Background: Abnormal uterine bleeding (AUB) interferes with the quality of life of an otherwise healthy woman. Until the pathology underlying menorrhagia is, accurately diagnosed, proper therapy is hardly possible. The objective of the study was to analyze different histopathological patterns of endometrium in AUB and observe the incidence of various pathologies in different age groups and their relation to parity.Methods: This two-year prospective studywas done in the department of pathology in atertiary care centre, which included 250 cases of clinically diagnosed AUB patients were evaluated. Histopathological examination of endometrial biopsies and hysterectomy specimens were done, followed by clinical correlation.Results: Out of 250 cases of AUB, Premenopausal bleeding was seen in 216 cases (86.4%) and 34 cases (13.6%) had postmenopausal bleeding. The commonest finding observed in the study was proliferative phase endometrium (37.2%), followed by secretory endometrium (34%) and endometrial hyperplasia (16%). Disordered proliferative endometrium was seen in 2.4% of patients. Endometrial carcinoma was seen in 4 (1.6%) cases. Endometrial hyperplasia was seen mostly in the age group 41-50 years (27 cases). Two cases of endometrial carcinomas were presented after age 60 years.Conclusions: Our study revealed the highest incidence of AUB in the perimenopausal age group (41-50 years). Hence a thorough histopathological workup and clinical correlation are mandatory in cases of abnormal uterine bleeding.

Histopathological spectrum of endometrium in abnormal uterine bleeding

Introduction: Endometrial biopsies and curettings constitute an important tool for diagnosis of endometrial pathology; whether benign, pre-malignant and malignant, and help the gynecologist to decide appropriate therapeutic strategy. The present study was carried out to document the histopathological appearances seen in endometrial biopsies, and their age–wise distribution in patients with infertility and abnormal (irregular, excessive or continuous) uterine bleeding due to endometrial causes.
Materials and Methods: A total of 214 specimens of endometrial curettings and biopsies from patients with abnormal uterine bleeding due to endometrial causes and inability to conceive, received in the Pathology department, Gian Sagar Medical College and Hospital, Banur, Rajpura, over a period of two years from January 2012 upto December 2013, were retrieved and analyzed retrospectively, and their findings were documented. The tissue had been received in 10% formalin, processed routinely, and the slides had been stained with Hematoxylin and Eosin.
Results and Conclusion: The most common histopathological diagnosis was proliferative endometrium seen 33% cases. Products of conception were confirmed histologically in 12% cases. Endometrial hyperplasias were seen in 09% cases, and disordered proliferative endometrium in 06%. Secretory endometrium was seen in 07% cases. 02% biopsies showed atrophic endometrium. Luteal phase defects were seen in 07% of the specimens. 01% cases showed tubercular endometritis and adenocarcinoma each. The most common finding in patients of infertility was proliferative endometrium indicating anovulatory cycles.
Endometrial biopsy is a valuable tool in assessment of endometrial status in infertility, as well as benign and malignant pathology in abnormal uterine bleeding due to relative ease and accessibility of procedure and rapid availability of results.

Keywords: Abnormal uterine bleeding, Infertility, Dysfunctional uterine bleeding, Hyperplasia, Ca

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A two year histopathological study of endometrial biopsies in a teaching hospital in Northern India

Introduction: Abnormal uterine bleeding (AUB) is considered as one of the most common problems both to the patient and the gynecologist. Until the pathology underlying atypical uterine bleeding is accurately diagnosed, proper therapy is hardly possible. The objectives of the study were to determine the types and frequencies of pathologies in endometrial curettings of abnormal uterine bleeding & compare different endometrial pathologies in different types of abnormal uterine bleeding in peri and postmenopausal patients. Methods: This is a retrospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Kolkata from November 2014 to October 2015. All cases of AUB in the peri and postmenopausal patients with a probable endometrial cause were included in the study. Results: A total of 156 cases were analyzed. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (43%). Histopathological diagnosis was not possible in 5 cases with inadequate sample material. Non-organic causes of the endometrium comprised 80.1% of total while in the rest (19.9%) definite organic pathology was found. Among the nonorganic causes secretory endometrium(42.9%) and in the organic group polyp(43.3%) was found to be commonest. Malignancy comprises 23.3% and hyperplasia constitutes 30% of total organic causes. Conclusion: Histopathological diagnosis of hyperplasia and malignancy is maximum in the patients presented with menometrorrhagia followed by postmenopausal bleeding. Hereby Histopathological evaluation of endometrial samples is especially indicated in peri and postmenopausal women to rule out neoplastic and preneoplastic conditions.

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A Study on Histopathological Patterns of Endometrium in Different Types of Abnormal Uterine Bleeding Among Peri And Postmenopausal Women

Background: Abnormal Uterine Bleeding (AUB) refers to bleeding that is excessive or occurs outside of normal cyclic menstruation. It accounts for two-thirds of all hysterectomies worldwide. Evaluation of the endometrium as a cause of AUB is done mainly in three modes i.e. by Imaging of endometrium by transvaginal/transabdominal ultrasound, visual assessment by hysteroscopy and cellular assessment by microscopic evaluation of endometrial samples. Methods: Ours is a retrospective observational study of all diagnostic hysteroscopies performed for AUB in 40-45 year age group at Cama and Albless hospital, Mumbai between April 2012 and January 2015. We studied 66 cases of conventional diagnostic hysteroscopy at our institute to establish correlation of hysteroscopy findings with other diagnostic tools i.e. ultrasound and histopathological findings. Results: On ultrasound 65.2% of the endometrial pathologies leading to AUB were due to endometrial hyperplasia with polyp accounting for 4.5%. 43.9% of the total patients were having fibroid as associated pathology on ultrasound. On hysteroscopy more number of cases of polyp were diagnosed (21.2%) as compared to ultrasound (4.5%). On histopathological appearance we found simple hyperplasia in 4.5% of cases and simple hyperplasia with atypia in 1.5% all of cases i.e. 6% total cases of hyperplasia. These are potentially carcinogenic patients. 47% of cases had endometrium in proliferative phase which is the commonest pathological finding on histopathological examination. Conclusions: The relatively poor sensitivity of both endometrial biopsy and ultrasound in the detection of intrauterine focal pathology encourage us to propose that Hysteroscopy be utilized as a first line investigation in AUB.

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Use of diagnostic hysteroscopy in abnormal uterine bleeding in perimenopausal age group and its clinicopathological co-relation with ultrasound and histopathology findings: experience in a tertiary care institute -

Background: Endometrial lesions are represented by a set of diversified disorders which has challenged clinicians for a long time. Due to its chances of progressing to malignant states, the condition needs prompt and focussed study, keeping clinical context in view. Methods: This 12-month (June 2016-May 2017) cross-sectional studyinvolved 100 specimens from dilatation and curettage (D & C) and hysterectomy specimens from female patientsaged ≥ 18 years who presented with complain of pelvic pain, abnormal uterine bleeding, dysmenorrhoea, pelvic mass and infertility. For all the specimens received,histopathological and immunohistochemical assessment was done. Results: Out of 100 cases of abnormal uterine bleeding 44 females showed physiological changes, 25 females showed benign lesions and 20 females had malignant lesions of endometrium. Out of 20 cases of endometrial carcinoma 50 % were well differentiated and 25% were moderately differentiated and 25% were poorly differentiated. Expression of Ki-67 was >35% in poorly differentiated carcinoma. Well differentiated carcinoma showed 80-85% positivity of ER, moderately differentiated showed 30-35% positivity and poorly differentiated carcinoma showed 6-12%. The association between benign and malignant endometrial lesion was found to be statistically significant with age-group, history of contraceptive use and chronic illnesses (p<0.05). Conclusion: Endometrial biopsy is one of the prompt tools in diagnosis and assessment of the benign and malignant diseases of endometrium. Immunohistochemical markers like ER (hormonal receptor) and Ki-67 ( proliferative marker) play a major role in diagnosis, prognostication and therapeutic management of malignant cases.

Histopathological and Immunohistochemical Study of Endometrial Lesions Obtained from D&C and Hysterectomy Specimens at a Tertiary Care Hospital

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

Shetty K Padma

Papers

Study of histopathological patterns of endometrium in abnormal uterine bleeding