrauterine systems, likely a stromal reaction to the foreign body.

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Abstract

The levonorgestrel-releasing intrauterine system (L-IUS) is widely used in contraception and in the treatment of menorrhagia, dysmenorrhea, adenomyosis, and endometriosis. L-IUS is also increasingly considered in the management of endometrial neoplasia and its precursors. Histologic changes in the endometrium can be due to the effects of high-dose progestogen or may be caused by the local irritant or mechanical effects of an intrauterine foreign body. In the present study, we describe a novel endometrial alteration associated with L-IUS that most closely resembles synovial metaplasia reported at other extra-articular anatomic sites. Eleven cases were identified with a mean age of 49.6 yr. In most patients L-IUS was used for management of menorrhagia or endometrial hyperplasia. Endometrial synovial-like metaplasia was always a focal finding and was associated with areas of surface epithelial erosion. The synovial-like cells showed a distinctive palisaded arrangement with orientation perpendicular to the endometrial surface. Multinucleate cells were present in 2 cases, but granulomas were not identified. The synovial-like cells were vimentin immunoreactive and a variable proportion of cells expressed CD68. Only focal CD10 staining was seen and there was no expression of estrogen receptor, progesterone receptor, or cytokeratin. In summary, L-IUS may be associated with a distinctive synovial-like metaplastic alteration which most likely represents a stromal reaction to an intrauterine foreign body following endometrial surface erosion. The synovial-like cells appear to comprise histiocytes and modified fibroblasts or stromal cells similar to this process in other sites.

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Condition tags

endometriosisadenomyosisdysmenorrhea

MeSH descriptors

Contraceptive Agents, Female Endometrium Intrauterine Devices, Medicated Levonorgestrel Metaplasia Synovial Membrane Adult Biomarkers Biomarkers Contraceptive Agents, Female Endometrial Hyperplasia Endometrial Hyperplasia Endometrium Female Foreign-Body Reaction Foreign-Body Reaction Foreign-Body Reaction Humans Immunohistochemistry Intrauterine Devices, Medicated

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References (26)

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