Biopsy Curettage Research Articles

Clinicopathological Aspects of Dilation and Curettage (D&C) Biopsies Taken from Patients Living at High Altitude in Taif, KSA, with a Special Emphasis on Chronic Endometritis.

Chronic endometritis (CE) is a persistent inflammation of the uterine lining. Although it has a minimal clinical presentation, CE adversely affects the reproductive ability of women. The aims of this study were to detect pathological endometrial patterns in D&C biopsies and to evaluate chronic endometritis in patients living in a high-altitude area (1800 m above sea level) in order to determine the clinical pathological features and prevalence. A cross-sectional study conducted at King Faisal Maternity Hospital included 100 samples of D&C biopsies from women complaining of various gynecological symptoms not due to gestational causes. The biopsies underwent tissue processing, H&E staining, and CD138 detection. Blood samples were taken for serological detection of infectious diseases, complete blood count, and chemical parameters. The mean age of women in the study with CE was 48.5 ± 8.5 years, and that of those without CE was 46.9 ± 9.7 years. The most common complaints were abnormal uterine bleeding, accounting for 83%. CE was present in 8% of cases, and there was a nonsignificant difference in hematological parameters between women with CE and those with other pathological diagnoses. There were also nonsignificant differences in chemical parameters, except for FSH and LH levels, which showed a significant difference, with p-values of 0.05 and 0.02, respectively. It can be concluded that the most common gynecological complaint of women in this study was abnormal uterine bleeding. The most commonly diagnosed pathological endometrial disorder in D&C biopsies was disordered proliferative endometrium, followed by endometrial polyps and endometrial hyperplasia. All of these are usually associated with hormonal disturbance, which appeared to be very common in the women in this study. The prevalence of chronic endometritis detected in our study was 8%, which is relatively high.

Histomorphological features and IHC expression in endometrial and endocervical adenocarcinoma

Background: The distinction of endometrial adenocarcinoma (EMA) from endocervical adenocarcinoma (ECA) has great significance preoperatively, since the therapeutic plan depends on the primary site of tumor. Immunohistochemistry (IHC) is an ancillary method in distinguishing primary EMA and ECA, especially in cases of histomorphological overlap. Aims and Objectives: Primary objective of this study was to describe the expression of IHC markers–estrogen receptor (ER), vimentin, monoclonal carcinoembryonic antigen (CEA), P16 in EMA and ECA. Secondary objective of this study was to describe the histomorphological features of EMA and ECA. Materials and Methods: This is a descriptive study done at the Department of Pathology, Government Medical College, Kottayam between November 2019 and May 2021. The sample size was 54 which included primary adenocarcinoma diagnosed on curettage biopsies. IHC was performed using ER, Vimentin, P16, and mCEA. A semiquantitative scoring was done using the German IHC scoring system. Results: Histomorphological features and IHC expression in EMA and ECA were studied. Percentage of cases with expression of IHC markers is as follows. In endometrioid EMA-ER in 100% of cases, Vimentin 83.3%, P16 0%, and CEA in 7.3% cases. About 80% of serous carcinomas showed P16 and vimentin positivity with negative staining for ER and CEA. In ECA-ER in 0% cases, vimentin 16.7%, P16 80%, and CEA in 66.7% of cases. Based on histomorphologic appearance, the common histologic subtype of EMA was endometrioid EMA followed by serous carcinoma. In ECA, the usual type was more common than gastric type. Conclusion: IHC markers-ER, vimentin, P16, and CEA are useful in distinguishing endometrioid EMA and ECA.

A Case Report of Spontaneous Regression of grade 3 Clear Cell Endometrial Cancer

Spontaneous remission of cancer (SR) is a rare, defined as a complete or partial, temporary, or permanent disappearance of all or at least some relevant parameters of a soundly diagnosed malignant disease without any medical treatment or with treatment that is considered inadequate to produce the resulting regression. We present the case of a 43-year-old woman who initially received a diagnosis of high- grade squamous intraepithelial lesion (HSIL) on a Pap smear, further examination and MVA (Manual Vacuum Aspiration) curettage biopsy revealing poorly differentiated clear cell adenocarcinoma of the endometrium, stage 1a3 and subclinical hypothyroidism. The patient was prescribed thyroid tablet replacement but chose not to pursue any cancer treatment. Following two consecutive MVA curettage procedures, she returned for a hysteroscopic examination and the third MVA curettage biopsy, the histological report indicated the absence of any malignancy. Throughout the course of her illness, the patient underwent a total of ten sessions of MVA endometrial curettage and received thyroid replacement therapy for her subclinical hypothyroidism. Despite our initial reservations, we continue to provide care and support to her throughout whole course of this illness. We demonstrated that a patient's autonomy in refusing medical treatment is a fundamental ethical and legal principle in healthcare. Conclusion: We report the 8 cases of spontaneous remission (SR) in endometrial cancer. Given the infrequent occurrence of such cases, it is imperative to involve in a comprehensive and in-depth discussion.

Manual vacuum aspiration (women's MVA) for endometrial biopsy for patients with suspected endometrial malignancies.

Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy. Forty-seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1-4, where 1 denoted poor and 4, good quality. The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p=0.0065). No differences were observed between the MVA and total curettage groups (p=1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p=0.0225 and p=0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%). Considering its quality and safety, Karman-type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde.

A Novel Xeno-Free Method to Isolate Human Endometrial Mesenchymal Stromal Cells (E-MSCs) in Good Manufacturing Practice (GMP) Conditions.

The cyclic regeneration of human endometrium is guaranteed by the proliferative capacity of endometrial mesenchymal stromal cells (E-MSCs). Due to this, the autologous infusion of E-MSCs has been proposed to support endometrial growth in a wide range of gynecological diseases. We aimed to compare two different endometrial sampling methods, surgical curettage and vacuum aspiration biopsy random assay (VABRA), and to validate a novel xeno-free method to culture human E-MSCs. Six E-MSCs cell samples were isolated after mechanical tissue homogenization and cultured using human platelet lysate. E-MSCs were characterized for the colony formation capacity, proliferative potential, and multilineage differentiation. The expression of mesenchymal and stemness markers were tested by FACS analysis and real-time PCR, respectively. Chromosomal alterations were evaluated by karyotype analysis, whereas tumorigenic capacity and invasiveness were tested by soft agar assay. Both endometrial sampling techniques allowed efficient isolation and expansion of E-MSCs using a xeno-free method, preserving their mesenchymal and stemness phenotype, proliferative potential, and limited multi-lineage differentiation ability during the culture. No chromosomal alterations and invasive/tumorigenic capacity were observed. Herein, we report the first evidence of efficient E-MSCs isolation and culture in Good Manufacturing Practice compliance conditions, suggesting VABRA endometrial sampling as alternative to surgical curettage.

Mini-resectoscopy Endometrial Biopsy Accuracy Respect Dilatation and Curettage in Endometrial Cancer: A Retrospective Analysis

<h3>Study Objective</h3> Dilatation and curettage (D&C) biopsy is a "gold standard" to confirm the histology and grade of endometrial cancer but the concordance rate was only 70% between D&C and hysterectomy. <h3>Design</h3> We retrospectively reviewed 187 cases of endometrial cancer that were treated at our institution from January 2017 to June 2019. We analyzed all patients who underwent Trans Cervical mini-Resectoscopy (TCR) or D&C biopsy at our institution and received laparoscopic/laparotomic hysterectomy or staging as the treatment by our surgical team. <h3>Setting</h3> We categorized the patients into the TCR group or the D&C group. For each group, we compared the biopsy histological grade and histology with the final hysterectomy of all patients. <h3>Patients or Participants</h3> We analyzed 187 cases of endometrial cancer aged from 29 to 81 years. <h3>Interventions</h3> TCR was carried out, with lidocaine local cervical injection and awake sedation. Resectoscopy was performed with a 7mm bipolar resectoscope. D&C was carried out in general anesthesia and the cervix is dilated up to 10mm Hegar dilators. Two different pathologies analyzed the initial and hysterectomy specimens. <h3>Measurements and Main Results</h3> Endometrial biopsy was obtained by D&C in 103 (55%) cases and by TCR in 84 (45%) of cases. the median operative time was 17,5 for TCR and 17,41 for D&C without significant differences between the two methods (p<0,99). The second stage was preoperative detective only with the use of TCR biopsy 5 (100% of cases) respect none of D&C. Among 72 patients who underwent TCR biopsy, only 4 patients have been grading misdiagnosed in the final pathology, which gives a rate of 5,5% (K 0,918 IC 95% 0,958-0,878 p<0,001). In the D&C group of 87 patients, 17 (19,5%) patients have been grading misdiagnosed (K 0,699 IC 95% 0,764 - 0,634 p<0,001). <h3>Conclusion</h3> Our data, although retrospective, demonstrate that Trans cervical mini-resectoscopy provides a more accurate reflection of FIGO grade than D&C endometrial sampling.

A COMPARATIVE STUDY OF PREOPERATIVE ENDOMETRIAL BIOPSY AND ENDOMETRIAL CURETTAGE FROM HYSTERECTOMY SPECIMEN IN PERIMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING

Objective: To assess the diagnostic accuracy of preoperative curettage biopsy samples and to correlate the ndings with post hysterectomy curettage samples for different endometrial pathologies. Methods: This cross-sectional study was conducted from October 2012 to September 2014 in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal, Manipur. Approval from institutional ethical committee was taken before starting the study. Specimens of all perimenopausal women with abnormal uterine bleeding (AUB) who underwent endometrial biopsy and subsequent hysterectomy were studied in the Department of Pathology. Results: A total of 50 cases of clinically diagnosed patients with abnormal uterine bleeding were studied. Preoperative Endometrial curettage biopsy was followed By curettage post-hysterectomy. Biopsy ndings were correlated with post-hysterectomy curettage ndings. The age group of the patients range from 37 years to 53 years with maximum number of cases in the range of 45 to 50 years (38%). Proliferative endometrium was the most common pattern (56%) obtained by endometrial curettage biopsy as well as in post hysterectomy curettage followed by secretory endometrium. Statistical analysis of endometrial biopsy study of 48 cases showed that it has a high Sensitivity (100%), Negative predicted value (100%), Specicity (97.44%) and Positive predicted value (90.91%). The Accuracy of the test was 98%. Conclusions: While endometrial curettage biopsy using uterine curette is not the gold standard for diagnosing endometrial pathologies in AUB, it is an important diagnostic tool in the investigation for assessment of endometrium as it has few advantages.

Comparison of biopsy results of HPV 16/18 and non-16/18 HPV positive patients with a normal PAP test, a tertiary center experience

Background/Aim: Optimal management for HPV positive and cytology negative patients remains a controversial issue. Immediate colposcopy is suggested for HPV 16/18 positive patients, whereas patients with non 16/18 HPV oncogenic virus positive are recommended to co-test after a year. In this study, we aim to compare the immediate colposcopic biopsy results between HPV 16/18 and non-16/18 HPV positive patients with cytology negative patients. Methods: In this prospective cross-sectional study, we included 1028 HPV positive and cytology negative patients who were screened for cervical cancer between January 2017 and 2019. Liquid based preparations were used for cytology samples (ThinPrep Pap Test). Cervical specimens were analyzed with Hybrid Capture for HPV types. Patients underwent colposcopic examination, biopsy procedure and endocervical curettage. Results: A total of 424 (41.2%) patients were HPV 16/18 positive, while 604 (58.8%) were non-16/18 oncologic HPV positive. Colposcopic biopsy results of the patients revealed that of the HPV 16/18 positive patients, 246 (23.9) had no dysplasia, 101 (9.8) had LGSIL and 77 (7.5%) had HGSIL. Among the non 16/18 positive patients, 422 (41.1%) had no dysplasia, 144 (14%) had LGSIL and 38 (3.7) had HGSIL. All patients were referred for endocervical curettage, which resulted as follows: Among HPV 16/18 patients, 384 (37.4%) had no dysplasia, 21 (2%) had LGSIL and 19 (1.8%) had HGSIL. Five hundred seventy-one non 16/18 positive patients had no dysplasia, 26 (2.5%) had LGSIL and 7 (0.7) had HGSIL. The comparison of colposcopic biopsy results of HPV 16/18 and non-16/18 HPV positive patients were different in terms of no dysplasia and HGSIL (P=0.001 and P=0.001, respectively), while LGSIL results were similar. The endocervical curettage biopsy results of the patients revealed a significant difference in HGSIL results (P=0.03). The two groups were similar with respect to reports of no dysplasia and LGSIL. Conclusion: Direct referral of the patients, who are expected to be lost to follow-up, could be convenient for non-16/18 HPV positive patients with negative cytology to reduce progression of cervical cancer and the psychological burden of HPV positivity.

A Rare Case Report of Dorsal Epidural Abscess Caused by Streptococcus agalactiae in a Diabetic Patient

This observation reports the case of a diabetic patient who presented with compressive neurological signs. The biological assessment showed an inflammatory syndrome, and a magnetic resonance imaging objectified epiduritis. The bacteriological study of curettage biopsy made it possible to isolate a <em>S. agalactiae</em>. The evolution was favorable under antibiotic treatment with disappearance of neurological and infectious signs.

Abstract 3490: Investigation of 27-hydroxycholesterol as a biomarker for aggressive endometrial cancer

Abstract Background: Strong risk factors for the most common (endometrioid) type of endometrial cancer (EC) include obesity and exposure to high estrogen levels. While EC has a favorable prognosis overall, one third of women present with advanced stage disease at diagnosis which has high recurrence and mortality rates. Given the estrogen-mediated etiology of EC, the current study focuses on the selective estrogen receptor modulator (SERM) 27-hydroxycholesterol (27HC) pathway. SERMs like 27HC can mimic estrogenic actions, and experimental work indicates 27HC exposure leads to continuous estrogenic stimulation and increases proliferation in the endometrium. Objective: to identify biomarkers for more aggressive disease, particularly markers present in early stages of carcinogenesis, to help guide decisions regarding treatment options. Methods: We conducted immunohistochemical staining on two tissue microarrays (TMAs) representing EC and its precursor endometrial intraepithelial neoplasia (EIN) tissues to measure protein levels of the enzymes that metabolize cholesterol into 27HC (CYP27A1) and 27HC into bile acids (CYP7B1), the receptors that bind 27HC (Estrogen Receptor [ER])-alpha, ER-beta as well as Liver Receptor X [LXR]-alpha and LXR-beta) and progesterone receptor (PR). We will use Fisher's exact test to evaluate 27HC associated biomarkers (categories split at the median) in relation to the presence of myometrial invasion (MI) and final diagnosis (EC or not) in the EIN TMA, and to assess clinico-pathologic factors including disease stage and grade in the EC TMA. Results: We created a new EIN TMA using formalin-fixed paraffin-embedded endometrial curettage or Pipelle endometrial biopsies from 144 EIN cases of diverse racial/ethnic backgrounds (Japanese, Hawaiian, White, Filipino and Asian/Pacific Islander) who were treated between 2007-16 in the Hawaii Pacific Health System. The EIN TMA contains both abnormal EIN tissues and neighboring benign/non-atypical tissues. In total, 50% of the EIN cases had no EC, 30% had cancer with no myometrial invasion (MI) and 20% had cancer with myometrial invasion. We are concurrently evaluating 27HC pathway markers in a TMA representing EC tumors from 96 cases who were treated in the same hospitals between 2001-07. The EC TMA represents diverse racial/ethnic groups including 28% Japanese American, 25% Native Hawaiian and 23% white cases (24% other). The EC TMA contains representative tissues from 91% endometrioid histotype cases and 72% localized and 28% regional/distant stage cases. We will examine associations between 27HC pathway biomarkers and clinico-pathologic characteristics of EC and EIN and will present our findings at the meeting. Conclusions: This study provides new data to determine whether 27HC pathway biomarkers may relate to characteristics of aggressive EC, such as the presence of myometrial invasion and higher stage and grade at diagnosis. Citation Format: Danja Sarink, Lenora W. Loo, Jeffrey Killeen, Brenda Y. Hernandez, Owen T. Chan, Melissa A. Merrit. Investigation of 27-hydroxycholesterol as a biomarker for aggressive endometrial cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3490.

Association of endometrial carcinoma with obesity and diabetes mellitus

Background: Endometrial cancer, previously referred to as carcinoma of the uterus. The incidence of endometrial cancer is raising, due to improved screening causing fewer hysterectomies in ageing population. Several studies are going on to find out the association and effects between DM and DM-related diseases, especially the cancer. Obesity and physical inactivity plays important role as modifiable determinants of insulin resistance, hyperinsulinaemia and diabetes. All these factors are also responsible for endometrial cancer.&#x0D; Objectives: To find out the association between endometrial carcinoma with obesity and diabetes mellitus&#x0D; Methods: This was a cross sectional and observational study, conducted among. 50 consecutive patients admitted as known case of endometrial carcinoma diagnosed by fractional curettage and endometrial biopsy and 50 consecutive patients having other common gynaecological problems in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2015 to December 2017.&#x0D; Results: Out of 50 women having endometrial carcinoma, only 4% (n=2) having healthy BMI, 36% (n=18) were overweight, 60% (n=30) were obese. Among 50 healthy women without endometrial carcinoma showed that 4% (n=2) having underweight, 70% (n=35) having healthy BMI, 14% (n=7) having overweight and only 12% (n=6) were obese. Regarding distribution of diabetes mellitus among study population, 50 women having endometrial carcinoma 26 % (n=13) were diabetic and 74% (n=37) were non diabetic.50 healthy women without endometrial carcinoma showed that 8% (n=4) diabetic and 92% (n=46) were non diabetic. Among total 17% (n=17) diabetic patients, 76.5% (n-13) having endometrial carcinoma and 23.5% (n=4) were healthy having no endometrial carcinoma. Among 83% (n=83) women having no diabetes 55.4% (n=46) were healthy having no endometrial carcinoma and 44.6% (n=37) having endometrial carcinoma. Association between Diabetes mellitus and endometrial carcinoma was statistically significant (p=0.017). Having high BMI (overweight, obese) and diabetics had significant elevated risks of endometrial cancer, compared with non-overweight non-diabetic subjects.&#x0D; Conclusion: Obesity, history of PCOS, physical inactivity and diabetes are the risk factors of endometrial carcinoma. So, it should be treated promptly these diseases to reduce risk factors. Moreover, strengthen public awareness to address these risk factors at earlier to reduce the cancer burden is recommended.&#x0D; Bangladesh Med Res Counc Bull 2020; 46(2): 120-127

Effective factors on inadequate results in endometrial biopsy with Pipelle

Objective: In this study, it was aimed to investigate the factors that may affect the pathological diagnosis in pipelle endometrial biopsies.&#x0D; Material and Methods: Four hundred and twenty endometrial biopsies performed by the same specialist using pipelle were analyzed retrospectively in our outpatient clinic for eleven months. Endometrial samples which were made for diagnosis of ectopic pregnancy and patients who have history of cancer or needed anesthesia for the procedure were excluded from the study. Group 1 was created from 65 patients whose endometrial biopsy were resulted as insufficient endometrial biopsy and Group 2 was created with 173 patients who had sufficient material as a result of biopsy. The effect of demographic information, ultrasound data (presence and localization of leiomyoma, endometrial thickness) and biopsy indications were investigated.&#x0D; Results: The average age of patients in Group 1 was found to be statistically significantly higher than Group 2, of 238 patients who were investigated retrospectively (p&lt;0,001). Endometrial thickness in Group 1 was statistically lower than Group 2 (p&lt;0,001). Endometrial biopsy indications were frequently observed as postmenopausal bleeding for Group 1 and abnormal uterine bleeding for Group 2.&#x0D; Conclusion: According to our opinion that it will be more appropriate to perform dilatation / curettage biopsy, instead of biopsy with pipelle if a need for endometrial sampling is required in older ages especially for the postmenopausal patient group.

Radiofrequency endometrial ablation with a novel endometrial tip for the management of heavy menstrual bleeding and abnormal uterine bleeding: a prospective study

Aim To evaluate the safety and efficacy of a radiofrequency ablation system with a novel endometrial tip (RFA-EMT) for the management of heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB). Methods This is a prospective study including a total of 38 premenopausal women with heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) that failed to respond to medical therapy. Hysteroscopic evaluation and curettage biopsy were performed just before the procedure. The procedure was timed to occur during the early proliferative phase (cycle days 4–10). RFA-EMT procedures were performed by a single surgeon with the patient under general anesthesia with a laryngeal mask airway. Primary outcome was reduction in bleeding, reported as amenorrhea, hypomenorrhea, and eumenorrhea, which were measured via hemoglobin level and pictorial blood assessment chart (PBAC) score. Secondary outcomes were adverse events, dysmenorrhea with numeric rating scale (NRS) score, and endometrial thickening in the early proliferative phase, as assessed by transvaginal ultrasonography. Results There were no peri- or post-procedural complications. Combined amenorrhea, hypomenorrhea, and eumenorrhea rates at 3 and 6 months were 97.4% and 100%, respectively. The hemoglobin level was significantly increased, and the PBAC score, NRS score, and endometrial thickening were significantly decreased after 3 months. These trends were maintained for 6 months after the procedure. Conclusion RFA-EMT, a new technique, is safe and effective for women with HMB or AUB for which medical therapy has failed.

Primary squamous cell carcinoma of the endometrium associated with human papilloma virus in a young woman: a case report

BackgroundPrimary squamous cell carcinoma of the endometrium is an extremely rare tumor with poorly understood pathogenesis.Case presentationWe report a case of a 28-year-old Togolese woman who had consulted for vaginal bleeding and pelvic pain. Ultrasound showed thickening of the lining of the endometrium, and biopsy curettage was done. Anatomopathological examination was noteworthy for a proliferation of squamous cells often connected by union bridges arranged in tumor lobules with dyskeratotic maturation. Immunohistochemistry showed epithelial membrane antigen positivity, anti-pancytokeratin 1 markers of tumor cells positivity, chromogranin A negativity, actin negativity, S100 negativity, estrogen receptor negativity, and progesterone receptor negativity. In situ hybridization had objectified human papillomavirus genotypes 16/18. The diagnosis of primary squamous cell carcinoma of the endometrium associated with human papilloma virus was retained. A hysterectomy was performed, and the tumor was classified pT1N0M0.ConclusionThe pathogenesis of this endometrial cancer is complex, and its association with human papillomavirus does not explain its genesis.

Langerhans cell histiocytosis presenting as eosinophilic granuloma of the bilateral forearms in an 8-year-old girl: a case report

BackgroundLangerhans cell histiocytosis previously known as histiocytosis X is a rare disease of children and young adults with a very broad clinical spectrum. In children, its annual incidence is estimated between 0.2–0.5 per 100,000.Case representationAn 8-year-old Moroccan girl with no known personal or family history presented to our institution with painful swelling of both forearms. An X-ray and magnetic resonance imaging were inconclusive. We then performed a biopsy curettage (of her left forearm). Microscopic analysis followed by immunohistochemical analysis disclosed a diagnosis of Langerhans cell histiocytosis. No chemotherapy was necessary. Clinical and radiological improvement was achieved after 6 months.ConclusionThe particularity of this observation is the bilaterality of the lesion on both forearms and it has not previously been reported. Langerhans cell histiocytosis should be included in the differential diagnosis of osteomyelitis and Ewing’s sarcoma.

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer.

Hormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer. We retrospectively analyzed patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups. Seventy-one patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4-49) and 12.0 months (range 3-35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20-38) and 12 months (range 4-48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test). A lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.

Endometrial Hyperplasia: Epidemiological Profile of Patients and Anatomical and Clinical Aspects of Lesions at Conakry University Hospital

Summary: Estimate the incidence of endometrial hyperplasia according to socio-demographic parameters and the type of lesions histological. Methodology: This was a retrospective, and 15-year descriptive study from January 1, 2000 to December 31, 2014 conducted at the Department of Anatomy and Pathological Cytology of the National Hospital Donka in collaboration with the obstetric gynecology departments of the Conakry University Hospital. Results: We collected 296 cases of malignant and benign endometrial hyperplasia in 15 years, accounting for 37% of all endometrial biopsy curettages examined. The age group 47 to 56 years was the most affected (81 cases) or 27, 36%. The mean age was 53.6 years with extremes of 27 and 83 years. Metrorrhagia was the main reason for consultation (206 cases), i.e. 69.59%. The suspicion of endometrial hyperplasia by physicians was the most frequently diagnosed circumstance (149 cases) or 50.33%. Biopsy curettage was the most frequently used method (176 cases), is 59.45%. Histological endometrial lesions of atypical complex adenomatous hyperplasia (79 cases) represented 26.69%. Benign behavior was most frequently observed in (235 cases) or 79.39%. Conclusion: Endometrial hyperplasia is an endometrial lesion whose atypical histological types represent the borderline lesions between benignity and malignancy.

Clinical Study of Postmenopausal Bleeding

Background: Women with postmenopausal bleeding (PMB) should be thoroughly evaluated. A thorough examination may help in the diagnosis of vulval, vaginal, cervical or pelvic pathology.Objective: This study was carried out to find the probable causes in patients presenting with postmenopausal bleeding.Materials and method: This observational study included 50 women with postmenopausal bleeding and was conducted in the department of Obstetrics and Gynaecology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) Hospital, Dhaka, Bangladesh, from January 2004 to December 2004. Transvaginal ultrasonogram (TVS), diagnostic curettage and cervical biopsy were done and histopathology report was collected.Results: The mean age of the patients was 57.74 years (range 48-75 years), and the median age of menopause was 50 years. Among the patients 18 (36%) had only diabetes and 25 (50%) patients had both diabetes and hypertension. Nineteen patients (38%) were overweight, 5 patients (10%) were obese and 2 (4%) were morbidly obese. Per speculum examination revealed suspected cervical carcinoma in 5 cases (10%) and cervical polyp in 1 case (2%). The most common clinical finding was atrophy of the uterus and vagina in 26 patients (52%). TVS revealed endometrial thickness of 5mm or more in 17 cases (37.7%) and &lt; 5mm in 26 cases (57.7%). Nine patients (18%) had carcinoma, 16 patients (32%) had benign pathology and 19 (38%) patients had endometrial atrophy on histology.Conclusion: A detailed history taking, thorough physical examination and relevant investigations can lead to a correct detection of cause of postmenopausal bleeding. Those who have normal adnexae and thin endometrium (endometrium &lt;5mm) may not need endometrial biopsy.Delta Med Col J. Jul 2017 5(2): 83-88

Punch biopsy guided by both colposcopy and HR-HPV status is more efficient for identification of immediate high-grade squamous intraepithelial lesion or worse among HPV-infected women with atypical squamous cells of undetermined significance

ObjectivesTo investigate the accuracy of colposcopy for diagnosing high-grade squamous intraepithelial lesion (HSIL) or worse (HSIL+) in human papillomavirus (HPV)-infected patients with atypical squamous cells of undetermined significance (ASCUS) cytology, and determine whether genotyping and viral load quantitation can be useful for detecting immediate HSIL+ risk in these patients. Study designThis study included 620 cases with ASCUS and positive for high-risk (HR)-HPV within 1 month before or after cervical cytology at Qilu Hospital between February 2013 and February 2014. Based on the colposcopic impression, lesion-targeted punch biopsy, endocervical curettage biopsy or random cervical punch biopsy in four quadrants was performed on these patients within 1 month. The accuracy of colposcopy for diagnosing HSIL+ was evaluated through comparison with the biopsy results. HR-HPV status determined by Hybrid Capture 2 or HPV genotyping was analysed retrospectively as a possible predictor of HSIL+. ResultsAgreement between colposcopic impression and cervical pathology was matched perfectly in 89.2% of cases (553/620), and the strength of agreement with the κ statistic was 0.698 (p<0.001). Colposcopy had high specificity (96.9%) but low sensitivity for detecting HSIL+ (67.5%). The risk of HSIL+ was significantly higher in patients with HPV-16 infection (52.3%) than in patients infected with other types of HPV (17.9%, p<0.001). HSIL+ and virus load was correlated at cut-offs (CO) of 50 relative light units (RLU)/CO and 100 RLU/CO (p=0.024 and 0.044, respectively). If considering HPV16 infection or high virus load (at 50 RLU/CO) as a diagnostic standard of HSIL+ when colposcopic impression was negative, sensitivity was improved to 74.7% and 81.0%, respectively. ConclusionsGood agreement was found between colposcopic and pathologic diagnosis. HR-HPV genotyping or virus load is relevant to the detection of HSIL+ among HPV-infected patients with ASCUS cytology. In these patients, biopsies considering HPV-16 infection or virus load ≥50 RLU/CO may be helpful for increasing the HSIL+ detection rate.

Availability of Hysteroscopy-Guided Resection of Endometrial Polyp

Endometrial polyp is a common disease that is often found in adult women. When malignancy is not pointed out pathologically in specimens of the blind endometrial aspiration biopsy or curettage biopsy and obvious lesion that needs to be treated is not observed by transvaginal ultrasonography, observation for periods depending on each case is usually indicated. To confirm the adequacy of such a management, we investigated past cases in which hysteroscopy-guided resection of endometrial polyp and pathological investigation in our hospital are underwent.