The Diagnostic Criteria for Chronic Endometritis: A Survey of Pathologists

Abstract

While acute endometritis is a reasonably well-defined entity of ascending infection and attendant active inflammation, chronic endometritis is less well defined. As part of a broad effort to define and refine the diagnostic criteria and management of the disease, we conducted a survey of pathologists to understand the variability in diagnostic criteria and implications of the diagnosis of nonspecific, nonobstetric chronic endometritis. Members of national and international professional pathology societies were surveyed utilizing anonymous electronic surveys designed to examine diagnostic criteria, etiological understanding and treatment implications of a pathologic diagnosis of nonspecific, nonobstetric chronic endometritis. There was substantial variability among pathologists in the diagnostic criteria used for making a diagnosis of nonspecific, nonobstetric chronic endometritis, with 28.5% of pathologists using the presence of a single plasma cell for making the diagnosis. There was additional variability in the use of special stains, reporting in the presence of coexisting lesions and the hormonal stage of the endometrium. There were no differences between generalists and specialists in the diagnostic criteria used, except the significantly greater likelihood of specialists making the diagnosis in gestational endometrium. The substantial variability in diagnostic criteria for nonspecific, nonobstetric chronic endometritis among pathologists, including among gynecologic pathologists, has the potential to confound the management of patients. Standardization of diagnostic criteria for chronic endometritis is essential to understand the implications of the diagnosis.

The Role of Special Intrauterine Balloon and Intrauterine Contraceptive Device after TCRA in the Treatment of Intrauterine Adhesions

“…Chronic endometritis is a continuous in ammation of endometrium, there are lots of plasma cells in the endometrial stroma, as the marker, CD138 and CD38 are detected to nd plasma cells by immunohistochemistry(IHC) [20,21].…”

Chronic endometritis: A prevalent yet poorly understood entity

“…Histological evidence of plasma cell in the endometrial tissue is reportedly the gold standard for diagnosis 3,4,13 21 and has been much debated amongst gynecologic pathologists since 14 22 making this criterion dated, nonspecific and left up to individual interpretation of the examining pathologist.…”

“…Pathology textbooks broadly define the histologic diagnosis as “the presence of an unspecified number of endometrial stromal plasma cells”, 22 making this criterion dated, nonspecific and left up to individual interpretation of the examining pathologist. About a third (28.5%) of pathologists diagnose based on evidence of a single plasma cell 14 …”

“…The diagnosis of CE was previously entirely based on histology. While the presence of plasma cell(s) in endometrial tissue has been used for diagnosing CE, 3,4,13 there is lacking consensus on number of plasma cells required 14 . Coexisting histological hallmarks besides plasma cells are often required for diagnosis 14 .…”

Retained products of conception as an aetiology for endometritis

“…Plasma cells present within the endometrium are often associated with reactive stroma, increased lymphocytic infiltrate, lymphoid aggregates and disordered glandular architecture; however, these changes are not required to render a diagnosis of chronic endometritis. 3 When present, chronic endometritis has been implicated in reduced reproductive potential, primarily through decreased embryo implantation and recurrent miscarriage. Several studies have suggested that treatment with antibiotics may improve subsequent reproductive outcomes in women with chronic endometritis, making screening and diagnosis essential to improving outcomes.…”