Arias-Stella reaction in upper genital tract in pregnant and non-pregnant women: a study of 120 randomly selected cases

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Aims1. To study the diagnostic importance of the Arias-Stella reaction.2. To study tubal epithelial changes in ectopic pregnancy.3. To study the occurrence of Arias-Stella reaction in non-pregnant women receiving hormonal treatment.MethodsA prospective study was conducted on 120 patients who underwent endometrial curettage and/or salpingectomy. The patients were divided into four groups, each comprising of 30 patients. Groups 1 and 4 included non-pregnant patients who were being evaluated for infertility and dysfunctional uterine bleeding respectively, while pregnant patients were included in Group 2 (intra-uterine abortions) and Group 3 (ectopic tubal gestation). The endometrial curettings and fallopian tube lining epithelial cells were examined for the changes described by Arias-Stella. Cases which showed the presence of the Arias-Stella reaction were further classified.ResultsThe changes of the Arias-Stella reaction in endometrial glands were observed in 80% cases of intra-uterine abortions. Secretory/hypersecretory pattern was the most commonly observed type (36.67%). The reaction was seen in 3.33% each of patients evaluated for infertility and patients on hormonal therapy with oral progestational agents for the management of dysfunctional uterine bleeding. Although uncommon, the Arias-Stella reaction was noted in the epithelium of fallopian tubes (16.67%) from patients with ectopic tubal gestation.ConclusionThe findings of the present study emphasize the diagnostic importance of the Arias-Stella reaction. The changes of the reaction are a histological clue to the presumptive diagnosis of the presence of chorial tissue in cases in which the chorionic material is not found in the endometrial biopsy. The morphological features can be mistaken for malignancy if the pathologist is not aware of the patient's pregnancy or history of hormonal intake.

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