Polypoid Endometriosis of the Uterine Cervix With Arias-Stella Reaction in a Patient Taking Phytoestrogens

Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Cedoc, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Paátria, Lisboa, Portugal.
International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists (Impact Factor: 1.67). 03/2010; 29(2):185-8. DOI: 10.1097/PGP.0b013e3181b7015e
Source: PubMed


We report for the first time a case of 2.5 cm polypoid cervical endometriosis with a superficial growth pattern in a 48-year-old patient with past tubal ligation. The lesion showed metaplastic changes (clear cell, eosinophilic, micropapillary) and a prominent Arias Stella reaction in the absence of concomitant pregnancy but presumably related to phytoestrogenic treatment. The eutopic endometrium, however, had a usual proliferative appearance, implying that it showed a different response from the endometriotic tissues, suggesting the possibility of a metaplastic origin for the endocervical polypoid endometriosis. The unusual histology of the lesion led to an erroneous diagnosis of papillary serous carcinoma in the biopsy. This was subsequently excluded on finding endometrial-type stroma surrounding glands, and was confirmed immunohistochemically by a low Ki-67 index and negativity for p53.

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    • "This ratio is 30-40% in infertile. A number of histopathological studies point that endometriosis might be the neoplastic procedure leading to endometrial ovarian and clear cell carcinoma, most expected resulting from accelerated propagation of endometrial glands and stroma exterior of the uterine cavity (34, 35). "
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    ABSTRACT: Background: Endometriosis is a female health disorder that occurs when cells from the lining of the uterus grow in other areas of the body. The cause of endometriosis is unknown. Objective: The purpose of this study was to investigate TP53 gene codon 72 polymorphism in women with endometriosis and compared it with healthy samples in Isfahan. Materials and Methods: We undertook a case-control study to examine the possible association of the TP53 gene codon 72 polymorphism with the risk of endometriosis in Isfahan. Ninety whole blood specimens from normal people as controls and ninety endometriosis specimens were analyzed. p53 codon 72 genotypes were identified using allele-specific polymerase chain reaction. Results: Frequency of genotype Arg/Arg (Arginine/Arginine) in the samples of endometriosis was 28.9% and in healthy samples 42.2%. Frequency of genotype Pro/Pro (Proline/Proline) in the samples of endometriosis was 15.6% and in healthy ones. Frequency of heterozygote's Arg/Pro was 55.6% in endometriosis samples and 54.45% in healthy ones 3.3%. By comparing statistical genotype Pro/Pro with two other genotypes in both groups there was a statistical meaningful difference between control group and endometriosis group. [p=0.009, CI=95%, OR=5.34 (1047-19.29)]. Conclusion: Recent research shows that genotype Pro/Pro codon72 exon4 TP53 gene may be one predisposing genetic factor for endometriosis in Isfahan.
    Full-text · Article · Jun 2013 · International Journal of Reproductive BioMedicine
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    • "In addition to pregnancy, Arias-Stella reaction is well known to occur in nonpregnant patients taking various types of hormonal preparations [16]. A recent report of cervical Arias-Stella reaction in a patient taking phytoestrogens highlights the fact that the source of hormonal exposure may not always be immediately evident [17]. Importantly, knowledge that the patient is pregnant or otherwise exposed to hormonal stimulants should not deter one from rendering a diagnosis of clear cell adenocarcinoma, as several cases of endocervical clear cell adenocarcinoma in pregnant women have been reported [18,19]. "
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    ABSTRACT: The Arias-Stella reaction is a hormone-related atypical endometrial change characterized by hypertrophy and vacuolization of glandular epithelial cells, associated with marked nuclear pleomorphism, enlargement, and hyperchromasia. When presenting in extra-uterine sites, the differentiation of Arias-Stella changes from other more ominous clear cell lesions may pose significant difficulties. We report a case of an endocervical clear cell lesion incidentally discovered during a prenatal visit of a young pregnant woman. Interpretation of the pathological findings was complicated by the small size and fragmentation of the specimen. Recognition of Arias-Stella reaction in extra-uterine sites, especially in young women, is critical to avoid misdiagnosis of this innocuous lesion as clear cell adenocarcinoma. Attention to cellular and nuclear detail, as well as careful consideration of the clinical scenario, is crucial for establishment of the correct diagnosis.
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