Histopathological and Immunohistochemical Study of Endometrial Lesions Obtained from D&C and Hysterectomy Specimens at a Tertiary Care Hospital
Abstract
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 study involved 100 specimens from dilatation and curettage (D & C) and hysterectomy specimens from female patients aged ≥ 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.References
Nandedkar SS, Patidar E, Gada DB , Malukani K, Munjal K , Varma A. Histomorphological Patterns of Endometrium in Infertility. The Journal of Obstetrics and Gynecology of India. 2015; 65 (5):328-334.
KS, Padma SK, Shetty KJP , H LKP, Permi HS, Hegde P. Study of histopathological patterns of endometrium in abnormal uterine bleeding. Chrismed Journal of Health and research. 2014;1(2):1-6.
Kaur P, Kaur A, Suri AK, Sidhu H. A two year histopathological study of endometrial biopsies in a teaching hospital in Northern India. Indian Journal of Pathology and Oncology. 2016 ;3(3):508-519.
Yasmin F, Farrukh R, Kamal F. Efficacy of pielle as a tool for endometrial biopsy. Biomedica. 2007;23:116-119.
Choudry A, Javiad M. Clinical usefulness of pipelle endometrial sampling. Pakisthan Armed Forces Medical Journal. 2005; 55(2): 55-59.
Setzler V. Benjamin F. Deutsch S. Perimenopausal bleeding patterns and pathologic findings. J Am Med Women’s Association. 1990; 45(4):132-134.
Dadhania B, Dhruva G, Agravat A, Pujara K. Histopathological study of endometrium in dysfunctional uterine bleeding. intj res med. 2013; 2(1):20-24.
Sunila SS, Sirmukaddam S, Agrawal D. Clinicopathological study of abnormal uterine bleeding in perimenopausal women. Journal of the Scientific Society. 2015; 42(1):3-6.
Vaidya S, Lakhey M, Vaidya S, Sharma PK, Hirachand S, Lama S, KC S. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J. 2013 ;15(1):74-77.
Doraiswami S, Johnson T ,Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK,The Study of Endometrial Pathology in Abnormal Uterine Bleeding. The Journal of Obstetrics and Gynecology of India. 2011; 61(4):426–430.
Damle RP, Dravid NV, Suryawanshi KH, Gadre AS, Bagale PS, Ahire N. Clinicopathological Spectrum of Endometrial Changes in Peri- menopausal and Post-menopausal Abnormal Uterine Bleeding: A 2 Years Study. Journal of Clinical and Diagnostic Research. 2013; 7(12): 2774-2776.
Reed SD, Newton KM, Garcia RL. Incidence of Endometrial Hyperplasia. Obstet Gynecol. Am J Obstet Gynecol. 2009; 200(6): 678.e1–678.e6.
Sharma V, Saxena V, Khatri SL. Histopathological Study of Endometrium in Cases of Infertility. J Clin Exp Pathol. 6: 272-275.
SS, Won H, Mranzcog MM, Nesbitt-Hawes E, Campbell N. Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature. Journal of Minimally Invasive Gynecology. 2011;18(5):569–581.
Bhatta S, Sinha AK. Histopathological study of endometrium in abnormal uterine bleeding, Journal of Pathology of Nepal. 2012; 2: 297 -300.
Mahapatra M, Mishra P. Clinicopathological evaluation of abnormal uterine bleeding. Journal of Health Research and Reviews. 2015;2(2):45-49.
Jagadale K, Sharma A. Histopathological study of endometrium in Abnormal Uterine bleeding in Reference to Different Age Groups, Parity and Clinical Symptomatology, Int J Clin and Biomed Res. 2015;1(2): 90-95 .
Nargis N, Karim I, S Sarwar KB. Abnormal Uterine Bleeding in Perimenopausal Age: Different causes and its relation with histopathology. Bangladesh Journal of Medical Science. 2014; 13(2):135-139.
Cibula D, Gompel A, MueckAO. Hormonal contraception and risk of cancer. Human Reproduction Update. 2010;16(6):631–650.
Aune D, Sen A, Vatten LJ. Hypertension and the risk of endometrial cancer: a systematic review and meta- analysis of case-control and cohort studies. Sci Rep. 2017; 7: 44808-13.
Kounelis S, Kapranos N, Kouri E, Coppola D. Immunohistochemical Profile of Endometrial Adenocarcinoma: A Study of 61 Cases and Review of the Literature. MOD pathology. 2000;13( 4): 379-388.
Modi M, Nilkanthe DCPR, Trivedi M. Detailed Histopathological Study of Endometrial Carcinoma, and Importance of Immunohistochemistry. Am J Clin Pathol.2016;146:S27-S32.
Suthipintawong C, Wejaranayang C, Vipupinyo C. Prognostic significance of ER, PR, Ki67, c-erbB-2, and p53 in endometrial carcinoma. J Med Assoc Thai. 2008; 91(12):1779-84.
Srijaipracharoen S, Pataradool TK. Expression of ER, PR and Her- 2/neu in Endometrial Cancer: A Clinico pathological Study. Asian Pacific Journal of Cancer Prevention. 2010 ; 11(1):215-220.
Markova I, Duskova M, Lubusky M, Kudela M, Zapletalová J, Procházka M, Pilka R. Selected immunohistochemical prognostic factors in endometrial cancer. Int J Gynecol Cancer. 2010; 20(4):576-82.
Sidonia S, Cristiana S, CM, A S. Endometrial carcinomas: correlation between ER. PR, Ki67 status and histopathological prognostic parameters. Romanian Journal of Morphology and Embryology.2011; 52(2):631–636.
Yu CG, Jiang XY, Li B, Gan L, Huang JF. Expression of ER, PR, C-erbB-2 and Ki-67 in Endometrial Carcinoma and their Relationships with the Clinicopathological Features. Asian Pac J Cancer Prev. 2015;16(15):6789-9.
Kumari PR, Renuka IV, Apuroopa M, Chaganti PD. A study of expression of estrogen and progesterone receptor, in atrophic, hyperplastic and malignant endometrial lesions, with emphasis on relationship with prognostic parameters. International Journal of Research in Medical Sciences. 2015; 3 (11):331.
Masjeed NMA, Khandeparkar SGN, Joshi AR, Kulkarni MM, Pandya N. Immunohistochemical Study of ER, PR, Ki67 and p53 in Endometrial Hyperplasias and Endometrial Carcinomas. Journal of Clinical and Diagnostic Research. 2017; 11(8):31-34.
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