Histopathological spectrum of endometrium in hysterectomy specimens from cases of abnormal uterine bleeding

Abstract

Introduction:In India, the prevalence of women suffering from abnormal uterine bleeding is around 17%. Dilatation and curettage, endometrial biopsy and hysterectomies play an important role in diagnosis as well as treatment of abnormal uterine bleeding cases. Though number of minimaly invasive surgical options available, hysterectomy remains the widely accepted and practiced treatment of choice. Therefore those cases where causes of bleeding cannot be determined clinically then histological examination of hysterectomy specimen required to establish the etiology of abnormal uterine bleeding. Material and Methods: This was a prospective study conducted for a period of two years in department of pathology in tertiary care hospital, GAIMS, G.K.General hospital, Bhuj, Kutch region in India. Total of 300 women presenting with abnormal uterine bleeding on whom consecutive hysterectomy done were included in the study. Gross examination done and H&Estained section were studied and analyzed according to publish protocols. Results: Total of 495 hysterectomy, 300(61%) of patients presented with abnormal uterine bleeding.86/300(29%) presented with heavy menstrual bleeding. Proliferative phase is the most common histological finding with 128/300(42%), endometrial hyperplasia in 40/300(13%), endometrial carcinoma in 2/300(1%) of women. Conclusion: Abnormal uterine bleeding is age related pathology with common symptom amongst women. Even though medical treatment and conservative surgeries have emerged, hysterectomy is the definitive treatment modality for abnormal uterine bleeding in developing and affluent countries. All hysterectomy specimens even if it appears grossly normal should be subjected for histopathological examination regardless of the preoperative diagnosis, as unsuspected incidental findings can be found in these specimens.

Clinicopathological Pattern of Endometrial Specimens in Women with Abnormal Uterine Bleeding and Ultrasonography Correlation

“…Previous studies have reported different incidence rates of endometrial carcinoma due to the variation in the geographical location, lifestyle, socioeconomic conditions, as well as their inclusion criteria. 1 We found chronic endometritis in 5 (1.2%) women, most commonly seen in the premenopausal age group (0.7%), due to abortions, intra-uterine contraceptive devices, and ascending route of infections.…”

“…25 In a study by Dhruvi et al, endometrial polyps were found in 2% of women. 1 A polyp is a focal hyperplastic overgrowth of endometrial glands and stroma around a vascular core in the uterine cavity. 26 Possible etiologies include genetic, biochemical, and hormonal factors.…”

“…Previous studies have reported different incidence rates of endometrial carcinoma due to the variation in the geographical location, lifestyle, socioeconomic conditions, as well as their inclusion criteria. 1 …”

“…AUB includes various features and types such as oligomenorrhea, menorrhagia, menometrorrhagia, polymenorrhagia and spotting. 1 , 2 In postmenopausal women, it is defined as any bleeding one year after menstruation stops. 3 AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits.…”