“STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING”

CONTEXT - Histopathological analysis of endometrial samples in various forms of abnormal uterine bleeding in adjunction with clinical history of patient to identify underlying cause of bleeding. This also helps in early diagnosis of premalignant and malignant lesions leading to their proper follow up and improved prognosis. AIMS - Histopathological analysis of causes of abnormal uterine bleeding with their clinical correlation. SETTINGS AND DESIGN -A prospective observational study MATERIAL AND METHODS - This study was done in department of pathology, GSVM medical college, Kanpur. This was a prospective study from year 2017-2018. A total of 300 cases were studied. Specimen received were xed in 10% formalin, processed and sections of 3-4 micron were prepared, stained with H and E. Histopathological examination was done. RESULTS - It was observed that the highest number of patients were between 41-50 years of age. (44.33%). Menorrhagia is the most common symptom accounting for 135 (45%) patients followed by metrorrhagia accounting for 135 (45%) patients and hypomenoorhea is the least common complaint. It was observed that there were signicantly higher number of patients with proliferative phase – 68 (22.67%) and in endometrial hyperplasia 35 (33.66%) patients. The least common cause were endometrial polyp, seen in 4 (1.33%) patients, gestational endometrium and gestational trophoblastic tumor accounted for 2 ( 0.67%) patients. In patients who presented with metrorrhagia, secretory phase endometrium was the most common histopathological nding accounting for 34.62% followed by proliferative phase. In cases of endometrial hyperplasia, 28 (80%) cases were simple cystic type, 5 ( 14.29%) cases were of simple endometrial hyperplasia with atypia and complex endometrial hyperplasia with atypia was found in 2(5.71%) cases. Among cases of endometrial hyperplasia, 28 (80%) cases were simple cystic type, 5 ( 14.29%) cases were of simple endometrial hyperplasia with atypia and complex endometrial hyperplasia with atypia was found in 2(5.71%) cases. Endometrial carcinoma is commonest complain in 51-60 years and >60 years age group. CONCLUSION - Histopathological analysis of AUB causes helps in identifying the cause and early diagnosis of premalignant and malignant cases.

Clinico-histopathological and ultrasonographic correlation of abnormal uterine bleeding in perimenopausal and postmenopausal women

Background: Abnormal uterine bleeding (AUB) accounts for one of the most common gynaecological problem, almost one third of total cases. The study was a prospective study done from December 2017 to November 2019. The histopathological reports of endometrial pattern as well as that of hysterectomy specimens were correlated with clinical diagnosis and ultrasonographic findings. The main objective was to study the correlation between clinical, ultrasonographic and histopathological correlation of AUB in perimenopausal, menopausal and postmenopausal women.Methods: Formal Permission was obtained from the administrator of St. Philomena’s hospital. Ethical clearance was obtained from institutional ethical review board of St. Philomena’s hospital. Informed consent was obtained from observational group and confidentiality was assured. Data entry and analyses was done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 20.0; SPSS Inc, Chicago).Results: A total number of 165 cases were studied. Maximum women were in the age group of 40-55 years 87.27%. Most common presentation of abnormal uterine bleeding is menorrhagia which accounts for 72.7% of women (120 women). The most common finding noted in USG was fibroid uterus which accounts for 44.2% of women (73 women). Most commonly observed histological pattern noted were proliferative (62.4%) followed by secretory endometrium (8.5%) and simple endometrial hyperplasia with atypia (8.5%).Conclusions: In conclusion, AUB is one of the most common condition for which patients seek advice in the gynaecological outpatient department. Analysis of histopathology of endometrium in abnormal uterine bleeding helps in management of patients and to know the pathological incidence of structural causes in AUB prior to surgery.

Prevalence of Coexisting Endometrial Carcinoma in Patients with Preoperative Diagnosis of 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