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