Extensive squamous metaplasia (morulosis) of the endometrium as a clinical and pathological problem: a case report and literature study

Abstract

The article presents a case of a 28-year-old woman with so-called morulosis – a form of squamous metaplasia of the endometrium, which may mimic malignancy. The term ‘morulosis’ indicates extensive squamous mulberry-like metaplasia, which in a large part or nearly entirely affects endometrium, whereas in turn, benign squamous metaplasia or single morules, refers to a limited, usually small regional pathology of endometrium. Because the endometrial glands and stroma gradually undergo the process of squamous metaplasia, in a scanty biopsy material the picture may lead to overdiagnosis. In the epithelioid regions small inactive glands with an immunofenotype different from the remaining endometrium might be observed. So far 21 cases have been reported in English literature. The patients (age 19–45) had presented with abnormal bleeding, infertility or after hormonal therapy. The mechanism of the extensive squamous metaplasia of endometrium is still not clear. The prevailing view holds that morulosis appears to be a result of hormonal imbalance. To shed light on possible pathogenic background of morulosis, we present a case of particularly severe extensive squamous metaplasia of the endometrium (morulosis).

摘要

本文描述了一例28岁女性“桑葚样化生”的病例。“桑葚样化生”是子宫内膜鳞状上皮化生的一种形式, 可能与恶性肿瘤相似。“桑葚样化生”一词是指影响大部分或者几乎整个子宫内膜的广泛性鳞状上皮桑葚样化生。良性鳞状上皮化生或者单个桑葚化生指局部的, 常常是小的区域性的子宫内膜病变。由于子宫内膜腺体和间质逐步发生鳞状化生, 在活检组织过少时, 镜下病理可能会出现过度诊断。在上皮样区域, 可能观察到与其余子宫内膜免疫表型不同的小的不活动的腺体。截止到目前, 英文文献已报道了21例。患者（19-45岁）伴随有异常出血、不孕, 或激素治疗后出现桑葚样化生。子宫内膜广泛性鳞状上皮化生的机制目前仍不清楚。普遍认为桑葚样化生是由激素失调引起的。为阐明桑葚样化生可能的病理机制, 我们报道了一例十分严重的子宫内膜广泛性鳞状上皮化生（桑葚样化生）。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Morulosis
• extensive squamous metaplasia
• infertility
• hypothyroidism
• endometrium

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by InterDokMed project no. POWR.03.02.00-00-I013/16 and Narodowe Centrum Badań i Rozwoju.