Endometritis is nowadays rare in developed countries and typically shows a subclinical or mild course; therefore, there are probably more cases of
endometritis than diagnosed but they lack clinical relevance. In the fertile period of life it can be the reason for
vaginal bleeding and
infertility. The most common causes for non-specific
endometritis are residual placental tissue after abortion or childbirth, intrauterine interventions, lesions within the uterine cavity, such as endometrial
polyps,
endometrial hyperplasia and
neoplasms,
intrauterine devices (IUD) and cervical
stenosis. The histological detection of plasma cells in the endometrial stroma is required for the diagnosis of chronic
endometritis. These can be detected immunohistochemically using anti-CD138
antibodies, which should be carried out particularly in cases of
infertility with only slight inflammatory symptoms and few plasma cells. The use of an IUD containing
progestin is frequently associated with an asymptomatic lymphoplasmacytic infiltration. After
curettage or endometrial biopsy, an eosinophilic xanthogranulomatous or granulomatous
endometritis and also a
foreign body granuloma reaction can occur. Specific forms of
endometritis, such as caused by
tuberculosis,
sarcoidosis, mycoplasma and herpes are very rare. Cytomegalovirus
endometritis is associated with immunosuppression.
Endometritis caused by
infections with Chlamydia trachomatis is characterized by an extensive lymphoplasmacytic infiltration. The differential diagnoses of chronic
endometritis include the very rare
malignant lymphoma, which is usually characterized by a relatively monotonous cell infiltration.