scholarly journals Postmenopausal Bleeding: An Update

2021 ◽  
Vol 3 (1) ◽  
pp. 28-33
Author(s):  
Shaikh Zinnat Ara Nasreen ◽  
Nusrat Mahjabeen ◽  
Safinaz Shahreen
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Hormone Replacement ◽  
Treatment Modalities ◽  
Clinical Approach ◽  
Postmenopausal Bleeding ◽  
Endometrial Sampling ◽  
Unopposed Estrogen ◽  
Endometrial Intraepithelial Neoplasia

The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia and to find out the real source. Postmenopausal bleeding is ‘endometrial cancer until proven otherwise’, although only 1-14% of such patients will actually have cancer. Clinical risk factors of endometrial carcinoma such as obesity, unopposed estrogen use, polycystic ovary syndrome, diabetes mellitus and family history of gynaecologic malignancy also should be considered during evaluation. Postmenopausal bleeding usually attributed to an intrauterine source, but it may arise from the cervix, vagina, vulva or fallopian tubes & ovaries. The origin of bleeding can also involve non-gynaecologic sites, such as the urethra, bladder, anus/rectum/bowel, or perineum. Meticulous history and thorough physical examination are must. Initial evaluation is by TVS, if endometrial thickness (ET) is <4mm no further evaluation is required but follow up consultation must. If ET is> 4mm, hysteroscopic evaluation and endometrial sampling is recommended Blind endometrial sampling is not accurate as only reveals when endometrial cancer exceeds more than 50% of the endometrial surface area so may be done if hysteroscopic evaluation is not possible. Higher dose of progesterone may be required for endometrial protection when higher doses of estradiol as hormone replacement therapy are used, or in women with high BMI. Unopposed estrogen therapy is associated with a duration and dose-related increase in risk of endometrial hyperplasia and cancer. Endometrial protection requires an adequate dose and duration of progestogen. Endometrial hyperplasia with atypia has much malignant potential but endometrial hyperplasia without atypia may be managed medically with 3 monthly endometrial sampling, if no regression or further progression hysterectomy is the choice of treatment. Finally, patient counseling with discussion of risks /benefits of different options of treatment modalities is the cornerstone of success of addressing postmenopausal bleeding.

scholarly journals Prevalence of Coexisting Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia with Atypia

2020 ◽  
Vol 7 (52) ◽  
pp. 3180-3184
Author(s):  
Divya Sara Raju ◽  
Resmy C. Raveendran ◽  
Ayswariya Manivannan
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Cross Sectional ◽  
Endometrial Sampling ◽  
Atypical Endometrial Hyperplasia ◽  
Invasion Stage ◽  
Endometrial Intraepithelial Neoplasia ◽  
Endometrial Hyperplasia With Atypia

BACKGROUND Concurrent carcinoma endometrium occurs in around 40 % of hysterectomy specimen done for premalignant endometrial intraepithelial neoplasia. We intend to study the prevalence of coexisting endometrial cancer in patients who were diagnosed with endometrial hyperplasia with atypia and had undergone hysterectomy. METHODS This cross-sectional study conducted at Government Medical College, Thrissur, included all women with a pre-operative diagnosis of endometrial hyperplasia with atypia (WHO) undergoing hysterectomy during the study period. RESULTS A total of 40 women were found to have atypical endometrial hyperplasia in the study period. The mean age of presentation was 51 ± 2. 7 yrs. and was more common in multiparous postmenopausal women. Postmenopausal bleeding was the most common presenting symptom and more than 50 % of women were overweight. The proportion of concurrent endometrial carcinoma in women with atypical endometrial hyperplasia was found to be 37. 5 %. 93 % of cases with concurrent endometrial carcinoma were of grade I endometrioid type. High risk features were defined as > 50 % myometrial invasion, seen in 47 % patients. Stage 2 endometrial carcinoma was seen in 27 % patients. 53 % patients had less than 50 % myometrial invasion. Stage 1a and 1b endometrial carcinoma was seen in 53 % and 20 % of patients respectively. CONCLUSIONS Large dicer of overlap exists between atypical endometrial hyperplasia (AEH) and early-stage endometrial carcinoma. Therefore, we should recognise the limitation of endometrial sampling in distinguishing between these two groups. KEYWORDS Atypical Endometrial Hyperplasia, Endometrial Carcinoma, Endometrial Sampling

Assessment of Risk Scoring Model for Prediction of Endometrial Cancer Among Symptomatic Postmenopausal Women (A Prospective Cohort Study)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Magdy M Abd Elgawaad ◽  
Amr M El Helaly ◽  
Malames M Faisal ◽  
Asmaa F Kasem
Keyword(s):  
Endometrial Cancer ◽  
Family History ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Serous Carcinoma ◽  
Scoring Model ◽  
Gynecological Malignancy ◽  
Risk Scoring ◽  
Study Population

Abstract Background Endometrial carcinoma is the most common gynecological malignancy in the developed countries and the third common gynecological malignancy in Egypt after breast and ovarian cancers. Aim of the Work to evaluate this risk scoring model on Egyptian patients and to study the effect of adding other patient characteristics (DM, BMI and relevant family history) on the sensitivity and specificity of RHEA scoring model. Patients and Methods The current study was conducted in Ain Shams University Maternity Hospital in the period between September 2017 and December 2018. A total of 100 women with postmenopausal bleeding and endometrial thickness &gt; 4mm were included in the study. Results Histological examination revealed that benign pathology (n = 65) (73%) was found to be: most common cause was endometrial hyperplasia without atypia (20.3%) followed by chronic endometritis (13.5%), then endometrial polyp (11.3%), cystic atrophy of endometrium (8.9%), proliferative endometrium (8.9%), endometrial hyperplasia with atypia (6.7%) and lastly mucous polyp (3.4%) while malignant histopathology(n = 24)(27%) which is significantly higher than the international rates showed: Endometriod adenocarcinoma (n = 19)(21.3%), papillary serous carcinoma (n = 4)(4.5%) and undifferentiated carcinoma (n = 1)(1.1%). The current study showed that RHEA score performs in our study population with a comparable validity to that reported by its inventors with sensitivity 79.2% (57.8% - 92.9%) vs. 87.5% and specificity 84.6% (73.5% - 92.4%) vs. 80.1% respectively. In results of the current study it was found that the time since onset of menopause rather than age was associated with endometrial cancer with the optimum cut-off for postmenopausal duration was estimated to be 9 years achieving a sensitivity of 87.5% and a specificity of 60.0%, but it needs multivariate analysis on larger and more representative sample size to confirm this association, A statistically significant regression model was including only postmenopausal duration, recurrent bleeding and endometrial thickness. None of age, BMI, family history or hypertension proved a statistically significant predictive effect after adjustment for other predictive variables. Conclusion Taking in consideration the higher prevalence of endometrial carcinoma in the sample of the current study, the wide 95% confidence intervals for the different validity indices for the RHEA scores derived from this study, it seems that RHEA score performs in this study population with a comparable validity to that reported by its inventors.

scholarly journals Forgotten Lippes Loop associated with Endometrial Carcinoma

2011 ◽  
Vol 3 (3) ◽  
pp. 147-148
Author(s):  
Smiti Nanda ◽  
Savita Rani Singhal ◽  
Seema Madan
Keyword(s):  
Endometrial Carcinoma ◽  
Vaginal Bleeding ◽  
Intrauterine Device ◽  
Endometrial Adenocarcinoma ◽  
Postmenopausal Bleeding ◽  
Endometrial Sampling

ABSTRACT Patients with a forgotten intrauterine device (IUD) present most often with irregular vaginal bleeding or postmenopausal bleeding. We report a case of nonmedicated IUD (Lippes loop) associated with endometrial adenocarcinoma in a woman who presented with postmenopausal bleeding and a forgotten IUD. Although the occurrence of endometrial adenocarcinoma with IUD is almost unknown, yet given the serious nature of the disease, endometrial sampling is indicated in any patient with postmenopausal bleeding and IUD in situ.

scholarly journals Neoplasia intraepitelial endometrial: una lesión precursora de cáncer de endometrio

2021 ◽  
Vol 81 (01) ◽  
pp. 75-85
Author(s):  
Ernesto Lara ◽  
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Intraepithelial Neoplasia ◽  
Atypical Hyperplasia ◽  
Classification Systems ◽  
World Health ◽  
Type I ◽  
Female Population ◽  
Typical Sequence ◽  
Endometrial Intraepithelial Neoplasia

Endometrial cancer represents worldwide the sixth most common malignant pathology in the female population, the endometroid type constitutes the most common form, usually developed from a typical sequence of endometrial hyperplasia secondary to sustained exposure to unopposed estrogens balanced by progestogens. Different classification systems for endometrial hyperplasia have been described, the most recent, published by the World Health Organization in 2014, proposes two categories: 1) hyperplasia without atypia, and 2) atypical hyperplasia or endometrial intraepithelial neoplasia. This classification avoids confusion due to the different terms in use and reflects a better understanding of the pathology behavior. Atypical hyperplasia or endometrial intraepithelial neoplasia is considered a precursor lesion to endometrial carcinoma type I. Health professionals must handle standardized terminology, accurately diagnose this entity, and ensure proper treatment of it. Keywords: Endometrial intraepithelial neoplasia, Endometrial hyperplasia, Atypical hyperplasia, Endometrial cancer.

COMPARISON OF ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA & WHO CLASSIFIED ENDOMETRIAL HYPERPLASIA IN PREDICTING THE RISK OF PROGRESSION TO ENDOMETRIAL CARCINOMA

2021 ◽  
pp. 59-61
Author(s):  
Bansi Kavar ◽  
Neeru Dave
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Intraepithelial Neoplasia ◽  
Atypical Hyperplasia ◽  
Cytological Atypia ◽  
Endometrial Intraepithelial Neoplasia ◽  
Risk Of Progression ◽  
Classi Cation ◽  
Cation System ◽  
Sampling Procedures

Background: Endometrial hyperplasia is the precursor lesion of most endometrial cancers of endometrioid type. The most commonly used classication system for endometrial hyperplasia is WHO 1994 classication system in which architecture disruption and cytological atypia are used to identify four types of endometrial hyperplasia including simple or complex hyperplasia with or without atypia. Newer EIN diagnosis by cytological atypia is of great consideration for the progression to endometrial cancer. Material And Methods: The study consists of 100 cases of WHO classied endometrial hyperplasia for period of 4 yrs from 2015 to 2019. Type of sampling procedures- dilation & curettage, endometrial biopsy and fractional curettage. Objective: 1. To discuss revised criteria for recognition of endometrial intraepithelial neoplasia (EIN). 2. To nd out the sensitivity of endometrial intraepithelial neoplasia (EIN) classication in predicting the risk of malignancy. Results: This study consists of 100 cases of endometrial hyperplasia. Patients were mostly postmenopausal & presented with abnormal vaginal bleeding. From WHO classied endometrial lesions, 2 out of 35 cases of simple typical hyperplasia, 10 out of 14 cases of complex typical hyperplasia,12 out of 20 cases of simple atypical hyperplasia and 20 out of 21 cases of complex atypical hyperplasia were reclassied as EI N. Conclusion: To estimate the risk of progression to carcinoma and guide clinical management, the histo-pathologic diagnosis of endometrial hyperplastic lesion is very important, specially the diagnosis of EIN lesions. EIN carries a much greater risk of progression to endometrial cancer than other WHO classied endometrial hyperplasia.

Relationship between Transvaginal Ultrasound Endometrial Volume, Body Mass Index and Endometrial Pathology in Women with Postmenopausal Bleeding

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Salah El Sokkary ◽  
Mahmoud Mohamed Ghaleb ◽  
Rowyna Hany Mohamed El Helw
Keyword(s):  
Statistical Analysis ◽  
Endometrial Carcinoma ◽  
Diagnostic Performance ◽  
Endometrial Hyperplasia ◽  
Transvaginal Ultrasound ◽  
Postmenopausal Bleeding ◽  
Diagnostic Characteristics ◽  
Endometrial Volume ◽  
One Year ◽  
Endometrial Pathology

Abstract Background Menopause is recognized to have occurred after one year of amenorrhea, for which there is no other obvious pathological or physiological cause. Perimenopause should include the period immediately prior to the menopause (when the endocrinological, biological and clinical features of approaching menopause commence) and the first one year after menopause. Objectives The aim of the study is classification of patients into those with benign endometrial pathology and those with endometrial hyperplasia or carcinoma using endometrial volume and BMI. Patients and Methods This observational cross sectional study was conducted at the Department of Obstetrics and Gynecology in Ain Shams University Hospital from March 2019 till January 2020. The population of this study was 100 menopausal women with postmenopausal bleeding ≥12 months and endometrial thickness by TVUS ≥5 mm. Results According to histopathology of endometrial carcinoma, statistical analysis of our data revealed that age, menopausal duration and BMI were significantly highest. Parity was significantly lowest. Endometrial volume was significantly highest in carcinoma (7.9±2.9 cc). Age, menopausal duration, parity and endometrial volume had significant moderate diagnostic performance in predicting endometrial carcinoma but BMI had significantly low. Age ≥ 62.0, menopausal duration ≥ 11.0 and parity ≤3.0 had low diagnostic characteristics in diagnosis of endometrial carcinoma but endometrial volume ≥ 6.0 had high sensitivity but low other diagnostic characteristics in the diagnosis of endometrial carcinoma. According to histopathology of endometrial hyperplasia, statistical analysis of our data revealed that age, menopausal duration, BMI, parity and endometrial volume had no significant diagnostic performance in the diagnosis of endometrial hyperplasia. Conclusion In our study, analysis of data revealed that the using of transvaginal measurement of endometrial volume is the best predictor of endometrial cancer with a positive correlation with BMI.

COMPARATIVE STUDY OF ENDOMETRIAL CYTOLOGY AND ENDOMETRIAL BIOPSY IN PERI MENOPAUSAL WOMEN

2021 ◽  
pp. 42-43
Author(s):  
Vasudha Rani ◽  
Punam Kumari ◽  
Asha Jha
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Endometrial Hyperplasia ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Focal Lesion ◽  
Diagnostic Strategy ◽  
Rule Out

Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anaesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, ofce vacuum aspiration (Pipette) and the use of ofce hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of nding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-à-vis each other. Histological assessment is the nal word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Carcinoma. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. Asingle-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the ofce hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.

scholarly journals Differential diagnosis between normal endometrium and endometrial hyperplasia with immunostaining cytology using anti-LeY monoclonal antibody

2003 ◽  
Vol 13 (1) ◽  
pp. 42-46
Author(s):  
Y. Arai ◽  
M. Nishida
Keyword(s):  
Monoclonal Antibody ◽  
Differential Diagnosis ◽  
Endometrial Cancer ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Negative Staining ◽  
Positive Staining ◽  
Normal Endometrium ◽  
Number Of Cells

We have previously reported that both endometrial cancer and endometrial hyperplasia stain positively for the anti-LeY monoclonal antibody, whereas normal endometrium does not. Endometrial hyperplasia is a premalignant change associated with the eventual development of endometrial carcinoma. However, it can be difficult to differentiate hyperplasia from normal endometrium in cytology. This study illustrates the use of immunocytochemical cytology using anti-LeY monoclonal antibody to differentiate between endometrial hyperplasia and normal endometrium. Immunostaining using anti-LeY monoclonal antibody was performed on cytologic specimens obtained from 17 normal endometria, 25 endometria with endometrial hyperplasia, and 13 endometria with endometrial carcinoma. All normal endometria displayed negative staining for anti-LeY monoclonal antibody, whereas all endometria with endometrial carcinoma displayed positive staining. Of the endometrial hyperplasia cases, 21 displayed positive staining. However, four displayed negative staining due to the small number of cells available for diagnosis. We believe that immunostaining cytology using anti-LeY monoclonal antibody is a useful method for differentiating between normal endometrium and endometrial hyperplasia.

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