Clinical Analysis of 44 Cases of Atypical Polypoid Adenomyoma of the Uterus

Background: Atypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although, it is considered as a benign lesion and treated conservatively previously, more and more cases show that APA has a high rate of recurrence or residual, and is found to precede the development of carcinoma. The clinical management of APA remains to be established. The aim of this study was to analyse the clinicopathological features of APA and discuss its diagnosis and prognosis.Methods: Forty-four patients with APA were admitted to Beijing Obstetrics and Gynecology Hospital from 2005-2019, and their clinical and histopathologic features were evaluated. B-ultrasound was performed, and all patients (n=44) underwent hysteroscopy. Endometrium excision was performed by means of the “Four-step diagnosis and treatment” method. Hysteroscopic transcervical resection (TCR) was performed in 5 cases with APA-H and 11 with APA-L. Except for one patient who underwent transcervical endometrial resection, all patients underwent hysterectomy and salpingectomy or salpingo-oophorectomy. Data from a median follow-up of 42 months (ranging from 3 to 174 months) were available for these patients.Results: Pathological diagnoses were made according to the degree of abnormality of APA surface glands, resulting in APA-L in 36 cases and APA-H in 8 cases. Among these cases, 28 (25 APA-L and 3 APA-H) were treated conservatively. “Four-step diagnosis and treatment” method performed a excellent effect for APA therapy. During the follow-up no evidence of recurrence was found.Conclusions: For cases with intracavitary lesions > 1 cm, hysteroscopic “four-step diagnosis and treatment” and pathological diagnosis are the basis of clinical treatment. More than 30% of APA surface glands have complex structures, characterized by branching and budding, or other high-risk factors, such as endometrial hyperplasia, which are indications for hysterectomy. For patients with the desire to become pregnant or for uterine preservation, hysteroscopy with complete excision of the lesions should be the preferred treatment method. The patients should be treated individually, followed up closely, and followed up by regular hysteroscopy and endometrial biopsy.

Case Report: Uterine Adenosarcoma With Sarcomatous Overgrowth and Malignant Heterologous Elements

A 46- year-old woman presented a uterine adenosarcoma originating in the lower uterine segment. The diagnosis was made in an endometrial biopsy and confirmed in the pathological examination of the complete surgical specimen, both identifying heterologous malignant elements. In addition, complementary immunohistochemical studies were performed. We reviewed the literature, illustrating the clinical and morphological characteristics and the differential diagnoses to be evaluated.

Correlation of Abnormal Uterine Bleeding (AUB) with Thyroid Profile and Endometrial Biopsy

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of loss. Menstrual disturbances and different endometrial pattern may accompany and precede thyroid dysfunction. The objective of the study was to correlate thyroid profile with endometrial biopsy in cases of AUB. This study was conducted on 74 patients who presented with AUB, had undergone TFT and endometrial biopsy/hysterectomy. Among 74 patients, thyroid disorders were identified in 26 patients. Maximum number of patients with AUB belonged to the category of hypothyroidism (27%) and 8.1% of cases had hyperthyroidism. In the present study 29 (39.1%) had proliferative endometrium, followed by secretory pattern in 21 (28.4%) patients. Hormone induced changes was seen in 3 (4.1%) patients. Disordered proliferative endometrium and endometrial hyperplasia was observed in 6 patients (8.1%) each. Malignant lesion was not common and it comprised of only 1.4% cases. AUB is frequently seen in patients with thyroid dysfunction. Thyroid function test is a cost effective, easily available test and can detect a possibly curable cause of AUB and avoid unnecessary intervention like hormonal treatment and hysterectomy. AUB due to endometrial cause is an age related pathology. Histopathological examination of endometrial biopsy is a major diagnostic tool in evaluation of AUB. It helps the physician to plan therapy for successful management of AUB.

IIB or not IIB, part 2: assessing inter-rater and intra-rater repeatability of the Kenney–Doig scale in equine endometrial biopsy evaluation

Inter- and intra-rater variability negatively affects the reliability of various histopathology grading scales used as prognostic aids in human and veterinary medicine. The Kenney–Doig categorization (grading) scale, which is used to associate equine endometrial histologic lesions with prognostic estimation of a broodmare’s reproductive potential, has not been evaluated for inter- or intra-rater variability, to our knowledge. To assess whether the Kenney–Doig system produces reliable results among observers, 8 pathologists, all with American College of Veterinary Pathologists certification, were recruited to blindly categorize the same set of 63 digital equine endometrial biopsy slides as well as to re-evaluate anonymously 21 of 63 of these slides at a later time. Cohen kappa values for pairwise comparison of final Kenney–Doig categories were −0.05 to 0.46 (unweighted) and 0.08–0.64 (weighted), with an average Light kappa of 0.19 (unweighted) and 0.36 (weighted) across all 8 pathologists, 0.14 (unweighted) and 0.33 (weighted) for pathologists at different institutions, and 0.22 (unweighted) and 0.46 (weighted) for pathologists at the same institution. Intra-class correlations measuring intra-rater agreement were 0.12–0.77 with an average of 0.55 for all 8 pathologists. We found that only slight-to-moderate inter-rater agreement and poor-to-good intra-rater agreement was produced by 8 pathologists using the Kenney–Doig scale, suggesting that the system is subject to significant observer variability and care should be taken when communicating Kenney–Doig categories to submitting clinicians with emphasis on the quality of endometrial lesions present instead of the category and associated expected foaling rate.

Histopathological evaluation of endometrial tissue in patients of abnormal uterine bleeding

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.

Office hysteroscopy: a review

With the invention of new techniques and modalities “see and treat” has become the norm of management now a days. Diagnostic hysteroscopy combined with histological examination of an endometrial biopsy is considered the ‘gold standard’ in the diagnosis of intrauterine abnormalities. The importance of office hysteroscopy lies in the fact that there is no need of any anesthesia and after the procedure the patient can return into his routine activity only with the minimal aid of NSAIDs. Two different types of hysteroscopes are used worldwide: flexible or rigid, which are made in different sizes. Optic miniaturization has been one of the greatest technological advancements in the field of hysteroscopy, both for rod-lens and fiberoptic scopes. The main concerns in office hysteroscopy are the need for necessary expertise, pain management and management of the complications in the office setting and the high cost of the equipment needed for the procedure. But office hysteroscopy has already demonstrated good correlation of findings compared with inpatient hysteroscopy, providing distinct advantages such as reduced anesthesia risks, enhanced time and cost-effectiveness, and faster recovery with less time away from work and home.

Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery

About 10–66% of patients with atypical endometrial hyperplasia diagnosed before surgery (preoperative-AEH) are found to have concurrent endometrial cancer (EC) at definitive hysterectomy, leading to incomplete primary surgery and delayed adjuvant treatment. This study aims to investigate the potential risk factors of concurrent EC in preoperative-AEH patients in a clinical setting with a gynecological pathology review. All patients diagnosed with AEH by endometrial biopsy or curettage that then underwent definitive hysterectomy from January 2016 to December 2019 in a tertiary hospital were retrospectively analyzed. All diagnoses were reviewed by gynecological pathologists. A total of 624 preoperative-AEH patients were included, 30.4% of whom had concurrent EC. In multivariate analysis, postmenopausal status and CA125 ≥ 35 U/mL significantly correlated with concurrent EC (OR = 3.57; 95% CI = 1.80–7.06; OR = 2.15; 95% CI = 1.15–4.03). This risk was remarkably increased in patients with both postmenopausal status and CA125 ≥ 35 U/mL (OR = 16.20; 95% CI = 1.73–151.44). Notably, concurrent EC seemed to occur more frequently in women with postmenopausal time ≥ 5 years (OR = 4.04, 95% CI = 1.80–5.85). In addition, CA125 ≥ 35 U/mL seemed to be an independent risk factor (OR = 5.74; 95% CI = 1.80–18.27) for concurrent intermediate-high-risk EC. Intermediate-high-risk EC was also more commonly seen in preoperative-AEH women with postmenopausal time ≥ 5 years (OR = 5.52, 95% CI = 1.21–25.19, p = 0.027). In conclusion, preoperative-AEH patients with postmenopausal status or elevated level of CA125 might have a high risk of concurrent EC. Adequate pre-surgical evaluation might be suggested for such patients.

Clear Cell Carcinoma of the Endometrium in a Patient Presenting with Postmenopausal Bleeding but Negative Endometrial Biopsy

Endometrial carcinoma is the most common gynecological malignancy in the USA with approximately 66,570 cases and 12,940 deaths in 2020. Clear cell carcinoma (CCC) of the endometrium is an estrogen-independent type II endometrial cancer which accounts for <5% of endometrial cancer. When diagnosed roughly, 45% of patients have extrauterine metastases. Current American College of Obstetrics and Gynecology guidelines recommend transvaginal ultrasound for postmenopausal bleeding and a biopsy for those with endometrial thickness >5 mm. However, we present a case of a postmenopausal woman with a history of fibroid where endometrial biopsy has failed to make diagnosis twice. Hence, further testing should be performed in patients with unexplained postmenopausal bleeding including vaginal hysterectomy with lymph node dissection.

Comparison of Pipelle and Hysteroscopy with D&C in Postmenopausal Patients

Objective: The aim of the study is to compare the pipelle method and hysteroscopy with D&C in postmenopausal patients Methods: In this prospective study, only those postmenopausal patients with postmenopausal bleeding and/or with a sonographically highly developed endometrium who were referred for hysteroscopy with D&C were included. A total of 92 patients were included in this study. Before each procedure, patients were explicitly informed about the study and gave consent. On the condition of anonymity of personal data (surname and first name, date of birth) and after signing a special informed consent form, the patients were allowed to be included in the study. The study was performed as a double-blind study. The obtained histologies (from pipelle and D&C) were sent separately to the same pathologist. Results: The group with malignant and premalignant findings has a central role in our study. After evaluation of the histologically malignant findings from the pipelle and the D&C, the sensitivity of the pipelle in our study was 82%. Conclusion: Endometrial biopsy is an important step to exclude endometrial carcinoma in postmenopausal bleeding. The aim is to minimize the burden and invasiveness of the procedure while maintaining a high degree of diagnostic certainty to avoid unnecessary invasive surgery. The pipelle sampling can be used as an outpatient method without anaesthesia during routine examination. Our study shows that this method of sampling is a safe, accurate and cost-effective outpatient procedure with high sensitivity for the detection of endometrial carcinoma.