Histopathological Spectrum of endometrial changes in women presenting with abnormal uterine bleeding with special reference to endometrial malignancies : A two years hospital based study
Keywords:
Abnormal uterine bleeding, clear cell carcinoma, endometrial hyperplasia, endometrial malignancy, proliferative endometrium.
Abstract
Background: Abnormal uterine bleeding(AUB) is a common symptom of the patients in all age groups attending out patient department of O&G. AUB is caused by a wide variety of causes in different age. Histopathological examination of endometrial biopsy is a major diagnostic tool in evaluation of AUB. Aim: To study the spectrum of endometrial changes in all age groups presenting with AUB and to find the incidence of endometrial malignancies in this area of upper Assam.Methods: The study was a retrospective cross sectional study of cases presenting with AUB . D&C material and endometrial biopsy specimens were collected in Pathology Department of Tezpur Medical College from 2013 July to 2015 June. Specimens were routinely processed and stained with H&E stain and morphological evaluation was done. Patients were categorized into reproductive age group(18- 40 yrs), perimenopausal (41yrs -50 yrs) and postmenopausal (> 50years). Result: A total of 150 specimens of D&C materials and endometrial biopsies were collected of which 18 cases were excluded due to inadequate sampling and finding of 132 cases were analysed . Maximum number of cases were received from reproductive age group (51.6%). Functional causes(64.4%) were the predominating irrespective of age, proliferative phase endometrium(37.2%) was the overall predominant histopathological finding. Most common cause of organic lesion was pregnancy related complications(PRC)(63%).In reproductive age PRC (35.3%) and perimenopausal age groups proliferative endometrium (35.6%) was commonest. In post menopausal age atrophic endometrium (57.8%) was the commonest finding. One case of endometrial carcinoma (0.75%) which was clear cell carcinoma, was recorded in 31-40 years group.Conclusion: : Histopathological evaluation of endometrial samples can be used as first step for diagnosis of abnormal uterine bleeding specially in post menopausal women who are at increased risk of malignancy. However histopathological evaluation is a challenge for the pathologist due to the frequent receipt of inadequate endometrial samples.References
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10. Brenner PF. Differential diagnosis of AUB.Am J Obstet Gynecol.1996;175:766-9.
11. Leather AT,Savvas M, Studd W. Endometrial histology and bleeding patterns after 8 years of continuous estrogen and progesterone therapy in postmenopausal women. Obstet Gynecol. 1991;78(6):1008-10.
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13. Chambers JT, Chambers SK.endometrial sampling: when? Where? Why? With what? Clin Obstet Gynecol 1992;35:28-39.
14. Felix YF IU, Stephen PY Yong, Hon –Cheung LLE. Managment of insufficient endometrial biopsy for investigation of premenopausal abnormal uterine bleeding. Hong Kong J Gynaecol Obstet Midwifery 2014;14(1):108-13.
15. Khare A,Bansal R.,Sharma S.,Elhence P.,Makkar N.,Tyagi Y.Morphological spectrum of Endometrium in patients presenting with dysfunctional uterine bleeding. People’s Journal of Scientific Research .2012;5(2):13-16.
16. Saera Afghan,Ara Yasmeen. Abnormal Uterine Bleeding A clinicopathological study of 150 cases.Ann. Pak.Inst.Med. Sci. 2013;9(4):201-204.
17. Vaidya S,Lakhey M,Vaidya Amatya S.,Sharma P K, Hirachand S,Lama S,KC S.Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J .2013;15(1):74-77.
18. Agrawal Sweta,Mathur Asha, Vaishnav Kusum.Histopathological study of endometrium in abnormal uterine bleeding women of all age groups in Western Rajasthan(400 cases).International Journal of Basic and Applied Sciences.2014;4(3):15-18.
19. Salvi Anuradha, Mital Premlata,Hooja Nupur, Batar Alka, Soni Pradeepkumar, Beniwal Ramesh.Spectrum of endometrial histopathology in women presenting with abnormal uterine bleeding Sch. J. App Med Sci,2015;3(1A):1-4.
20. Bhatta S, Sinha AK.Histopathological study of endometrium in abnormal uterine bleeding.Journal of Pathology of Nepal.2012;2:297-300.
21. Damle Rajshri P,Dravid N.V,Kishor H,Suryawanshi, Gadre Arundhati S, Bagale Priya S, Ahire Neelam.Clinicopathological spectrum of endometrial changes in perimenopausal amd post-menopausal abnormal uterine bleeding: A 2 year study. J Clin Diagn Res. 2013 ; 7(12): 2774–2776.
22. Mahapatro Mitali, Mishra Pratima.Clinicopathological evaluationof abnormal uterine bleeding.Journal of Health Research and Reviews,2015;2(1):45-49.
23. Prajapati Rujuta, Meena R.,Daveshwar A. Clinicopathological correlation of endometrial pattern in patients with Abnormal Uterine Bleeding. Int. J. Res Med.2015;4(2):128-132.
24. Sandeepa Supriya, Jayprakash H.T,Ashwini M.C. Histopathological study of endometrium in Abnormal Uterine Bleeding in different age group. International Journal of Scientific Reasearch.2014;3(11):422-424.
25. Karmakar Pragati J,Wilkinson Anne, Rathod Mayuri. Histopathologcal evaluation of postmenopausal bleeding,2014;13(10):53-57.
26. Wei Jain Ju, Paintal Ajit, Keh Pacita. Histologic and Immunohistochemical analysis of endometrial carcinomas. Arch Pathol Lab Med ,2013;137:1574-83.
27. Christopherson, William M, Alberhasky,Robert C, Connelly, Patrick J. Carcinoma of the Endometrium: I. A Clinicopathologic Study of Clear-Cell Carcinoma and Secretory Carcinoma. Pathology n laboratory medicine.2013:5(2);122-124.
2. Speroff L, Fritz MA. In : Clinical gynaecologic endocrinology and infertility. 7th edition. Jaypee Brothers Med Publishers (P) Ltd; 2005. Menopause and the peri-menopausal transition; 621–88.
3. Critchley HOD, Maybin JA. Molecular and cellular causes of abnormal uterine bleeding of endometrial origin. Semin Reprod Med 2011;29(5):400–409
4. Munro MG, Critchley HOD, Fraser IS. The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding. Semin Reprod Med 2011;29(5):391–399
5. Dueholm M. Levonorgestrel-IUD should be offered before hysterectomy for abnormal uterine bleeding without uterine structural abnormalities: there are no more excuses! Acta Obstet Gynecol Scand 2009;88(12):1302–1304.
6. Moodley M,Roberts C. Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol 2004; 24:736
7. Saraswati doraiswami, Thanka Johnson, Shalinee Rao, Aarthi Rajkumar, Jaya Vijayaraghavan and Vinod kumar Panicker. J Obstet Gynaecol India 2011;61(4):426- 430.
8. Market Opinion and Research International (MORI). Women’s health in 1990. [Research study conducted on behalf of Parke-Davis Laboratories]. London: MORI; 1990
9. Phillips V, McCluggage W G. Results of a questionnaire regarding criteria for adequacy of endometrial biopsies. J Clin Pathol 2005:417–419.
10. Brenner PF. Differential diagnosis of AUB.Am J Obstet Gynecol.1996;175:766-9.
11. Leather AT,Savvas M, Studd W. Endometrial histology and bleeding patterns after 8 years of continuous estrogen and progesterone therapy in postmenopausal women. Obstet Gynecol. 1991;78(6):1008-10.
12. Critchley HO,Warner P, Lee AJ, Breehin S, Guise J, Graham B. Evaluation of abnormal uterine bleeding: Comparision of three out patient procedures within cohorts defined by age and menopausal status. Health technol Assess.2004;8(34):iii-iv,1-139.
13. Chambers JT, Chambers SK.endometrial sampling: when? Where? Why? With what? Clin Obstet Gynecol 1992;35:28-39.
14. Felix YF IU, Stephen PY Yong, Hon –Cheung LLE. Managment of insufficient endometrial biopsy for investigation of premenopausal abnormal uterine bleeding. Hong Kong J Gynaecol Obstet Midwifery 2014;14(1):108-13.
15. Khare A,Bansal R.,Sharma S.,Elhence P.,Makkar N.,Tyagi Y.Morphological spectrum of Endometrium in patients presenting with dysfunctional uterine bleeding. People’s Journal of Scientific Research .2012;5(2):13-16.
16. Saera Afghan,Ara Yasmeen. Abnormal Uterine Bleeding A clinicopathological study of 150 cases.Ann. Pak.Inst.Med. Sci. 2013;9(4):201-204.
17. Vaidya S,Lakhey M,Vaidya Amatya S.,Sharma P K, Hirachand S,Lama S,KC S.Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J .2013;15(1):74-77.
18. Agrawal Sweta,Mathur Asha, Vaishnav Kusum.Histopathological study of endometrium in abnormal uterine bleeding women of all age groups in Western Rajasthan(400 cases).International Journal of Basic and Applied Sciences.2014;4(3):15-18.
19. Salvi Anuradha, Mital Premlata,Hooja Nupur, Batar Alka, Soni Pradeepkumar, Beniwal Ramesh.Spectrum of endometrial histopathology in women presenting with abnormal uterine bleeding Sch. J. App Med Sci,2015;3(1A):1-4.
20. Bhatta S, Sinha AK.Histopathological study of endometrium in abnormal uterine bleeding.Journal of Pathology of Nepal.2012;2:297-300.
21. Damle Rajshri P,Dravid N.V,Kishor H,Suryawanshi, Gadre Arundhati S, Bagale Priya S, Ahire Neelam.Clinicopathological spectrum of endometrial changes in perimenopausal amd post-menopausal abnormal uterine bleeding: A 2 year study. J Clin Diagn Res. 2013 ; 7(12): 2774–2776.
22. Mahapatro Mitali, Mishra Pratima.Clinicopathological evaluationof abnormal uterine bleeding.Journal of Health Research and Reviews,2015;2(1):45-49.
23. Prajapati Rujuta, Meena R.,Daveshwar A. Clinicopathological correlation of endometrial pattern in patients with Abnormal Uterine Bleeding. Int. J. Res Med.2015;4(2):128-132.
24. Sandeepa Supriya, Jayprakash H.T,Ashwini M.C. Histopathological study of endometrium in Abnormal Uterine Bleeding in different age group. International Journal of Scientific Reasearch.2014;3(11):422-424.
25. Karmakar Pragati J,Wilkinson Anne, Rathod Mayuri. Histopathologcal evaluation of postmenopausal bleeding,2014;13(10):53-57.
26. Wei Jain Ju, Paintal Ajit, Keh Pacita. Histologic and Immunohistochemical analysis of endometrial carcinomas. Arch Pathol Lab Med ,2013;137:1574-83.
27. Christopherson, William M, Alberhasky,Robert C, Connelly, Patrick J. Carcinoma of the Endometrium: I. A Clinicopathologic Study of Clear-Cell Carcinoma and Secretory Carcinoma. Pathology n laboratory medicine.2013:5(2);122-124.
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2016-05-12
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