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

Colin J R Stewart, Stewart CJ, Leake R, 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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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 Adult Biomarkers Biomarkers Biomarkers Contraceptive Agents, Female Contraceptive Agents, Female Endometrial Hyperplasia Endometrial Hyperplasia Endometrial Hyperplasia Endometrium Endometrium Female Female

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References (26)

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