Navigating through perplex morphologic changes after exogenous hormone usage

Area of Science:

• Gynecologic Pathology
• Hormone Therapy Effects
• Surgical Pathology

Background:

• Exogenous hormone use for contraception and gynecologic disorders is common.
• Hormonal therapies induce significant morphologic changes in female reproductive tract tissues.
• Accurate interpretation of these changes is vital for correct diagnosis and clinical decision-making.

Purpose of the Study:

• To review morphologic changes in endometrial, cervical, and myometrial specimens due to hormonal therapies.
• To focus on changes induced by progestin treatment.
• To provide guidance for assessing challenging cases, particularly in endometrial biopsies.

Main Methods:

• Review of current literature on hormone-induced morphologic alterations.
• Summarization of changes in neoplastic and non-neoplastic tissues.
• Proposal of an approach for challenging endometrial biopsies, including diagnostic algorithms and immunohistochemistry.

Main Results:

• Progestin therapy can obscure high-grade cervical dysplasia and alter endometrial hyperplasia assessment.
• Endometrial biopsies from progestin-treated patients show challenging features with poor interobserver agreement.
• Myometrial lesions like adenomyosis and smooth muscle neoplasms exhibit hormone-related changes, such as decidualization and apoplectic changes.

Conclusions:

• Understanding hormone-induced changes is essential for pathologists to accurately diagnose gynecologic specimens.
• Specific diagnostic strategies, including immunohistochemistry (PAX-2, PTEN, beta-catenin), aid in evaluating progestin-affected endometrial lesions.
• Recognizing these hormone-related scenarios improves diagnostic accuracy and clinical management.