|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 1 | Page : 89-91
Ichthyosis uteri: An incidental finding with review of literature
Shailja Puri Wahal, Kavita Mardi
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||15-Mar-2014|
Shailja Puri Wahal
Department of Pathology, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wahal SP, Mardi K. Ichthyosis uteri: An incidental finding with review of literature. Muller J Med Sci Res 2014;5:89-91
Ichthyosis uteri is an uncommon condition in which the entire surface of the endometrium is replaced by stratified squamous epithelium.  It is considered a benign lesion, but its association with malignancy has been reported in the literature. We report an incidental finding of squamous metaplasia of the endometrium in a uterus removed for prolapse.
A 48-year-old female P 5 + 0 presented with chief complaints of something coming out of the introitus for 1 year. On examination, there was a third degree descent. A hysterectomy with bilateral salpingo-oophorectomy was performed and sent for histopathological examination. Grossly, a hysterectomy specimen measuring 7.5 cm × 6 cm × 3 cm was received. Endometrium measured 1 mm and myometrium measured 2 cm. The cervical lips were everted, hypertrophied and keratinized. Bilateral tubes and ovaries were within normal limits. Microscopic examination of the endometrium showed the endometrial lining replaced by stratified squamous epithelium [Figure 1]. The sub-epithelial tissue showed atrophic endometrial glands and the normal endometrial stroma. The stratified squamous epithelial lining was benign and showed no features of dysplasia. The cervix was lined by keratinized hyperplastic stratified squamous epithelium with flattened rete ridges and chronic inflammatory cell infiltrate in the stroma. The Fallopian tube More Detailss and ovaries showed normal histology. A report of endometrium-ichthyosis uteri was signed out.
|Figure 1: Endometrium lined by stratified squamous epithelium, sub-epithelial tissue shows atrophic endometrial gland (H and E, ×40)|
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The term ichthyosis uteri was first coined by Zeller in 1885 to describe the extensive keratinization of the endometrium seen following intrauterine application of caustic substances, like hot formalin.  Similar changes have been seen in association with tuberculous endometritis, puerperal endometritis, endometrial polyps, hyperplasias and pyometra secondary to cervical stenosis or malignancies.  A commoner finding is the presence of non-keratinizing squamous cells occurring either diffusely (adenoacanthosis) or in the form of berry-like aggregates (morules).  Most are seen in premenopausal women, in those receiving exogenous hormones, or in association with polycystic ovarian disease.  This change is distinguished from well-differentiated endometrial adenocarcinoma with squamous metaplasia (adenoacanthoma) because of the benign appearance of the glandular elements.  Ichthyosis uteri associated with dysplasia, in situ carcinoma and frank squamous cell carcinoma has been reported by Murheka et al.  in 2008, Bagga et al.  in 2008 and Takeuchi et al.  in 2012. Heckeroth and Ziegler  in their study have reported development of invasive cell carcinoma at the base of ichthyosis uteri. The carcinoma developed from discrete squamous metaplasia of the endometrial body in the presence of slight endometritis over a period of 3 years. In a population based study from Norway, the prevalence of primary squamous cell carcinoma is 0.1%.  To be accepted as a primary carcinoma of the endometrium, the tumor must satisfy the criteria established by Fluhmann and modified by Kay:  there must be no coexisting endometrial adenocarcinoma; there must be no connection between endometrial tumor and squamous epithelium of cervix; there must be no primary squamous carcinoma of the cervix; and if cervix shows an in situ carcinoma, there must be no connection between this and independent endometrial neoplasm.
The etiology of endometrial keratinization is not well understood. Chronic trauma, repair, irritation, inflammation, foreign material and estrogenic effects have all been implicated. No such predisposing factors could be found in our case. If widespread squamous epithelium covering the entire endometrial surface is detected in the curettage or biopsy an advanced examination should be done because of the possibility of the underlying malignancy association.
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