Study of endometrial histopathology in women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is a major gynaecological problem accounting for 33% of Gynaec outpatients. The cause of the bleeding is established in only 50-60% of the cases. The aim of this study was to evaluate the various histopathological patterns in the endometrial biopsy of patients presenting with abnormal uterine bleeding and to determine the specific pathology in the different age groups.Methods: This was a prospective study done in a tertiary care teaching hospital for a period of 2 years. Total of 905 patients with abnormal uterine bleeding were included in the study and they were subjected to a Dilatation and Curettage. Histopathological examination of the endometrial biopsy was done and the various histopathological patterns identified and classified.Results: The age of patients ranged from 24-74 years. 54.7% were in the age group 40-49 years followed by 23.4% in the age group 30-39 years. The most frequent findings were proliferative findings in 47.3% followed by secretory endometrium in 16.1 % patients. Proliferative endometrium was more common in the age group 40-49 years as also disordered proliferation, secretory endometrium, cystoglandular hyperplasia and endometrial hyperplasia.Conclusions: Endometrial curettings and biopsy is an important diagnostic procedure for assessing all cases of abnormal uterine bleeding and to plan for successful management.

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Study of endometrial pathology in women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184962 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5037

Author(s):

Jessy Varghese ◽

Jeyashambavi J. ◽

Deepa S.

Keyword(s):

Histopathological Examination ◽

Abnormal Uterine Bleeding ◽

Clinical History ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Reproductive Age ◽

Age Group ◽

Endometrial Pattern ◽

Proliferative Endometrium ◽

A Prospective Study

Background: Abnormal uterine bleeding is one of the most common complaint that reproductive age women bring to their clinicians. Causes are varied and study of endometrium by dilatation and curettage with histopathological examination is an important aspect of treating patients with Abnormal uterine bleeding (AUB). The present study was done for evaluation of the histopathology of the endometrium for identifying endometrial causes of AUB.Methods: A prospective study was conducted over a period of one year from July 2017 to July 2018 in the department of Obstetrics and Gynaecology in collaboration with the department of Pathology at Aarupadai Veedu Medical College, Puducherry. A complete clinical history, complete clinical examination, laboratory investigations, pelvic scan and endometrial biopsy were done to diagnose causes of AUB.Results: A total of 152 cases are included. The age of the patients having AUB was ranging from 21 to 70 years. AUB was more common the age group in the age group 41-50 years (49%) followed by 31-40 years (36%). Majority were multiparous (74%). Menorrhagia (61%) was the commonest presentation. Majority of the cases showed a disordered proliferative endometrial pattern (34.2%), followed by secretory pattern (25%). 9.8% had polyp and 1.3% showed simple hyperplasia and 0.62% revealed complex hyperplasia without atypia and carcinoma endometrium.Conclusions: Abnormal uterine bleeding was more common in the perimenopausal age group and majority had disordered proliferative endometrium and secretory changes. Endometrial sampling followed by histopathological examination helps us to diagnose the underlying pathology and will help in treating the patients appropriately including ruling out premalignant and malignant conditions of the uterus.

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Retrospective study of histopathological pattern of endometrium in abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201065 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1346

Author(s):

A. Shantha ◽

Nazia Hussain

Keyword(s):

Retrospective Study ◽

Social Life ◽

Ultrasound Examination ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Age Group ◽

Dilatation And Curettage ◽

Proliferative Endometrium ◽

Considerable Morbidity

Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint associated with considerable morbidity. It significantly affects the patient’s family personal and social life. The aim of this study was to analyse the histopathological patterns of endometrium in patients presenting with AUB.Methods: This is a retrospective study conducted in the teaching hospital in the department of obstetrics and gynecology along with the pathology department. All patients with AUB were included in the study. This study of 138 samples both from hysterectomy specimens and endometrial biopsy were included.Results: The specimen obtained for examination of the endometrial samples 86 comprised from dilatation and curettage and rest 52 samples were obtained from hysterectomy specimens. Most common histopathological pattern was found to be proliferative endometrium, followed by disordered proliferative endometrium and atropic endometrium.Conclusions: Study of the histopathological pattern of the endometrial biopsies can be included in the initial evaluation of women with AUB when the cause of bleeding is not known along with ultrasound examination, then using it as the last modality for diagnostic and therapeutic purposes, irrespective of age group.

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Routine Syndecan-1 Immunohistochemistry Aids in the Diagnosis of Chronic Endometritis

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-1000-rsiait ◽

2004 ◽

Vol 128 (9) ◽

pp. 1000-1003 ◽

Cited By ~ 11

Author(s):

Ilene B. Bayer-Garner ◽

Jennifer A. Nickell ◽

Soheila Korourian

Keyword(s):

Plasma Cells ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Endometrial Polyp ◽

Chronic Endometritis ◽

Underlying Malignancy ◽

Proliferative Endometrium ◽

Exogenous Progesterone ◽

Secretory Endometrium

Abstract Context.—Chronic endometritis is reportedly observed in 3% to 10% of women undergoing endometrial biopsy for abnormal uterine bleeding. The diagnosis of chronic endometritis rests on the identification of the plasma cells. Their identification may be obscured by a mononuclear cell infiltrate, plasmacytoid stromal cells, abundant stromal mitoses, a pronounced predecidual reaction in late secretory endometrium, menstrual features, or secondary changes due to exogenous progesterone treatment prior to the biopsy. Syndecan-1 is a proteoglycan that is found on the cell surface of plasma cells and keratinocytes. Immunohistochemistry stains for this antibody may facilitate diagnosis of chronic endometritis. Objective.—To determine whether or not routine syndecan-1 immunohistochemistry will aid in the diagnosis of chronic endometritis. Design.—Immunohistochemistry stains for syndecan-1 were performed on 3 levels of 47 endometrial biopsies from patients with abnormal uterine bleeding. None of the patients had endometrial hyperplasia or an underlying malignancy. Clinical correlation and follow-up was attempted in 20 cases that showed evidence of plasma cells by syndecan-1 by immunohistochemistry. Results.—Plasma cells were identified in 20 cases, 7 of which were initially diagnosed as chronic endometritis. The remaining 13 positive cases were diagnosed as tubal metaplasia (1), secretory endometrium (4), proliferative endometrium (4), menstrual endometrium (1), endometrial polyp (1), secretory endometrium with endometrial polyp (1), and endometrial polyp with exogenous hormone effect (1) based on the original hematoxylin-eosin section. Conclusions.—Syndecan-1 may be a useful adjunct in the diagnosis of chronic endometritis. Approximately half of the cases of chronic endometritis responded to an antibiotic regime; thus, this diagnosis is important and may potentially obviate the need for surgical intervention.

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A clinicopathological study of dysfunctional uterine bleeding

Journal of Pathology of Nepal ◽

10.3126/jpn.v4i8.11500 ◽

2014 ◽

Vol 4 (8) ◽

pp. 635-638

Author(s):

N Katuwal ◽

G Gurung ◽

A Rana ◽

A Jha

Keyword(s):

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

University Teaching ◽

Age Group ◽

Dysfunctional Uterine Bleeding ◽

Obstetrics And Gynaecology ◽

Proliferative Endometrium ◽

One Year ◽

Complete History

Background: Dysfunctional uterine bleeding is a form of abnormal uterine bleeding when there is absence of organic disease of the genital tract. The objective of this study was to find out the clinical and pathological aspect of women presenting with dysfunctional uterine bleeding.Materials and Methods: A descriptive study was conducted over a period of one year from April 14th 2010 to April 13th 2011 in the Department of Obstetrics and Gynaecology and Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. A complete history, clinical examination, pelvic scan, hormonal status if required and endometrial biopsy were done to diagnose dysfunctional uterine bleeding.Results: A total of 120 cases were included. The age of the patients diagnosed dysfunctional uterine bleeding were ranging from 24 -63 years. Dysfunctional uterine bleeding was most common in the age group 40-44 yrs (30%) followed by 45-49 yrs (27.5%). Menorrhagia (41.7%) was the most common presenting sign. Majority histopathology of endometrium revealed anovulatory pattern (61.7%) followed by ovulatory (38.3%). Of the cases with an anovulatory pattern 48.6% was proliferative endometrium, 33.8% disordered proliferative endometrium, 6.8%atrophic, 5.4% weakly proliferative and 2.7% each of simple hyperplasia without atypia and complex hyperplasia with atypia. All cases with ovulatory pattern showed secretory endometrium.Conclusion: Dysfunctional uterine bleeding was the most common in the perimenopausal age group and chiefly in the form of an anovulatory endometrium. . Histopathological evaluation of endometrium helps exclude the local causes and establishes the diagnosis of dysfunctional uterine bleeding, its types, and clinical correlation to histopathological findings and finally helps to determine the mode of management.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11500 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 635-638

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Abnormal Uterine Bleeding – A Clinico-pathological Study

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.2926 ◽

2021 ◽

Vol 8 (1) ◽

pp. A9-13

Author(s):

Sarita . ◽

Nisha J Marla ◽

Nagarathna . ◽

Jayaprakash C S

Keyword(s):

Abnormal Uterine Bleeding ◽

Cost Effective ◽

Reproductive Period ◽

Uterine Bleeding ◽

Target Organ ◽

Direct Access ◽

Age Group ◽

Morphological Findings ◽

Dilatation And Curettage ◽

Proliferative Endometrium

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.

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Diagnostic hysteroscopy in abnormal uterine bleeding: a five years study in Kathmandu university hospital

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20171998 ◽

2017 ◽

Vol 3 (5) ◽

pp. 128

Author(s):

Abha Shrestha ◽

Bhagirathi Kayastha ◽

Ramesh Makaju

Keyword(s):

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

University Hospital ◽

Histopathologic Examination ◽

Diagnostic Modality ◽

Submucous Myoma ◽

Dilatation And Curettage ◽

Proliferative Endometrium ◽

Method Of Evaluation ◽

A Prospective Study

Background: Abnormal uterine bleeding is the cause of concern, inconvenience and discomfort to many ladies, this affects millions of women in both developed and developing world. Until recent times, dilatation and curettage was the usual method of evaluation .This detects the cause of bleeding in less than 50% of the cases, but hysteroscopy is a better diagnostic modality and prompt treatment can be provided in the same setting.Methods: A prospective study was carried out in the Department of Obstetrics and Gynecology at Dhulikhel hospital, Kathmandu University Hospital, Kavre, Nepal from January 2010 to January 2016. Two hundred and eighteen cases were enrolled in this study. Patients with abnormal uterine bleeding above the age of 18 years were enrolled. Hysteroscopic examination was done in all patients after the pregnancy was ruled out with urine pregnancy test and ultrasonology. The patients then underwent hysteroscopic guided endometrial sampling and endometrium was sent for histopathologic examination. The correlation between findings on hysteroscopy and histopathologic examination was tabulated. Results: Following were the findings on hysteroscopy: proliferative endometrium was in 59%, secretary endometrium was in 14%,endometrial hyperplasia in 12%, atrophic in 2 %, endometrial polyp in 7%, submucous myoma in 5% and carcinoma of endometrium in 1%.Conclusions: In patients with abnormal uterine bleeding, hysteroscopy provides more accurate diagnosis than dilatation and curettage.

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Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding

The Journal of South Asian Federation of Menopause Societies ◽

10.5005/jp-journals-10032-1120 ◽

2017 ◽

Vol 5 (2) ◽

pp. 123-128

Author(s):

Nikhitha Chandrashekar ◽

Jyothi GS ◽

Prasanna Shetty

Keyword(s):

Predictive Value ◽

Endometrial Hyperplasia ◽

Tertiary Care ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Histopathological Analysis ◽

Care Hospital ◽

Dilatation And Curettage ◽

Risk Of Cancer

ABSTRACT Aim The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&C). Materials and methods Pipelle endometrial biopsy and D&C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis. Results The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%. Conclusion It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle. Clinical significance Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids. How to cite this article Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.

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Histopathological evaluation of endometrial tissue in patients of abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215077 ◽

2021 ◽

Vol 11 (1) ◽

pp. 69

Author(s):

Zothansangi . ◽

Vanremmawii . ◽

Naveen P.

Keyword(s):

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Endometrial Tissue ◽

Histopathological Study ◽

Age Group ◽

North East ◽

The North ◽

Resource Setting ◽

A Prospective Study

Background: Abnormal uterine bleeding (AUB) is one of the commonest complaints in the gynecology OPD. It is also one of the most common reason for hysterectomy among Mizo women. Endometrial biopsy is a gold standard and first step for diagnosis of AUB in a low resource setting like the North-east states of India. The aim of the study was to evaluate the histopathology of endometrium for proper management of AUB cases.Methods: This was a prospective study done to evaluate the histopathology of all the cases of AUB who attended gynaecology OPD, from the year 2018 to 2020. This study comprised of 668 AUB cases and material of the study was endometrial tissue of the cases of Abnormal uterine bleeding collected by dilatation and curettage, and sent for histopathological study to the department of pathology.Results: Most of the abnormal uterine bleeding patients was in the age group of 40 to 49 years, and the most common histopathological finding was proliferative endometrium, 35.5% followed by disordered proliferation, 21%. 14 cases of carcinoma endometrium were found among the age group above 40 years.Conclusions: The research evident that all the women above 40 years old need to undergo screening, keeping in mind the higher risk of carcinoma in the older age group of women.

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HISTOPATHOLOGICAL STUDY OF ENDOMETRIUM IN WOMEN WITH ABNORMAL UTERINE BLEEDING

10.36106/ijsr/6103945 ◽

2021 ◽

pp. 30-33

Author(s):

Bhakti D Deshmukh ◽

Anuradha Malpani ◽

Alka V Gosavi ◽

Kalpana R Sulhyan ◽

Rucha M Pimpalkhute

Keyword(s):

Histopathological Examination ◽

Tertiary Care ◽

Abnormal Uterine Bleeding ◽

Intraepithelial Neoplasia ◽

Mucinous Carcinoma ◽

Uterine Bleeding ◽

Serous Carcinoma ◽

Histopathological Study ◽

Care Hospital ◽

Age Group

BACKGROUND –Abnormal uterine bleeding (AUB) is dened as a bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle. The term dysfunctional uterine bleeding (DUB) is used to describe abnormal uterine bleeding for which no specic cause has been found. AUB is one of the most common gynaecological problems. This study was done to evaluate histological patterns of endometrium in women with abnormal uterine bleeding. AIMS AND OBJECTIVE – To study various histological patterns of endometrium in abnormal uterine bleeding and correlate it with age, parity and symptoms. MATERIAL AND METHODS –This is a retrospective study, conducted in the Department of Pathology, in a tertiary care hospital from 1st July 2016 to 30th June 2019. Total 718 specimens with AUB were included in the study from the age group of 21 to 95 years. The specimens received were hysterectomy (74.65 %), endometrial biopsies (21.45%), dilatation and curettage (2.79 %) and transcervical resection of endometrium (1.11 %). RESULTS –The patients with AUB were mainly from the age group 41-50 years with menorrhagia as the chief complaint. Most of the women with AUB were multiparous (84.54%). The most common pattern observed on histopathological examination was proliferative endometrium (49.86%) followed by atrophic endometrium (10.31%). Malignancy was found in 2.23% (Endometrioid carcinoma – 1.81%, serous carcinoma - 0.14% and mucinous carcinoma – 0.28%). Endometrial hyperplasia without atypia (23 cases, 3.20%) was more common than endometrial atypical hyperplasia (EAH) / endometrioid intraepithelial neoplasia {EIN} (4 cases, 0.56 %). Various other patterns of endometrium on histopathology were endometritis (6.82 %) followed by endometrial polyp (4.46 %). CONCLUSION – Histopathological examination of endometrium should be done generously in women presenting with abnormal uterine bleeding especially after the age of 40 years to rule out malignant pathology.

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Histopathological spectrum of endometrium in abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183767 ◽

2018 ◽

Vol 7 (9) ◽

pp. 3633 ◽

Cited By ~ 1

Author(s):

Simridhi Bindroo ◽

Monika Garg ◽

Tajinder Kaur

Keyword(s):

Endometrial Hyperplasia ◽

Histopathological Examination ◽

Age Groups ◽

Healthy Woman ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Age Group ◽

Proliferative Endometrium ◽

Histopathological Workup ◽

Endometrial Carcinomas

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.

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