Uterine intravascular menstrual endometrium simulating malignancy.

Banks ER, Mills SE, Frierson HF Jr
The American journal of surgical pathology · 1991 · doi:10.1097/00000478-199104000-00010 · PMID:2006721
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This case report describes intravascular menstrual endometrium in a hysterectomy specimen, highlighting its histological features and immunohistochemical profile to aid pathologists in distinguishing this benign condition from uterine malignancies.

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This case report describes a 28-year-old female with cervical dysplasia who presented with numerous foci of menstrual endometrium within the parametrial blood vessels during hysterectomy. Histological analysis revealed biphasic tissue containing spindled stromal cells and cuboidal epithelial cells, which immunohistochemically stained positive for vimentin and epithelial markers respectively. The authors emphasize that this benign condition can mimic intravascular malignancies such as carcinoma or sarcoma, particularly during frozen section diagnosis, but can be distinguished by recognizing its bland cytology and appropriate marker application. This paper is centrally about endometriosis — specifically illustrating an unusual presentation of ectopic endometrial tissue within uterine vasculature that requires careful pathological differentiation from cancerous processes.

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Abstract

Intravascular menstrual endometrium, a rare finding in hysterectomy specimens, can pose clinically critical differential diagnostic problems. We describe a 28-year-old female with cervical dysplasia and numerous foci of menstrual endometrium in the parametrial blood vessels of her subsequent hysterectomy specimen. Histologically, the intravascular tissue consisted of small spindled stromal cells, larger cuboidal epithelial cells, or both components in close association. Immunohistochemically, the small spindled cells were vimentin positive and the larger cuboidal cells stained with epithelial markers. Distinction of intravascular menstrual endometrium from intravascular malignancies such as carcinoma, sarcoma, or lymphoma may be difficult, especially at the time of frozen-section diagnosis. Awareness of this process, attention to its cytologically bland, usually biphasic appearance, knowledge of the menstrual status, and application of appropriate immunohistochemical markers will allow distinction from neoplasia.
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Uterine Intravascular Menstrual Endometrium Simulating Malignancy - Evelyn R. Banks - Stacey E. Mills - Henry F. Frierson Intravascular menstrual endometrium, a rare finding in hysterectomy specimens, can pose clinically critical differential diagnostic problems. We describe a 28-year-old female with cervical dysplasia and numerous foci of menstrual endometrium in the parametrial blood vessels of her subsequent hysterectomy specimen. Histologically, the intravascular tissue consisted of small spindled stromal cells, larger cuboidal epithelial cells, or both components in close association. Immunohistochemically, the small spindled cells were vimemin positive and the larger cuboidal cells stained with epithelial markers. Distinction of intravascular menstrual endometrium from intravascular malignancies such as carcinoma, sarcoma, or lymphoma may be difficult, especially at the time of frozensection diagnosis. Awareness of this process, attention to its cytologically bland, usually biphasic appearance, knowledge of the menstrual status, and application of appropriate immunohistochemical markers will allow distinction from neoplasia.

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