Small biopsy pathology of mass lesions of the endometrial cavity: differential diagnostic considerations

Abstract Sampling for histological examination is usually part of the work-up for further planning with regard to the management of patients presenting with uterine bleeding. This review, utilising the classification of the World Health Organization, aims to discuss some commonly recurring differential diagnostic problems on small biopsy specimens. Diagnostic difficulties generally relate to representativeness of the sample, determining the site of the lesion, and fragmentation and trauma artefact. Reference is made to clinical relevance, and attention drawn to some lesser known diagnostic entities. Morphological features and immunohistochemical markers that are useful in certain differential diagnostic scenarios are highlighted. The level of diagnostic certainty should be indicated in the report, and when the limitations do not permit a definite diagnosis in a small sample, the pathologist should provide the clinician with a differential diagnosis on which further management decisions can be based.