Clinicopathological Evaluation of Abnormal Uterine Bleeding with Special Reference to Estrogen Receptor (ER), Progesterone Receptor (PR)2 and HER-2 / NEU Status
Keywords:
ER, PR, HER-2/NEU, Imaging devices, Dilation, curettage
Abstract
Background: Abnormal Uterine Bleeding (AUB) may be defined as any variation from normal menstrual cycle including alteration in its regularity, frequency, duration of flow and amount of blood loss. AUB can present as menorrhoea, metrorrhagia, poly menorrhoea and dysfunctional uterine bleeding. The study aimed to found out the various aetiopathological factors responsible for AUB. To correlate clinical presentation with histopathological examination and also to study the hormone receptor markers ER (Estrogen Receptors), PR (Progesterone receptor) and marker of oncogene HER-2/NEU for prognostication. Methods: This study was conducted during the period Sept. 2012 to January 2015 in the Department of Obstetrics and Gynecology in collaboration with Dept. of Pathology, Hi-Tech Medical College, Bhubaneswar. 140 patients of 15-55 yrs of age groups were randomly selected excluding pregnant patients and patients below 15 yrs and above 55 yrs. All patients were subjected to Transvaginal-ultransonography, saline infusion sonography and dilation and curettage (D&C) along with endometrial biopsy. All histopathological samples were stained with Hematoxylin and Eosin stain (H&E stain) and subsequently immunostaining was done for ER, PR and HER-2 / NEU. Result: 37.20% cases of AUB were observed in the age group of 41-45. 0.7% among age group of 51-55 yrs. 64.3% of rural population & 67.2% of patients from lower socio-economic group had AUB. 48.6% cases presented with menorrhagia and 42.9% cases had etiological features of dysfunctional uterine bleeding (DUB), 20% had endometrial polyp and 14 cases out of 140 had endometrial carcinoma. In the present study ER were positive in 84.7% and PR were positive in 76.7%. HER-2/NEU expression in this study showed different histopathological pattern of endometrium in AUB. The present study also showed HER-2/NEU expression in 21.4% cases of different grades of Endometrial Carcinoma and all DUB cases showed negative HER-2 / NEU expression. Conclusion: In this study clinical presentation, use of different diagnostic modalities and histopathological correlation were reviewed. Large number of patients belonged to age group 41-50 yrs. The incidence of AUB was maximum in rural areas and most patients belong to lower socio-economic group. By use of Hormone receptors expression of ER & PR and observing the over expression of HER-2 / NEU the prognosis of endometrial lesions can be assessed for early and proper management.References
1. Elza C, De Almeidaa SA, Alberto A, Nogueiraa F et al. Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps and adjacent endometrium in postmenopausal women. Maturitas. 2004; 49 : 229-233.
2. Mc Gurgan P, Taylor LJ, Duffy SR, O’ Donovan PJ. Are endometrial polyps from premenopausal woman similar to postmenopausal women. Maturites. 2006; 54 : 277-284.
3. Lopes RG, Baracat EC, de Albuquerque Neto LC, Ramos JF, Yatabe S, Depesr DB, Lippi UG. Analysis of oestrogen and progesterore receptor expression in endometrial polyps. J. Mirimum invasive Gynecol. 2017; 14 : 300-303.
4. Teleman S, Hilgarth M, Freudenberg N, Bettendorf H, Mihailovici MS. An immunohistochemical study of the steroid hormone receptors in endometrial hyperplasia. Rev Med Chir Soc Med Nat Iasi. 1999; 103(1-2):138-41.
5. Nunobiki O, Taniguchi E, Ishii A, Tang W, Utsunomiya H, Nakamura Y, Mori I, Kakudo K. Significance of hormone receptors status and tumor vessels in normal hyperplastic and neoplastic endometrium. Pathology Int. 2003; 53 (12) 846-52.
6. Rasty G, Richard M, Leo Lu, Paul K, Guy B, Shahla M. Expression of HER-2 / NEU oncogene ia normal, hyperplastic and malignant endometrium. Ann Clin. Lab Sci. 1998; 28 : 138-143.
7. Kim JW, Kim SH, Kim YT, Kim DK. Clinicopathologic and biological parameters predicting the prognosis in endometrial cancer. Yonsei Med J. 2002; 43(6): 769-778.
8. Stoian SC, Simionescu C, Mărgăritescu , Stepan A, Nurciu M. Endometrial carcinomas: correlation between ER, PR, Ki67 status and histopathological prognostic parameters. Rom J Morphol Embryol. 2011; 52(2):631-6.
9. Sunitha CH. Clinical study of diagnostic hysteroscopy in AUB and its histopathological correlation (dissertation). Bijapur: SHRI B.M. Patil medical college hospital & research centre; 2006.
10. Abdullah LS, Bondagji NS; Histopathological Pattern of Endometrial Sampling Performed for Abnormal Uterine Bleeding. Bahrain Med Bull. 2011; 33(4): 1-6.
11. Hanprasertpong J, Sakolprakraikij S, Geater A. Endometrial cancer in Thai women aged 45 years or younger. Asian Pac J Cancer Prev. 2008; 9: 58-62.
12. Richter CE, Qian B, Martel M, et al. Ovarian preservation and staging in reproductive-age endometrial cancer patients.Gynecol Oncol. 2009; 114: 99-104.
13. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis. Am J Obstet Gynecol. 2005; 193: 1640-4.
14. Archana B and Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleedia in premenopausal women Bombay Hosp. J. 2010; 52 : 69-72.
15. Khare A, Bansal R, Sharma S, Elhence P, Makkar N, Tyagi Y. Morphological spectrum of endometrial in patients presenting with DUB. Peoples Journal of scientific research. 2012; 5(2) : 13-16.
16. Armando A, Jose V, Anderson P, Rogério L, Aarão M, Pinto N, Lucia costa P. Immunohistochemical expression at ER, PR receptors in endometrial polyp. Maturities. 2015; 49 : 229-233.
17. Williams GP. The role of oestrogen in the pathogenesis of obesity, type 2 diabetes, breast cancer and prostate disease. Euro J Cancer Prev. 2010; 19(4): 256–71.
18. Mirza T, Saadia A, Aamir M, Sadiya A, Tariq M, Tazeen M. Histopathological pattern of AUB. J of Basics and Applied Sciences, 2012; 8: 14-17.
19. Ejaz S. Causes of post menopausal bleeding Cancer. J. Clin. 2001; 4: 260-262.
20. Cai Q. Expression of ER receptors alpha and beta protein in endometrial carcinoma. cancer therapy. 2003; 6: 907- 912.
21. Bergeron C, Ferenczy A, Toft DO. Immunohistochemical study of PR receptors during menstrual cycle. Lab. Invest. 1988; 59: 862-869.
22. Rasty G, Murray R, Lu L, Kubilis P, Benrubi G, Masood S. Expression of HER-2/neu oncogene in normal, hyperplastic, and malignant endometrium. Ann Clin Lab Sci. 1998; 28(3):138-43
2. Mc Gurgan P, Taylor LJ, Duffy SR, O’ Donovan PJ. Are endometrial polyps from premenopausal woman similar to postmenopausal women. Maturites. 2006; 54 : 277-284.
3. Lopes RG, Baracat EC, de Albuquerque Neto LC, Ramos JF, Yatabe S, Depesr DB, Lippi UG. Analysis of oestrogen and progesterore receptor expression in endometrial polyps. J. Mirimum invasive Gynecol. 2017; 14 : 300-303.
4. Teleman S, Hilgarth M, Freudenberg N, Bettendorf H, Mihailovici MS. An immunohistochemical study of the steroid hormone receptors in endometrial hyperplasia. Rev Med Chir Soc Med Nat Iasi. 1999; 103(1-2):138-41.
5. Nunobiki O, Taniguchi E, Ishii A, Tang W, Utsunomiya H, Nakamura Y, Mori I, Kakudo K. Significance of hormone receptors status and tumor vessels in normal hyperplastic and neoplastic endometrium. Pathology Int. 2003; 53 (12) 846-52.
6. Rasty G, Richard M, Leo Lu, Paul K, Guy B, Shahla M. Expression of HER-2 / NEU oncogene ia normal, hyperplastic and malignant endometrium. Ann Clin. Lab Sci. 1998; 28 : 138-143.
7. Kim JW, Kim SH, Kim YT, Kim DK. Clinicopathologic and biological parameters predicting the prognosis in endometrial cancer. Yonsei Med J. 2002; 43(6): 769-778.
8. Stoian SC, Simionescu C, Mărgăritescu , Stepan A, Nurciu M. Endometrial carcinomas: correlation between ER, PR, Ki67 status and histopathological prognostic parameters. Rom J Morphol Embryol. 2011; 52(2):631-6.
9. Sunitha CH. Clinical study of diagnostic hysteroscopy in AUB and its histopathological correlation (dissertation). Bijapur: SHRI B.M. Patil medical college hospital & research centre; 2006.
10. Abdullah LS, Bondagji NS; Histopathological Pattern of Endometrial Sampling Performed for Abnormal Uterine Bleeding. Bahrain Med Bull. 2011; 33(4): 1-6.
11. Hanprasertpong J, Sakolprakraikij S, Geater A. Endometrial cancer in Thai women aged 45 years or younger. Asian Pac J Cancer Prev. 2008; 9: 58-62.
12. Richter CE, Qian B, Martel M, et al. Ovarian preservation and staging in reproductive-age endometrial cancer patients.Gynecol Oncol. 2009; 114: 99-104.
13. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis. Am J Obstet Gynecol. 2005; 193: 1640-4.
14. Archana B and Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleedia in premenopausal women Bombay Hosp. J. 2010; 52 : 69-72.
15. Khare A, Bansal R, Sharma S, Elhence P, Makkar N, Tyagi Y. Morphological spectrum of endometrial in patients presenting with DUB. Peoples Journal of scientific research. 2012; 5(2) : 13-16.
16. Armando A, Jose V, Anderson P, Rogério L, Aarão M, Pinto N, Lucia costa P. Immunohistochemical expression at ER, PR receptors in endometrial polyp. Maturities. 2015; 49 : 229-233.
17. Williams GP. The role of oestrogen in the pathogenesis of obesity, type 2 diabetes, breast cancer and prostate disease. Euro J Cancer Prev. 2010; 19(4): 256–71.
18. Mirza T, Saadia A, Aamir M, Sadiya A, Tariq M, Tazeen M. Histopathological pattern of AUB. J of Basics and Applied Sciences, 2012; 8: 14-17.
19. Ejaz S. Causes of post menopausal bleeding Cancer. J. Clin. 2001; 4: 260-262.
20. Cai Q. Expression of ER receptors alpha and beta protein in endometrial carcinoma. cancer therapy. 2003; 6: 907- 912.
21. Bergeron C, Ferenczy A, Toft DO. Immunohistochemical study of PR receptors during menstrual cycle. Lab. Invest. 1988; 59: 862-869.
22. Rasty G, Murray R, Lu L, Kubilis P, Benrubi G, Masood S. Expression of HER-2/neu oncogene in normal, hyperplastic, and malignant endometrium. Ann Clin Lab Sci. 1998; 28(3):138-43
Published
2018-05-21
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