Reprinted, with additions, from the A. M. A. Archives of Pathology August 1954, Vol. 58, pp. 112-128 Copyright, 1954, by American Medical Association ATYPICAL ENDOMETRIAL CHANGES ASSOCIATED WITH THE PRESENCE OF CHORIONIC TISSUE

THE PURPOSE of this paper is to describe certain endometrial changes which occur in the presence of chorionic tissue and which, it is thought, result from the hormonal activity of this tissue. Although these alterations are not infrequent, we have been unable to find any study of their characteristics or any mention of them in a survey of current textbooks of pathology (References 1 through 5). Only a few references have been found that we think deal in part with the problem to be discussed. Deelman (6), in his "Die Histopathologie der Uterusmucosa", called attention to some endometrial patterns which occur in cases of uterine abortion and which can be confused with neoplastic growths. Deelman explained these atypical endometrial patterns on the basis of inflammatory-degenerative effects, a point of view that observations reported here do not support. Ferguson (7) called attention to a possible source of error in the cytological diagnosis of vaginal smears in cases of abortion or syncytial hyperplasias of endometrium. In these conditions, he states, glands with marked variations in cellular size and staining quality are frequently found. No details of the histological features of these cases or interpretation of the lesions is given. Aguero (8), in an extensive study on the histology of endometrial abortion, comments that in some cases the endometrial mucosa shows alterations characterized by "enlargement of the glandular cells with, perhaps, associated proliferative phenomena". He believes that pregnancy and inflammation may have played a role in the pathogenesis of this atypical change. Aguero refers to a case of chorio-epithelioma in which "the cells of the endometrial glands showed a monstrous size and aspect" in a degree "not found in any description". He seems to think that "abnormal and exaggerated endocrine influences" could be implicated in the pathogenesis of these lesions.