ISSN: 2320-5407 Int. J. Adv. Res.

10(02), 258-262

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/14202
DOI URL: http://dx.doi.org/10.21474/IJAR01/14202

RESEARCH ARTICLE
HISTOPATHOLOGICAL STUDY OF ENDOMETRIAL BIOPSIES IN ABNORMAL UTERINE
BLEEDING

Dr. Farhana Zakaria1, Dr. Taqiya Nuzhath2 and Dr. Ayisha Begum3

1. Associate Professor, Department of Pathology, Srinivas Institute of Medical Sciences and Research Centre,
Mangalore
2. Assistant Professor, Department of Pathology, Kanachur Institute of Medical Sciences, Mangalore
3. Assistant Professor, Department of Obstetrics and Gynecology, Kanachur Institute of Medical Sciences,
Mangalore
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Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Introduction: Excessive and painful bleeding from uterus is a common
Received: 10 December 2021 cause for distress among menstruating women, perimenopausal as well
Final Accepted: 13 January 2022 as post-menopausal. There are innumerable causes for abnormal
Published: February 2022 bleeding from uterus. We carried out a retrospective study to enumerate
the causes of abnormal uterine bleeding.
Key words:-
Abnormal Uterine Bleeding, Materials And Methods: Consecutive 200 slides of endometrial
Histopathology, Endometrial biopsies done for abnormal uterine bleeding were evaluated over a
Hyperplasia,Endometrial Biopsies, period of two years between June 2019 to May 2021. The slides were
Endometrial Carcinoma
stained with haematoxylin and eosin stain. All the slides were
evaluated, examined and reported by two experienced pathologists. The
results were tabulated depending upon the age and diagnosis.
Results: Commonest age group noted for abnormal uterine bleeding
was between 41-50yrs. Disordered proliferative phase was the
commonest (16%) functional cause of abnormal bleeding and
diagnosis. The most common organic cause of abnormal bleeding was
simple endometrial hyperplasia without atypia (28%). Endometrial
carcinoma was diagnosed in 2 cases above 50yrs.
Conclusion: Simple endometrial hyperplasiawas the most common
cause of abnormal bleeding from uterus in our series. Atypical
hyperplasia or endometrial carcinoma should be ruled out in post-
menopausal age group.

Copy Right, IJAR, 2022, All rights reserved.

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Introduction:-
Abnormal uterine bleeding (AUB) is a distressing symptom seen in both young as well as elderly women. The
mental agony associated with it is unbearable. Any abnormal excessive bleeding from uterus is thought of a
symptom of malignancy until proved otherwise. Hence, it leads to anxiety and confusion among the patients and
their near ones. But most of the time it is due to various benign causes like irregular ripening, irregular shedding,
endometrial hyperplasia or atrophy.1,2

Corresponding Author:- Dr. Farhana Zakaria

Address:- Associate Professor, Department of Pathology, Srinivas Institute of Medical Sciences and
Research Centre, Mangalore 258
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Abnormal uterine bleeding is any form of uterine bleeding that is varying in amount, or timing and not related to
menstrual bleeding.3 Dysfunctional uterine bleeding (DUB) is defined as irregular bleeding from uterus not
associated with malignancy, inflammation and pregnancy. 4 Even though the terms are sometimes used
synonymously they are not same.

The endometrial biopsyis usually chosen to evaluate abnormal uterine bleeding as it is a simple procedure and has
several advantages over other methods of diagnosis.Histopathological examination of endometrial biopsies is the
standard of care diagnostic tool in the assessment and evaluation of abnormal uterine bleeding. It helps to come to a
specific diagnosis to plan the management and treatment of AUB. 4 The samples are obtained easily and safely and
has a high diagnostic accuracy. Examination and reporting of slides from endometrial biopsies and curettingis a
challenging task for a practicing pathologist as they exhibit a variety of histopathological patterns from normal to
abnormal cyclical changes, infections, ingestion of drugs, hormonal influence etc..5

Materials and Methods:-

This two-year prospective study was done in a tertiary care centre between June 2019 and May 2021, which
included consecutive 200 cases of clinically diagnosed AUB. Patients with history of coagulation disorders,
previously diagnosed gynaecological malignancy, pregnancy related complications, leiomyoma, cervical or vaginal
pathology and autolysed specimens were excluded from the study.The biopsy specimenweretransported in 10%
formalin, underwent routine histopathological processing and paraffin blocks were prepared. The paraffin blocks
were sectioned and stained with Haematoxylin and Eosin stain.

The examination findings were broadly divided into functional causes and organic causes.In this study the functional
causes of AUB considered were normal cyclical endometrium (secretory and proliferative phase), other changes like
disordered endometrium and atrophic endometrium. Organic causesincluded were simple endometrial hyperplasia
withatypia, simple endometrial hyperplasia without atypia, complex endometrial hyperplasia with atypia,complex
endometrial hyperplasia without atypia, endometrial polyp, endometrial carcinoma and retained products of
conception.

Depending upon the reproductive and menopausal status patients were categorized into the following age groups:
Reproductive (18-40 years), perimenopausal (41-50 years) and post-menopausal (> 50 years).

Exclusion Criteria:
Patients with known causes of organic lesions involving the genital tract like fibroid uterus, adenomyosis, vaginal
and cervical diseases were excluded from the study. Also, patients with systemic diseases like bleeding and
coagulation disorders were excluded.

Adequacy of specimen criteria:

In slides or blocks where no endometrial tissue was seen or the preparation was poor and no conclusion was arrived
at, then the specimen was termed as inadequate and was excluded from the study group.

Results:-
A total of 200 consecutive endometrial biopsies and curetting’s from the patients with abnormal uterine bleeding
were analysed. Out of the 200 cases, organic cause was the predominant finding seen in 56% of cases and the
remaining 44% showedfunctional causes.

Patient’s age ranged from 21-65 years [Table 1]. Majority of the patients were in the age group of 41-50years.
Simple endometrial hyperplasia without atypia was the most common finding. It was seen in 56 cases (28%). This
was followed by complex endometrial hyperplasia without atypia. It was seen in 38 cases (19%) [Table 2]. Complex
endometrial hyperplasia with atypia was seen in only 2 of 200 patient slides analysed.

Among the functional causes, disordered proliferative endometrium was the most common finding noticed which
wasseen in 32 cases (16%) [Table 3].

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Table 1:- Age Distribution.

Age (in years) No. of patients Percentage (%)
21-30 26 13
31-40 44 22
41-50 114 57
51-60 8 4
>60 8 4
Total 200 100

Table 2:- Age distribution of different histopathological spectrum.

ENDOMETRIAL 21-30 31-40 41-50 51-60 >60 TOTAL PERCENTAGE
PATTERN
Proliferative Phase 8 10 2 0 0 20 10
Secretory Phase 6 6 6 0 0 18 9
Disordered 2 6 20 4 0 32 16
Proliferative Phase
Atrophic 0 0 0 0 2 2 1
Endometrium
Progesterone 0 2 12 2 0 16 8
Induced Changes
Retained Products of 2 2 0 0 0 4 2
Conception
Endometrial Polyp 4 6 0 0 10 5
Simple 6 8 36 4 2 56 28
Endometrial
Hyperplasia
without Atypia
Complex 2 6 26 4 0 38 19
Endometrial
Hyperplasia Without
Atypia
Complex 0 0 0 0 2 2 1
Endometrial
Hyperplasia with
Atypia
Endometrial 0 0 0 1 1 2 1
Carcinoma

Table 3:- Showing the various functional causes of AUB.

Endometrial Pattern No. of Patients Percentage
Proliferative Phase 20 10%
Secretory Phase 18 9%
Disordered Proliferative Phase 32 16%
Atrophic Endometrium 2 1%
Progesterone Induced Changes 16 8%

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Table 4:- Showing various organic causes of AUB.

Endometrial Pattern No. of Patients Percentage
Retained Products of Conception 4 2%
Endometrial Polyp 10 5%
Simple 56 28%
Endometrial
Hyperplasia
without Atypia
Complex Endometrial Hyperplasia 38 19%
Without Atypia
Complex Endometrial Hyperplasia 2 1%
with Atypia
Endometrial Carcinoma 2 1%

Discussion:-
The most common gynaecological problem encountered is abnormal uterine bleeding. In otherwise healthy women,
it significantly alters the quality of life with various symptoms like dysmenorrhoea, menorrhagia, polymenorrhagia
and metrorrhagia. Abnormal uterine bleeding includes bothbleeding from structural causesand dysfunctional uterine
bleeding (DUB).6

Abnormal uterine bleeding is defined as any bleeding from uterus other than regular menstrual bleeding. AUB
secondary to organic pathology is more common in young girls of pubertal age and perimenopausal women, though
it can occur in reproductive women of all ages.7World Health Organization defines peri-menopause as two to eight
years preceding menopause and one year after the final menstrual period. 8

During pre-menopausal period there is reduction in number of ovarian follicles. As a result, when woman is nearing
menopause, her cycles tend to become short and often become anovulatory intermittently. The fluctuations in
estradiol level in body leads to abnormal patterns of uterine bleeding.

When there is withdrawal of estrogen and progesterone from the body normal menstrual bleeding occurs. Whenever
there is anovulation, then there is no production of progesterone. As a result, there are no secretary changes seen in
endometrium. Estrogen remains unopposed giving rise to persistent proliferative or hyperplastic endometrium.9

In our study 57% of the slides were from age group of 41-50 years, which formed the most common age group
presenting with AUB [Table 1]. It was comparable to study conducted byBoldeet al. 10

In our study, incidence of functional causes of AUB was 44% and incidence of organic causes were56%.

The most common histological pattern observed in our study was endometrial hyperplasia and was seen in 40% of
slides. Of which simple hyperplasia without atypia being the predominant pattern 28%. It was comparable to study
of Vijay Sreedhar et al where they had 27.4%.9 In the study by K. Sajithaet al, they found it to be higher at 56.4%. It
might be as a result of a greater number of slides included in their study. 11 Endometrial hyperplasia isa known
precursor of endometrial carcinoma, and hence the importance associated with it. 12 The chances of progression of
endometrial hyperplasia to cancer is said to be around 5-10%.13

We observed endometrial polyps in 5% of cases [Table 4] which was much less than 9.3% seen by Vijay Sreedhar et
al and 8.2% in Chhatrasal et al, but higher than Gupta et al and Kafle N et al who had seen it in 2.41%. 9,14,15,16

Endometrial carcinoma occurs can a result of excess estrogenic stimulation. The most common endometrial cancer
is of endometroid type. We noted two cases of endometrial carcinoma, one in 51-60 and other in >60 years age
group. Kafle N et al observed endometrial carcinoma in 2.41% where as we observed it in only 1%. Bindroo et
alfound endometrial carcinoma in 5.9% and it was 9% in Vijay Sreedhar et al.6,9

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Conclusion:-
We found that a greater number of cases of abnormal uterine bleeding is seen in the perimenopausal age group (41-
50 years). Most of the cases are due to endometrial hyperplasia. Simple endometrial hyperplasia without atypia is
the most common type of endometrial hyperplasia. A detailed clinical and diagnostic study is required in patients
with abnormal uterine bleeding for proper management. Though endometrial carcinoma is rare in our study, it
should be suspected in post-menopausal age group.

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