title: Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research.
abstract: While endometrial neutrophils and plasma cells are criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease (PID) research, plasma cell misidentification and nonspecificity may limit the accuracy of these criteria. Herein, we examined: (1) the identification of endometrial plasma cells with conventional methyl green pyronin-based methodology versus plasma cell-specific (CD138) immunostaining, (2) the prevalence of endometrial plasma cells among women at low risk for PID, and (3) endometrial leukocyte subpopulations among women diagnosed with acute or chronic histologic endometritis by conventional criteria. We observed an absence of CD138+ cells in 25% of endometrial biopsies in which plasma cells had been identified by conventional methodology, while additional immunohistochemical analyses revealed indistinguishable inflammatory infiltrates among women diagnosed with acute or chronic endometritis by conventional criteria. Among women considered at lower risk for PID development, flow cytometric analyses detected plasma cells in 30% of endometrial biopsy specimens, suggesting that these cells, even when accurately identified, only nonspecifically identify upper genital tract inflammatory processes. Combined, our findings underscore the limitations of the criteria used to diagnose histologic endometritis in PID-related research and suggest that satisfactory understanding of PID pathogenesis, treatment, and prevention is hindered by continued use of these criteria.
authors: University of Pittsburgh School of Medicine, Department of Pediatrics, PA 15224, USA.
authors: Rodolfo D
authors: RD
authors: Vicetti Miguel
authors: Mamatha
authors: M
authors: Chivukula
authors: Uma
authors: U
authors: Krishnamurti
authors: Antonio J
authors: AJ
authors: Amortegui
authors: Jeffrey A
authors: JA
authors: Kant
authors: Richard L
authors: RL
authors: Sweet
authors: Harold C
authors: HC
authors: Wiesenfeld
authors: Jaclyn M
authors: JM
authors: Phillips
authors: Thomas L
authors: TL
authors: Cherpes
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal; D001706:Biopsy; D004716:Endometritis / Q000175:diagnosis* / Q000453:epidemiology; D004717:Endometrium / Q000473:pathology*; D016021:Epidemiologic Studies; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007150:Immunohistochemistry; D007962:Leukocytes / Q000166:cytology; D009504:Neutrophils / Q000473:pathology*; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000453:epidemiology; D010950:Plasma Cells / Q000145:classification* / Q000473:pathology; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D053668:Syndecan-1 / Q000378:metabolism*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; C508241:SDC1 protein, human; D053668:Syndecan-1