PAPILLARY PROLIFERATION

• Lehman and Hart have describe localized papillary endometrial proliferations that could lead to a misdiagnosis of a villoglandular endometrioid adenocarcinoma,especially in a fragmented biopsy or curettage specimen.
• The lesions typically occur in postmenopausal women who present with bleeding. Two-thirds of the lesions involved polyps, but in some cases the lesion occured in the absence of, or at a distance from, a polyp.
• The proliferations are characterized by papillae with fibrovascular cores and variable degrees of branching. The papillae are covered by epithelial cells with bland to mildly atypical nuclei, with occasional mitotic figures in some cases.
• One or more metaplastic epithelial changes are often present, including (in descending order of frequency in the cited study) mucinous, eosinophilic cell, ciliated cell, squamous, and hobnail cell metaplasia.
• The patients had uneventful outcomes, but only three who were not treated by hysterectomy had appreciable follow-up.
• Awareness that the lesion tend to occur in polyps, the typically bland cytologic features, and the usual presence of metaplastic epithelia facilitate the diagnosis.