Endometrial Biopsy Research Articles

Complement and coagulation cascade cross-talk in endometriosis and the potential of Janus Kinase inhibitors—a network meta-analysis

BackgroundMolecular events that drive endometriosis (EM) and cause accompanying immune deregulation remain elusive. Our purpose was to identify key pathways involved in lesion formation across diverse populations and to detect transcriptomic changes in eutopic endometrium that accompany EM.MethodsWe searched Gene Expression Omnibus and ArrayExpress and performed differential gene expression analysis and a network meta-analysis on nine qualifying datasets. Those contained transcriptomic data on 114 ectopic endometrium samples (EL), 138 eutopic endometrium samples from women with endometriosis (EEM), and 79 eutopic endometrium samples from women without endometriosis (EH). Gene ontology and enrichment analysis were performed in DAVID, Metascape, and Cytoscape, and drug repurposing was done in CMap.ResultsEEM compared to EH upregulated CCL21 and downregulated BIRC3, CEL, and LEFTY1 genes (|log2FC| > 0.5, p < 0.05). EL showed increased expression of complement and serpin genes (EL vs. EEM: C7, logFC = 3.38, p < 0.0001; C3, logFC = 2.40, p < 0.0001; SERPINE1, logFC = 1.02, p < 0.05; SERPINE2, logFC = 1.54, p < 0.001) and mast cell markers (EL vs. EEM: CPA3, logFC = 1.54, p < 0.0001; KIT, logFC = 0.74, p < 0.001). Functional enrichment analysis highlighted complement and coagulation, inflammation, angiogenesis, and extracellular matrix remodeling as drivers of endometriosis. Pharmacogenomic analysis indicated Janus kinase (JAK), cyclin-dependent kinase (CDK), and topoisomerase inhibitors as therapy targets.ConclusionOur results suggest an interplay between complement and coagulation, mast cells, extracellular matrix remodeling, and the JAK/STAT3 pathway in endometriosis. We underscore the significance of complement C3 and propose JAK inhibitors as therapy candidates. Detected expression differences between EEM and EH are important for the development of diagnosis via endometrial biopsy.

The Effect of Intrauterine Device Use on the Quality of Sampling Material in Patients Undergoing Endometrial Biopsy.

Objective: This retrospective study aims to evaluate the effect of copper intrauterine device (Cu-IUD) use on the adequacy and diagnostic quality of endometrial biopsy specimens in women with abnormal uterine bleeding (AUB). Patients with levonorgestrel-releasing intrauterine systems (LNG-IUS, e.g., Mirena) were excluded from the study. The study compares the histopathological adequacy of endometrial samples between Cu-IUD users and non-users, highlighting potential interpretation challenges in routine pathological assessment. Methods: The study was conducted on 409 women aged 25-55 who presented with abnormal uterine bleeding (AUB) to the Gynecology and Obstetrics Outpatient Clinic at Kayseri City Hospital between 1 April 2021 and 1 April 2023. The patients were divided into two groups: copper IUD (Cu-IUD) users (n = 215) and non-IUD users (n = 194). Patients using levonorgestrel-releasing intrauterine systems (LNG-IUS, e.g., Mirena) were excluded from the study. Endometrial biopsies were obtained using the Pipelle curette technique without anesthesia, preserved in 10% formalin, and assessed for pathological classification and diagnostic adequacy. Results: The proportion of unclassifiable pathological categories was significantly higher in copper IUD users (63.93%) compared to non-IUD users (36.05%) (p = 0.013). Additionally, a negative correlation was observed between pathological category and endometrial thickness (r = -0.3147, p < 0.001), suggesting that thinner endometrial lining may reflect atrophic or diagnostically ambiguous tissue patterns. However, no significant association was found between IUD use and endometrial thickness (p = 0.073). Conclusions: The findings indicate that copper IUD use may affect the diagnostic adequacy of endometrial biopsy specimens, likely due to inflammatory or structural changes in the endometrium. These results underline the importance of considering IUD-related alterations when interpreting biopsy findings. Further research is needed to refine diagnostic approaches and better understand the clinical implications of these effects.

Endometrial biopsy versus no endometrial biopsy with a normal appearing cavity during in-office hysteroscopy for postmenopausal bleeding: A randomized controlled trial.

Endometrial biopsy versus no endometrial biopsy with a normal appearing cavity during in-office hysteroscopy for postmenopausal bleeding: A randomized controlled trial.

Hysteroscopic criteria for the diagnosis of chronic endometritis: a systematic review and diagnostic test accuracy meta-analysis.

Hysteroscopic criteria for the diagnosis of chronic endometritis: a systematic review and diagnostic test accuracy meta-analysis.

Histopathological pattern of disease seen in patients undergoing endometrial biopsies - Two years study at a tertiary care hospital

Objective: The objective of the study was to analyse the spectrum of various histopathological patterns and frequencies of endometrial disorders, affecting the patients presenting with abnormal uterine bleeding, who underwent the procedure of endometrial biopsies. Material and Methods: This was a retrospective cross-sectional study, carried out at Histopathology department of Foundation University Medical College, Islamabad. Duration of study was two years which extended from June 2022 to May 2024. Results: A total number of 1835 of cases were analysed. The average age of patients was 29-76 years (4750). Main presenting complaint of the patients was abnormal uterine bleeding. The most common functional cause of AUB in our study was Disordered Proliferative Endometrium (18.80 %). The major organic cause was endometrial hyperplasia without atypia (21.25%). Majority of the patients belonged to perimenopausal age group. Conclusion: Endometrial biopsy remains the most important and least invasive procedure for diagnosing an underlying endometrial pathology till date. Disordered Proliferative Endometrium is the commonest cause of abnormal uterine bleeding specially in perimenopausal females. Keywords: Abnormal uterine bleeding, Disordered proliferative endometrium, Endometrial hyperplasia, Endometrial carcinoma

Novel Risk Factors for Placenta Accreta Spectrum in Women Without Prior Cesarean Section: Insights From a Case-Control Study

Placenta accreta spectrum (PAS) is a significant contributor to maternal morbidity and mortality, often complicating pregnancies due to abnormal placental attachment. While cesarean section (CS) remains the most recognized risk factor, nearly one-third of PAS cases occur in women without a history of CS. Identifying risk factors in these women is critical for improving early detection and management. This study aims to investigate maternal characteristics and risk factors associated with PAS in women without a history of CS, focusing on surgical histories and other potential predictors. A case-control study was conducted at the Maternity Teaching Hospital in Sulaimania, Kurdistan Region, Iraq. The study included 120 pregnant women diagnosed with placenta previa: 60 with PAS (cases) and 60 without PAS (controls). Women with a history of CS or uterine surgery were excluded. Data on maternal age, body mass index (BMI), parity, uterine surgical history, and other clinical factors were analyzed. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors. Significant risk factors for PAS included previous uterine myomectomy by laparotomy (OR 65.23, 95% CI: 7.85-541.72, P&lt;0.0001), uterine septum excision (OR 9.45, 95% CI: 1.10-81.23, P=0.022), and a history of multiple endometrial biopsies (OR 3.92, 95% CI: 1.03-14.93, P=0.045). Repeated uterine curettage also emerged as a significant predictor (OR 3.78, 95% CI: 1.05-13.59, P=0.042). Conversely, traditional risk factors such as multiparity, gestational hypertension, and diabetes mellitus were not significantly associated with PAS in this cohort. Our study highlights uterine myomectomy, septum excision, repeated biopsies, and curettage as significant risk factors for PAS in women without a history of CS. These findings emphasize the importance of careful monitoring and risk assessment in such patients to improve early detection and management of PAS.

Prospective evaluation of mid-luteal endometrial BCL6/SIRT and correlation with outcomes of euploid frozen embryo transfer: a prospective cohort study.

To study whether mid-luteal endometrial B-cell lymphoma 6 (BCL6) or sirtuin-1 (SIRT1) immunostaining in an ovarian stimulation (fresh) in vitro fertilization (IVF)cycle was predictive of risk for endometriosis. Additionally, to evaluate for association with future euploid frozen embryo transfer (FET) pregnancy outcomes. Prospective, blinded observational cohort study in an academic fertility center. Patients pursuing IVFwith euploid FET within 1year who met inclusion criteria for one of three groups: (G1) surgically confirmed endometriosis (n = 10), (G2) unexplained infertility or recurrent pregnancy loss (n = 42), or (G3) controls without identifiable female infertility (n = 24). BCL6 and SIRT1 immunostaining was quantified in endometrial samples obtained 5-7days after oocyte retrieval (HSCORE > 1.4 considered positive). Euploid FET in a subsequent cycle was blinded to BCL6/SIRT1 assessment. Demographic and pregnancy outcomes for each group were correlated with BCL6/SIRT1 levels. There was high BCL6 positivity with a significant interaction among groups (G1: 80%, G2: 97.6%, G3: 100%; p = 0.044), but pairwise comparisons did not demonstrate a difference between individual groups. Median BCL6 levels by H-SCORE were similarly high in all groups [median (inter-quartile range); G1: 3.7 (3.45, 4.0), G2: 3.8 (3.6, 3.8), G3: 3.8 (3.4, 4.0); p = 0.95]. Median SIRT1 levels also did not differ between groups. Pregnancy outcomes following FET were comparable between groups (live birth rate G1: 57.1%, G2: 62.1%, G3: 54.5%; p = 0.68). BCL6 levels were inversely correlated with serum progesterone level on the day of endometrial biopsy (τ = - 0.223, p = 0.01). Correlation analysis of pregnancy outcomes for all patients included in the study revealed no difference between BCL6 or SIRT1 levels for patients who did or did not experience a live birth. Endometrial BCL6 and SIRT1 levels collected in a fresh ovarian stimulation cycle did not correlate with endometriosis diagnosis nor pregnancy outcomes. BCL6 levels were inversely correlated with serum progesterone levels. NCT0410712.

Stalling of the endometrial decidual reaction determines the recurrence risk of miscarriage.

In every menstrual cycle, progesterone acting on estrogen-primed endometrium elicits an inflammatory decidual reaction, rendering it poised for embryo implantation and transformation into the decidua of pregnancy. Here, we show that the sequential functions of the decidual reaction-implantation and decidualization-pivot on the time-sensitive loss of progesterone-resistant DIO2+ stromal cells that form a specialized implantation niche and reciprocal expansion of progesterone-dependent PLA2G2A+ predecidual cells. Simultaneously, uterine natural killer (uNK) cell proliferation results in the accumulation of immunotolerant subsets. Examination of endometrial biopsies from 924 women revealed that the recurrence risk of miscarriage closely aligns with the incidence of a weakened or stalled decidual reaction, more so than poor uNK cell expansion. Analysis of paired biopsies obtained in different cycles and modeling in assembloids intimated that prior miscarriages disrupt intercycle endometrial homeostasis and calibration of the decidual reaction. Our findings show that erosion of the decidual reaction following a miscarriage drives the recurrence risk irrespective of maternal age.

The Role of Apparent Diffusion Coefficient in Differentiating Benign and Malignant Endometrial Pathologies: A Prospective Single-Center Study

Abstract To investigate the added role of apparent diffusion coefficient (ADC) in differentiating benign from malignant pathologies.Hospital-based random sampling was done and all the females with clinical details suggestive of endometrial pathologies and abnormal ultrasound underwent contrast-enhanced magnetic resonance imaging (MRI). In addition to the routine sequences, imaging was done at different b-values and ADC was calculated. The higher the ADC value the more the chances of benignity. Dynamic contrast-enhanced imaging was also done. Two radiologists with 18 and 10 years of experience evaluated the imaging findings and interobserver agreement was also made. Imaging findings were correlated with diagnosis as made by endometrial aspirate biopsy, dilatation–curettage, or postoperative histopathological examination.The addition of ADC value and dynamic contrast-enhanced MRI showed a significant role in differentiating benign from malignant conditions. The mean ADC measurement in malignant lesions was 0.88 × 10−3 ± 0.27 × 10−3, whereas the mean ADC measurement for benign lesions was 1.03 × 10−3 ± 0.38 × 10−3. The differences between the two were found to be significant (t-value: 2.754, p-value: 0.014). The cutoff of mean ADC and minimum ADC with the highest sensitivity and specificity were reported to be ≤1 × 10−3 and ≤0.8 × 10−3, respectively.Adding the ADC value with routine magnetic resonance sequences plays a significant role in differentiating between benign and malignant endometrial pathologies, especially in indeterminate cases

Development and characterization of a dual-fiber Raman probe for accurate and rapid endometrial carcinoma detection

We report on the development and characterization of a dual-fiber optic Raman probe for enhancing real-time endometrial carcinoma biopsy. The fiber optic probe was designed with two miniaturized coating fibers with an outer diameter (OD) of 3.1 mm. We demonstrate that with the use of the Raman probe associated with the background subtraction algorithms, high-quality tissue Raman spectra covering the fingerprint (FP) (500−1800cm−1) can be acquired from different tissue types (e.g., muscle, fat, parathyroid gland, and thyroid gland). Using an anti-reflection coating filter and background subtraction algorithms, our probe has better signal-to-noise (SNR) than a conventional coating probe with a comparable OD. Meanwhile, our probe has less OD and 58% SNR compared with the handheld probe (OD = 10 mm). We developed a Raman fiber probe with a small outer diameter and high SNR (&gt;90 in fat) simultaneously and used the small-size probe for accurate and rapid endometrial carcinoma detection. Specifically, a total of 220 fingerprint Raman spectra was obtained from 22 endometrial carcinoma (EC) patients (benign: 10, malignant: 12) and divided into two batches (110 spectra from 11 patients for each) from different patients for robustness test. The mean area under the receiver operating characteristic curves (AUC) for differentiating benign and malignant EC reached 0.946, with a mean accuracy of 93.1% and a mean time expense of 5 seconds by the ResNet model. Furthermore, the specific Raman features corresponding to biomolecules (e.g., amide I II, lipid, and collagen) were found to contribute to the accurate classification.

One-Stop Colon and Endometrial Screening (ONCE): a prospective study of combined cancer screening for Lynch syndrome

Background Individuals with Lynch syndrome face up to a 60% lifetime risk of developing endometrial and gastrointestinal cancer. Established guidelines recommend colonoscopies every 1 to 2 years beginning at age 20 to 25 and endometrial biopsy every 1 to 2 years beginning at age 30 to 35. We evaluated the patient experience with a combined endometrial biopsy and gastrointestinal cancer screening procedure for patients with Lynch syndrome. Methods Patients with Lynch syndrome undergoing combined colon and endometrial screening from June 2021 to September 2023 were prospectively enrolled. Patients had both procedures during a single session using propofol sedation. Appropriate patients also underwent upper endoscopy. Patient satisfaction was assessed by questionnaire. Surveys were distributed to patients via email 1 day after their procedure. Twenty patients were enrolled, and 18 completed the survey (90%). Results None of the patients reported pain during the procedure. The average combined procedure duration was 42 minutes (range 27–59) and average total operating room time was 54 minutes (range 37–93). One patient was found to have complex atypical endometrial hyperplasia and had a hysterectomy for stage 1 A uterine clear cell carcinoma. There were no cases of colon or gastric cancer. A total of six adenomatous polyps and five serrated polyps were removed. Conclusion Patients with Lynch syndrome undergoing One-Stop Colon and Endometrial Screening (ONCE) reported high satisfaction with the combined procedure. To maximize patient care, physicians and health care systems should consider support for and investment in the implementation of combined screening approaches.

Conservative hysteroscopic treatment of endometrial intraepithelial neoplasia and endometrial cancer in patients with high surgical risk with mechanical hysteroscopic tissue removal systems: A retrospective cohort study.

Conservative hysteroscopic treatment of endometrial intraepithelial neoplasia and endometrial cancer in patients with high surgical risk with mechanical hysteroscopic tissue removal systems: A retrospective cohort study.

Abstract P4-05-11: Physical changes caused by low-dose Tamoxifen therapy

Abstract Background: Ten-year data of the phase III trial TAM-01 showed that low-dose Tamoxifen reduced recurrence of invasive breast cancer and ductal carcinoma in-situ. Purpose: The first objective of the study was to learn about the gynecological and other side effects caused by low-dose Tamoxifen therapy in daily practice. A second objective was to report disease outcome. Methods: The study group consisted of women with DCIS who received low-dose Tamoxifen and did their follow-up at Davidoff Center in Israel. Consecutive patients from July 2019 to July 2021 were enrolled. The endometrial thickness, uterine fibroid and uterine polyps were assessed by gynecological US. General potential side effects were assessed by a questionnaire. Results: A total 33 patients were enrolled. 23 of them were included in the study. The median follow-up was 50 months (38, 60). The median age at diagnosis was 51 (40,66) years. 8.6% of the women were referred to an endometrial biopsy or polypectomy during the study period, none of them discovered malignancy. The median endometrial thickness before the treatment with Tamoxifen was 4 (2,9) mm, the median maximal endometrial thickness during the treatment with Tamoxifen was 8 (4,15) mm. New symptoms were developed during the treatment, 47% of the women reported hot flashes, 43% leg cramps and 37.5% of premenopausal women reported prolongation of the menstrual cycle. One (4.3%) of the women developed DCIS recurrence. Conclusions: Low-dose Tamoxifen therapy is associated with increased endometrial thickness, formation of new endometrial polyps, and general side effects such as hot flashed and leg cramps. Citation Format: Daniel Hendler, Sivan Agranat, Olga Ulitsky, Matan Ben-Zion Berliner, Ofer Rotem, Yinon Gilboa, Rinat Yerushalmi. Physical changes caused by low-dose Tamoxifen therapy [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-05-11.

PCOS endometrium-derived epithelial organoids as a novel model to study endometrial dysfunction.

Are we able to establish endometrium epithelial organoids (EEOs) from endometrial samples obtained from women with PCOS, and do they differ from non-PCOS EEOs? We were able to establish, for the first time, PCOS EEOs which capture endometrial abnormalities present in women with PCOS, including increased inflammation and decreased receptivity-related gene expression. Patient-derived EEOs could serve as a tool to study endometrial dysfunction, as diseased tissue-derived organoid models typically retain the disease-related traits. In PCOS, endometrial dysfunction likely contributes to subfertility and pregnancy complications, yet previous research on the endometrial epithelial compartment has been scarce and, so far, no PCOS-derived EEOs have been established. EEOs were established from endometrial biopsies from two cohorts of women with PCOS-including overweight/obese (O-PCOS, n = 4) and lean (L-PCOS, n = 4)-along with BMI-matched controls (overweight/obese control (O-Ctrl), n = 4; lean control (L-Ctrl), n = 4). EEOs were exposed to combinations of steroid hormones (β-estradiol (E2), progesterone, cAMP, and the Wnt/β-catenin signaling (WNT) inhibitor XAV-939)for 6days to simulate the proliferative or secretory phases of the menstrual cycle, with or without simultaneous androgen exposure with dihydrotestosterone (DHT). Bulk RNA-sequencing was conducted to identify variations in gene expression between PCOS and Ctrl EEOs, while reverse-transcription quantitative PCR RT-qPCR was employed to validate these results. Morphological assessment of EEOs was performed using hematoxylin and eosin staining and immunostaining. The size of EEOs was evaluated after 6days of hormonal exposure. PCOS EEOs from both BMI groups demonstrated increased inflammation-related gene expression (including increased expression of Oncostatin M Receptor (OSMR) and Intercellular Adhesion Molecule 1 (ICAM1)) and showed a reduced diameter compared to their respective control EEOs. The O-PCOS EEOs displayed an aberrant response to steroid exposure with E2 and progesterone (including reduced expression of receptivity-related genes progestagen-associated endometrial protein and leukemia inhibitory factor)as compared to control EEOs. Addition of DHT to the culture media did not affect EEO transcriptome, aligning with the minimal androgen receptor (AR) expression in the EEOs. Sequencing data are available from the corresponding author upon request. The study should be replicated with a larger number of samples and with other PCOS phenotypes apart from different weight categories. Furthermore, as this work is the first one to establish PCOS EEOs, future studies should focus on incorporating other endometrial cell types, including immune cells, in a co-culture system. This novel in vitro organoid model for PCOS captures the endometrial abnormalities present in the two weight categories of women with PCOS, thereby providing a valuable tool to gain insights into PCOS-related endometrial dysfunction. Our findings propose potential links to the increased risk of pregnancy complications in women with PCOS, such as the role of altered receptivity and implantation environment including increased inflammation, which may contribute to aberrant placentation and subsequent placental dysfunction. Jusélius Foundation, Novo Nordisk Foundation, Research Council of Finland, Horizon 2020 Marie-Curie MATER Innovative Training Network (all to T.T.P.), Fund for Scientific Research Flanders-Belgium (FWO, G0A6719N to J.V. and GO99023N to H.V.); KU Leuven Research Fund (C14/21/116 to H.V. and C14/24/152 to J.V.), University of Oulu Scholarship Foundation Grant (to L.L.), and PhD grant of China Scholarship Council (CSC, to M.W.). The authors have no conflicts of interest to declare.

The impact of GnRH agonists on endometrial immune cells in patients with adenomyosis: a prospective cohort study

BackgroundAdenomyosis is associated with lower implantation and higher miscarriage rates. Studies on recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) have shown that endometrial immune cell populations play a crucial role during implantation and early pregnancy. In women with adenomyosis, improved pregnancy outcomes following assisted reproductive technologies (ART) and pre-treatment with GnRH-agonists (GnRH-a) prior to frozen embryo transfer (FET) have been reported. We aimed to compare the endometrial immune cell populations of women with adenomyosis to those of women with RPL and RIF, and to characterise endometrial leucocyte subpopulations within the adenomyosis group before and after GnRH-a.MethodsWe conducted a prospective study between 2021 and 2024. Women with infertility and adenomyosis undergoing ART underwent one endometrial biopsy 6–9 days after oocyte retrieval and a second biopsy after 3 months of GnRH-a prior to FET. Women in the RPL and RIF groups underwent one endometrial biopsy in the midluteal phase. We performed flow cytometry (FC) to characterise immune cell populations and immunohistochemistry (IHC) to analyse uterine natural killer cells (uNKs) and plasma cells (PC). The Kruskal–Wallis test was used for comparisons between the study groups, and the Wilcoxon signed rank tests were used for paired samples before and after GnRH-a.ResultsEndometrial leucocyte subpopulations at baseline showed no significant differences between the adenomyosis (n = 20), the RPL (n = 40) and RIF (n = 15) group. In the adenomyosis group, following GnRH-a, we observed a significant decrease in the percentage of monocytes, from 77% (IQR 71, 82) to 71% (IQR 65, 75) (adj. p = 0.030). Baseline IHC showed elevated plasma cell concentrations (≥ 5/mm2) in 1/20 adenomyosis patients (5%), 4/40 RPL patients (10%) and 1/15 RIF patients (6.7%) while uNK cells were elevated (≥ 300/mm2) in 8/20 adenomyosis patients (40%), 11/40 RPL patients (27.5%) and 1/15 RIF patients (6.7%).ConclusionsWomen with infertility and adenomyosis showed a similar endometrial immune profile as women with RPL and RIF. The beneficial effect of GnRH-a prior to FET in women with adenomyosis may be mediated through effects on monocyte subpopulations. Based on the high prevalence of elevated uNK cells in patients with adenomyosis, we suggest testing women with adenomyosis undergoing ART before FET.

Comparison of intraoperative frozen section consultation and hysterectomy characteristics in patients diagnosed with EIN in endometrial biopsies.

This study aimed to assess the likelihood of detecting cancer in final pathology and evaluate the accuracy of intraoperative frozen-section assessment in cases of endometrioid intraepithelial neoplasia (EIN). We included patients diagnosed with EIN at Hacettepe University Hospital who subsequently underwent hysterectomy at the same center between January 2011 and March 2023. EIN diagnoses made at other institutions were re-evaluated and confirmed by co-author gynecopathologists. A total of 354 patients diagnosed with EIN underwent hysterectomy. The majority of patients (68.5%) had a final diagnosis of EIN. Endometrial cancer (EC) was identified in 11.3% (n = 40) of patients in the final pathology. Advanced age (≥50 years) (OR = 2.52; 95% CI: [1.27-4.96]; p = 0.006) and menopausal status (OR = 2.62; 95% CI: [1.34-5.11]; p = 0.004) were significantly associated with an increased risk of EC. Among 263 patients who underwent intraoperative frozen-section assessment, EC was detected in 12.9% (n = 34). The sensitivity and specificity of frozen-section assessment for EC detection were 41.1% and 100%, respectively. The frozen-section assessment failed to identify only one of the seven patients who required staging surgery. Our study demonstrates that a preoperative EIN diagnosis carries an 11.3% risk of concurrent EC. Additionally, the likelihood of EC is significantly higher in older and postmenopausal patients. The majority of patients requiring staging surgery were identified by frozen-section assessment. Our findings indicate that frozen-section assessment provides the necessary information for adequate surgical treatment in EIN cases.

Effects of Unani Herbal Formulae in the Management of Endometrial Polyp: A Case Report.

A 53-year-old married woman who had an irregular menstrual cycle complained of vaginal spotting for three months. She also reported gaining weight. After a Pipelle biopsy revealed a hyperplastic polyp in her uterus, she was recommended to undergo total laparoscopic hysterectomy, along with an endometrial biopsy and a hysteroscopy beforehand. She had only a month left before her surgery when she came for treatment at the Gynecology clinic (Unani). Itrifal-e-Ghudadi and Majun-e-Dabidulward were prescribed 5 grams twice daily orally after meals, and Marham-e-Dakhiliyoon for local application on the lower abdomen daily in the morning. After about seven months of treatment, the patient's symptoms were completely resolved, and her transvaginal sonography was completely normal, even after more than 6 months devoid of treatment. Thus, she avoided undergoing a total laparoscopic hysterectomy and was able to keep her uterus intact. Hence, it can be concluded that the Unani system of medicine is advantageous in treating endometrial polyps. case report; endometrial biopsy; endometrial polyp; hysteroscopy; total laparoscopic hysterectomy; Unani system of medicine.

Heterochronic pelvic high-grade myxoinflammatory fibroblastic sarcoma and uterine endometroid carcinoma harboring common gene mutations: a rare case report with genomic analysis

ObjectiveThis report presents a rare case involving an extreme epithelial-to-mesenchymal transition, in which a specific type of sarcoma developed heterochronically as a recurrence of endometrioid carcinoma.Case presentationA female in her 50’s presented with abnormal genital bleeding, and an endometrial biopsy revealed endometrioid carcinoma. Following the diagnosis of stage IA endometrioid carcinoma according to the 2008 classification system of the International Federation of Gynecology and Obstetrics, a robot-assisted simple hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node navigation surgery were performed. Six months postoperatively, a tumor mass developed in the pelvis. A transrectal needle biopsy revealed spindle cell proliferation, and pelvic tumor resection was conducted for diagnostic therapy. The patient received no adjuvant chemotherapy or radiotherapy after the second surgery and remained free of tumor recurrence for 8 months. The resected yellowish solid tumor mass, measuring 16 × 12 × 9 cm, exhibited hemorrhage, necrosis, and cystic degeneration and was composed of fascicular proliferation of spindle tumor cells showing nuclear pleomorphism and frequent mitotic figures within a myxoid and inflammatory stroma. No epithelial component or organoid patterns were observed. Immunohistochemically, the tumor cells were positive for factor XIIIa, CD10, and cyclin D1, but negative for keratins (AE1/AE3 and CAM5.2) and other specific markers, supporting a diagnosis of high-grade myxoinflammatory fibroblastic sarcoma (MIFS).ConclusionGenomic analysis revealed identical mutations in PTEN, PIK3R1, CDKN2 A, and TP53 in both the primary uterine endometrioid carcinoma and heterochronic pelvic MIFS. An integrative approach involving histology, immunohistochemistry, and genomic analysis is critical for elucidating the pathogenesis of rare pelvic and uterine tumors.

Histochemical Assessment of Reticulin–Collagen Patterns in the Mid-Secretory Endometrium Predicts Recurrent Pregnancy Loss

Background/Objectives: Normal remodeling of the extracellular matrix of the endometrium is a necessary condition for the implantation of a blastocyst. We evaluated whether the use of histochemical reticulin–collagen staining can improve the assessment of the extracellular matrix of the mid-secretory endometrium in recrudescent clinical/biochemical pregnancy losses in comparison with ultrasound and routine histological examination. Methods: We compared the histochemical pattern of reticulin–collagen endometrial biopsy (21st day of the cycle) with ultrasonography and standard histological examination of the endometrium in the following groups: (1) fertile women with gravidity ≥ 2, (gravidity = parity) and (2) women with two or more clinical/biochemical pregnancy losses. Results: A normal pattern (NP) with ordered reticulin fibers forming cellular structures was determined in 92% of biopsies with physiological reproductive status and 44% of biopsies with recrudescent reproductive failure (p < 0.05), despite the fact that there were no differences in ultrasonography and standard histological examination between the groups (p > 0.05). A histochemical pattern of insufficient secretory endometrial transformation with abnormal noodle-like pattern (aNP) collagen fibers was more common in recrudescent reproductive failure (56%) than in women with physiological reproductive status (8%) (p < 0.001), despite the fact that insufficient secretory endometrial transformation with an abnormal noodle-like pattern with collagenization (aNPC) was detected only in recrudescent reproductive failure, and it was not detected in women with physiological reproductive status (p < 0.00001). Conclusions: We determined the histochemical pattern of the extracellular matrix of the endometrium in terms of the type of reticulin–collagen, associated in our study with recrudescent clinical/biochemical pregnancy loss, with improved predictability compared to ultrasonography and standard histological examination. We propose to use the method of histochemical evaluation of the reticulin–collagen pattern in order to stratify groups of women of fertile age at risk of reproductive failure.

Risk of endometrial cancer after insufficient endometrial biopsy: a retrospective cohort study.

Risk of endometrial cancer after insufficient endometrial biopsy: a retrospective cohort study.