engleski

Endometrial changes assessed by transvaginal sonography – replay.

Odgovor na repliku (Goldstein S) Prof. Goldstein primarily addresses the problem of the thick endometrium scanned by transvaginal sonography versus a patohistological appearance of atrophy. Although we did not supply the scattergram all the measurements appear to be distributed inside the box and whiskers' plots. It is true that only one measurement showed 14 mm of endometrial thickness scanned by transvaginal sonography that was after D&C recognised as “ atrophy." As the histological appearance and thickness of the endometrium depend on hormonal status, if an irregular proliferation or a glandular cystic hyperplasia (simplex hyperplasia) precedes the decrease in the level of oestrogen, an entity called “ cystic atrophy” results.1 The appearance of an atrophic endometrium is different in hysterectomy and biopsy specimens. In hysterectomy specimens, under low magnification, the cystically dilated glands may be confused with simple hyperplasia.2 This implies that a cystically atrophic endometrium can be as thick as a hyperplastic one. In specimens provided by aspiration or D&C, atrophic endometrium is typically scant, consisting of a small amount of mucoid material with a few fragments and strips of glands. The intact glands are not usually found and stroma is frequently absent.2, 3 Our specimens were bioptical, so that the pathologist could not be more precise in deciding among “ endometrial atrophy” or “ cystic endometrial atrophy." We also want to stress the statement concerning the atrophic endometrium being one cell layer thick is not correct. Only the epithelium lining of the atrophic glands is one cell layer thick, lacking mitotic activity, indicating therefore that no proliferation takes place. The thickness of the endometrium, that can be readily distinguished into the basal and functional layers before the menopause, declines after the physiological cessation of ovarian function. However, the endometrium is never one cell layer thick. That would mean that no glandular lamina are seen and the stroma has disappeared completely. It is true, though, that towards the end of the reproductive life, the endometrium is no longer differentiated into functional and basal layers.4 Saline infusion sonohysterography would be sufficient to clear the problem of an endometrial polyp in discussible situations. Our cohort showed “ only 16.5% of patients with postmenopausal bleeding with endometrial thickness measurements Ł 5 mm.” According to the other authors it is significantly less. As there are no data from the “ eastern” milieu we can only compare our results with Central-European and Anglo-Saxon papers. Maybe the answer is in the demographic and ethnical difference. It is obvious also that we should expect more precise results by an extension of the group. Of course the endometrium is a three dimensional structure, but the fact is that if we apply the transvaginal sonography as a conventional method, without using a colour doppler or 3D technique, our measurements are reduced to the current state of art. Sincerely yours, Ivan Fistonic, MD REFERENCES: 1. Dallenbach-Hellweg G, Poulsen H: Atlas of endometrial histopathology. Berlin, Springer Verlag, 1996, p. 38. 2. Mazur MT, Kurman RJ: Diagnosis of endometrial biopsies and curretings: A practical approach. New York, Springer Verlag, 1994. 3. Kurman RJ, Mazur MT: Benign diseases of the endometrium. In Kurman RJ, ed: Blaustein˘s Pathology of the Female Genital Tract. 4th ed. New York-Berlin, Springer Verlag, 1994, p. 383. 4. More JAR: The normal human endometrium. In Fox H, ed: Haines & Taylor Obstetrical and Gynaecological Pathology. Vol. 1. 4th ed. New York-Edinburgh, Churchill Livingstone, 1995, p. 365-382.

Endometrium; Cancer; Ultrasound

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