Study of endometrial pathology in abnormal uterine bleeding

Abstract

Introduction: Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynaecology out-patient department. Endometrial sampling could be effectively used as the first diagnostic step in AUB, although at times, its interpretation could be quite challenging to the practicing pathologists. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of AUB. We also tried to observe the incidence of various pathology in different age groups presenting with abnormal uterine bleeding.

Material and methods: This was a study done at Sri Ramachandra Medical College and Research Institute, Chennai, India on 620 patients who presented with AUB from June 2005-June 2006. Out of which 409 cases of isolated endometrial lesions diagnosed on histopathology were selected for the final analyses. A statistical analysis between age of presentation and specific endometrial causes was done using χ(2) test.

Results: The most common age group presenting with AUB was 41-50 years (33.5%). The commonest pattern in these patients was normal cycling endometrium (28.4%). The commonest pathology irrespective of the age group was disordered proliferative pattern (20.5%). Other causes identified were complications of pregnancy (22.7%), benign endometrial polyp (11.2%), endometrial hyperplasias (6.1%), carcinomas (4.4%) and chronic endometritis (4.2%). Endometrial causes of AUB and age pattern was statistically significant with P value <0.05.

Conclusion: There is an age specific association of endometrial lesions. In perimenopausal women AUB is most commonly dysfunctional in origin and in reproductive age group, one should first rule out complications of pregnancy. The incidence of disordered proliferative pattern was significantly high in this study, suggesting an early presentation of these patients.

Keywords: Abnormal uterine bleeding; Endometrium.

Fig. 1

Endometrial glands in irregular shapes with focal crowding of glands and presence of dense compact stroma (Hematoxylin and eosin ×20)

Fig. 2

Closely packed endometrial glands with sparse intervening stroma (Inset shows stratification of lining epithelium and epithelial cells show cytological atypia with high nucleocytoplasmic ratio and irregular clumping of nuclear chromatin on higher magnification)

Graph 1

Distribution of cases of hyperplasia