Abnormal Uterine Bleeding – A Clinico-pathological Study

  • Sarita . Department of Pathology, Father Muller Medical College
  • Nisha J Marla Department of Pathology, Father Muller Medical College
  • Nagarathna . Department of OBG, Father Muller Medical College
  • Jayaprakash C S Department of Pathology, Father Muller Medical College
Keywords: Abnormal Uterine Bleeding, Endometrial samples, Histomorphology, Clinico-pathological study

Abstract

Background: Abnormal Uterine Bleeding (AUB) can occur at any age in a woman`s reproductive period and needs to be assessed very carefully and immediately. When it occurs in the older age group, a more meticulous screening for malignancy is imperative so that treatment can be more radical. Dilatation and curettage is a simple, cost effective, safe and a reliable investigation and it gives us a direct access to the target organ. Methods: Study was conducted prospectively on 162 patients presenting with AUB in reproductive, perimenopausal and postmenopausal age group. All the endometrial samples procured from the endometrial curettage were fixed in 10% buffered formalin for 12-24 hours, processed in the automated tissue processor, cut and stained with Hematoxylin & Eosin (H & E) stain and were finally studied in detail for the morphological findings under light microscopy. Result: In our study Secretory endometrium was most common type, which was followed by Proliferative endometrium. Disordered proliferative endometrium and Endometrial hyperplasia were the commonest histopathological patterns seen in AUB of organic type. Endometrial carcinoma was seen more commonly in postmenopausal age group. Further, in our study Mc Cluggage criteria was applied to all the samples to categorize endometrial samples which were unassessable and inadequate. Conclusion: Evaluation of Endometrial samples is important in all patients with Abnormal Uterine Bleeding (AUB) to find out the Organic Pathology. Histopathological typing of endometrium is crucial for appropriate therapy. Its interpretation is quite challenging and also may show considerable interobserver variability. In AUB, the endometrial samples should be taken during the bleeding episode itself. Dilatation and curettage is a simple, cost effective, safe and reliable investigation and gives us a direct access to the target organ.

References

Gupta R, Porwal V, Porwal SK, Swarnkar M et al. A Retrospective Histopathological Study of 100 cases of Endometrial Curetting in Perimenopausal Women with Abnormal Uterine Bleeding. Journal of Pharm Biomedical Science 2015;05(09):757–759.

Sarwar A, Haque A. Types and frequencies of pathologies in endometrial curettings of abnormal uterine bleeding. International Journal of Pathology 2005;3(2): 65-70.

Das B, Das A. Histophological Patterns of Endometrial Biopsy in Abnormal Uterine Bleeding. Indian Journal of Applied Research. 2016; 6(6): 2249-2555.

Dadhania B, Dhruva G, Agravat G, Agravat A et al. Histopathological Study Of Endometrium In Dysfunctional Uterine Bleeding. Int J Res Med. 2013; 2(1);20-24.

Khadim M T, Zehra T, Ashraf H M. Morohological study of pipelle biopsy specimens in cases of abnormal uterine bleeding. Journal Pak Med Assoc( JPMA) 2015 Jul;65(7):705-9.

Sharma J, Bhargava R, Bharath V, Sharma T et al . A study of spectrum of morphological changes in endometrium in abnormal uterine bleeding. Journal of advance researches in Biological Sciences .2013; 5(4): 370-5.

Rosai J. Female reproductive system – Uterus – corpus. In: Rosai and Ackerman’s Surgical Pathology. 10th ed. vol 2.Edinburg: Mosby; 2011: 1480-1635.

Sajitha K, Shetty K P, Shetty J, Kishan Prasad HL et al. Study of histopathological patterns of endometrium in abnormal uterine bleeding. Chrismed Journal of Health and Research.2014; 1( 2).

Berek J S et al. Editors. Novak’s Textbook of Gynaecology. 15th edition. Lippencott Williams & Wilkins. 2007.

Herschorn S. Female Pelvic Floor Anatomy : The Pelvic Floor, Supporting Structures, and Pelvic Organs. PMC National Library of Medicine. 2004; 6(5): S2-S10.

Ghani N A, Abdulrazak A A, Abdullah E M. Abnormal uterine bleeding :A histopathological study. World research journal of clinical pathology.2012 ;1(1):6-8.

Coward A,Well D. Textbook of Clinical Embryology. Cambridge University press.2013 ;5(4):370-75.

Oehler M K, Rees M C. Menorrhagia an update. Acta Obstet Gynecol Scand 2003;82:405-22

Longacre T A, Atkins K A , Kanpson R L, Hendrickson M R .The Uterine Corpus .In: Mills S E , Cartec D, Greenson J K, Ureuter V S, Stoler M H . 5th edition. Philadelphia : Lippincott William and Wilkins ;2010:2184-2277.

Dijkhuizen F P, Mol B W, Brolmann H A, Heintz A P. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia. 2000;89(8) :1765-72.

Takreem A, Danish N, Razaq S. Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/menorrhagia in perimenopausal women. J Ayub Med Coll Abbottabad 2009;21(2):60-3.

Buckley CH, Fox H. Biopsy Pathology of the endometrium. 2nd edition. Hoddor Arnold. 2002 March 29.

Padubidri VG, Daffary SN. Shaw’s textbook of Gynaecology. 16th edition. Elsevier. 2014.

Published
2021-01-30
Section
Original Article