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. 2025 Jan 16;17(1):e77542.
doi: 10.7759/cureus.77542. eCollection 2025 Jan.

Histopathological Spectrum of Endometrium in Abnormal Uterine Bleeding in a Tertiary Care Centre: A Three-Year Retrospective Study

Mary Nandini Singh  1 , Athira Sasidharan  1 , Benzy Paul  1 , Sathi Puthen Parambath  1
Affiliations

Histopathological Spectrum of Endometrium in Abnormal Uterine Bleeding in a Tertiary Care Centre: A Three-Year Retrospective Study

Mary Nandini Singh et al. Cureus. .

Abstract

Background: Abnormal uterine bleeding (AUB) is a universally prevalent affliction seen worldwide. However, the diagnosis and treatment of AUB are rarely straightforward due to the multifactorial aetiology, often requiring varied investigations to differentiate between functional and organic pathological lesions. A crucial diagnostic method that is beneficial is a simple endometrial biopsy procedure with an accurate histopathology diagnosis. This interventional procedure in patients suffering from AUB is warranted when medical management fails or if a radiologically suspicious endometrial thickening is seen, especially in perimenopausal and postmenopausal women.

Aim: The present study was undertaken to study the histopathological spectrum of endometrial lesions, to identify the various functional/organic causes of AUB, and to highlight the importance of a definitive histopathology diagnosis in challenging cases. The study also gathered data from AUB patients diagnosed with endometrial hyperplasia/carcinoma on biopsy who underwent a hysterectomy at our institution, with the aim of examining the concordance rate between the initial biopsy diagnosis and the final diagnosis.

Materials and methods: A retrospective three-year study was conducted in a tertiary care centre with 956 patients presenting with AUB who underwent endometrial sampling, dilation and curettage (D&C)/Pipelle aspiration as a diagnostic work-up.

Results: Of the 956 endometrial samples received, 106 were found to be inadequate for diagnosis, reducing the sample size to 850. Data analysis showed that perimenopausal women had the highest incidence of AUB (379/850; 44.5%). The incidence of functional and organic causes of AUB was 73.9% (628/850) and 26.1% (222/850), respectively. The most common functional cause of AUB was disordered proliferative endometrium (DPE) (235/628; 27.7%), followed by proliferative endometrium with 155/850 cases (18.2%). The most common organic lesion was benign endometrial polyp (102/850; 12%). It was followed by non-atypical hyperplasia (55/850; 6.5%) and then atypical endometrial hyperplasia/endometrial intraepithelial neoplasia (AEH/EIN) (41 cases, or 4.8%). Of the 22 cases of endometrial carcinomas, 81.8% were of the endometrioid type, followed by 9.2% cases of carcinosarcoma, and the remaining were clear cell carcinoma (4.5%) and serous carcinoma (4.5%).

Conclusion: Endometrial sampling, D&C/Pipelle aspiration is an essential gynaecological investigation in the evaluation of AUB. An accurate histopathology diagnosis, especially in endometrial malignancies, brings clarity and sets the stage for effective treatment strategies.

Keywords: abnormal uterine bleeding; carcinoma; endometrial biopsy; hyperplasia; post-menopausal bleeding.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Kunhitharuvai Memorial Charitable Trust Medical College Institutional Ethics Committee issued approval IECKMCT/22/2024-26.02.2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Method of endometrial sampling employed (n=850)
Figure 2
Figure 2. Distribution of cases according to parity (n=850)
Figure 3
Figure 3. Distribution of cases of AUB according to the histopathological patterns (n=850)
AUB: Abnormal uterine bleeding
Figure 4
Figure 4. Histopathological spectrum of endometrial lesions seen in PMB (n=200)
AEH/EIN: Atypical endometrial hyperplasia/Endometrial intraepithelial neoplasia; DPE: Disordered proliferative endometrium; EM: Endometrium/endometrial; Hyp: Hyperplasia; PMB: Postmenopausal bleeding
Figure 5
Figure 5. Photomicrograph of various endometrial lesions in AUB
5A: Proliferative endometrium, 40 years (H&E, 10x); 5B: DPE, 49 years (H&E, 4x); 5C: Benign endometrial polyp, 45 years (H&E, 4x); 5D: AEH, 52 years (H&E, 4x) AEH: Atypical endometrial hyperplasia; AUB: Abnormal uterine bleeding; DPE: Disordered proliferative endometrium; H&E: Hematoxylin and eosin
Figure 6
Figure 6. Photomicrograph of various neoplastic endometrial lesions in AUB
6A: Endometrioid adenocarcinoma, 51 years (H&E, 40x); 6B: Carcinosarcoma endometrium, 52 Years (H&E, 40x); 6C: Serous carcinoma endometrium, 64 Years (H&E, 10x); 6D: Clear cell carcinoma endometrium, 65 Years (H&E, 40x) AUB: Abnormal uterine bleeding; H&E: Hematoxylin and eosin
See this image and copyright information in PMC

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