Question

Which one of the following endometrial histopathological findings is suggestive of an ectopic pregnancy?

• A. Decidual reaction
• B. Chorionic villi
• C. Proliferative endometrium
• D. Secretory endometrium

Hint:

Look for decidua without any villi, that gap is the clue.

Answer 1

The Correct Option is A

This question is about the biopsy pattern that hints at a pregnancy sitting outside the uterus rather than inside it.

1. Decidual reaction: Pregnancy hormones convert the endometrium into decidua wherever the embryo actually is. When the sample shows decidua but no villi, it means the pregnancy hormones are active but the pregnancy tissue itself is not in the uterus, which is exactly what happens in an ectopic pregnancy.
2. Chorionic villi: Finding villi in the sample means the placenta has formed inside the uterine cavity, so this confirms an intrauterine pregnancy, not an ectopic one.
3. Proliferative endometrium: This is the normal estrogen driven pattern seen before ovulation in a non pregnant cycle and has no special link to ectopic pregnancy.
4. Secretory endometrium: This is the normal progesterone driven pattern after ovulation and is seen in many non pregnant cycles too, so it does not point specifically to an ectopic pregnancy.

The telling combination is decidua present with villi absent, since it shows the hormones of pregnancy are working on the uterine lining while the pregnancy itself has implanted somewhere else.

Let's summarize:

• Villi in the sample means intrauterine pregnancy.
• Decidua without villi is the classic sign pointing to ectopic pregnancy.

So the finding suggestive of ectopic pregnancy is decidual reaction without chorionic villi.