Expression of Bcl-2 and Ki-67 in Endometrial Hyperplasia and Disordered Endometrium: A Cross-sectional Study

Abstract

Introduction: Endometrial hyperplasia affects both premenopausal and postmenopausal women and is a pathological condition that ranges from mild, reversible glandular proliferations to direct precursors of cancer. B-cell Lymphoma 2 (Bcl-2), an antiapoptotic gene involved in the regulation of apoptosis, and Ki-67, a proliferation marker, serve as indicators for cell proliferation from endometrial hyperplasia to endometrial carcinoma. Aim: To examine the expression of Bcl-2 and Ki-67 in endometrial hyperplasia and disordered endometrium. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at MVJ Medical College and Research Hospital, located in Hoskote, Karnataka, India, over a period of two years, from September 2020 to September 2022. All endometrial samples and hysterectomy specimens were included. Immunohistochemical staining was performed using Bcl-2 and Ki-67 in disordered proliferative endometrium and endometrial hyperplasia, and the staining and intensity were graded. Statistical analysis was performed, with qualitative variables presented as percentages and quantitative variables presented as Mean±Standard Deviation (SD). A p-value <0.05 was considered statistically significant. Results: The mean age of the study participants was 49.36 years. A total of 33 cases were included in the study, with 15 cases of disordered proliferative endometrium and 18 cases of endometrial hyperplasia. Bcl-2 expression in the 15 cases of disordered proliferative endometrium showed a score 4 positivity in 2 (13.3%) cases, score 8 positivity in 3 (20%) cases, and score 12 positivity in 10 (66.7%) cases, with a mean score of 10.13. Ki-67 expression in the 15 cases of disordered proliferative endometrium showed a score 4 positivity in 10 cases (66.7%), score 8 positivity in 4 (26.7%), and score 12 positivity in 1 (6.67%) case, with a mean score of 5.6. Conclusion: The overexpression of Bcl-2 in endometrial hyperplasia is considered to be an indicative of progression towards frank malignancy. Ki-67, the proliferation marker, is used to determine the progression of endometrial hyperplasia to carcinoma.