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Steroid hormone control of endometrial, epithelial, stromal, and presumably endothelial cells is mediated by estrogen receptors and progesterone receptors. They have high affinity to bind estradiol and progesterone, respectively.These steroid receptors are specific proteins concentrated exclusively in the nuclei of both endometrial epithelial and stromal cells, as well as the endothelial cells of stromal capillaries. This chapter contains a review of the technical procedures for handling endometrial tissues and a discussion of the morphologic aspects of the endometrium, focusing on the interpretation and understanding of the physiomorphology of the endometrial cycle.Method To ensure a good specimen for morphologic interpretation, a biopsy sample should be taken from both the anterior and the posterior endometrium and fixed immediately in 10% buffered formalin.In current practice, the device that is most often used is the Pipelle endometrial aspirator.In cases in which little or no tissue is obtained but the endometrium was penetrated with the aspirator, a repeat procedure should be performed.If the repeat aspiration still yields little tissue, one can assume severe endometrial atrophy or obstructing endometrial polyp.Taking an endovaginal ultrasonography of the uterus may solve this dilemma.Morphologically, the endometrium is one of the most dynamic target tissues in women.
Because of this interplay of structure, function, and ovarian hormonal stimuli, the endometrium is considered one of the most sensitive indicators of the hypothalamic-pituitary-ovarian hormonal axis. Estradiol promotes endometrial proliferation, whereas after ovulation, progesterone converts estradiol-primed endometrium into secretory tissue.
As a result, morphologic evaluation of the endometrium is used in diagnostic evaluation of infertile patients to determine whether ovulation is occurring (Fig. Postovulatory estradiol amplifies the progesterone effect, and after withdrawal of both estradiol and progesterone, the endometrial mucosa breaks down and regenerates within the period of menstruation.
To ensure a maximum amount of tissue for morphological reading, the specimen should be placed on a piece of lens paper or some other adhesive tissue and then immersed in the fixative.
By this means, all of the tissue fragments remain tightly attached to the lens paper, rather than floating in the fixative, and no tissue will be lost for histologic examination.
In premenopausal women with regular menstrual cycles, histological preparations include the upper portion of the functional layer of the endometrium.