Diagnosis of lesions
suspicious but subdiagnostic for EIN is a contentious topic.
This is a small category of cases, in which diagnostic uncertainty may be
contributed by a variety of specific and often identifiable causes. An
explanation for the lack of a definitive diagnosis should be identified and
communicated by the pathologist whenever possible.
This will be more relevant in guiding therapy than its indeterminate
status per se.
In the case of indeterminate endometria, a descriptive diagnosis with
explanatory comments from the pathologist will be helpful in deciding between
therapeutic options. For example, the patient who is biopsied while on exogenous
progestins may be easier to evaluate after withdrawal of hormones.
Controversial histologies such as those obscured by extensive altered
cellular differentiation ("metaplasias") should be described clearly.
Other specimens may be compromised by sampling errors, or regenerative
epithelial changes. All should be
clarified by additional studies, including either immediate additional
endometrial sampling to detect the presence of diagnostic areas elsewhere in the
endometrium, or regular followup with rebiopsy at 6 month intervals to monitor
possible progression. Another option
would be to attempt a trial of high dose progestins to provide symptomatic
relief, followed by a post-withdrawal biopsy.
Copyright 1998-2015 by George L. Mutter, MD. All Rights Reserved