Histopathological spectrum of endometrial biopsies in abnormal uterine bleeding: A one year experience in a tertiary care centre

Abstract

Background: Abnormal uterine bleeding (AUB) shows spectrum of patterns on histopathology and pathologist plays a very vital role in reporting of endometrial biopsies and helps in differentiating non-neoplastic lesion from neoplastic lesions, early detection of the precursor lesions and exclusion of malignancy. The aim of this study is to study the spectrum of endometrial patterns in women with AUB and to correlate it with the different age groups. Materials and Methods: 272 samples of endometrial biopsies with AUB were received from the gynaecology department, processed and stained with hematoxylin & eosin and subjected to histopathological examination. Results: The peak incidence is observed in the age group of 41-50 years. The most common histomorphological pattern is proliferative pattern. 66 cases (24.26%) show endometrial hyperplasia out of which 8cases show atypia. 6 cases of endometrial carcinoma were reported and most of them were present in postmenopausal age. Pill endometrium and chronic endometritis were not reported in postmenopausal age group and all 3 cases of atrophic endometrium were reported in postmenopausal age group. Conclusion: AUB significantly affects the quality life of women and leads to anemia. Hence histopathological examination should be considered which plays a critical role in early diagnosis of endometrial pathology and to provide appropriate gynaecological management. Keywords: AUB, endometrial biopsy, endometrial hyperplasia, endometrial carcinoma, proliferative phase, secretory phase Abbreviations: AUB-abnormal uterine bleeding, DUB-dysfunctional uterine bleeding Introduction Endometrial diseases are seen in women across all age groups and are a leading cause of increased maternal morbidity and mortality. The majority of females with endometrial diseases present mostly with abnormal uterine bleeding (AUB) [1, 2]. Thus, AUB calls for the need of urgent diagnosis. AUB-is a term used to describe any bleeding that does not fall within the normal ranges for amount, frequency, duration, or cyclicity. The most common presenting symptoms are menorrhagia, polymenorrhea, metrorrhagia, and intermenstrual bleeding. Dilatation and curettage [3] (D and C) is the mainstay of endometrial sampling. D and C also let for a fractional curettage with separate sampling of both endometrial and endocervical tissue. The underlying disease can be detected by histological variations of endometrium taking into account the age of the woman, the phase of her menstrual cycle, and use of any exogenous hormones. Pregnancy-related and dysfunctional uterine bleeding are more common in patients with younger age group, whereas atrophy and organic lesions become more frequent in older individuals. Hyperplasia is found in up to 16% and endometrial carcinoma in fewer than 10% of postmenopausal patients undergoing biopsy [4, 5]. Patients with a history of anovulation, obesity, hypertension, diabetes, and exogenous estrogen use are also at an increased risk for hyperplasia and adenocarcinoma. The aim of this study is to evaluate spectrum of endometrial patterns in women with AUB and to correlate with different age groups i.e. reproductive, perimenopausal and postmenopausal age groups.