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J Ayub Med Coll Abbottabad 2016;28(4)http://www.jamc.ayubmed.edu.pk721ORIGINAL ARTICLE HISTOLOGICAL PATTERN OF ENDOMETRIAL SAMPLES IN POST-MENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDINGFarhat Deeba, Shaista, Bushra Khan*Women Medical College, Abbottabad, *Ayub Teaching Hospital Abbottabad-PakistanBackground: Abnormal uterine bleeding is one of the most common clinical problems in gynaecological practice and is an indicator of various underlying disorders.An endometrial biopsy should be done in all women over 35 years with AUB to rule out endometrial cancer or pre-malignant lesion and to initiate treatment. However, wide range of histological patterns on endometrial biopsy offer a diagnostic challenge to practicing pathologists. The objective of this study was to determine histological patterns of endometrium in postmenopausal women with abnormal uterine bleeding.Methods: This cross-sectional study was conducted in thedepartment of obstetrics and gynaecology, Benazir Bhutto Shaheed women and children teaching hospital, Abbottabad from 15/11/2014 to 14/05/2015.This study involved 110 postmenopausal women presenting with abnormal uterine bleeding. A written informed consent was obtained from every patient.Results: The mean age of the patients was 61.60±6.17 years and the mean duration of AUB was 5.20±2.80 years. Most of the patients were para 6 (28.2%) and para 5 (28.2%) followed by para 4 (18.2%) and para 3 (17.3%) while only 8.2% were para 1. The most common histological pattern observed was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%). When stratified the data, there was no significant difference of histological patterns across various age groups (p=.673), duration of AUB (p=.064) and parity (p=.242).Conclusion: The most common histological pattern observed in postmenopausal women with AUB was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%).Keywords: Postmenopausal Women; Abnormal Uterine Bleeding; Histological Endometrial PatternsJ Ayub Med Coll Abbottabad 2016;28(4):721–4INTRODUCTIONAbnormal uterine bleeding (AUB) is a very common gynaecological condition that affects all age groups. One third of the patients attending gynaecology OPD present with complaints of abnormal uterine bleeding.1 Bleeding is set to be abnormal when the pattern is irregular, abnormal duration (>7 days) or menorrhagia or abnormal amount(>80ml/menses).2AUB is an indicator of various underlying disorders, which have been newly classified by the International Federation of Gynaecology and Obstetrics (FIGO) Menstrual Disorders Group. Under this system of classification, causes of AUB are classified as polyps (AUB-P), adenomyosis (AUB-A), leiomyomas (AUB-L), malignancy and premalignant conditions (AUB-M), coagulopathy(AUB-C), ovulatory disorders (AUB-O), endometrial disorders (AUB-E), iatrogenic (AUB-I), and “not classified’’ (AUB-N).3An endometrial biopsy should be done in all women over 35 years with AUB to rule out endometrial cancer or pre-malignant lesion (e.g., a typical hyperplasia). Endometrial biopsy should also be considered in women between the age of 18 and 35 years with AUB who have risk factors for endometrial cancer or if AUB fails to resolve with medical management.4In peri-menopausal age groups menstrual cycle becomes shortened, irregular and often an ovulatory as the ovarian activity declines initially and then ovulation fails, no corpus luteum form and no progesterone is secreted from the ovary. The irregularity in menstrual cycle during perimenopause can be due to anovulation or to irregular maturation of follicles.5 The increased risk of endometrial hyperplasia and endometrial carcinoma is more evident in peri-menopausal and post-menopausal women with abnormal uterine bleeding.6Most hyperplasias that occur in menopausal women are associated with chronic anovulation. Typically postmenopausal women with hyperplasia or carcinoma have moderate or heavy vaginal bleeding compared with atrophic endometrium where there will be only spotting per vaginum.7The aim of this study was to find the
J Ayub Med Coll Abbottabad 2016;28(4)http://www.jamc.ayubmed.edu.pk722histological pattern of endometrium in abnormal uterine bleeding in post-menopausal age group.MATERIAL AND METHODSThis cross-sectional study was conducted in thedepartment of obstetrics and Gynaecology, Benazir Bhutto Shaheed Women and Children Teaching Hospital, Abbottabad over a period of six months from 15-11-2014 to 14-05-2015. Sample size was 110 patients and all these cases were taken over this six months period (inclusive criteria was postmenopausal women aged 50–70 years with abnormal uterine bleeding who underwent dilatation and curettage). Written informed consent and detailed history was taken from each patient. Their demographic details were also noted. Following examination under anaesthesia (EUA) and dilatation & curettage, endometrial biopsy was taken and sent forhistopathology. Histopathological pattern reported by histopathologic was noted and recorded into the attached proforma along with patients’ demographic details. All the histopathologies were acquired from same (Hospital) lab to eliminate bias.RESULTSThe age of the patients ranged from 50 years to 70 years with a mean of 61.60±6.17 years. The duration of AUB ranged from 1 year to 10 years with a mean of 5.20±2.80 years. Most of the patients were para 6 (28.2%) and para 5 (28.2%) followed by para 4 (18.2%) and para 3 (17.3%) while only 8.2% were para 1.The most common histological pattern observed was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%) as shown in table-1.When stratified the data for various age groups, the frequency of malignancy was higher with increasing age of the patient; 50–55 years (8%), 56-60 years (12.5%), 61–65 years (12.9%), 66–70 years (15.8%). Similarly thefrequency of complex hyperplasia with atypia (0% vs. 0% vs. 6.5% vs. 7.9%) and without atypia (24% vs. 31.3% vs. 32.3% vs. 34.2%) was also higher with increasing age of the patient. However, the observed difference was statistically insignificant (p=.673) as shown in table-2.When stratified the data for duration of AUB, the frequency of malignancy was higher with increasing duration of AUB; 1–3 years (5.6%), 4–7 years (14.6%), 8–10 years (18.2%). Similarlyfrequency of complex hyperplasia with atypia (0% vs. 4.9% vs. 9.1%) and without atypia (22.2% vs. 31.7% vs. 39.4%) was higher with increasing duration of AUB. However again the observed difference was statistically insignificant (p=.064) as shown in table-3.When stratified the data for parity, the frequency of malignancy was higher with increasing parity of the patient; para 2 (0%), para 3 (10.5%), para 4 (10%), para 5 (12.9%) and para 6 (19.4%). Similarly the frequency of complex hyperplasia with atypia (0% vs. 0% vs. 5% vs. 6.5% vs. 6.5%) and without atypia (11.1% vs. 26.3% vs. 30% vs. 32.3% vs. 38.7%) was also higher with increasing parity of the patient. However, the observed difference was statistically insignificant (p=.242) as shown in table-4.Table-1: Frequency table for histological patternType FrequencyPercentAtrophic Endometrium2724.5Simple Hyperplasia2623.6Complex Hyperplasia without Atypia3430.9Complex Hyperplasia with Atypia54.5Benign Endometrial Polyp43.6Malignancy1412.7Total110100.0Table-2: Age groups and histological pattern cross tabulationHistological PatternTotalp valueAtrophic EndometriumSimple HyperplasiaComplex Hyperplasia without AtypiaComplex Hyperplasia with AtypiaBenign Endometrial PolypMalignancy7760322550–55 Years28.028.024.0.012.08.0100.05450021656–60 Years31.325.031.3.0.012.5100.077102143161–65 Years22.622.632.36.53.212.9100.0881330638Age Groups66–70 Years21.121.134.27.9.015.8100.02726345414110Total24.523.630.94.53.612.7100.0.673
Dr. Farhat Deeba, , Shaista, , Bushra Khan. (2016) HISTOLOGICAL PATTERN OF ENDOMETRIAL SAMPLES IN POST-MENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING, JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD, Volume 28, Issue 4.
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