Symplastic Atypia in Neoplastic and Non-neoplastic Endometrial Stroma: Report of 3 Cases With a Review of Atypical Symplastic Cells Within the Female Genital Tract

Rajeev Shah, Shah R, McCluggage WG, W. Glenn McCluggage
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2009 · vol. 28(4) , pp. 334–337 · doi:10.1097/pgp.0b013e3181999450 · PMID:19483632 · W1998321829
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This report describes three cases of endometrial stromal cells with symplastic nuclear atypia, occurring in non-neoplastic endometrium, endometriosis, and endometrial stromal sarcoma, reviewing similar findings in the female genital tract.

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This case report describes three instances of marked nuclear atypia with a symplastic appearance in endometrial stromal cells, highlighting that this phenomenon had not been previously documented in endometriosis. The study includes two cases involving non-neoplastic endometrium—one within an ovarian endometriotic cyst and another in normal eutopic tissue—and one case associated with endometrial stromal sarcoma. In all instances, the atypical cells were focal, characterized by enlarged, hyperchromatic, and multilobated nuclei without mitotic activity, indicating a benign change with no clinical significance for the non-neoplastic cases. Relevance to endometriosis: The paper is centrally about endometriosis as it presents the first reported cases of symplastic atypia occurring specifically within an ovarian endometriotic cyst, distinguishing this benign finding from malignant processes.

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Abstract

SUMMARY: We report 3 cases in which endometrial stromal cells exhibited marked nuclear atypia with a symplastic appearance. Two cases involved non-neoplastic endometrial stroma, one within an ovarian endometriotic cyst and the other within normal eutopic endometrium. In the third case, the symplastic change involved the neoplastic cells of an endometrial stromal sarcoma. Symplastic endometrial stromal cells have rarely been described in normal endometrium and in endometrial stromal sarcoma but, as far as we are aware, this phenomenon has not been reported previously in endometriosis. In the 3 cases, the atypical cells were a focal finding. The abnormal nuclei were markedly enlarged, atypical, and hyperchromatic with multilobated forms but without mitotic activity. This unusual phenomenon is a benign change when involving non-neoplastic endometrial stroma and is of no clinical significance. It is analogous to the presence of atypical symplastic nuclei in normal tissues and in other pathologic lesions in the female genital tract. In reporting these cases, we review normal tissues and pathologic lesions in the female genital tract with atypical symplastic nuclei.
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Symplastic Atypia in Neoplastic and Non-neoplastic Endometrial Stroma: Report of 3 Cases With a Review of Atypical Symplastic Cells Within the Female Genital Tract - Rajeev Shah - W. Glenn McCluggage We report 3 cases in which endometrial stromal cells exhibited marked nuclear atypia with a symplastic appearance. Two cases involved non-neoplastic endometrial stroma, one within an ovarian endometriotic cyst and the other within normal eutopic endometrium. In the third case, the symplastic change involved the neoplastic cells of an endometrial stromal sarcoma. Symplastic endometrial stromal cells have rarely been described in normal endometrium and in endometrial stromal sarcoma but, as far as we are aware, this phenomenon has not been reported previously in endometriosis. In the 3 cases, the atypical cells were a focal finding. The abnormal nuclei were markedly enlarged, atypical, and hyperchromatic with multilobated forms but without mitotic activity. This unusual phenomenon is a benign change when involving non-neoplastic endometrial stroma and is of no clinical significance. It is analogous to the presence of atypical symplastic nuclei in normal tissues and in other pathologic lesions in the female genital tract. In reporting these cases, we review normal tissues and pathologic lesions in the female genital tract with atypical symplastic nuclei.

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Condition tags

endometriosis

MeSH descriptors

Endometrial Stromal Tumors Endometrium Stromal Cells Uterine Neoplasms Aged Aged, 80 and over Endometrial Stromal Tumors Endometrium Female Humans Immunohistochemistry Middle Aged Stromal Cells Uterine Neoplasms

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