Diagnosis Of Hyperplasia Research Articles

Causes of Abnormal Uterine Bleeding in Females of Reproductive Age Group attending Gynaecology Dept of UOL Hospital

Background: Abnormal uterine bleeding is a prevalent problem that prompts a female to seek medical help. The most common symptom of abnormal uterine bleeding is heavy menstrual bleeding. The impact of abnormal uterine bleeding on one's quality of life is important. Aim: To determine the causes of abnormal uterine bleeding. Methods: This cross-sectional study was conducted at Department of Gyneacology University of Lahore Teaching Hospital Lahore over a period of one year from Nov 2020 to Nov 2021. Eighty females of reproductive age with Abnormal Uterine Bleeding were selected. All females were examined for the etiology of abnormal uterine bleeding. The females with menstrual blood loss lasting >8 days, passage of blood clots or haemoglobin concentration < l0 gm/dl were enrolled. The exclusion criteria includes the females less than 20 years of age, or with pubertal menorrhagia or postmenopausal females. Results: Out of total eighty females, 25% females belong to 42 years age group. The most prevalent etiology of abnormal uterine bleeding was fibroid uterus i.e. 62.5% cases, followed by adenomyosis (15%), endometrial polyp (10%) and endometrial hyperplasia (12.5%). Fifty females (50%) were multipara, 20 (25%) were grand multipara and 10(12.5%) were great grand multipara. Severe anemia was noted in almost 10 females (12.5%), moderate anemia in 56 cases (70%) and mild anemia in 14 cases (17.5%). Transabdominal scan was done to confirm the diagnosis of fibroid uterus, adenomyosis, endometrial hyperplasia and endometrial polyp. Conclusion: Fibroid uterus was the commonest cause in females presenting with abnormal uterine bleeding to University of Lahore Teaching Hospital affecting quality of life in females and causing psychological problems. Keywords: Abnormal uterine bleeding, Menorrhagia, Metrorrhagia, Fibroid uterus, Endometrial polyps.

429 Diagnostic hysteroscopy and endometrial biopsy in the assessment of intrauterine alterations in infertile patients

Introduction and aims of the study: Diagnostic hysteroscopy enables the direct visualization of the cervical canal and the uterine cavity, allowing an accurate assessment of intrauterine alterations. As for endometritis and endometrial hyperplasia diagnosis, endometrial biopsy’s role is really crucial. Hysteroscopy and endometrial biopsy suggest valid and efficient procedures, both evaluating the endometrial factor in terms of female infertility. The purpose of this study was to estimate the reliability of hysteroscopy, routinely performed along with endometrial biopsy, by analyzing and comparing hysteroscopic and histopathological outcomes in asymptomatic infertile patients.

Immunohistochemical Study of Ki-67 in Hyperplastic and Endometrium Carcinoma: A Comparative Study.

Endometrial hyperplasia is defined as a common clinical disorder caused by the increased levels of estrogens with low levels of progesterone; therefore, this hormonal imbalance leads to an increase in the proliferation rate of the endometrial cells. Endometrial carcinoma is one of the most important malignancies affecting women all over the world "accounting for 37.7% of all other disorders affecting the female reproductive system". The expression of the Ki-67 protein is related to the proliferative behavior of malignant tumor cell populations of their own, allowing it to be used as a marker of tumor aggressiveness. The present study was conducted to examine the expression of the proliferation marker, Ki-67 in various endometrial lesions. Ki-67 expression was evaluated in 60 endometrial samples that resulted as either endometrial curetting or hysterectomy specimens, diagnosed with simple hyperplasia (n=10), complex hyperplasia (n=20), atypical hyperplasia (n=6), and endometrial carcinoma (n=24). In patients with endometrial carcinoma, there was an increased expression of Ki-67, compared to proliferative endometrium and simple hyperplasia (P-value=0.0001). There was no such discrepancy between atypical hyperplasia and endometrial carcinoma cases. The expression of Ki-67 showed a positive association with the degree of endometrial cancer (P-value=0.0013), however, not with the age of the patients (P-value>0.05). There is a wide range of variations in the proliferation rate within the development of different endometrial lesions, including benign and malignant lesions. Our findings may be of value in differential diagnosis and prognosis of endometrial hyperplasia and endometrial carcinoma.

Noninvasive Predictor for Premalignant and Cancerous Lesions in Endometrial Polyps Diagnosed by Ultrasound.

BackgroundThere was no consensus for management of asymptomatic endometrial polyps (EPs) up to date.ObjectiveThe aim of present study was to determine the risk factors of malignant lesions in EPs diagnosed by ultrasound and establish a noninvasive predictor to decrease unnecessary hysteroscopy for EPs.Study DesignWe reviewed the records of all consecutive patients who underwent hysteroscopy for EPs in the Women’s Hospital School of Medicine Zhejiang University between January 1, 2001 and December 31, 2018. The patients with histological diagnoses of atypical hyperplasia or cancer were defined as malignancy, while the patients with histological diagnoses of benign lesions were randomly selected as benign group according to the ratio of 1:4 (malignancy:benign), matching by age and year of hospitalization. Logistic regression analysis was used to analyze the clinical parameters for predicting malignancy of EPs. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed to find a noninvasive predictor. The sensitivity, specificity, and the receiver operating characteristic curve (ROC) were used for assess the efficacy of the noninvasive predictor. New diagnosed EPs patients received in 2019 were used for verifying the accuracy of the noninvasive predictor.ResultsThe age in 15,790 cases of benign lesions was significantly younger than that in 230 malignancy cases (41.97 ± 11.53 year vs 53.31 ± 11.61 years, p <0.001). AUB (OR 7.306, 95%CI 4.927–10.835), large EPs (OR 2.595, 95%CI 1.662–4.052), and blood flow signal in EPs (OR 2.690, 95%CI 1.872–3.866) were independent predictive factors of malignancy in all enrolled patients. A noninvasive predictor for malignancy of EPs was established, through combining with AUB, large polyps and blood flow signal. This predictor presented excellent sensitivity and NPV (91.3 and 95.8%), with acceptable specificity and AUC (0.801). Further validation in new diagnosed EPs also suggested excellent sensitivity and reasonable specificity (100 and 58.5%) of the predictor. Factors such as thickened endometrial thickness, menopause shorter than 10 years, hypertension, obesity and nulliparous were also validated as independent predictors of malignancy in different subgroup analysis.ConclusionsThe noninvasive predictor combined with other risk factors from subgroup analysis would be reliable to distinguish the benign lesions from malignancy for EPs diagnosed by ultrasound.

Diagnostic accuracy of hysteroscopy vs dilation and curettage (D&amp;C) for atypical endometrial hyperplasia in patients performing hysterectomy or serial follow-up

Background: Endometrial hyperplasia (EH) is considered a heterogeneous pre-neoplastic clinical entity characterized by an abnormal glandular proliferation, with less than half of the tissue area occupied by the stroma. The aim of this retrospective study was to evaluate the correlation between the histological diagnosis of atypical endometrial hyperplasia (AEH) obtained through office hysteroscopy (OH) or uterine dilation and curettage (D&amp;C) and the definitive histological evaluation after hysterectomy. Methods: Among 112 patients with atypical EH, 45 (40%) underwent hysteroscopy and 67 (60%) curettage. Results: The diagnostic accuracy of OH was very high: in particular, it showed a diagnostic coincidence in 87% of cases with the definitive histological diagnosis through hysteroscopy. The curettage, instead, had diagnostic coincidence only in 14% of cases. Conclusion: Office hysteroscopy is the ideal procedure for both diagnosis and follow-up of endometrial hyperplasia.

Роль трансвагинальной соноэластографии в дифференциации злокачественной и доброкачественной патологии эндометрия у женщин в постменопаузе

Objective. To study the clinical significance of transvaginal sonoelastography (TVSE) in the differential diagnosis of endometrial hyperplasia and carcinoma. Patients and methods. Fifty-four patients with postmenopausal bleeding and/or ultrasound features of endometrial pathology (mean age: 67.8 ± 3.2 years) were examined. The average length of postmenopause was 8.12 ± 3.4 years. The strain index (SI), which was measured automatically, was used as the main criterion of TVSE. Results. The mean SI varied widely depending on the histological type of endometrial pathology: 2.0 (0.8–4.0) in patients with endometrial carcinoma; 1.6 (0.4–3.2) in patients with atypical endometrial hyperplasia; 0.8 (0.30–1.60) in patients with endometrial hyperplasia without atypia; 0.6 (0.5–2.40) in patients with endometrial polyps against the background of mucosal atrophy. A significant difference for SI was found only when comparing the group of patients with carcinoma with other groups, regardless of the morphological type of benign pathology (p &lt; 0.05). Conclusion. TVSE allows to supplement the results of transvaginal ultrasound according to IETA (International Endometrial Tumor Analysis) system and improve the differential diagnosis of endometrial carcinoma with other benign endometrial pathologies. Key words: transvaginal ultrasound, sonoelastography, endometrial carcinoma, endometrial hyperplasia, endometrial polyps, strain index

Multiparameter Flowcytometry for Diagnosis and Subtyping of Mature Lymphocytic Neoplasms in Peripheral Blood and Bone Marrow: A Prospective Observational Study

Introduction: Multiparameter Flowcytometry (MFC) is a high throughput, quick, and practical technique for diagnoses of Chronic Lymphoproliferative Disorders (CLPDs). Indian CLPDs cases have distinct distribution and presentation than the developed world. Moreover, limited studies have confirmed the diagnostic utility of MFC in Indian CLPDs cases. Aim: To evaluate the diagnostic utility of MFC in peripheral blood and bone marrow aspirate of CLPDs cases. Materials and Methods: This was a single centre, prospective, observational study involving clinico-morphologically suspected or diagnosed 85 CLPDs cases. It was carried out in the Department of Pathology, Government Medical College and Hospital, Nagpur, Maharashtra, India, from January 2016 to November 2019. The patients were followed up for peripheral smear (PS) and Bone Marrow(BM) MFC and staging in nodal or extranodal Non-Hodgkin’s Lymphoma was done. Results: Clinico-morphological examination led to the diagnosis of 74 CLPD cases, while remaining 11 cases were strongly suspected. MFC immunophenotyping was contributory in diagnosing 74 CLPD cases which on further subtyping consisted of B-cell CLPD (N=70), and T-cell CLPD (N=3), while one case of B-NHL could not be subtyped. The most common B-cell CLPD included multiple myeloma (n=27), chronic lymphocytic leukemia (n=25), diffuse large B-cell lymphoma (n=7). T-cell CLPD included hepatosplenic gamma delta T-cell lymphoma (N=2) and adult T-cell lymphoma, follicular lymphoma (n=3), burkitt’s lymphoma (n=2), mantle cell lymphoma (n=2), prolymphocytic leukemia (n=2), splenic marginal zonal lymphoma (n=2), B Cell Non-Hodgkin’s Lymphoma (n=1). Finally, 11 suspected cases mostly comprised of reactive lymphocytosis (81.8%). Conclusion: MFC immunophenotyping led to diagnoses and determination of CLPD sub-class. It also resulted in rapid diagnoses of reactive hyperplasia and non-hematolymphoid malignancy which may mimic CLPD on morphology and hence, difficult to diagnose based on morphology alone.

The Value of Vaginal Microbiome in Patients with Endometrial Hyperplasia.

Objective To investigate the profiles of the vaginal microbiome in patients with endometrial hyperplasia and to explore the potential value of vaginal microbiome in the diagnosis of endometrial hyperplasia. Materials/Methods. 26 patients suffering from abnormal uterine bleeding (AUB) with thickened endometrium revealed by transvaginal ultrasonography were enrolled. Based on pathology, 12 patients with endometrial hyperplasia were classified as the Veh group and 14 patients with proliferative endometrium were classified as the Vne group. The vaginal samples were collected for the presence of microbial DNA by high-throughput next-generation sequencing of the 16S rRNA gene. The α-diversity and ß-diversity of vaginal microbiome were analyzed and compared between bacterial populations. The ROC curve was made to evaluate the feasibility of flora as a biomarker. Results The diversity of vaginal microbiome in the Veh group was significantly lower than that in the Vne group (P < 0.05). Lactobacillus was the most represented genus in the Veh group. The study's t-test between the two groups showed that Lactobacillus has the only significant difference in the abundance of the first 15 genera (P < 0.01). ROC analysis of the abundance of Lactobacillus showed that the area of AUC was 0.83, the sensitivity was 93.00%, and the specificity was 75.00%. Conclusion The study offers insight into the nature of the vaginal microbiome and suggests that surveying the vaginal microbiota might be useful for detection of endometrial hyperplasia.

Endometrial Stromal Expression of ER, PR, and B-Catenin Toward Differentiating Hyperplasia Diagnoses.

Background. The interpretation of histopathological changes of endometrial hyperplasia with or without atypia can be challenging. We aim to investigate the role of specific immunohistochemical markers in the endometrial stroma to classify endometrial hyperplasia in difficult cases. Methods and Results. We retrospectively reviewed and reclassified (WHO 2014): 47 specimens with endometrial hyperplasia without atypia, 33 with atypical hyperplasia (AH), and 13 endometrioid adenocarcinomas. We performed IHC for B-catenin, E-cadherin, p16, estrogen receptors and progesterone receptors, and B-cell lymphoma 2 (BCL2). Percentage of positive stromal cells was calculated. B-catenin was equally expressed in the stroma of both hyperplasia and AH (mean 60%, 50%; P = .17) and was absent from adenocarcinoma (0%, hyperplasia vs adenocarcinoma; P < .0001, AH vs adenocarcinoma; P < .0001). E-cadherin was not expressed in the stroma of any lesion, while p16 expression levels were not statistically different (hyperplasia vs AH; P = .46, hyperplasia vs adenocarcinoma; P = .22, AH vs adenocarcinoma; P = .48). Estrogen and progesterone were highly identified in stromal cells of hyperplasia (80%) and diminished in AH (respectively, at 30% and 60%, hyperplasia vs AH; P < .0001), and in adenocarcinoma (0% and 40%, respectively). Finally, BCL2 was not differentially expressed (hyperplasia vs AH; P = .33, hyperplasia vs adenocarcinoma; P = .17, AH vs adenocarcinoma; P = .36). Conclusion. Estrogen and progesterone were strongly expressed in stroma exclusively of hyperplasia, while B-catenin was particularly expressed in hyperplasia and AH. Use of these markers can be useful in the differential diagnosis of hyperplasia from AH, and AH from adenocarcinoma in challenging cases.

Molecular Profiling in Thyroid cancer- Using next generation sequencing to differentiate rare cases of papillary thyroid hyperplasia from papillary thyroid carcinoma

Abstract Introduction/Objective Differentiating papillary thyroid hyperplasia from papillary thyroid carcinoma is made primarily on differences in key histologic and cytomorphologic features. These include architectural features such as invasion and nuclear changes such as chromatin pallor, nuclear grooves, and intranuclear pseudoinclusions. Distinguishing between these two diagnoses is not always straightforward in a minority of cases, as papillary thyroid hyperplasia nodules can be misinterpreted as papillary thyroid carcinoma and vice versa. This is because the nuclear changes can be subtle and be induced artificially by poor or inadequate formalin fixation. Immunostains such as cytokeratin 19 (CK19), galectin-3, and HBME1 may be used to distinguish between papillary thyroid hyperplastic nodules and papillary thyroid carcinoma; however, as immunostaining results are not always definitive, other more definitive ancillary tests are sometimes utilized such as molecular testing. Methods/Case Report Thyroid cases with indeterminate diagnoses (n=6) were obtained from the archives. Such cases included papillary thyroid hyperplasia and cases with descriptive diagnoses such as well-differentiated encapsulated and low-grade papillary carcinoma. Five cases of definitive papillary thyroid carcinoma and one case of follicular thyroid carcinoma (n=6) were used as a comparison group. Next generation sequencing (NGS) assays were performed using a custom SLIMamp targeted DNA solid tumor panel (Pillar Biosciences) and a targeted multi gene RNA fusion panel (Invitae). Results (if a Case Study enter NA) All of the definitive cases of papillary thyroid carcinoma showed characteristic mutations such as BRAF V600E as well as RNA fusions such as RET/PTC while all of the indeterminate cases did not show any detectable DNA mutations or RNA fusions, confirming their benign nature. A separate case that was signed out as non-invasive follicular thyroid neoplasm with papillary-like nuclear features showed an NRAS Q61R mutation and a novel ETV1-ERG fusion. Conclusion This study demonstrates the utility of molecular testing as an adjunct to histopathological evaluation in definitive diagnosis and differentiation of papillary thyroid hyperplasia from papillary carcinoma. Next generation sequencing with targeted DNA and RNA panels will be beneficial for both known and novel variant or fusion detection in suspect cases.

Synchronous microwave ablation followed by core-needle biopsy via a coaxial cannula for highly suspected malignant lung ground-glass opacities: A single-center, single-arm retrospective study.

BackgroundThis study aimed to retrospectively explore the safety and feasibility of computed tomography (CT)‐guided synchronous microwave ablation (MWA) followed by core‐needle biopsy (CNB) via a coaxial cannula for highly suspected malignant lung ground‐glass opacities (GGOs).MethodsThe clinical data of 66 patients (66 GGOs) treated with CT‐guided synchronous MWA followed by CNB via a coaxial cannula from January 2019 to January 2021 were included in this study. The technical success rate, curative effect, and complications were evaluated.ResultsTechnical success rates were 100%. The pneumothorax rate was 36.4% (24/66). 72.7% (48/66) patients had the bronchopulmonary hemorrhage, 81.3% of hemorrhage was attributable to CNB. 24.2% (16/66) patients had varying degrees of pleural effusion. The pathological results were adenocarcinomas (n = 44), atypical adenomatous hyperplasia (n = 2), chronic inflammation (n = 3) and indeterminate pathological diagnosis (n = 17) with a 69.7% (46/66) positive diagnosis rate. The therapeutic response rate was 100.0% (66/66).ConclusionsSynchronous MWA followed by CNB via a coaxial cannula has a satisfactory ablation effectiveness and an acceptable biopsy positive rate, which is an alternative treatment for highly suspected malignant GGOs.

Les hyperplasies thymiques

Thymic hyperplasia presents as an anterior mediastinal mass and poses important diagnostic and therapeutic challenge. Two types of thymic hyperplasia are described: true hyperplasia and follicular hyperplasie. Literature data are peculiar concerning both entities. We aimed to describe the clinical and microscopic characteristics of thymic hyperplasia through a single institution experience during an 11-year-period.Thymic hyperplasia diagnosed during the period between 2009 and 2020 were included.In all, 46 thymic hyperplasias were diagnosed. The 46 patients consisted in 33 women and 13 men with a mean age of 30 years. Microscopic diagnosis concluded to a follicular hyperplasia in 12 cases and a true thymic hyperplasia in 34 cases. The diagnosis of true thymic hyperplasia posed a diagnostic challenge with an involuted thymus in 1 case and a thymolipoma in 1 case. The confrontation with the clinical data allowed retaining the diagnosis.The diagnosis of thymic hyperplasia is based on microscopic features. The confrontation with clinical data and the measurements of the thymus according to the age allow to retain the diagnosis in most challenging cases.

The Risk of Endometrial Hyperplasia and Malignancy May be Increased in Patients with Endometriosis

<h3>Study Objective</h3> The objective of our study is to further investigate the role of endometriosis on subsequent diagnosis of endometrial hyperplasia and malignancy (EHM). <h3>Design</h3> Retrospective cohort study <h3>Setting</h3> Single academic institution <h3>Patients or Participants</h3> All cases of histologically diagnosed endometriosis were evaluated between 2005 and 2020. Women over 18 years of age were included. All endometrial malignancies were included for analysis. Patients with a history of hysterectomy were excluded. <h3>Interventions</h3> No interventions were performed <h3>Measurements and Main Results</h3> Demographic information and past medical and surgical history were assessed. For the EHM cohort, oncologic data, endometriosis stage, patient age and body mass index (BMI) at time of diagnosis were collected. A total of 2,122 women with endometriosis were included. Of these, 198 (9.3%) were found to have co-existing eutopic endometrial hyperplasia (n=56) or malignancy (n=142). At the time of oncologic diagnosis, the mean age was 55.6 years and mean BMI was 33.1. Within the EHM group, 82.3% of endometriosis diagnoses were made at the time of their surgical management and the majority were stage 1 by ASRM criteria (70.0%). When comparing characteristics between those with and without a diagnosis of EHM, there was no significant difference in race, ethnicity, tobacco use, prior diagnosis of PCOS or diagnosis of breast or colon cancer. Significant differences were seen in type 2 diabetes (p<0.0001), hypertension (p<0.0001), prior use of tamoxifen (p=0.0021), gravidity (p=0.0331) and parity (p<0.0001). Statistical analysis was performed using chi-square and Mann-Whitney tests. A p-value of <0.05 was considered significant. <h3>Conclusion</h3> Compared to the population prevalence of less than 1% of both endometrial hyperplasia and malignancy, our study suggests that endometriosis may be a predictor of subsequent diagnosis of endometrial cancer and malignancy. Further research is needed to control for known confounders of endometrial hyperplasia and malignancy.

DIFFUSE IDIOPATHIC PULMONARY NEUROENDOCRINE HYPERPLASIA IN A PATIENT WITH MYCOBACTERIUM AVIUM COMPLEX

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Diffuse idiopathic pulmonary neuroendocrine hyperplasia (DIPNECH) is a preneoplastic lesion that can progress to carcinoid tumors. It differs from reactive hyperplasia in its expression of tumor antigens such as Ki67 as well as the possibility of progression to carcinoid tumors. We present a case of an elderly female with a dry cough who was found to have a lung nodule showing granulomatous inflammation and a focus of neuroendocrine cell hyperplasia suggesting DIPNECH. CASE PRESENTATION: A 78-year-old female with a history of rheumatoid arthritis, breast cancer post excision and radiation therapy, presented with dry cough for a few months. She had a ten-pack-year history of smoking and quit eight years ago. She denied fevers, chills, night sweats, or acute weight changes. Chest CT and PET scan revealed a right middle lobe (RML) lung nodule with increased metabolic activity. EBUS and bronchoscopy specimens did not reveal any organisms or abnormal cytology. The patient underwent wedge resection of the RML. Pathology revealed extensive chronic inflammatory infiltrate with necrotizing granulomas and sparse foreign body giant cells, and a focus of bland appearing cells that stained positive for chromogranin and synaptophysin indicating neuroendocrine differentiation. MiB-1 proliferation index was 1%. Tissue culture grew MAC. A diagnosis of DIPNECH was established. On resection of the nodule, our patient's symptoms resolved, and she required no further therapy. On follow-up at 1.5 years, she was asymptomatic. DISCUSSION: DIPNECH is a rare lung condition presenting mainly with dry cough. CT chest can show solitary or bilateral pulmonary nodules, mosaic perfusion, bronchial wall thickening, ground-glass opacities, air trapping, or bronchiectasis. MiB-1 (antibody to Ki67) expressed in her case indicates tumor antigen expression supporting a diagnosis of DIPNECH vs. reactive hyperplasia. The miB-1 index was 1%, predicting low mitotic activity and a better prognosis. Tissue cultures of her resected specimen grew MAC. MAC is not known to be associated with such a preneoplastic condition. As per our literature review, only two other cases have been reported that describe the concurrence of pulmonary neuroendocrine growth and lung infection. MAC was associated in both these cases. Overall, most patients with DIPNECH experience a stable clinical course. However, severe clinical decline has been reported in a few. CONCLUSIONS: DIPNECH is a rare preneoplastic condition with a good prognosis, although it can sometimes progress to carcinoid tumors with clinical deterioration. Identification of risk factors may be helpful in timely diagnosis and treatment of DIPNECH. MAC is one such factor that seems to be associated with DIPNECH. Further studies should be undertaken to investigate their relationship. REFERENCE #1: Böhm J, Koch S, Gais P, Jütting U, Präuer HW, Höfler H. Prognostic value of MIB-1 in neuroendocrine tumours of the lung. J Pathol. 1996;178(4):402-409. doi:10.1002/(SICI)1096-9896(199604)178:4<402::AID-PATH498>3.0.CO;2-5 REFERENCE #2: Chassagnon G, Favelle O, Marchand-Adam S, De Muret A, Revel MP. DIPNECH: when to suggest this diagnosis on CT. Clin Radiol. 2015;70(3):317-325. doi:10.1016/j.crad.2014.10.012 REFERENCE #3: Krvavac A, Patel PH, Kamel G, Najmuddin M, Nayak RP, Patolia S. Pulmonary Neuroendocrine Cell Hyperplasia in a Patient with Mycobacterium avium Complex. Am J Respir Crit Care Med. 2018 Nov 1;198(9):e109-e110. doi: 10.1164/rccm.201801-0199IM. PMID: 30130431. DISCLOSURES: No relevant relationships by Lipisha Agarwal, source=Web Response No relevant relationships by Divyansh Bajaj, source=Web Response No relevant relationships by Chinmay Jani, source=Web Response No relevant relationships by Joseph Khoory, source=Web Response No relevant relationships by Abdullah Melhim, source=Web Response No relevant relationships by Gabriel Ryan, source=Web Response No relevant relationships by Harpreet Singh, source=Web Response

Relationship between Transvaginal Ultrasound Endometrial Volume, Body Mass Index and Endometrial Pathology in Women with Postmenopausal Bleeding

Abstract Background Menopause is recognized to have occurred after one year of amenorrhea, for which there is no other obvious pathological or physiological cause. Perimenopause should include the period immediately prior to the menopause (when the endocrinological, biological and clinical features of approaching menopause commence) and the first one year after menopause. Objectives The aim of the study is classification of patients into those with benign endometrial pathology and those with endometrial hyperplasia or carcinoma using endometrial volume and BMI. Patients and Methods This observational cross sectional study was conducted at the Department of Obstetrics and Gynecology in Ain Shams University Hospital from March 2019 till January 2020. The population of this study was 100 menopausal women with postmenopausal bleeding ≥12 months and endometrial thickness by TVUS ≥5 mm. Results According to histopathology of endometrial carcinoma, statistical analysis of our data revealed that age, menopausal duration and BMI were significantly highest. Parity was significantly lowest. Endometrial volume was significantly highest in carcinoma (7.9±2.9 cc). Age, menopausal duration, parity and endometrial volume had significant moderate diagnostic performance in predicting endometrial carcinoma but BMI had significantly low. Age ≥ 62.0, menopausal duration ≥ 11.0 and parity ≤3.0 had low diagnostic characteristics in diagnosis of endometrial carcinoma but endometrial volume ≥ 6.0 had high sensitivity but low other diagnostic characteristics in the diagnosis of endometrial carcinoma. According to histopathology of endometrial hyperplasia, statistical analysis of our data revealed that age, menopausal duration, BMI, parity and endometrial volume had no significant diagnostic performance in the diagnosis of endometrial hyperplasia. Conclusion In our study, analysis of data revealed that the using of transvaginal measurement of endometrial volume is the best predictor of endometrial cancer with a positive correlation with BMI.

Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment.

Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions.

Нейроендокринна гіперплазія немовлят (огляд сучасної літератури — 2018)

Огляд присвячений систематизації сучасних світових уявлень про легеневі нейроендокринні клітини та пов’язане із їх гіперплазією захворювання — нейроендокринну гіперплазію немовлят. У статті представлені основи патогенезу, клінічні та інструментальні діагностичні критерії, диференційна діагностика з іншими інтерстиціальними захворюваннями легень у дітей раннього віку. Поданий алгоритм діагностики, лікування на сучасній стадії та результати катамнестичного спостереження за дітьми, що перенесли нейроендокринну гіперплазію.

Using 3D Medical Modeling to Evaluate the Accuracy of Single-Photon Emission Computed Tomography (SPECT) Bone Scintigraphy in Diagnosing Condylar Hyperplasia

To evaluate the accuracy of single-photon emission computed tomography (SPECT) in diagnosing unilateral condylar hyperplasia (UCH) and to describe the condylar growth of patients with UCH. Using a retrospective study design, patients with UCH who had undergone SPECT and cone-beam computed tomography (CBCT) examinations at the same time were included in the study. We used 3D medical models based on CBCT data as the gold standard. The SPECT results were compared with the model data, and the sensitivity and specificity were calculated. To further describe the condylar growth activity, statistical analysis was performed, and the P value was set at 0.05. The sample was composed of 75 patients. The sensitivity of SPECT was 55.3%, the specificity was 48.6%, and the area under the receiver operating characteristic curve was 0.53. There was no significant difference in sex between patients with and without active growth. The sensitivity and specificity of SPECT are poor, and SPECT alone is not suitable for evaluating the active stage of condylar growth. 3D medical modeling has good prospects for application in the diagnosis of condylar hyperplasia.

Analysis of the Impact of Comorbidities on Endometrial Lesions Using the Charlson Comorbidity Index in Western Romania.

Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions.

Changes in diagnosis rate and treatment trends of benign prostatic hyperplasia in Korea: A nationwide population-based cohort study.

PurposeThis study aimed to evaluate benign prostatic hyperplasia (BPH) diagnosis rate and the changing landscape of medical and surgical management of BPH over the last decade using national population data of South Korea.MethodsThe present study analyzed data of patients diagnosed with BPH (N40) who underwent medical treatment or surgery in 3% of the national patient sample of the Health Insurance and Review Assessment database each year between 2012 and 2018. The primary outcome was the proportion of medical and surgical treatment for BPH. It was evaluated each year between 2012 and 2018. Secondary outcomes included total BPH diagnosis rate in each year of the study period. BPH diagnosis rate by age group was evaluated. The proportion of medical and surgical treatment for BPH according to the type of medical institution was investigated.ResultsThe proportion of surgical treatment was 1.2% in 2012, 1.0% in 2013, 1.0% in 2014, 0.9% in 2015, 0.8% in 2016, 0.7% 2018, and 0.8% 2018, showing a progressive overall decrease from 2012 to 2018. The rate of surgical treatment for BPH increased with increasing age during the study period, showing a progressive overall increase (from 9,202 per 100,000 men in 2012 to 11,610 per 100 000 men in 2018). The number of patients with BPH was increased steadily from 2012 to 2018 in all age groups. The rate of surgical treatment in tertiary referral hospitals was the highest during the study period, followed by that in general hospitals, hospitals, and clinics.ConclusionsIn Korea, the diagnosis rate of BPH was steadily increasing during the study period. Overall surgical treatment gradually decreased compared with an increase in medical treatment among all treatments for BPH. Thus, a comprehensive treatment plan for BPH should be established considering this trend.