Endometrium : Secretory phase
Glands : They are enlarged and dilated, with convolutions and are lined by columnar epithelium. The lining epithelium contains glycogen rich subnuclear vacuoles in the early secretary phase. The vacuoles will be supranuclear in midsecretary phase. In the late secretary phase, the glands are saw toothed and serrated with luminal secretions
Stroma: the stromal cells which were spindle shaped in proliferative cells, are now enlarged. they are round to polygonal with vesicular nuclei and abundant eosinophilic cytoplasm. This is called predecidual change as these are the precursors of decidual cells in pregnancy.
The endometrium is obtained for evaluation by a process called dilatation and curettage or by endometrial biopsy. This is done to evaluate infertility or dysmenorrhea.
Dating of endometrium:
|
Proliferative phase |
||
| Glands | stroma | |
| Early proliferative (day 4-7 ) | Straight short glands, thin epithelium | Compact. Few mitosis |
| Mid proliferative ( day 8-10) | Columnar epithelium, curved glands | Dense stroma, many mitosis |
| Late proliferative ( day 11-14) | pseudostratification , crowded glands
|
Moderately dense stroma, mitotically active |
| Ovulation | Presence of subnuclear vacuolations in at least 50 % of the glands | Same as above |
|
Secretary phase Days 16-20: early secretory phase (glandular changes predominate) |
||
| Day 15 (interval phase) | Not much change | |
| Days 16, 17 | Subnuclear vacuolations ( PIANO KEY Appeareance) | |
| Day 18 | Vacuoles become small, nuclei reaches base of the cell. | |
| Day 19 | Few vacuoles, intraluminal secretions begin, no pseudostratification | |
| Day 20,21 | Maximal secretion | Stromal edema appears |
| Day 22 | Secretion still active , but subsiding | Maximum stromal edema |
| Day 23 | Glands begins to show regressive changes | Spiral arterioles become prominent |
| Day 24 | Regressive changes in the glands | Predecidual cells begins to appear around the spiral arterioles |
| Day 25 | Marked regression | Predecidual cells begins to appear beneath the surface epithelium |
| Day 26 | Marked regression | Sheets of predecidual cells, few granular lymphocytes begin to appear |
| Day 27 | Marked regression | More granular lymphocytes, focal necrosis |
| DAY 28 | Glands starts shedding, exhausted glands | Necrosis and hemorrhage prominent. |
