Morphological changes in hysterectomies after endometrial ablation

Abstract

Electrosurgical ablation of the endometrium is a therapeutic choice for those patients having abnormal uterine bleeding. When ablation is followed by a hysterectomy, tissue damage due to thermal effect can be seen. From a total of 350 women with endometrial ablation, 12 required subsequent hysterectomy. The histological features found in these specimens are described and related to the elapsed time between the two surgical procedures. The mean elapsed time between ablation and hysterectomy was 19 +/- 17.3 months. Scarring with formation of additional endometrial cavities was seen in five cases, and endocervical stenosis in two cases. In seven patients, endometrial regrowth was seen at hysterectomy. Necrosis, granulomatous and foreign-body giant cell reaction, eosinophilic infiltrate and pigment-containing macrophages in the myometrium were seen in the long-term post-ablation hysterectomies. Necrosis was seen in short period post-ablation hysterectomies. Six of the seven patients with endometrial regeneration had adenomyosis in the hysterectomy specimen. Endometrial ablation induces thermal effects in the endometrium and granulomatous reaction with foreign-body giant cell reaction, fibrosis and deposition of pigment within macrophages in the myometrium. Adenomyosis is a possible explanation for endometrial regeneration in cases of ablation failure.

Cytomorphology and Histomorphology After Thermal Endometrial Ablation

“…12,13 The effect of thermal ablation of the endometrium is described in previous articles on the histology of the acute and chronic phases. 9,10,14 The features in those studies were coagulation necrosis in the acute phase, ranging from 0 to 2 weeks after ablation, followed by a chronic reparative phase and endometrial regeneration. In the present study, we analyzed the cytolomorphologic changes immediately after thermal ablation and correlated them with histology.…”

“…8 The few reports on the morphology of the endometrium following thermal balloon ablation therapy analyzed histologic sections. 9,10 However, in the literature reviewed there are no reports on the cytomorphologic features of the endometrium following thermal balloon ablation.…”

Sonographic Findings in Postmenopausal Women With a Prior Endometrial Ablation: Interpretation and Management of Women With Endometrial Thickening and Bleeding

“…Specifically, endometrial thickening was defined as the sonographic detection of an endometrial thickness .5 mm [9]. The endometrium was measured at its thickest point, between both endometriummyometrium interfaces, from anterior to posterior in the sagittal plane of the uterus [10,11].…”

Management of Heavy Menstrual Bleeding: Is Hysterectomy the Radical Mastectomy of Gynecology?

“…148 Adenomyosis has been associated with an increased risk of REA failure 150 and has been found frequently in hysterectomy specimens. 151 It is less clear that adenomyosis affects the same outcomes in women undergoing endometrial resection or vaporization. However, there is some evidence that with increasing depth of resection and ablation, the failure rate with REA drops, (from 22% to 5%) including that for women with adenomyosis.…”