Archives of Gynecology and Obstetrics

, Volume 276, Issue 1, pp 47–52 | Cite as

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

  • Neerja Dhingra
  • Rajpal Singh Punia
  • Anuradha Radotra
  • Harsh Mohan
Original Article



1. 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.


A 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.


The 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.


The 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.


Fallopian Tube Ectopic Pregnancy Chorionic Villus Endometrial Gland Dysfunctional Uterine Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Arias-Stella J (1954) Atypical endometrial changes associated with the presence of chorionic tissue. Arch Pathol 58:112–128Google Scholar
  2. 2.
    Arias-Stella J (2002) The Arias-Stella reaction: facts and fancies four decades after. Adv Anat Pathol 9:12–23PubMedCrossRefGoogle Scholar
  3. 3.
    Frederiksen T (1958) The Arias-Stella reaction as an aid in the diagnosis of ectopic pregnancy. Acta Obstet Gynecol Scand 37:86–96PubMedCrossRefGoogle Scholar
  4. 4.
    Huettner PC, Gersell DJ (1994) Arias-Stella reaction in nonpregnant women: a clinicopathologic study of nine cases. Int J Gynecol Pathol 13:241–247PubMedCrossRefGoogle Scholar
  5. 5.
    Oertel YC (1978) The Arias-Stella reaction revisited. Arch Pathol Lab Med 102:651–654PubMedGoogle Scholar
  6. 6.
    Arias-Stella J (1972) Atypical endometrial changes produced by chorionic tissue. Hum Pathol 3:450–453CrossRefGoogle Scholar
  7. 7.
    Silverberg SG (1972) Arias-Stella phenomenon in spontaneous and therapeutic abortion. Am J Obstet Gynecol 112:777–780PubMedGoogle Scholar
  8. 8.
    Lloyd HED, Fienberg R (1965) The Arias-Stella reaction–a nonspecific involutional phenomenon in intra as well as extrauterine pregnancy. Am J Clin Pathol 43:428–432PubMedGoogle Scholar
  9. 9.
    Roach WR, Guderian AM, Brewer JI (1960) Endometrial gland cell atypism in the presence of trophoblast. Am J Obstet Gynecol 79:680–691PubMedGoogle Scholar
  10. 10.
    Arias-Stella J Jr, Arias-Velasquez A, Arias-Stella J (1994) Normal and abnormal mitoses in the atypical endometrial change associated with chorionic tissue effect. Am J Surg Pathol 18:694–701PubMedCrossRefGoogle Scholar
  11. 11.
    McCormick CJ, Menai-Williams RA (1995) Tripolar mitotic figures occurring in an Arias-Stella reaction within an endocervical polyp. Histopathology 26:575–576PubMedCrossRefGoogle Scholar
  12. 12.
    Birch HW, Collins CG (1961) Atypical changes of genital epithelium associated with ectopic pregnancy. Am J Obstet Gynecol 81:1198–1208Google Scholar
  13. 13.
    LaIuppa MA, Cavanagh D (1963) The endometrium in ectopic pregnancy: a study based on 35 patients treated by hysterectomy. Obstet Gynecol 21:155–164PubMedGoogle Scholar
  14. 14.
    Azzopardi JG, Zayid I (1967) Synthetic progestogen-oestrogen therapy and uterine changes. J Clin Pathol 20:731–738PubMedGoogle Scholar
  15. 15.
    Lui M, Boerner S (2005) Arias-Stella reaction in cervicovaginal smear of a woman undergoing infertility treatment: a case report. Diagn Cytopathol 32(2):94–96PubMedCrossRefGoogle Scholar
  16. 16.
    Nucci MR, Young RH (2004) Arias-Stella reaction of the endocervix: a report of 18 cases with emphasis on its varied histology and differential diagnosis. Am J Surg Pathol 28(5):608–612PubMedGoogle Scholar
  17. 17.
    Dockerty MB, Smith RA, Symmonds RE (1959) Pseudomalignant endometrial changes induced by administration of new synthetic progestins. Proc Mayo Clin 34:321–328PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Neerja Dhingra
    • 1
  • Rajpal Singh Punia
    • 1
  • Anuradha Radotra
    • 2
  • Harsh Mohan
    • 1
  1. 1.Department of PathologyGovernment Medical College and HospitalSector 32Chandigarh160030India
  2. 2.Department of Obstetrics and GynecologyGovernment Medical College and HospitalChandigarhIndia

Personalised recommendations