Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases

A l A m e e n J M e d S c i 2 0 1 3 ; 6 ( 1 ) : 2 1 - 2 8 ● US National Library of Medicine enlisted journal ● I S S N 0 9 7 4 - 1 1 4 3 ORIGINAL ARTICLE CODEN: AAJMBG Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases Zeeba S. Jairajpuri, S. Rana and S. Jetley* Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi-110062, India Abstract: Background: AUB is one of the most common problems in women of all ages especially those in the peri-menopausal age group. The abnormal bleeding can be caused by a wide variety of disorders and it is one of the commonest complaints leading to endometrial sampling. Objectives: Our study aimed at determining the types and frequencies of endometrial pathologies in patients presenting with abnormal uterine bleeding at our hospital which caters largely to women of low socioeconomic status. Material and Methods: The present study was conducted at the Hakeem Abdul Hameed Centenary Hospital, New Delhi. This was a retrospective age specific comparative analysis of 638 women presenting with abnormal uterine bleeding, who underwent endometrial sampling at our hospital. The pattern of endometrial histopathological changes were identified and classified. Results: Age of the patients ranged from 15 to 70 years, maximum patients (35.89 %) in the age group 41-50 years. The most common clinical presentation was represented by menorrhagia (41%) Various patterns on histopathology were secretory endometrium(28.99%)the commonest, followed by proliferative endometrium (24.92%). Incidence of malignancy was low in the present study. Conclusion: Endometrial curetting and biopsy is an important diagnostic procedure in evaluation of AUB.. Endometrial causes of AUB are age related, therefore it is specially recommended in women of the perimenopausal age presenting with AUB, to rule out preneoplasia and malignancy. Keywords: Endometrium, atypical, bleeding, histopathology Introduction Endometrium is a dynamic, hormonally sensitive and responsive tissue which constantly and rhythmically undergoes changes in the active reproductive life. Abnormal uterine bleeding (AUB) may be defined as a bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause [1]. AUB is one of the most common problems in women of all ages especially those in the peri-menopausal age group. The abnormal bleeding can be caused by a wide variety of disorders and it is one of the commonest complaints leading to endometrial sampling. It may represent a normal physiological state, and observation alone may be warranted. Alternatively, the bleeding can be a sign of a serious underlying condition necessitating aggressive treatment. Dilatation and curettage is a useful and cost effective method of detecting intrauterine pathologies and very few lesions escape detection [2]. Wide range of morphologic patterns resulting from both normal and abnormal changes offer a diagnostic challenge to practicing pathologists. Our study is aimed at determining the types and frequencies of endometrial pathologies in patients presenting with abnormal uterine bleeding at our hospital which caters largely to women of low socioeconomic status. Material and Methods The present study was conducted at the Hakeem Abdul Hameed Centenary Hospital, New Delhi. Our hospital caters to a predominant population belonging to low socioeconomic status residing in the nearby localities. This was a retrospective age specific comparative analysis of 638 women presenting with abnormal uterine bleeding, who underwent endometrial sampling at our hospital. The study spanned a period of 4 years and 4 months from January 2008 to April 2012. Data on the age and presenting clinical features were retrieved from the accompanying laboratory request forms, or © 2013. Al Ameen Charitable Fund Trust, Bangalore 21 Al Ameen J Med Sci; Volume 6, No.1, 2013 patients records where ever available. All endometrial biopsies and curettages of women with abnormal uterine bleeding were retrieved and reviewed, the pattern of uterine histopathological changes identified and classified. Endometrial tissue collected by sampling procedures such as dilatation and curettage (D&C), endometrial biopsy and fractional curettage which had been sent to the pathology lab for evaluation were included in the study. The total tissue submitted was processed. Paraffin blocks were prepared and tissue section (4-6µ) cut. The sections were stained with hematoxylin and eosin stain (H&E) and sent for microscopic examination by the pathologist. The clinical presentation on including the age of the patient and the endometrial histology were correlated and results compared with those in literature. Results A total of 638 patients underwent diagnostic D&C for AUB during the study period and the curettage was submitted for histopathological examination. The age of the patients studied were categorized into six groups (Table 1), patients with AUB ranged from 15 to 70 years with a mean age of 31.5years and a median age of 33years. Maximum patients (35.89 %) with abnormal uterine bleeding presented in age group 41-50 years closely followed by 33.22% in the age group 31-40yrs. The adolescent group (<20yrs) comprised of 2.82%patients while least number of patients were seen in the 60-70 years age group (0.62%) Jairajpuri ZS et al Figure-1: Microphotograph of endometrial granulomas (arrows) with Langhans giant cells. (Inset) (H&E, 10X) Data on the clinical presentation was limited, out of the 638 cases of AUB the details of patterns of bleeding were available in only 462 patients. Out of these, the most common clinical presentation was represented by menorrhagia (41%) followed by metrorrhagia (18%) menometrorrhagia, polymenorrhea, polymenorrhagia amongst others. (Figure 2) Graph-2: Distribution of cases according to clinical presentation Graph-1: Distribution of cases according to age Figure-2: Microphotograph of endometrial adenocarcinoma showing closely packed glands lined by epithelial cells with cytological atypia. (H&E, 40 X) AJMS WISHES YOU HAPPY NEW YEAR 2013 © 2013. Al Ameen Charitable Fund Trust, Bangalore 22 Al Ameen J Med Sci; Volume 6, No.1, 2013 Jairajpuri ZS et al An age specific comparative analysis of the clinical presentation (Table1) revealed that menorrhagia was the commonest complaint in the 41-50 years accounting for 41.2% of the cases presenting with the complaint. Metrorrhagia was also a frequent presentation in the 41-50 year age group seen in 41.4% patients with the complaint. Amongst the other clinical presentation those with oligomenorrhea were seen more in the pre and perimenopausal age group whilst continuous bleeding was more common in the 21-30 year age group. Table-1: Clinical presentation of atypical uterine bleeding according to age Pattern of bleeding <20years 21-30ye (...truncated)