Online ISSN: 2515-8260

Keywords : Endometrium

Figo’s Palm Coein Classification of Abnormal Uterine Bleeding – It’s Clinico-Histopathological Correlation in Indian Setting"

Keshamalla Swetha, Mortha Sanjana

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3728-3740

Background: To study and analyze the structural and functional component of PALM COEIN of AUB in Perimenopausal women and its correlation with the Histopathology where ever applicable especially PALM component.
Materials and Methods: This is a prospective observational study carried out on 100 non gravid women of perimenopausal and postmenopausal age groups who came to Gynaecology OPD with complaints of AUB. The data was analysed considering the inclusion and exclusion criteria. The PALM- COEIN classification was used to classify causes of AUB.
Results: In our study most of the patients were in the age group of 41-50 years (45%). So that AUB is most common in late reproductive years and perimenopausal age groups. Most women with AUB were multiparous. More than half of the women were overweight and obese. So that high BMI is a risk factor for AUB. Most common presenting complaint was heavy menstrual bleeding (44%). Most cases of AUB were due to structural (PALM) abnormalities (61%) &67% based on HPE. Most common cause of AUB was leiomyoma (30%) and more cases were seen in the age group of 31- 50 years .most of the cases of leiomyoma were. Sub mucosal type. 2nd most common cause of AUB was ovulatory dysfunction (17%). In endometrial polyps the D & C reports showed more cases of proliferative endometrium showing that estrogen regulates the growth of the polyps. More cases of AUB-A, AUB-M, AUB-A,L were detected on histopathological examination. Malignancy and hyperplasia is mostly seen after 51 years and mostly these are post-menopausal.
Conclusions: In our study more cases of AUB-A,AUB-M,AUB-A,L were detected more than that of clinical case after histopathological examination, which is more accurate in detecting the pathology. Hence, a proper and adequate clinico histopathological workup of perimenopausal patients helps in accurate diagnosis which aids in better management of AUB.


Kesavachandra Gunakala, P.M. Rekharao, Seshadri Sahaja, Vennela Mude

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2338-2359

Background: Pipelle endometrial sampling versus Dilatation and curettage in collecting a sufficient endometrial sample for histopathological diagnosis was the subject of this observational clinical correlation diagnostic study. Aim: The present study is done in our hospital to know if Pipelleaspiration endometrial sampling can replace D&C for histological examination in cases of AUB.
Materials and Methods: This was an observational clinical correlation diagnostic study designed to compare the efficacy of Pipelle endometrial sampling with Dilatation and curettage in obtaining an adequate endometrial sample for histopathological diagnosis. After obtaining informed consent to participate and determining fitness for the procedure, 100 patients who reported with AUB to the Department of Obstetrics &Gynaecology at Government Medical College, Kadapa, were enrolled in the study. The study was carried out from October 2019 to September 2021. The patient underwent a thorough clinical evaluation in the outpatient department, which included a history, physical examination, and baseline investigations. Prior to the procedure, TAS/TVS were done. Endometrial sampling was performed using the Pipelle device, followed by a diagnostic reference standard and D&C endometrial sampling under anaesthesia.
Results: The most common age group presented with AUB is between 41 and 45 years. Most of the patients (45%) had < 6months duration of AUB. Pre and perimenopausalwomen made up 94% of the study population, whereas postmenopausal women made up 6%. Among the study group, 4% were nulliparous, and the remaining 96% were parous women. Of the study group, the ET thickness varies as - 13 had < 6mm, 18 had ET between 6.1- 9mm, 50 had ET between 9.1-12mm, 13 had ET between 12.1-15mm, 4 constitute between 15.1-18mm, 2 had >18mm ET. In Pipelle and D & C, sampling inadequacy was significantly more in menopausal women compared to pre-menopausal women. (P<0.05). In 16 cases, Pipelle sampling was deemed challenging. Sampling was difficult in nulliparous women when compared to parous women. Histopathology reports were obtained in 93 of the 100 Pipelle samples and 94 of the 100 D&C samples in current study.  The most frequent endometrial pattern observed was Hyperplasia without atypia (21%) , followed by proliferative phase of the endometrium (20%), no evidence of malignancy (14%), Secretory phase (11%),  disordered proliferative phase (11%), atrophic endometrium (4%), nonsecretory phase in (4%), endometrial polyp (2%), Hyperplasia with atypia (2%), early secretory phase (1%), endometrial carcinoma (1%), late secretory phase (1%), Endometrial glandular hypertrophy (1%). When comparing Pipelle to D&C, the chi-square test shows that Pipelle has a sensitivity of 98.9% for retrieving sufficient tissue and a specificity of 100%. The positive predictive value is 100 percent, while the negative predictive value is 85.7%. The p-value estimated is< 0 .001, which is statistically significant. Out of 100 cases that had Pipelle sampling, 91 had no complications. 5 had pain, and 4 had bleeding. Out of 100 cases that had D & C, 59 had no complications, 29 had pain, 5 had bleeding, and 7 had both pain and bleeding.
Conclusion: Pipelle sampling can be used as an effective screening procedure in the outpatient department.


Manasa R, Jyostnalatha P, Dr. Manikanta Veesam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2656-2662

Background: Leiomyoma (fibroid) is the commonest neoplasm accounting for 75% of benign tumours affecting women in reproductive age group. They are dependent upon the steroid hormones for their growth and maintenance. As the endometrium and leiomyoma (fibroid), are both steroid hormone dependent, we studied the corresponding histological changes in endometrium in cases of uterine leiomyoma.
Materials and Methods: The study included 100 hysterectomy cases where leiomyoma/leiomyomas were present. Brief clinical history regarding age, clinical presentation, parity was obtained. The specimens were fixed in 10% formalin; tissue bits from representative areas were taken and stained with Haematoxylin and Eosin.
Results: The commonest age group was 4th decade (54%). The commonest clinical presentation or chief complaint in current study is menorrhagia (46% cases). Majority of the women in the study were multiparous (89%) and the most common type of leiomyoma encountered in the study, based on location, was intramural type (62% cases). Proliferative pattern of endometrium (62%) is the most common pattern associated with leiomyomatous uteri in this study.
Conclusion: Uterine fibroids (leiomyomas) are the most common benign gynecological tumors in women of reproductive age globally. Endometrium and leiomyoma (fibroid), are both dependent on steroid hormones for the growth and maintenance. Histopathological diagnosis is the mainstay to identify the uterine leiomyoma, though some amount of clue may be obtained from the endometrial curettings.

Histopathological correlation of hysterectomy specimens with clinical and other investigational findings

Dr. Killol Nathubhai Desai, Dr. Vidya Satapara, Dr. Alpeshkumar Maheshbhai Maru, Dr. Harshid L. Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1040-1048

Context: Hysterectomy is the surgical removal of the uterus and is the most common major
gynaecological surgical procedure performed worldwide.
Aims: To study the incidence and distribution of various types of pathologies in the
hysterectomy specimens in the population studied.
Methods and Material: A total of 500 cases were studied. The study material was obtained
from patients’ hospitals that underwent hysterectomy and also specimens sent from nearby
private or government
Results: Among various significant pathologies, benign accounted for 95.7% of lesions while
malignant for 4.3% of lesions. Among benign lesions, adenomyosis was commonest with 203
(136 isolated + 67 with leiomyoma) cases and it was most common in 41-50 years age group.
Leiomyoma was next common with 183 (116 isolated + 67 with adenomyosis) cases and it
was also most common in 41-50 years age group. 67 (13.4%) cases had both leiomyoma and
adenomyosis. CIN1 or LSIL accounted for 15 cases, serous cystadenoma of ovary for 12
cases, endometrial polyp for 12 cases, mature cystic teratoma of ovary for 8 cases,
endocervical polyp for 9 cases, cervical leiomyoma for 6 cases, mucinous cystadenoma for 3
cases, placenta accreta for 3 cases, simple endometrial hyperplasia without atypia for 2 cases,
infected decidua for 2 cases, CIN2/CIN3 or HSIL for 2 cases, adult granulosa cell tumour for
2 cases, endometriosis of ovary for 2 cases, broad ligament leiomyoma for 2 cases, acute
salpingitis for 1 case, endometriosis of fallopian tube for 1 case, complete hydatidiform mole
for 1 case, invasive hydatidiform mole for 1 case and adenomatoid tumour of myometrium
for 1 case. Among malignant lesions, carcinoma of cervix was commonest with 11 cases,
followed by carcinoma of ovary with 7 cases and carcinoma of endometrium with 3 cases.

Clinicopathological study of abnormal uterine bleeding in perimenopausal women attending a tertiary care district hospital

Dr. Gayathri BN, Dr. Mallikarjun A Pattanashetti, Dr. Somashekar HK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1759-1764

Background: Abnormal Uterine Bleeding (AUB) is defined as any bleeding that does not correspond with the frequency, duration or amount of blood flow of a normal menstrual cycle. Endometrial biopsy is important in perimenopausal age group women (40-55 years) to rule out endometrial pathology and malignancy. This study was done to assess Clinicopathological aspects and different histopathological patterns related to Abnormal Uterine Bleeding as no studies have been done in this region of Karnataka, India.
Methods: This is a cross sectional study done from 2019 to 2020. All female patients in the perimenopausal age group presenting with symptoms of AUB were included. Patients less than 40 years of age and endometrial tissues inadequate for opinion on microscopy were excluded. Relevant history and clinical data regarding pattern and duration of abnormal uterine bleeding was retrieved. Endometrial biopsy tissues was processed and stained by H&E. The diagnosis was done and results analysed.
Results: Present study included 94 biopsies of which 6 biopsies were inadequate for opinion. The most common age group presenting with AUB was 40-45 years (53.40%). The most common symptom was menorrhagia. The commonest histopathological pattern among all the perimenopausal age was disordered proliferative endometrium followed by simple hyperplasia without atypia. Other patterns were proliferative endometrium, secretory endometrium, simple hyperplasia, carcinomas etc. The commonest etiology of AUB was Dysfunctional Uterine Bleeding (46.59%) followed by Endometrial hyperplasias. (23.86%)
Conclusions: Correlation with clinical history, radiological investigations along with endometrial biopsy establishes etiology and diagnosis for patients with AUB.