The pap test can be difficult to analyse during pregnancy because of large ectropion, frequent inflammation, presence of confusing decidual cells that can be mistaken for atypia, also called an arias stella reaction, but has the same accuracy as in nonpregnant women. I found a modified ariasstella reaction in paratubal epithelial cells. Glypican3 expression in clear cell adenocarcinoma of the. The characteristic histologic features of the ariasstella reaction include large cells with abundant eosinophilic or vacuolated cytoplasm, nuclear enlargement, and hyperchromasia. Ectopic pregnancy human chorionic gonadotropin uterus. Distinctive changes are also observed during times of physiologic hormonal changes, such as in pregnancy, or in pathologic and iatrogenic hormonal imbalances, as in certain functioning. Arias stella reaction up to 10% of gravid hysterectomy specimens. Gpc3 expression was observed almost exclusively in endometrium in the gestational state, which showed arias stella reaction. Typically found in the endometrium focal or in a substantial portion of the endometrium. Most pathologists are familiar with the ariasstella reaction in the endometrium, because it is seen in approximately 25% of curettage specimens duri. The arias stella phenomenon was first described by javier arias stella in 1954 as atypical endometrial changes associated with the presence of chorionic tissue. Both had a history of passing tissue and were diagnosed clinically with incomplete miscarriage.
Unlimited viewing of the articlechapter pdf and any associated supplements. Arias stella endometrial reaction is suggestive but not diagnostic of ectopic pregnancy. Keywords ariasstella, signet ringlike, endometrium, benign. Original article histopathological study of villous. Atypical nuclei are often pleomorphic nuclear atypia can be seen in reactive changes, preneoplastic changes and malignancy. The ariasstella reaction in early normal pregnancyan involutional. Synthetic progestogenoestrogen therapy and uterine. Ariasstella reaction, also arias stella phenomenon, is a benign change in the endometrium associated with the presence of chorionic tissue ariasstella reaction is due to progesterone primarily. The abdominal ectopic pregnancy is very rare and accounts for less than 1% of all ectopic gestations. View the article pdf and any associated supplements and figures for a period of 48 hours. The endometrium is typically biopsied because of abnormal bleeding. Benign mimics of em hyperplasia artefacts endometritis endometrial polyp arias stella reaction disordered proliferative endometrium benign papillary proliferations lower uterine segment endometrium 53.
Get your full text copy in pdf american journal of case. Polypoid endometriosis of the uterine cervix with arias stella reaction in a patient taking phytoestrogens. The ariasstella reaction asr is a common and universally recognized feature of gestati. Download as ppt, pdf, txt or read online from scribd. However, the arias stella reaction is exceedingly rare in the fallopian tube, and may be confused with herpetic infection or malignancy. The ariasstella phenomenon was first described by javier ariasstella in 1954 as atypical endometrial changes associated with the presence of. The glands also show marked cytoplasmic vacuolization. The endometrial glands are lined by cells with abundant clear cytoplasm. Ariasstella reaction of uterine cervix is a benign tumorlike condition caused due to a change in the cervix. Identical changes can be seen in an ectopic pregnancy.
Departments of gynaecology and pathology, university of glasgow. Ariasstella reaction atypical endometriumendometrial change. Stella reaction as an indication of pregnancy is examined, with special reference to the diagnosis of ectopic pregnancy. The specimens selected for evaluation were all positive for the reaction on pathology studies. The arias stella reaction is a hormonerelated atypical endometrial change characterized by hypertrophy and vacuolization of glandular epithelial cells, associated with marked nuclear pleomorphism, enlargement, and hyperchromasia. Modified ariasstella reaction in paratubal epithelium springerlink. If the ectopic pregnancy miscarries, the uterine decidua may slough off as a cast, but more commonly as fragments mixed with small blood clots.
Arias stella reaction like changes in endocervical glandular epithelium in cervical smears during pregnancy and postpartum statesa potential diagnostic pitfall. Vida culic, bernarda lozic, ivana kuzmicprusac, goran mijaljica, jasminka pavelic. Scattered nuclei with a smudgy, degenerated appearance are present. Research article value of histopathologic examination of. Facts and fancies four decades after since its first description more than four decades ago, the. Since its first description more than four decades ago, the atypical endometrial change associated with chorionic tissue effect has been widely confirmed in the literature. The authors present a case of arias stella reaction in the fallopian tube and discuss the. The glandular cells showed signs of macronucleosis and little proliferative activity measured by ki67. Due to the lack of clinical suspicion, many obstetricians confuse it with other diseases and manage it inappropriately. The two patients whose examination exhibited an arias stella reaction were determined to have missed miscarriage, as both had previous ultrasounds that confirmed intrauterine pregnancies. A cytological evaluation of the ariasstella reaction. Napsin a is a specific marker for ovarian clear cell.
Especially the arias stella reaction, we obtained endometrial specimens by either aspiration cytology, or curettage. It is identical in appearance to the arias stella reaction within the gravid endometrium. Ariasstella reaction, also ariasstella phenomenon, is a benign change in the endometrium. Arias stella reaction is a hormoneinduced atypical. An overview of gynecologic pathology is in the gynecologic pathology article. Research article value of histopathologic examination of uterine products after firsttrimester miscarriage sharifaalialsibiani department of obstetrics and gynaecology, faculty of medicine, king abdulaziz university, p. The ariasstella reaction hyperplastic changes of the endometrial epithelium associated with cellular atypia may be seen in uterine or extrauterine pregnancies. The ariasstella reaction in early normal pregnancyan involutional phenomenon. Pdf polypoid endometriosis of the uterine cervix with. Ariasstella reaction with signet ringlike cell histomorphology.
In this study, classic cc immunohistochemical markers napsin a, hnf1. Infiltration with glycogen as the cause of the clear appearance of epithelial cells is suggested. Value of histopathologic examination of uterine products. Immunohistochemical staining for ki67 and p53 helps. Identification of decidua without chorionic villi is suggestive of extra uterine pregnancy. It is a term used in cytopathology and histopathology. Ariasstella reaction in fallopian tube epithelium a light. Severe nuclear atypia is, in most cases, considered an indicator of malignancy see also. Ariasstella reaction of uterine corpus is a benign tumorlike condition caused due to a change in the endometrium of the uterus.
Ariasstella reaction in fallopian tube epithelium a light and. This site was designed with the wix website builder. The endometrium exhibits a unique physiology in its ability to cyclically respond to steroid hormones, resulting in morphologic changes that allow the pathologists interpretation of proper endometrial function. Endometrial hyperplasia and endometrial carcinoma are dealt with in separate articles. Cytologically, it looks like a malignancy and, historically, it was diagnosed as endometrial cancer.
Histopathological changes of decidua and decidualvessels. Arias stella reaction with a hypersecretorypattern shows strati. Continuous therapy with synthetic progestogenoestrogen produces marked atrophy of endometrial glands and massive pseudodecidual stromal transformation. Cambridge core history of medicine eponyms and names in obstetrics and gynaecology by thomas f. Division of womens and perinatal pathology department of pathology brigham and womens hospital boston.
The endometrium is an ideal tissue for study of the interrelated effects of ovarian hormones, enzymes, and prostaglandins. Benign lesions of the cervix the belgian society of. The distinction of the arias stella reaction from clear cell carcinoma of the endometrium is usually straightforward. Reduced vessels per villi and hydropic change were significantly associated with abortions happening at 8 10 weeks, while reduced patency of vessels, abnormal villous contour, ghost villi and trophoblastic proliferation were more associated. Pdf on mar 10, 2017, laura ardighieri and others published arias stella reaction find, read and cite all the research you need on researchgate. The purpose of this study is to describe the morphologic features observed in the decidual blood vessels of early pregnancy loss cases prior to 20 weeks gestation, and to compare these findings with arias stella reaction and with changes found in endometrial biopsies of. The glands, which may be only partially affected, are lined by pseudostratified glandular. When presenting in extrauterine sites, the differentiation of arias stella changes from other more ominous clear cell lesions may pose. Clear cell adenocarcinoma of the uterine cervix in a 24yearold woman. In endocervical polyp histologic features similar as in the endometrium. Immuno stains might help, in arias stella reaction er and pr are positive, and ki67 is. Modified ariasstella reaction in paratubal epithelium. The ariasstella reaction hyperplastic changes of the endometrial epithelium associated with cellular.
The ariasstella phenomenon in the diagnosis of ectopic pregnancy. Arias stella reaction, atypical endometrium, endometrial change. Pdf on mar 10, 2017, laura ardighieri and others published ariasstella reaction find, read and cite all the research you need on researchgate. Full trisomy 5 in a sample of spontaneous abortion and arias stella reaction.
An understanding of the mechanism of enlargement of the nucleus and the unique. In the cervix arias stella reaction might involve isolated glands and frequently the cells in arias stella reaction are more atypical than the cells in clear cell carcinoma. Advances in the biochemistry and physiology of the uterus have stimulated reinterpretation of the cyclic morphological changes in the endometrium. The arias stella reaction may involve endocervical glands of pregnant women. Use of oral contraceptives usually focal, superficial glands. Here, we are reporting the case of a 41yearold woman that was referred to our hospital because of severe vaginal bleeding caused by multiple uterine perforations during the. New york 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. Clear cell adenocarcinoma of the uterine cervix in a 24. Nuclear atypia refers to abnormal appearance of cell nuclei. A case report, diagnostic cytopathology, 2005, 32, 2, 94wiley online library. Eponyms and names in obstetrics and gynaecology by thomas. Article information, pdf download for ariasstella reaction with signet. The condition is a normal physiological process of the body, caused due to hormonal response. In order to evaluate pregnancy specific endometrial changes cytomorphologically.
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