Clinicopathologic Analysis of Patients With Adipose Tissue on Endometrial Biopsies

The identification of adipose tissue in endometrial biopsy or curettage specimens is an important yet rare histologic finding that may suggest uterine perforation, warranting careful pathologic evaluation to distinguish it from histologic mimickers.

To assess the presence of adipose tissue in endometrial samples and evaluate its diagnostic challenges and clinical implications.

A retrospective cohort study was performed on cases from an 8-year period in which adipose tissue was identified in endometrial biopsy or curettage specimens. Hematoxylin-eosin-stained sections were reviewed, and relevant clinical data, including postoperative outcomes, were analyzed.

Twenty-three patients were included (mean age ± standard deviation, 60.6 ± 13.3 years); 18 of 23 patients (78.3%) underwent curettage. Endometrial polyp was the most common concurrent diagnosis (8 of 23; 34.8%). Uterine perforation was clinically identified intraoperatively in 6 cases (6 of 23; 26.1%), all managed without complications. Most samples (16 of 23; 69.6%) contained a small amount of adipose tissue (1%-25%). Common risk factors included fibroids (5 of 23; 21.74%); cervical stenosis, polyps, intrauterine synechiae (4 of 23; 17.39% each); and history of prior cesarean delivery (10 of 23; 43.48%). The mean interval to notify clinicians of the adipose finding was 2.79 ± 1.65 days. One patient developed a postoperative abscess, successfully treated with antibiotics. No significant associations were found between risk factors or adipose proportion and intraoperative detection or postoperative complications (all P ≥ .05).

While adipose tissue in endometrial specimens may indicate uterine perforation, it was not associated with significant adverse outcomes in this cohort. Pathologists must remain vigilant, as benign mimics such as pseudolipomatosis or lipomatous tumors should be excluded during evaluation.