The spectrum of endometrial pathology induced by progesterone receptor modulators
Progesterone receptor modulators (PRM) are hormonally active drugs effective in the management of endometriosis and uterine leiomyomata. The endometrial effects of progestin blockade by PRMs in premenopausal women are currently being evaluated in several clinical trials, but few pathologists have ha...
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Published in | Modern pathology Vol. 21; no. 5; pp. 591 - 598 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Elsevier Inc
01.05.2008
Nature Publishing Group US Elsevier Limited |
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Abstract | Progesterone receptor modulators (PRM) are hormonally active drugs effective in the management of endometriosis and uterine leiomyomata. The endometrial effects of progestin blockade by PRMs in premenopausal women are currently being evaluated in several clinical trials, but few pathologists have had access to these materials and published information of the histological changes is scanty. Eighty-four endometrial specimens from women receiving one of four different PRMs were reviewed by a panel of seven experienced gynecologic pathologists to develop consensus observations and interpretive recommendations as part of an NIH-sponsored workshop. Although the pathologists were blinded to agent, dose, and exposure interval, the review was intended to provide an overview of the breadth of possible findings, and a venue to describe unique features. Endometrial histology included inactive and normal-appearing cycling endometrium. Overtly premalignant lesions (atypical hyperplasia or EIN) were not seen. In a subset of cases, asymmetry of stromal and epithelial growth resulted in prominent cystically dilated glands with admixed estrogen (mitotic) and progestin (secretory) epithelial effects of a type not encountered in contemporary clinical practice. The variety of endometrial appearances suggested that findings might differ by agent and dose over time according to relationships that must be specified for each agent. The constellation of changes seen in those endometria with cystically dilated glands is so novel that new terminology and diagnostic criteria are required for pathologists to recognize them. The panel has designated these changes as PRM-associated endometrial changes (PAEC). Additional follow-up studies will be needed to fully define their natural history and relationship to specific agents and administration regimens. |
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AbstractList | Progesterone receptor modulators (PRM) are hormonally active drugs effective in the management of endometriosis and uterine leiomyomata. The endometrial effects of progestin blockade by PRMs in premenopausal women are currently being evaluated in several clinical trials, but few pathologists have had access to these materials and published information of the histological changes is scanty. Eighty-four endometrial specimens from women receiving one of four different PRMs were reviewed by a panel of seven experienced gynecologic pathologists to develop consensus observations and interpretive recommendations as part of an NIH-sponsored workshop. Although the pathologists were blinded to agent, dose, and exposure interval, the review was intended to provide an overview of the breadth of possible findings, and a venue to describe unique features. Endometrial histology included inactive and normal-appearing cycling endometrium. Overtly premalignant lesions (atypical hyperplasia or EIN) were not seen. In a subset of cases, asymmetry of stromal and epithelial growth resulted in prominent cystically dilated glands with admixed estrogen (mitotic) and progestin (secretory) epithelial effects of a type not encountered in contemporary clinical practice. The variety of endometrial appearances suggested that findings might differ by agent and dose over time according to relationships that must be specified for each agent. The constellation of changes seen in those endometria with cystically dilated glands is so novel that new terminology and diagnostic criteria are required for pathologists to recognize them. The panel has designated these changes as PRM-associated endometrial changes (PAEC). Additional follow-up studies will be needed to fully define their natural history and relationship to specific agents and administration regimens. |
Author | Glant, Mick Bergeron, Christine Ferenczy, Alex Deligdisch, Liane Williams, Alistair R W Merino, Maria Blithe, Diana L Mutter, George L |
Author_xml | – sequence: 1 givenname: George L surname: Mutter fullname: Mutter, George L email: gmutter@rics.bwh.harvard.edu organization: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA – sequence: 2 givenname: Christine surname: Bergeron fullname: Bergeron, Christine organization: Department of Pathology, Laboratoire Pasteur-Cerba, Cergy Pontoise, France – sequence: 3 givenname: Liane surname: Deligdisch fullname: Deligdisch, Liane organization: Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA – sequence: 4 givenname: Alex surname: Ferenczy fullname: Ferenczy, Alex organization: Department of Pathology, Jewish General Hospital, Montreal, QC, Canada – sequence: 5 givenname: Mick surname: Glant fullname: Glant, Mick organization: Department of Pathology, DCL Medical Laboratories Inc., Indianapolis, IN, USA – sequence: 6 givenname: Maria surname: Merino fullname: Merino, Maria organization: Department of Pathology, National Institutes of Health, Bethesda, MD, USA – sequence: 7 givenname: Alistair R W surname: Williams fullname: Williams, Alistair R W organization: Department of Pathology, University of Edinburgh, Edinburgh, UK – sequence: 8 givenname: Diana L surname: Blithe fullname: Blithe, Diana L organization: The Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, Bethesda, MD, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18246050$$D View this record in MEDLINE/PubMed |
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Copyright | 2008 United States & Canadian Academy of Pathology United States and Canadian Academy of Pathology, Inc. 2008 Copyright Nature Publishing Group May 2008 |
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Keywords | endometrium pathology histology progesterone receptor modulators |
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publication-title: Int J Gynecol Pathol doi: 10.1097/PGP.0b013e31802e4696 contributor: fullname: Mutter – volume: 18 start-page: 61 year: 2003 ident: 10.1038/modpathol.2008.19_bib13 article-title: Effect of long-term treatment with low-dose mifepristone on the endometrium publication-title: Hum Reprod doi: 10.1093/humrep/deg022 contributor: fullname: Baird |
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SubjectTerms | Birth control Childrens health Clinical trials Clinical Trials as Topic Endometriosis Endometriosis - drug therapy Endometrium Endometrium - drug effects Endometrium - pathology Estrogens Female Histology Hormone Antagonists - adverse effects Hospitals Humans Hyperplasia Laboratory Medicine Leiomyoma - drug therapy Medical laboratories Medicine Medicine & Public Health original-article Pathology Pharmaceutical industry progesterone receptor modulators Receptors, Progesterone - drug effects Uterine Neoplasms - drug therapy Womens health |
Title | The spectrum of endometrial pathology induced by progesterone receptor modulators |
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