Spectrum of endometrial histological findings in women with abnormal uterine bleeding in mosul province via immunohistochemical technique

Abstract

Endometrial biopsy make a main part of the workloads in many histopathology laboratories. The most frequent indication is abnormal uterine bleeding(AUB). The reports on the frequency of different endometrial lesions in cases of AUB in Mosul Province are scanty, so this study aims to define the various findings in these women . This is a case series study that enrolled analysis of data of 188 females who were admitted to Al-Rabeeh, and Al-Zahrawy Private Hospitals , Mosul Province, Northern Iraq, and they were underwent an elective D&C and or hysterectomy during a period of one year .All cases were presented with AUB. Categorization of cases was done according to their ages into: Reproductive (17-40 years), perimenopausal (41-50 years) and postmenopausal (> 50 years). Then specimens were fixed in 10% formalin were prepared for microscopic examination and for immunohistochemical staining of Ki-67 . RESULTS: Sections of 16 cases out of 30 females (who aged from 31-40 years) were diagnosed as functional cause , while sections of 36 out of 79 females (who aged from 41-50 years) revealed presence of functional causes .Lastly , functional causes were identified in sections of 10 in.52 females that their ages ranged between 1-60 years. The proliferative phase was the commonest pattern and accounted for 58 (30.9 %) out of 188 females. On the other hand, secretory phase was detected in sections of 12(6.4%) out of 188 cases. Features of simple endometrial hyperplasia in sections of 40(21.3%) with evidence of simple endometrial hyperplasia in sections of 33cases (17.6%) ,while those of cystic subtype were noticed sections in seven cases(3.7%).On the other hand, complex endometrial hyperplasia was detected in 7(3.7%) out of 188 cases Sections of about 21(11.2%) out of 188 cases exhibited features of endometrial atrophy . Microscopic findings of endometrial polyp was found in sections of 26 (13.8%) out of 188 females. Observation of 3 sections (1.6%) revealed squamous metaplasia. In this study, sections of about 14(7.5%) out of 188 females were diagnosed as carcinoma. Moreover, features of leiomyosarcoma was identified in just one case 1(0.5%). The present work revealed that about 80(42.5%) out of 188 females were at perimenopausal period. Women in postmenopausal period were about 68 (36.2%).The present work revealed that features of endometrial hyperplasia were shown in about 20 ( 25%) out of 79 females who aged from 41-50 years. Complex endometrial hyperplasia was diagnosed in sections of 3 cases, while features of polyp were shown in sections of 8 cases. On the other hand, carcinoma were identified in sections of 3 cases. Secondly, sections of 16 out of 52 females who aged from 51-60 presented with endometrial hyperplasia. Complex endometrial hyperplasia was shown in sections of 4 cases, features of polyp were shown in sections of 10 cases . Three cases of carcinoma were identified in this age. This descriptive study gives a base on the histopathological level about the pattern of AUB in Mosul Province that may highlight this subject and assists the gynecologists for the modification of their managements protocols. Abnormal uterine bleeding was frequent in Mosul Province. The cases of benign lesion was the most frequent. A considerable frequency was for cases of polyp and cases carcinoma in post menopause women. The conscientious sampling and carful management and should be more precise to keep the uterus.