Introduction
The endometrium is uniquely endowed throughout the female reproductive lifespan with a complex of periodic proliferation, differentiation, breakdown and regeneration.1 Abnormal uterine bleeding (AUB) is a symptom and not a disease and it accounts for more than 70% of all gynecological consultations in the perimenopausal and postmenopausal age group.2 AUB is defined as changes in frequency of menstruation, duration of flow or amount of blood loss.3 It includes both dysfunctional uterine bleeding (DUB) and bleeding from structural causes like fibroids, polyps, endometrial carcinoma, and pregnancy complications.4 It occurs in various forms such as menorrhagia, polymenorrhea, polymenorrhagia, metrorrhagia, and menometrorrhagia.2 Endometrium is a hormonally sensitive, dynamic and responsive tissue which constantly and rhythmically undergoes changes in the active reproductive life.5 Wide range of morphologic patterns resulting from both normal and abnormal changes offer a diagnostic challenge to practicing pathologists. Endometrial samplings by dilatation and curettage, endometrial biopsy, pipelle and hysterectomy specimens are chosen methods to evaluate AUB.
Aims and Objectives
To find out the pathological spectrum of different endometrial lesions in Abnormal uterine bleeding and Correlation of different pathological findings with clinical history and examination.
Materials and Methods
Detailed clinical history and relevant diagnostic findings were collected from patients presenting with abnormal uterine bleeding during a period of two years, from August 2017 to July 2019. All specimens were transported in 10% formalin to the Department of Pathology, VIMS Bellary. The tissue bits were processed and paraffin blocks were prepared. Tissue sections (3-5 µ) were cut and stained with hematoxylin and eosin stain (H&E). A detailed histological study was carried out and the findings were noted and classified.
Results
The study material included a total number of 247 endometrial samples (endometrial curettage and biopsy). Age range in the study group was from 22 years to 70 years, thus including reproductive to postmenopausal age group with more number of cases seen to be clustered in reproductive age group (Table 1). Predominant histopathological pattern noted was proliferative endometrium (Figure 1) seen in 23.1% cases (Table 2).
Out of 247 cases, only 200 cases were included in our table, after excluding non-diagnostic cases. Out of 200 cases, 126 cases were non neoplastic and 74 cases were pre- neoplastic/ neoplastic (Table 3). Under non neoplastic conditions, proliferative phase endometrium (57 cases) was most common finding and simple hyperplasia was documented as most common finding under pre neoplastic conditions (Figure 2).
Hyperplasia was observed in 67 cases (Table 4), simple hyperplasia was most common which includes cystic glandular hyperplasia and of 67 hyperplasia, 20 cases presented with atypia (Figure 3)
Table 1
Distribution of cases in different age categories
|
Category |
No. of cases |
Percentage |
|
Reproductive |
136 |
55.1 |
|
Perimenopausal |
75 |
30.4 |
|
Postmenopausal |
36 |
14.6 |
|
Total |
247 |
100 |
Table 2
Analysis ofhistopathological findings in endometrial biopsy samples
Table 3
Distribution of Pre-neoplastic and Non neoplastic conditions
Table 4
Types of Hyperplasia
Discussion
Endometrial sampling is an indispensable and an outstanding tool in the assessment of underlying pathology in patients with AUB. The main purpose of endometrial sampling is early detection of endometrial hyperplasia and carcinoma.2
The age distribution of AUB in our study revealed that most of the cases were seen in 31-40 years of age group which is in concordance with study done by Mitali Mahapatra et al 10 and Hetal et al.11 The number of cases of AUB in the age group of >50 years (14.6%) which is almost similar to the data mentioned by Smita S. Pudale et al. 8 ( 14.3%) and Bindroo S et al. 12 (13.2%)
Proliferative phase (23.1%) was most common histopathologic pattern, similar observations were made by Sadia Khan et al 13 (46.6%), Mitali Mahapatra et al 10 (45.70%), Hetal Rajendra Patel et al 11 (47.69%) but with a higher incidence.
Incidence of endometrial polyp was seen in 2.4% of cases in our study which is comparable with that of Shruti Singh et al 14 (4.8%) and Rehana Khan et al 15 (3.33%). Atrophic endometrium in the present study comprised of 0.80% cases of AUB while its incidence was higher in study done by Bhatta S et al 3 (7.38%) and Jairajpuri ZS et al 5 (1.10%).
Endometrial hyperplasia was observed in 27.12% of cases. Present study shows a higher incidence of hyperplasia when compared with the studies (Table 5). 12, 6, 9, 7 In the present study it was noted that hyperplasia without atypia were more common in cases <40 years of age while hyperplasia with atypia were most commonly seen in cases >40 years of age.
Conclusion
Malignancy in particular is common in patients over 40 years of age. Hence the histopathological study of endometrium in abnormal uterine bleeding in women above the age of 40 years plays an important role in diagnosing various histological patterns and aetiopathological factors. A comparative clinicopathological study will help in arriving at the cause and correct diagnosis, proper management of cases.
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