ENDOMETRIAL CYTOLOGY IN POSTMENOPAUSAL HORMONE REPLACEMENT THERAPY

Endometrial changes in postmenopausal hormone replacement therapy (HRT ) were studied by comparing cytological and histological findings. Cyt ological and histological examinations were conducted on 138 benign ca ses and 26 abnormal cases, including 24 cases with disordered prolifer ative phase (DOP) and 2 cases with simple endometrial hyperplasia (SEH ), for a total of 164 cases. Hormones were administered as follows: 1) single cyclic administration of estrogen only (Single-HRT) for 31 cas es, 2) cyclic administration of estrogen and progestin (Cyclic-HRT) fo r 105 cases, and 3) continuous administration of estrogen and progesti n (Continuous-HRT) for 28 cases. All of the 164 cases were studied cyt ologically as to shape, appearance, nuclear number on maximum diameter and so on. The benign cases in each mode of administration as describ ed above revealed the following: 1) Single-HRT, atrophy or the prolife rative phase was noted histologically, and the copresence of the endom etrial epithelium and the ciliated cell metaplasia was observed cytolo gically; 2) Cyclic-HRT; the first half of the administration term was of the proliferative phase histologically, and the linear and long gla nds were seen cytologically. In the latter half of the administration term the secretory phase was noted histologically and the curved/linea r glands with subnuclear vacuolization were observed cytologically; an d 3) Continuous-HRT atrophy was noted histologically and fewer glands and atrophic cells on the endometrial epithelium with wrinkles mixed t herein were seen cytologically. On the other hand cytological examinat ions of the abnormal cases revealed a mean average of 35 nuclei on the maximum diameter of the gland protrusion and/or ramification of the g lands, densely clustered glands, and back-to-back glands without fusio n, as well as irregularly dilated tortuous glands in SEH. These abnorm al findings were considered useful for early detection of endometrial disorders in the hormone replacement therapy by cytodiagnosis. Diagn. Cytopathol. 1998;19:161-167, (C) 1998 Wiley-Liss, Inc.