Departments of Pathology and Obstetrics-Gynecology and Reproductive Science, The Mount Sinai-NYU Medical Center, New York, New York Correspondence: Liane Deligdisch, M.D., Mount Sinai Medical Center, Department of Pathology, One Gustave Levy Place, New York, NY 10029. The endometrial tissue is a sensitive target for steroid sex hormones and is able to modify its structural characteristics with promptness and versatility.
Prolonged use results in progressive endometrial atrophy.Ovulation induction therapy accelerates the maturation of the stroma and is often associated with a discrepancy between early secretory glands and an edematous or decidualized stroma with spiral arterioles.Hormone replacement therapy with estrogen alone may result in continuous endometrial proliferation, hyperplasia, and neoplasia.The use of both estrogen and progesterone elicits a wide range of histologic patterns, seen in various combinations: proliferative and secretory changes, often mixed in the same tissue sample; glandular hyperplasia (in polyps or diffuse) ranging from simple to complex atypical; stromal hyperplasia and/or decidual transformation; epithelial metaplasia (eosinophilic, ciliated, mucinous); and inactive and atrophic endometrium.Progesterone therapy for endometrial hyperplasia and neoplasia induces glandular secretory changes, decidual reaction, and spiral arterioles.
Glandular proliferation is usually arrested, but neoplastic changes may persist and coexist with secretory changes.Lupron therapy produces a shrinking of uterine leiomyomas by accelerating their hyaline degeneration, similar to that in postmenopausal involution. Tamoxifen for breast carcinoma has an estrogen-agonist effect on the uterus in approximately 20% of patients, who develop endometrial polyps, glandular hyperplasia, adenomyosis, and/or leiomyomata.Both endometrioid and nonendometrioid carcinomas are seen, often in polyps.Their causal relationship to tamoxifen therapy is debatable.Departments of Pathology and Obstetrics-Gynecology and Reproductive Science, The Mount Sinai-NYU Medical Center, New York, New York Hormone therapy is widely used throughout the world by women of all ages for a variety of reasons, ranging from oral contraception and ovulation stimulation for family planning to hormone replacement therapy in menopause, to adjuvant therapy of tumors of the breast and uterus.The histopathologic changes of the uterus, and particularly of the endometrium, associated with these therapies encompass a variety of morphologic features that are often difficult to interpret.