DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222298
Published: 2022-08-29

Histopathological evaluation of endometrial patterns in workup of abnormal uterine bleeding

Jayasree Raman, Prakash Pushpangadan, Febby K. Philip, Shobha S. Pillai

Abstract


Background: Abnormal uterine bleeding (AUB) is defined as bleeding pattern that differs in frequency, duration and amount from the normal cyclical flow. Endometrium in AUB vary depending on etiology and age. The present study attempts to categorize the histopathology of endometrium in abnormal uterine bleeding in women of various age groups.

Methods: A hospital based prospective study was carried out in 220 cases of abnormal uterine bleeding. Paraffin processed endometrial biopsies analyzed correlating the clinico-radiological data. Endometrial samples of infertility and pregnancy related bleeding were excluded.

Results: 220 cases of AUB from 25 years to 78 years of age were evaluated under three groups, reproductive (23%), perimenopausal (52%) and postmenopausal (25%). AUB was most common in the perimenopausal group. The predominant pattern seen was physiological cyclical endometrium (67.2%). Disordered proliferative endometrium (18.63%) was the predominant abnormal pattern. Malignant lesions were (99.5%) in postmenopausal age and disordered proliferative endometrium seen predominantly (65.85%) in perimenopausal age group. As per PALM-COEIN classification, uterine structural abnormalities (PALM) were found in 70 (31.9%), non-structural causes (COEIN) in 150 (68.1%). Endometrial thickness >16 mm on radiology were seen in endometrial carcinoma.

Conclusions: Endometrial morphology vary with ovulatory abnormalities, anovulation and uterine abnormalities. Acronym PALM-COEIN is useful in categorizing AUB. The incidence of disordered proliferation, hyperplasia and malignancy seen in extremes of age, reiterates that early clinic-radiological workup and endometrial study are the mainstay in early detection of lesions.


Keywords


Abnormal uterine bleeding, Endometrium, Curettage, PALM COEIN

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References


Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.

Dasharathy SS, Mumford SL, Pollack AZ, Perkins NJ, Mattison DR, Wactawski-Wende J, Schisterman EF. Menstrual bleeding patterns among regularly menstruating women. Am J Epidemiol. 2012;175(6):536-45.

Cameron IT. Dysfunctional uterine bleeding. Baillieres Clin Obstet Gynaecol. 1989;3(2):315-27.

Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.

Dimitraki M, Tsikouras P, Bouchlariotou S, Dafopoulos A, Liberis V, Maroulis G, et al. Clinical evaluation of women with PMB. Is it always necessary an endometrial biopsy to be performed? A review of the literature. Arch Gynecol Obstet. 2011;283(2):261-6.

Gimpleson R, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage. A review of 276 cases. Am J Obstet Gynecol. 1988;158:489-92.

Longacre TA, Atkins KA, Kempson RL, Hendrickson MR. The Uterine Corpus. In: Mills S editor. Sternberg’s Diagnostic Surgical Pathology. 5th edition. Philadelphia: Lippincott Williams & Wilkins. 2010.

Goldstein SR. Menorrhagia and abnormal bleeding before the menopause. Best Pract Res Clin Obstet Gynaecol. 2004;18(1):59-69.

Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-9.

Salvi A, Mital P, Hooja N, Batar A, Soni P, Beniwal R. Spectrum of Endometrial Histopathology in Women Presenting with Abnormal Uterine Bleeding. Sch J App Med Sci. 2015;3(1A):1-4.

Sajitha, Padma SK, Shetty KJ, Prasad HLK, Permi HS, Hegde P. Study of histopathological patterns of endometrium in abnormal uterine bleeding. CHRISMED J Health Res. 2014;1(2):76-81.

Odeta H, Maksim G. Dysfunctional Uterine Bleeding. Int J Ecosystems Ecol Sci. 2015;5(4):623.

Vaidya S, Lakhey M, Sharma PK. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J. 2013;15(1):74-7.

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;61(4):426-30.

Dhangal G. A Study of Endometrium of Patients with Abnormal Uterine Bleeding at Chitwan Valley, Katmandu University Med J. 2003;1(2):110-2.

Bhatta S, Sinha AK. Histopathological study of endometrium in abnormal uterine bleeding. J Pathol Nepal. 2012;2(4):297-300.

Dr. Junu Devi, Dr. Naima Aziz Study Of “Histopathological Pattern Of Endometrium In Abnormal Uterine Bleeding In The Age Group 40-60 Years” –A Study Of 500 Cases. International Journal of Medical Science And Clinical Inventions Volume 1 issue 10 2014 page no. 579-585.

Deka RR, Saikia T, Handique A, Sonowal B. Histopathological Spectrum of Endometrial Changes in Women Presenting with Abnormal Uterine Bleeding with Special Reference to Endometrial Malignancies: A Two Years Hospital Based Study. Ann Appl Bio-Sci. 2016;3(2).

Gorla P, Sanapala S, Devi E, Atla B, Rasaputra M. Figure 3 from histopathology of endometrium in abnormal uterine bleeding, in correlation with thyroid profile and ultrasonography findings. Int J Res Med Sci. 2016;4(5):1463-9.

Lotha L, Borah A. Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal women. Int J Reprod Contracept Obstet Gynecol. 2017;5(9):3072-4.

Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age A cross-sectional study. Medicine (Baltimore). 2018;97(31).

Singh P, Jaiswal VK, Garg P. Endometrial patterns in abnormal uterine bleeding. Int Jour of Biomed Res. 2016;7(5):244-50.

Gouri SRS, Rani PVLNG, Kumar NA. Categorization of the Causes of Abnormal Uterine Bleeding According to PALM- COEIN Classification. Int J Scientific Study. 2016;4(2).

Pillai SS. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2016;3(1):113-7.