IJCRR - 7(22), November, 2015
CLINICOPATHOLOGICAL STUDY OF ENDOMETRIUM IN PATIENTS WITH ABNORMAL UTERINE BLEEDING
Author: Humaira Bashir, Nazia Bhat, Mehnaz Sultan Khuroo, Ruby Reshi, Mir Junaid Nazeir, Mohammad Zubair Qureshi
Objectives: Abnormal Uterine Bleeding (AUB) is considered one of the most common and challenging problems presenting to the gynaecologist, regardless of the age the women .The present study was done with the aim of studying the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding.
Methods: This was a prospective study conducted on endometrial curettings of 460 patients in the Department of Pathology, from January 2013 to August 2014.
Results: The age of patients ranged from 18 to 70 yrs. The patients were categorized in reproductive age group (<40yrs), perimenopausal >40yrs and post-menopausal group (>50yrs/clinical scenario). Maximum number of patients were in the perimenopausal group, 220 patients (47.8%), followed by 182 patients (39.6%) in the reproductive age group. Post-menopausal patients constituted 12.6 % ( 58) of total no of cases. Menorrhagia was the most common presenting symptom. Normal cyclic endometrium, 210 cases (45.65%), was the most common histopathological pattern seen in the reproductive and perimenopausal group,
whereas in the postmenopausal group simple hyperplasia, 16 cases (27.6%), followed by complex hyperplasia, 8 cases (13.7%) was the commonest pattern seen. Malignancy was seen in 7 cases (1.52%)
Conclusion: Histopathological examination of endometrial curetting specimens in patients with Abnormal uterine bleeding showed a wide spectrum of histopathological changes ranging from normal endometrium on one hand to malignancy on another hand thus rendering endometrial curetting an important diagnostic procedure in evaluation of Abnormal uterine bleeding. Accurate analysis of endometrial samplings is the key to effective therapy and optimal outcome
Keywords: Abnormal uterine bleeding, Endometrial hyperplasia, Histopathology
Humaira Bashir, Nazia Bhat, Mehnaz Sultan Khuroo, Ruby Reshi, Mir Junaid Nazeir, Mohammad Zubair Qureshi. CLINICOPATHOLOGICAL STUDY OF ENDOMETRIUM IN PATIENTS WITH ABNORMAL UTERINE BLEEDING International Journal of Current Research and Review. 7(22), November, 67-73
1. Rosai J: Female reproductive system-uterus-corpus. In:Rosai and Ackerman’s Surgical Pathology. 10th Edn.;Mosby: An Imprint of Elsevier, Missouri, 2011;pp.1579- 1615.
2. Wren BG. Dysfunctional Uterine Bleeding. Aus Fam Physician 1998; 27: 371-7.
3. ACOG Practice Bulletin: Clinical Management of Anovulatory Bleeding. Int J Gynaecol Obstet 2001; 72: 263-71
4. Takreem A, Danish N, Razaq S. Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/menorrhagia in perimenupausal women. J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21:60-3.
5. Ely JW, Kennedy CM, Clark EC, Bowdler NC. Abnormal Uterine Bleeding: A Management Algorithm. J Amer Board Fam Med 2006; 19: 590-602.
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 Mar;15:74-7.
7. Davey DA. Dysfunctional Uterine Bleeding. In: Whitfield CR, ed. Dewhurst’s Textbook of Obstetrics and Gynaecologyfor Postgraduates. Glasgow: Blackwell Science; 1997:590-608
8. Muzzafar M, Akhtar KAK and Yasmin S et al. Menstrual Irregularities with excessive blood loss: a clinico-pathological correlation. J Pak Med Assoc 2005;55:486-489
9. Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India. 2011 Aug;61:426-30.
10. Silverberg SG. Problems in the differential diagnosis of endometrial hyperplasia and carcinoma. Mod Pathol. 2000;13:309– 27
11. Ellenson LH, Ronnett BM, Kurman RJ. Precursor Lesions of Endometrial Carcinoma. In:Kurman RJ, Ellenson LH, Ronnett BM, eds. Blaustein’s Pathology of the Female GenitalTract. 6th Ed. New York: Springer Verlag, 2011: 385-92.
12. Patil SG1 , Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation. J Gynecol Endosc Surg. 2009 Jul;1:98-104.
13. Abid M, Hashmi AA, Malik B, Haroon S, Faridi N, Edhi MM, Khan M. Clinical pattern and spectrum of endometrial pathologies in patients with abnormal uterine bleeding in Pakistan: need to adopt a more conservative approach to treatment. BMC Womens Health. 2014 Nov 5;14:132.
14. Ellenson LH, Edyta C and Pirog. The female genital tract. Robbins and Cotran Pathologic Basis of Disease. 8th edition., Elsevier, A division of Reed Elsevier India Pvt. Ltd.,2010. Chapter 22: p. 1005-1063
15. Soleymani E, Ziari K, Rahmani O, Dadpay M, Taheri-Dolatabadi M, Alizadeh K, Ghanbarzadeh N. Histopathological findings of endometrial specimens in abnormal uterine bleeding. Arch Gynecol Obstet. 2014 Apr;289:845-9.
16. Purdie DM1 , Green AC. Epidemiology of endometrial cancer. Best Pract Res Clin Obstet Gynaecol. 2001 Jun;15:341-54.
17. Canavan TP, Doshi NR. Endometrial cancer. Am Fam Physician 1999Jun;59:3069-77
18. Davis PC1 , O’Neill MJ, Yoder IC, Lee SI, Mueller PR. Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics. 2002 Jul-Aug;22:803-16.
19. Gredmark T, Kvint S, Havel G, Mattsson LA. Histopathological Findings in women with postmenopausal Bleeding. Br J Obstet Gynaecol. 1995 Feb;102:133-6.
20. Harmanli OH, Shunmugham S, Shin T, Houck KL, Chatwani A. The negative predictivevalue of inadequate endometrial biopsy in diagnosing endometrial neoplasia. J Gynecol surg 2004 ;20:13-6
21. Bakour SH1 , Khan KS, Gupta JK. Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy. BJOG. 2000 Oct;107:1312-4.