Histopathological interpretation of endometrium in abnormal uterine bleeding

Abstract

Background: Abnormal uterine bleeding is one of the most frequent problems in life of an adult female. Accurate analysis of endometrium & localization of intrauterine lesion is the goal to effective management & better outcome of problem. Aims & Objective: To evaluate various histopathological features in D & C and/or hysterectomy in patients presenting with abnormal uterine bleeding and to find the efficacy of D & C as a better, cost effective and minimally invasive tool for screening in patients with AUB. Materials and Methods: The present study was conducted in Department of Pathology, tertiary care hospital, Ahmedabad, Gujarat, India over a period of one and half years. A total 320 patients aged 20 years & above, presenting with AUB were included. Endometrial samples were analysed, histopathological changes identified and classified. Results: Age of patients ranged from 21 to 70 years mean age being 42.6 ± 6.9 years, maximum patients (53.4%) belonged to 41-50 years of age group. Most common histopathological pattern was normal cyclical endometrium (47.3%) followed by endometrial hyperplasia (42.9%). Endometrial hyperplasia was most common (57.1%) in perimenopausal age group (41-50 years). The diagnostic accuracy of D &C was found to be 93.4%; amongst all histopathological patterns it was maximum for complex hyperplasia (typical and atypical) and simple atypical hyperplasia. Conclusion: Endometrial causes of AUB are age related therefore it is specially recommended in women of perimenopausal age group to rule out preneoplastic and neoplastic etiology. D & C is an accurate, minimally invasive outdoor procedure for detecting endometrial pathology especially hyperplasia.

Abnormal uterine bleeding: role of sonography and histopathology in endometrial study with emphasis on the organic causes

“…The maximum patients were in the age group of 40-49 years (40.22%). A similar high incidence was reported by Gopalan U et al, 5 S Vaidya et al, 11 Preeti Singh et al, 12 Rupal Shah et al 13 The high incidence of AUB in this age group may be because of their climacteric period, 9 prior to the which changes occur in the ovarian-pituitary function. 15 AUB presents with different bleeding patterns.…”

“…24 Endometrial hyperplasias appear to be most common cause of abnormal bleeding patterns in the perimenopausal age group as they are in the climacteric period where anovulatory cycles occur causing persistent high levels of estrogen which leads to the development of hyperplasia and polyps. 13 In the present study 19.4% cases of hyperplasias were in the reproductive age group (20 -39yr).This signifies the fact that irrespective of the age group it is necessary to evaluate a case of AUB as hyperplasias are considered to be precursors of endometrial malignancy with a considerable risk of 5-10%. 8 There were no cases of polyp noted above 50yr.…”

“…Though endometrial biopsy and histopathological examination provides with a specific diagnosis, it has a false negative rate of 2% to 6%. D&C being a blind procedure may lead to diagnostic error 13 due to the inadequacy of sampling as 18% of focal lesions such as polyps or any focal changes in the endometrium may be missed which usually occurs in direct sampling methods. 9 Transvaginal sonography is a good method to study the endometrial abnormalities with high sensitivity (upto 92%).…”

Endometrial Aspiration Using MVA Syringe in Dysfunctional Uterine Bleeding

“…There is variance with reports of other researchers where DUB was more commonly encountered in their fourth decades of life. We found a greater percentage as compared to Doraswami et al 1 , Dadhania et al 2 and R Shah et al 3 . A higher incidence than our study was reported by R Damle et al 4 and Shazia Anjum et al 5 .…”

Histopathological evaluation of endometrial biopsies and curetting’s in abnormal uterine bleeding

“…The incidence of hyperplasia in other studies were 10%, 25% and 6% with the most common age group being 41-55yrs [6,7,8]. Endometrial hyperplasia thus is most common in the perimenopausal age group [11]. Unopposed estrogen stimulation in the perimenopausal age causes endometrial proliferation & hyperplasia which in turn leads to fragile mucous membrane and irregular sloughing [2].…”