Online ISSN: 2515-8260

Keywords : abnormal uterine bleeding


HISTOMORPHOLOGICAL SPECTRUM OF ENDOMETRIAL AND CERVICAL LESIONS FOLLOWING CURETTAGE AND BIOPSY- A RETROSPECTIVE STUDY

Rashmikumari T. R, Priyanka Prasad Arvind, Astha Srivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2121-2128

Background: Abnormal uterine bleeding (AUB) is the most common clinical presentation in premenopausal and postmenopausal period which could be due to either endometrial or cervical lesions. Early detection of precursor lesions and exclusion of malignancy is a diagnostic challenge for pathologists. Many studies were done on either endometrium or cervix alone, hence we took this study to evaluate both simultaneously before the hysterectomy. Objectives: To profile the histomorphological spectrum of endometrium and cervical lesions on curettage and biopsy concurrently before hysterectomy and correlation with hysterectomy specimens wherever available.
Materials and Methods: The present study was conducted on 153 cases of endometrial curetting’s and cervical biopsies received from Department of Gynaecology to Department of Pathology, RIMS, Raichur during a period of February 2020 to January 2022. Histopathology slides were retrieved from the archives of Department of Pathology. New slides were made from Paraffin embedded blocks wherever necessary and stained with Haematoxylin and Eosin. Histopathological examination of the hysterectomy specimens was conducted wherever available.
Results: Majority of the patients were in third decade of life with mean age of 41.3 years (P<0.0001) and the commonest clinical indication was AUB ((P<0.0001). Majority of the endometrium showed cyclical changes in both endometrial curettage and in hysterectomy specimens which showed a perfect positive coefficient correlation of 0.92 (P value = 0.028). Similarly, the cervical biopsy and cervix findings in hysterectomy specimen showed a highly significant P < 0.0001. The commonest histomorphological lesion in cervix was non-specific chronic cervicitis (NSCC).
Conclusion: Abnormal uterine bleeding is a major gynaecological problem in perimenopausal and post-menopausal women. It could be due to either endometrial / cervical lesions hence if it is evaluated simultaneously with a minimally invasive procedure as our study so that unnecessary radical surgeries can be avoided and medical/ conservative treatment could be offered.

ULTRASOUND DIAGNOSIS OF DYSFUNCTIONAL UTERINE BLEEDING WITH HISTOPATHOLOGICAL CORRELATION

Dr M Radhika , Dr J Madhavi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2149-2159

Background: Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause.
Aims : To study accuracy of Transvaginal Sonography in relation to endometrial biopsy in depicting endometrial changes in DUB and to formulate an effective protocol for the first line evaluation of all cases of DUB at the out-patient level.
Materials and methods: This study on ultrasound diagnosis of DUB with histopathological correlation in 50 patients between 18-45 yrs. The study was aimed to study accuracy of TVS in relation to endometrial biopsy in depicting endometrial changes in DUB. TVS and endometrial sampling was done as outpatient procedure 2-3‘days prior to date of menstruation or on day of menstruation. The relevant clinical findings and investigations were recorded in the proforma which is enclosed. A master sheet showing all details of the cases is also enclosed.
Results: The incidence of DUB in age groups of 18-45 years is high. Menorrhagia was noted in 44% , Polymenorrhagia in 20% by histopathology. In cases of normal endometrium, proliferative endometrium noted in 52%, secretory endometrium in 12% , menstrual endometrium in 12% .Simple hyperplasia was noted in 14%, Cystoglandular hyperplasia in 6%. Out of 6 patients with ET 1 – 4.9 mm , endometrial parenchyma is menstrual on TVS and HPE . Out of 4 patients with ET 15 and above endometrium show hyperplasia on TVS and HPE . The sensitivity , specificity ,PPV and NPV of TVS findings in comparision to Histopathology as Proliferative phase :- 88.8% , 100% , 100% , 88.46% . Secretory phase :- 100% , 86%, 53% , 93% . Menstrual phase :-100% , 100% ,100%, 100%. Hyperplasia :- 70% , 100% ,100% ,93.02% . Surgery is done in 22% of cases , all are above 35 years.
Conclusions: Endo-vaginal scan when combined with endometrial sampling is an valuable tool for the preliminary screening, diagnosis, management all cases of DUB. Therefore, we strongly recommend the routine use of endovaginal scan with endometrial sampling in the clinical and laboratory evaluation of all cases.

Clinical profile and management of patients with abnormal uterine bleeding

Dr. Swapna Y, Dr. Juveria Fatima .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5356-5362

Background:Global prevalence of abnormal uterine bleeding (AUB) ranges from 3%-30% among women 15-45 years. It is necessary to rule out any pathological condition that may be responsible for AUB so that it can be corrected at the earliest.
Objective:To study and review various causes, diagnostic and treatment modalities in evaluating abnormal uterine bleeding
Methods:Hospital based cross sectional study was carried out among 240 women with AUB. History, examination, USG pelvis and relevant examination was carried out. PALM-COEIN criteria was used to classify AUB. Appropriate management was followed.
Results:Prevalence of AUB was 19%. Majority belonged to 31-40 years. 21.7% had hypertension. Majority (58.3%) presented with heavy menstrual bleeding. 60% had AUB for 3-6 months.Per speculum examination showed that 11.7% had polyp and 22.1% had cervical erosions. On per vaginal examination, 52.9% had bulky uterus. On USG examination, 23.8% were found to have fibroids.Most common histopathological diagnosis was proliferative phase in 19.6% of the cases.55% of the women were found to have polyp followed by leiomyoma in 25% of the cases as per PALM criteria while as per COEIN criteria, most common cause of AUB was endometrial in 21.3% of the cases followed by ovulatory in 13.8% of the cases.70% cases of AUB could be managed conservatively while surgery was required in 27.9% of the cases; however, five cases resolved without any sort of intervention.
Conclusion:Prevalence of AUB was high in the study population. Age 31-40 years, associated co-morbidities, obesity and lower-class women had higher prevalence of AUB. It can be managed conservatively in most of the cases.

SIGNIFICANCE OF HISTOPATHOLOGICAL EVALUATION IN THE DIAGNOSIS OF ENDOMETRIAL LESIONS IN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN

Madhavi Bodepudi; Lakshmi P; Bharani K

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1111-1114

AIMS and Objectives: To study the incidence, clinical and histopathological correlation of various types of endometrial lesions in premenopausal and postmenopausal women. To study the clinicopathological spectrum and histopathological evaluation of endometrium in abnormal uterine bleeding in peri-menopausal and post-menopausal age groups. 

VALUE OF HYSTEROSCOPY AND GENETIC RESEARCH OF WOMEN WITH ABNORMAL UTERINE BLEEDING IN PERIMENOPAUSE

Zebo Zafarjonovna Askarova; Nasiba Raximbayevna Saparbayeva; Madina Zafarjanovna Kurbaniyazova; Dilfuza Abdullayevna Aliyeva

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 409-416

The perimenopause period is characterized by a gradual extinction of ovarian function, during which hypoluteinism is replaced by anovulation with relative hyperestrogenia and then hypoestrogenia. At any stage of perimenopause, there is a high probability of the formation of menstrual dysfunction, in particular, abnormal uterine bleeding (AUB). The frequency of AUB
in premenopause reaches 60-70% among gynecological diseases [5, 12, 18]. Today, hysteroscopy is becoming increasingly important as a method for detecting intrauterine pathology in patients with abnormal uterine bleeding. [11.13]. The pathology of the endometrium and uterine cavity is represented by hyperplastic processes, uterine body leiomyoma, developmental abnormalities (Müller's abnormalities), inflammatory and immunopathological conditions, tumor processes that are clinically manifested by abnormal bleeding, as well as changes in neighboring organs and systems resulting from tumor damage.