Severe Eosinophilic Endometritis appears after injury from a preoperative diagnostic procedure. It is an unusual and distinctive inflammatory uterine disease process, in response to eosinophil chemotactic substances. We report this case of a 55-year-old lady who developed severe eosinophilic endometritis following a diagnostic curettage

Desai, SR

Shinagare, SA

English

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Severe Eosinophilic Endometritis Following Diagnostic Curettage

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Case Report:
Severe Eosinophilic Endometritis Following Diagnostic Curettage
Desai SR, Professor & Head,
Shweta A. Shinagare,
Krishna Institute of Medical Sciences, Karad, Maharashtra, India
Address For Correspondence:
Dr. S. R. Desai,
Professor & Head, Department of Pathology,
Krishna Institute of Medical Sciences,
Karad, Maharashtra - 415110, India.
E-mail: dr.shwetas@gmail.com
Citation:  Desai SR, Shinagare SA.  Severe Eosinophilic Endometritis Following Diagnostic Curettage.  Online J Health Allied Scs.  
2010;9(1):12
URL: http://www.ojhas.org/issue33/2010-1-12.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Nov 20, 2009; Suggested revision: Apr 1, 2010; Resubmitted: Apr 7, 2010; Accepted: Jun 11, 2010; Published: Jul 30, 2010
Abstract:
Severe Eosinophilic Endometritis appears after injury from a 
preoperative  diagnostic  procedure. It  is  an unusual  and dis-
tinctive inflammatory uterine disease process, in response to 
eosinophil  chemotactic  substances.  We report  this  case of  a 
55-year-old lady who developed severe eosinophilic endomet-
ritis following a diagnostic curettage.
Key Words: Eosinophilic endometritis, curettage
Introduction:
Eosinophilic  endometritis  is  a  condition  in  which  there  is 
abundant  eosinophilic  infiltration  of  the  endometrium.  The 
probable causative agents are the eosinophil chemotactic sub-
stances liberated from the myometrial mast cells and from the 
degrading blood clot filling the uterine cavity.
We present this case in view of its rarity, as the search across 
medline revealed only a single article by Miko TL, et al.[1]
Case Report:
A 55-year-old post-menopausal female came with complaints 
of bleeding per vaginum & pain in abdomen of two months 
duration. She had three children and her obstetric history was 
unremarkable.  She reached her menopause  at the age of  46 
years.  The  differential  leukocyte  count  in  peripheral  blood 
showed presence of 70% polymorphs, 26% lymphocytes and 
4% eosinophils. No abnormality was detected on the routine 
urine examination. Her hematological profile and biochemical 
profile including blood sugar level, blood urea and serum cre-
atinine were within normal range. Ultrasound examination of 
pelvis revealed a bulky uterus, showing mildly thickened en-
dometrial layer (measuring 7mm in thickness).  A diagnostic 
curettage was performed but no opinion was possible due to 
inadequacy of the sample. Therefore, another diagnostic cur-
ettage was performed after eight days. 
The sections  from the specimen revealed endometrial  tissue 
with tiny tubular glands lined by columnar epithelium along 
with stromal bits infiltrated by eosinophils,  plasma cells and 
polymorphs  (Figure  1).  More  than  40  eosinophils  per  high 
power field were noted in all the fields, in all the slides. A sep-
arate bit showed only inflammatory cell exudate rich in eos-
inophils, plasma cells, polymorphs and few lymphocytes (Fig-
ure 2). No other cause of tissue eosinophilia, such as allergic, 
infective or any other etiology could be found. Plasma cells 
are not  present in normal menstrual endometrium.[2] There-
fore,  in  view  of  infiltration  of  the  endometrial  glands  and 
stroma by plasma cells and eosinophils,  diagnosis of eosino-
philic endometritis was made.
The bleeding stopped following the curettage. The post-pro-
cedure course was uneventful. The patient had no complaints 
or recurrence of bleeding per vaginum at the 8 month follow-
up visit.
Figure  1:  High  power  (40x)  H  &  E  stain  of  endometrial 
sample shows eosinophilic  infiltration of endometrial  glands 
(Arrow) and stroma (Arrowheads)
Figure 2: High power (40x) H & E stain showing dense eos-
inophilic infiltration (Arrowheads)
1
This work is licensed under a
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Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 9, Issue 1; Jan-Mar 2010
Discussion:
Eosinophilic endometritis is an unusual & distinctive inflam-
matory  uterine  pathology.  It  appears  any  time  between  18 
hours to 21 days after a previous diagnostic procedure such as 
curettage. Our case had undergone a diagnostic curettage eight 
days before the second diagnostic curettage. The second dia-
gnostic curettage was performed due to inadequate sample on 
the first curettage.
Lymphocytes,  polymorphs  and macrophages  are the  normal 
constituents  of the endometrium.  However,  plasma cells are 
never found in the normal endometrium.[2] Hence, a diagnosis 
of endometritis  depends on the presence of plasma cells.  In 
view of the extensive infiltration of the endometrial glands and 
stroma by both eosinophils and plasma cells, the diagnosis of 
eosinophilic endometritis was made instead of simple eosino-
philic  infiltration  of  endometrium.  Eosinophils  and  plasma 
cells may also be seen in  chronic  endometritis,  although  in 
small numbers. In a large study, Adegboyega et al [3] found 
an average of 2.74 eosinophils per HPF in patients with chron-
ic endometritis. Presence of eosinophils in endometrial biopsy 
should prompt a search for plasma cells, with immunostaining 
if required.[3] In our patient, plasma cell infiltrate was present 
in addition to more than 40 eosinophils per high power field 
all the fields, in all the slides.
To the best of our knowledge, no definite quantitative criteria 
for the diagnosis and severity of eosinophilic endometritis ex-
ist.  Diagnostic  criteria  have  been  proposed  for  eosinophilic 
esophagitis. Many authors suggest one high-power field with 
>20 eosinophils or multiple high-power fields with >15 eos-
inophils as the cut-off for the diagnosis  of eosinophilic  eso-
phagitis.[4] Even though it is not clear whether eosinophilic 
endometritis  and  eosinophilic  esophagitis  share  a  common 
etiopathology, we tried to apply the diagnostic criteria of eos-
inophilic  esophagitis  to our case,  for lack of other available 
diagnostic  criteria.  Our  case fulfils  these diagnostic  criteria. 
We labeled presence of >40 eosinophils per high power field 
in all the fields in every slide, as severe eosinophilic endomet-
ritis. Other causes of blood eosionphilia and tissue eosinophil-
ia, including infective or allergic etiologies, need to be ruled 
out before making the diagnosis of eosinophilic endometritis. 
In our case, the patient’s history, and hematological, biochem-
ical or urine examination did not reveal any other cause of tis-
sue or blood eosinophilia. 
A  retrospective  analysis  of  1065  endometrial  curettage 
samples and 1248 hysterectomy specimens seen in our insti-
tute over the past two years was performed. Apart from the 
case discussed here, no other case fulfilled the diagnostic cri-
teria for eosinophilic endometritis as described above.
In eosinophilic  endometritis,  the degree of inflammation ap-
pears to correlate with the extent of previous injury.[1] How-
ever,  the  histological  changes show no correlation  with  the 
clinical signs or  symptoms.  It  is proposed that the probable 
causative agents are eosinophil chemotactic substances liber-
ated from the  myometrial  mast  cells  & from the  degrading 
blood clot filling the uterine cavity.[1] 
Our search across medline revealed only one article by Miko 
TL etal documenting eosinophilic endometritis associated with 
diagnostic curettage in humans.[1] A case of contact dermatit-
is to copper-containing intrauterine contraceptive device has 
been  reported  in  which  endometrial  eosinophilic  infiltration 
was present.[5]  This  could  point  towards an allergic  origin, 
just like  eosinophilic  esophagitis.[6]  Significant  eosinophilic 
infiltrate was also noted in 6.4% cases of infertility in a study 
in  Nigerian women.[7]  However,  the  available  literature  on 
eosinophilic endometritis is sparse.
To conclude,  severe  Eosinophilic  Endometritis  is  a  peculiar 
entity  usually  found  following  diagnostic  uterine  curettage. 
More research into its etiology and pathogenesis is necessary, 
considering the scarcity of available literature.
References:
1. Miko TL, Lampe LG, Thomazy VA, Molnar P, Endes P. 
Eosinophilic endomyometritis associated with diagnostic 
curettage. Int J Gynecol Pathol. 1988;7:162-72. 
2. Symmers WC. Systemic pathology.  Volume 6- Female 
reproductive system, 3rd ed. London: Butler and Tanner 
Ltd. 1991. p 160. 
3. Adegboyega  PA,  Pei  Y,  McLarty  J.  Relationship 
between  eosinophils  and  chronic  endometritis.  Hum 
Pathol 2010;41:33-7. 
4. Chang F, Anderson S. Clinical and pathological features 
of  eosinophilic  oesophagitis:  a  review.  Pathology. 
2008;40:3-8. 
5. Purello D'Ambrosio F, Ricciardi L, Isola S, Gangemi S, 
Cilia  M,  Levanti  C.  Systemic  contact  dermatitis  to 
copper-containing IUD. Allergy. 1996;51:658-9. 
6. Straumann A, Bauer M, Fischer B, et al. Idiopathic eos-
inophilic esohapgitis is associated with a T(H)2-type al-
lergic  inflammatory  response.  J  Allergy  Clin  Immunol 
2001;108:954-61. 
7. Ekanem IA, Ekanem AD. Endometrial pathology associ-
ated with infertility among Nigerian women. Niger Post-
grad Med J. 2006;13:344-7.
2


Clinical and pathological features of eosinophilic oesophagitis: a review.

Endometrial pathology associated with infertility among Nigerian women.

Eosinophilic endomyometritis associated with diagnostic curettage.

Idiopathic eosinophilic esohapgitis is associated with a T(H)2-type allergic inflammatory response.

Relationship between eosinophils and chronic endometritis.

Systemic contact dermatitis to copper-containing IUD.

Systemic pathology. Volume 6- Female reproductive system, 3rd ed. London: Butler and Tanner Ltd.

Severe Eosinophilic Endometritis Following Diagnostic Curettage

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