DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204308

Histopathological evaluation of endometrium and its clinical correlation in patients of abnormal uterine bleeding

Neha Khatik, Arti Tiwari, Kalpana Yadav

Abstract


Background: Abnormal uterine bleeding (AUB) is a very common, challenging gynaecological problem in all age group women. Neoplastic lesions are responsible for very less number of cases but they should be diagnosed early. Endometrial biopsy is necessary for histopathological diagnosis of endometrial lesions and to rule out any malignancy. In present study, we evaluated histopathological pattern of endometrium and different clinical parameters in AUB patients.

Methods: A retrospective observational study done in Obstetrics and Gynecology department of SSMC Rewa, Madhya Pradesh in 2 year from 1st October 2017 to 30th September 2019. AUB patients who fulfilled inclusion criteria were included in study. All data were collected from department records in predesigned proforma and statistically analyzed by statistical package for the Social sciences (SPSS) version 20.

Results: Total 366 AUB patients were included in study; most frequent clinical presentation was HMB (56%). Mostly patient’s age ranged from 24-84 years, belonged to 41-50 years age group (44%), multiparous (78%), and premenopausal (53%). On histopathological evaluation of endometrium most commonly nonneoplastic lesions (75%) were seen, out of which proliferative phase endometrium was most frequent. Neoplastic lesions were seen in 25% cases. Out of which benign lesions were noted in 7%, premalignant in 17.3% and malignant in 1% (all in >45 year patients).

Conclusions: Endometrial biopsy should be done in all AUB patients >45 years and in selected premenopausal in order to get early diagnosis, to rule out malignancy and to help in management. Endometrial biopsy should be considered as first diagnostic modality.


Keywords


AUB, Endometrium, Histopathological diagnosis, Perimenopausal, Postmenopausal, Premenopausal

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References


American College of Obstetricians and Gynecologists. Management of anovulatory bleeding. ACOG Practice Bulletin No. 14. Washington, DC: ACOG; 2000.

Munro MG, Critchley HO, Broder M, Fraser ID. FIFWGoM FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in non gravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3-13.

American College of Obstetricians and Gynecologists. Diagnosis of abnormal uterine bleeding in reproductive-aged women: Practice Bulletin No. 128. Obstet Gynecol. 2012;120:197-206.

Fraser IS, Critchley HO, Munro MG. Abnormal uterine bleeding: getting our terminology straight. Curr Opin Obstet Gynecol. 2007;19(6):591-5.

Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012;207(4):259-65.

Dutta DC. Abnormal menstrual bleeding. 4th ed. Konar H, editor. Text book of gynaecology including contraception. New central book agency (P) Ltd; 2003:175-186.

Bignardi T, Van den Bosch T, Condous G. Abnormal uterine and post-menopausal bleeding in the acute gynaecology unit. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):595-607.

Giannella L, Mfuta K, Setti T, Cerami LB, Bergamini E, Boselli F. A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness> 4 mm. BioMed Res Int. 2014;2014.

Chiang JW, Wilcox N. Premalignant lesions of the endometrium. WebMD Professional. 2011.

Van Hanegem N, Breijer MC, Khan KS, Clark TJ, Burger MP, Mol BW, Timmermans A. Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach. Maturitas. 2011;68(2):155-64.

Özdemir S, Çelik Ç, Gezginç K, KIreşi D, Esen H. Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding. Arch Gynecol Obstet. 2010;282(4):395-9.

Kim M, Kim J, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci. 2016;59(3):192.

Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D. Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women. Facts Views Vis Obgyn. 2015;7( 1):17-24.

Royal College of Obstetricians and Gynaecologists. Standards for gynaecology: report of e working party. London: RCOG, 2008.

Singh S, Best C, Dunn S, Leyland N, Wolfman WL, Wolfman W, et al. Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Canada. 2013;35(5):473-5.

National Institute for health and clinical excellence CG44. Heavy menstrual bleeding. NICE, 2007.

Committee on Practice Bulletins- Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206.

Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35:219-34.

Shukla M, Fonseca MN, Kharat D, Tekale P. A study to correlate histopathological findings in patients with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;6:654-7.

Bashir H, Bhat N, Khuroo MS. Clinicopathological study of endometrium in patients with abnormal uterine bleeding. Int J Cur Res Rev. 2015;7(22):67-73.

Tiwari A, Kaur N, Jain S, Rai R, Jain SK. Histopathological study of endometrial biopsy specimens for abnormal uterine bleeding. J Lumbini Med Coll. 2016;4(2):72-6.

Mani R, Nayak S, Kagal A, Bharadwaj R. Tuberculous endometritis in infertility: a bacteriological and histopathological study. Indian J Tubercul. 2003;50:161

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

Baral R, Pudasaini S. Histopathological pattern of endometrial samples in abnormal uterine bleeding. J Pathol Nepal. 2011;1(1):13-6.

Hileeto D, Fadare O, Martel M, Zheng W. Age dependent association of endometrial polyps with increased risk of cancer involvement. World J Surg Oncol. 2005;3(1):1-6.

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;61:426.

Gredmark T, Kvint S, Havel G, et al. Histopathological findings in women with postmenopausal bleeding. B J Obstet Gynaecol. 1998;102:133–6.

Patil SG, Bhute SB, Inamdar SA. role of diagnostic hysteroscopy in abnormal uterine bleeding and histopathologic correlation. J Gynecol Endosc Surg. 2009;1:98-104.

Aslam M, Ijaz L,Tariq S, Shafqat K, Meher-un-Nisa, Ashraf R, et al. Comparison of Transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci (Qassim). 2007;1(1):17-24.

Dhakal HP, Pradhan M. Histological pattern of gynecological cancers. JNMA J Nepal Med Assoc. 2009;48:301-5.

Dangal G. Endometrial study of abnormal uterine bleeding in women at 45 years and above. JNMA J Nepal Med Assoc. 2003;42:83-5.

Sarwar A, Haque A. Types and frequencies of pathologies in endometrial curettings of abnormal uterine bleeding. Int J Pathol. 2005;3(2):65-70.