Abstract
Objective: We analyzed the histologic and immunohistochemical changes in the endometrial leukocytic subpopulations to determine which of them are characteristic of chronic endometritis. Results: Endometrial biopsies from 25 cases of chronic endometritis and 35 controls were studied. Characteristic morphologic findings included the presence of a plasma cell infiltrate, and a prominent, albeit non-specific, lymphocytic infiltrate in all patients with endometritis. A neutrophilic infiltrate was also noted in 90% of the patients. Other non-specific histologic findings included occasional prominent lymphoid aggregates, stromal edema, hemorrhage, and necrosis and cystic dilation of some glands in endometria of patients with chronic endometritis. Endometrial immune cells were investigated immunohistochemically using antibodies to CD3 (pan-T), CD20 (pan-B, L26), and Ham-56 (macrophage). In control patients, endometrial immune cells were predominantly composed of CD3 and Ham-56 positive cells. CD20 positive cells comprised <2% of immune cells in control patients [mean: <2 cells/high power field (HPF)]. Large numbers of CD20 and CD3 lymphocytes were seen in endometria of patients with chronic endometritis. A semiquantitative analysis showed that the numbers of CD20 and CD3 positive cells in patients with chronic endometritis were increased 50- and 3-fold, respectively, when compared to those of control patients (mean B cells: 49 vs. 2 cells/HPF; mean T cells: 149 vs. 45 cells/HPF). CD20 positive cells were predominantly seen in subepithelial and periglandular aggregates. CD3 positive cells had a predominant stromal distribution and an occasional intra- or subepithelial localization. There was no difference in the number and distribution of Ham-56 positive cells in patients with or without endometritis. Conclusions: These findings suggest that CD20 cells may have a significant role in the pathogenesis of chronic endometritis and that immunostaining for B and T lymphocytes could be used in confirming the diagnosis of endometritis or in diagnosing subclinical or progressing endometritis in which plasma cells could not be detected or are rarely identified.
Highlights
KEY WORDS chronic endometritis; B lymphocytes; T lymphocytes; macrophages; neutrophils ince first described by Hitschman and Adler, the presence of plasma cells in the endometrial stroma has been considered the hallmark for the histologic diagnosis of chronic endometritis. 1-1 characteristic nuclear and cytoplasmic features for plasma cells are well known, the search for them in endometrial stroma can be tedious in a large number of cases
Plasma cells could be found randomly distributed throughout the endometrial stroma, but were mostly seen close to the surface epithelium and in close proximity to endometrial glands and blood vessels
Lymphocytes were seen scattered throughout the endometrial stroma of all cases studied
Summary
Endometrial tissue from 60 patients treated at the University of Kansas Medical Center was used in this study. Twenty-five cases exhibited the characteristic histologic features of chronic endometritis, as described below. The mean age of these patients was 37.4 years (range 18-92 years). 4 African American, and 3 of other races. 92% of cases (23/25) presented with irregular vaginal bleeding. One of the remaining 2 patients presented for fertility workup and the other for pelvic pain. Their mean age was 40.4 years (range 20-81 years). Of these patients, 25 were white, 9 African American, and American Indian. Similar to the chronic endometritis group, the majority of the control group (71%, 25 cases)
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