Endometrial Curettage Research Articles

Effect of Tissue Fragments Remain in the Karman Cannula on the Histopathological Diagnosis of Abnormal Uterine Bleeding.

The aim of this study was to perform histopathological analysis of residual material in the cannula by endometrial sampling using a Carmen injector, and to compare the results. The study was conducted in the Department of Gynaecology, Mardin Training and Research Hospital, Artuklu/Mardin, Turkiye, from December 2021 to June 2022. The study group consisted of 104 patients who presented to the outpatient clinic with complaints of abnormal uterine bleeding. Endometrial curettage material was collected from all patients using a Carmen injector. The collected material was discharged into the pathology container (Group 1). Subsequently, the residual material remaining in the injector was placed in a separate pathology container (Group 2). Specimens were sent to the pathology laboratory with buffered formol. The pathological evaluation was performed by the same pathologist without revealing the patients' names. Comparative histopathological results of the patients in Group 1 and Group 2 were found to be fully compatible in 64.4% of the patients. In 35.6% of the patients, the histopathological results were different from each other between Group 1 and Group 2. Pathological results were different from each other in 21.2% of patients with incompatible pathology results. In Group 1, 16.7% of the patients were over-diagnosed, while 7.7% of the patients were over-diagnosed in Group 2. It would be beneficial to carefully remove the material remaining in the cannula and send it for pathological examination as it may affect the histopathological results. Key Words: Abnormal uterine bleeding, Probe curettage, Karman cannula, Histopathological evaluation.

Chronic endometritis and infertility. Clinical and morphological aspects

Target. Optimize the diagnosis of chronic endometritis. To evaluate the influence of various factors on the formation of chronic endometritis in patients with infertility, to study the effectiveness of office hysteroscopy and endometrial biopsy in its diagnosis.Materials and methods of research. A retrospective analysis of the medical histories of patients with chronic endometrioma and a history of infertility was conducted for the period from 2020 to 2022 at the Stavropol Regional Clinical Multidisciplinary Center in Stavropol.Results. Hysteroscopy with endometrial scratching, as well as routine endometrial curettage, were among the leading risk factors for the development of chronic endometritis. More gentle office hysteroscopy with endometrial biopsy showed high sensitivity but average specificity in the diagnosis of chronic endometritis.

Endometrial pattern in women with abnormal uterine bleeding attending a tertiary care centre of Kathmandu

Background: Abnormal uterine bleeding is one of the most common problems among pre and postmenopausal women. Abnormal uterine bleeding is diagnosed when there is a substantial change in frequency, duration, or amountof bleeding during or between periodsin the absence of any organic pathology. The study was perform to assess the endometrial causes of abnormal uterine bleeding and their incidence in different age groups. Materials and methods: It was a cross sectional and descriptive study carried out at a Manmohan medical College & hospital, over a period of two year from 13th April, 2020 to 15th March, 2022. In the study all the endometrial tissue either obtained by endometrial curettage and biopsy or hysterectomy presenting with abnormal uterine bleeding for more than 3 months were included Results: A total of 88 cases were received during this period, out of which there were 78 endometrial tissue samples and 10 hysterectomy specimens. The patient’s age ranged from 20 years to 73years. The pattern of endometrial biopsy are Proliferative (37.5%) and secretory (20.45%) phase endometrium is the most common pattern seen, followed by disordered proliferative endometrium (13.63%), endometrial hyperplasia without atypia (9.09%), Change consistent with Exogenous Hormone (5.68%), Chronic Endometritis (5.68%), Endometrial Polyp(3.40%), Endometrial Hyperplasia with Atypia(2.27%) and Endometrial Carcinoma (2.27%). Conclusions: Patients with abnormal uterine bleeding show a varying spectrum of endometrial pattern. Cyclic endometrium is commonly seen in the reproductive age group whereas hyperplasia and carcinomas are seen in pre/postmenopausal age group. Endometrial biopsy with histopathological examination is a major diagnostic tool in the evaluation of abnormal uterine bleeding.

PERITONEAL KERATIN GRANULOMAS MIMICKING PERITONEAL CARCINOMATOSIS: A POTENTIAL DIAGNOSTIC PITFALL

Abstract Introduction/Objective Keratin granulomas from a primary uterine cancer can present as peritoneal tumor nodules, mimicking peritoneal carcinomatosis. Endometrial adenocarcinomas with viable peritoneal tumor implants and/or involvement of bladder or bowel mucosa are categorized as stage IV disease. We present a rare case of endometrial adenocarcinoma of the uterus with squamous differentiation and multiple peritoneal nodules of keratin granulomas, masquerading as peritoneal carcinomatosis. Methods/Case Report A 68-year-old female with insignificant past medical history presented with complaints of postmenopausal bleeding for the past four months. Physical examination was unremarkable. Transvaginal ultrasound showed a 4.9 cm echogenic mass in the uterus. The endometrial biopsy showed squamous debris with atypical cells suspicious of malignancy. Endometrial curettings revealed endometrial adenocarcinoma, endometrioid type with squamous differentiation, FIGO Grade 1. Subsequently, she underwent hysterectomy with bilateral salpingo- oophorectomy. Intraoperatively, multiple suspicious nodules on the sigmoid colon and in the pelvis were identified, of which excisional biopsies and pelvic peritoneal washing were taken. Microscopic examination of the resection confirmed endometrial adenocarcinoma, FIGO Grade 1, nuclear grade 1, with extensive foreign body giant cell reaction to dead squamous cells (ghost cells). Cytologic examination of the peritoneal washing was unremarkable and excisions of the sigmoid serosal and peritoneal nodules showed pink eosinophilic laminated nodules surrounded by inflammatory cells including plasma cells, lymphocytes and multinucleated giant cells without any viable tumor cells. Results (if a Case Study enter NA) NA Conclusion Keratin granulomas are a foreign body reaction to keratin deposition from the squamous component of endometrioid adenocarcinoma. The pathogenesis of this foreign body response to keratin is considered to be a trans- tubal spread of keratin through retrograde shedding from the fallopian tubes. In the absence of viable tumor cells, it appears to have no negative prognostic significance. Careful microscopic examination of peritoneal keratin granulomas is imperative to avoid erroneous upstaging of the tumor and the subsequent advanced treatment.

Endometrial Microcalcification in a 31-Year-Old Woman: A Case Report

Endometrial microcalcifications are an uncommon event, though they may be a cause of amenorrhoea and infertility. It is often detected incidentally as echogenic lesions on ultrasonography and in endometrial samples sent for histopathological examination. A 31-year-old Para 0+3 presented with amenorrhoea and a “curettage sample” obtained from an evacuation performed for a missed abortion at ten weeks gestation. She brought the tissue obtained during the endometrial curettage, which was performed at a private hospital for histopathological examination and follow-up at the Gynaecology Clinic. A provisional diagnosis of atrophic endometrium was made following a pelvic ultrasound scan, while histopathological examination revealed placenta tissue with microcalcifications. The patient was subsequently placed on combined oral contraceptives for three cycles, having ruled out possible contraindications. She had regular per vaginam bleeding for three consecutive cycles. She resumed spontaneous menses and eventually achieved pregnancy. Although endometrial microcalcification is rare, it is a potential cause of secondary amenorrhea and infertility in women of reproductive age group.

Immunohistochemical study of hormone receptors in endometrium with abnormal uterine bleeding

In the case of AUB, estrogen and progesterone exert their effects by acting on specific nuclei. Receptor proteins such as estrogen receptor (ER) and progesterone receptor (PR). And periodic changes in its expression have been shown in human uterine tissue. Immunohistochemistry (IHC). Immunohistochemistry using specific monoclonal antibodies estimate the content of the receptor at the cellular level and interpret their exact location and distribution.A two-year descriptive study was conducted. There were a total of 50 cases clinically diagnosed with AUB who underwent hysterectomy and endometrial curettage, and 20 non-AUB controls were included in this study. IHC was performed for ER and PR receptors in all cases and controls.The age range was 29 to 65 years and the average age of the patients was 43.21 years. Out of 50 patients, 26 were pre-menopausal and 24 were post-menopausal, and the mean hemoglobin, fertility and bleeding duration were 10.34 g/dL, 2.8 and 8.4 days per cycle. The average thickness of the endometrium was 10.5 mm in the cases and 6.25 mm in the control group. Increasing endometrial thickness was statistically significantly related to AUB and increased ER and PR HSCORE in stroma and glands (p<0.001). In terms of histomorphology, the highest number of cases was endometrial hyperplasia without atypia (27 cases), followed by early proliferative phase (7 cases). ER expression was more abundant in glands and PR expression was more in stroma. In endometrial hyperplasia with atypia, the expression of ER and PR was higher than in other endometrial stages.In addition to pelvic ultrasound and histology, immunohistochemistry. ER and PR have the advantage of allowing these hormone receptors to localize to the tissue.Endometrial aspiration samples and anxiliary tests in patient treatment allong with AUB. Endometrial hyperplasia is more common in patients with AUB. The concentration of estrogen and progesterone receptors is significantly higher. Therefore, the location and concentration of ER and PR receptors increases and this makes it possible for targeted therapies and avoid invasive surgical procedures using selective progesterone receptor modulators and progesterone antagonists in the treatment of patients with AUB and endometrial hyperplasia.

P-323 Endometriosis and adenomyosis present lower expression in uterine natural killer cells

Abstract Study question Is there an association between endometriosis and uterine natural killer cells? Summary answer Decreasing level of uterine natural killer cells had positively associated with Endometriosis and Adenomyosis. What is known already Uterine natural killer cells (uNK) represent the predominant lymphocyte population within the decidua during implantation and in the initial stages of pregnancy. Dysregulation of uNK function has been associated with reproductive challenges, including recurrent miscarriage (RM) or recurrent implantation failure (RIF). This suggests an underlying disruption in immune activity during implantation. Endometriosis is a chronic and inflammatory disorder that usually affects the pelvic cavity and can cause severe pain during menstruation. However, there are paucity studies focus on the role of uNK in endometriosis and adenomyosis. The aim of this study was to identify the association between endometriosis and uNK. Study design, size, duration In this Prospective cohort study, 60 participants were recruited from May 2023 to January 2024 at the outpatient department of Obstetrics and Gynecology in Chang Gung Memorial Hospital, Kaohsiung Medical Center in Taiwan. The inclusion criteria were as follows: adult women of childbearing age were eligible to participate. Old age (>45 years old) patients, or patient with underlying medical disease, immune diseases and malignancy, or patient using immunosuppressant were excluded. Participants/materials, setting, methods Endometrial tissues were collected during the mid-luteal phase using an endometrial curette. The level of uNK were measured by immunohistochemistry with CD56+, and was presented in absolute number per high power filed. CD138 was also measured, and the level above 5 cell/HPF was defined as chronic endometritis. Endometriosis and adenomyosis were confirmed histologically. RM was defined as ≧2 previous miscarriages. RIF was defined as ≧2 previous failures to achieve clinical pregnancies after embryo transfer. Main results and the role of chance At least one uNK/HPF was revealed in 58 cases, 0-10uNK/HPF in 15 cases (24.5%), 11-20 uNK/HPF in 19 cases (31.6%) and above 20 uNK/HPF in 26 cases. After adjusting for covariates, patient with endometriosis and adenomyosis were positively associated with lower uNK level(low vs. high uNK(cut-off value: 20 uNK/HPF), odds ratio (OR) (95% confidence interval (CI)), 9.434 (1.101–83.33), p = 0.032; 2.000 (1.515–2.639), p = 0.015). Moreover, there are 14 patients with RM (23.3%), 26 patients with RIF (43.3%) and 7 patients with CE (11.7%). However, our study did not find significantly association between RM or RIF or CE with uNK levels. Limitations, reasons for caution Because of the single-center, Asian origin of our patients, and the sample size was relatively small. Further large-scale longitudinal studies are required to verify our findings and evaluate the underlying pathophysiology between endometriosis and uNK. Wider implications of the findings Our study highlights the significantly decreased uNK level in endometrium of women with endometriosis and adenomyosis, which may indicate some alteration in immune environment under endometriosis. Further research is warranted for understanding the immuno-modulation in endometriosis. Trial registration number not applicable

Unusual Extension of Superficial Spreading Squamous Cell Carcinoma of Cervix to Uterus, Paraovarian, Paratubal Tissue, and Vaginal Surface: A Unique Case Report

ABSTRACT Superficial spreading cervical squamous cell carcinoma (SCC) is a rare phenomenon with few cases reported in the literature. The present case report briefs the findings of superficial spreading cervical SCC in postmenopausal women. A 65-year-old postmenopausal woman presented with bleeding per-vaginum for 1–2 months. On examination, the cervix was healthy with no visible growth. She was diagnosed with an endometrial malignancy on magnetic resonance imaging. On endometrial and cervical biopsy, histopathology revealed cervical intraepithelial neoplasia III in ectocervix with SCC in endocervical and endometrial curetting. The patient underwent modified radical hysterectomy with bilateral pelvic lymphadenectomy and histopathology revealed superficially spreading cervical SCC with tumor cells involving endometrium, myometrium, paratubal, paraovarian, vaginal margins without extending to pelvic, and para-aortic lymph nodes. The patient was further managed successfully with adjuvant chemoradiotherapy. Superficial spreading cervical SCC is very rare phenomenon. Its spread is not only limited to endometrium but can extend to involve myometrium, paratubal, paraovarian, and vaginal tissues.

Colombian consensus for the molecular diagnosis of endometrial cancer

Objective: The Cancer Genome Atlas research program (TCGA) developed the molecular classification for endometrial cancer with prognostic and therapeutic utility, which was replaced by the ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) classification by consensus and international guidelines due to its high cost. This article aims to present national recommendations from an expert consensus that allows unification and implementation of the molecular classification for women with endometrial cancer nationwide, with a rational use of resources and technology. Methods: Consensus of 36 experts in clinical oncology, oncological gynecology, pathology, and genetics, with clinical practice in the national territory. The leader group performed a literature review and structuring of questions rated 1 to 9 points. A modified nominal group technique was used. There was a face-to-face meeting with master presentations, deliberative dialogue, and Google Forms (Google LLC, Mountain View, CA, USA) questionnaire voting with analysis and discussion of responses. The non-consensual responses led to a second round of voting. The final manuscript was finally prepared and revised. Results: Seven recommendations were formulated integrating the panelist responses based on evidence, but adjusted to the Colombian context and reality. Recommendation 1. The molecular classification is recommended in all the endometrial cancers using the immunohistochemistry markers as subrogated results from the molecular profile initially proposed in the TCGA classification. Recommendation 2. The sequential test strategy is recommended, starting with the immunohistochemistry markers (p53, MLH1, MSH 2, MSH6, PMS2) simultaneously in all the patients, defining to request POLE (DNA polymerase epsilon) (if available) according to the risk classification based on the surgical piece. Recommendation 3. It is recommended, that the gynecologist oncologist should be the one to request the POLE (if available) according to the final pathology report. This test must be requested for all endometrial cancers stage I-II, except in low risk (stage IA low grade endometrioid histology without linfovascular invasion normal p53) and, stages III-IV without residual disease, without affecting the request of subrogated immunohistochemistry molecular markers upon histology. The consensus proposes that the POLE is requested after the immunohistochemistry and according to the categories in the risk classification established by the 2020 ESGO/ESTRO/ESP guidelines. Recommendation 4. It is recommended to perform immunohistochemistry for hormonal receptors for all women with endometrial cancer and the HER2 in patients with p53abn, simultaneously with the others immunohistochemistry markers. Recommendation 5. It is recommended to perform the immunohistochemistry markers (p53, MLH1, MSH2, MSH6 y PMS2) in an initial endometrial biopsy or curettage when the specimen is adequate and available. In case the initial immunohistochemistry is inconclusive, or there are histological discrepancies between the initial and definitive pathology, it is recommended to repeat the molecular profile in the surgical pathology. The immunohistochemistry markers must be reported in the pathology report according to the CAP (College of American Pathologists) recommendations, independently of the type of sample. Recommendation 6. It is recommended to perform MLH1 promoter methylation testing in patients who exhibit loss of expression of MLH1 in immunohistochemistry whether it is accompanied or not with loss of expression of PMS2. All the patients with deficient MMR (mismatch repair), should be sent for genetic counseling to rule out Lynch syndrome. Recommendation 7. It is recommended to consider the molecular classification in addition to the classical histopathological criteria when making adjuvant judgments, as incorporated by the classification of prognostic groups of the 2020 ESGO/ESTRO/ESP guidelines. Conclusions: It is necessary to implement the molecular classification of endometrial cancer in clinical practice in accordance to the Colombian context, due to its prognostic and probably predictive value. This will enable the characterization of the Colombian population in order to offer individualized guided treatments. This is an academic and nonregulatory document.

A prospective study of endometrial histopathology in post-menopausal women in Jharkhand.

Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal women. In the early menopausal years, endometrial hyperplasia, polyps and submucosal fibroids are common etiologies of post menopausal bleeding. The most common cause of postmenopausal bleeding is endometrial atrophy, comprises of 60-80%, while endometrial hyperplasia and endometrial cancer contribute to only 11% of Post menopausal bleeding. The aim of study is to analyses histomorphological pattern of endometrium in patients presenting with post-menopausal bleeding in Jharkhand. 103 postmenopausal women presenting to tertiary center of Jharkhand in 2020-22 with bleeding were subjected to endometrial curettage for histopathology. Analysis is based on morphological criteria to assess endometrium. Endometrial histology is of four categories: Proliferative, Secretory, premalignant and carcinoma. The highest incidence of postmenopausal bleeding was noticed in age group of < 60 years and incidence of malignancy was higher after 57 years of age. The majority of patients had parity between 1 and 3 (78.6%). Malignant & premalignant lesions comprises about 22.3% among that 77.7% were due to benign causes. Among the benign causes of postmenopausal bleeding, proliferative endometrium was the commonest finding. Types of hyperplasia encountered were simple hyperplasia without atypia (6.8%), Complex hyperplasia without atypia (3.9%),Complex hyperplasia with atypia (4.8%) and Simple hyperplasia with atypia (4.8%). 21.4% of cases of postmenopausal bleeding were associated with atrophic endometrium. Secretory endometrium seen in 17.5% of women. Endometrial carcinoma accounted for 12.6% of cases of postmenopausal bleeding. Out of these 69.2% were of endometroid type of endometrial carcinoma, 15.3% were of papillary serous carcinoma and 15.3% had clear cell carcinoma. The mean age of patients with endometrium carcinoma was 62.3 years. All cases of endometrial carcinoma were associated with 1 or more risk factor like diabetes/hypertension/Nulligravida. Proliferative Endometrium was a major cause of postmenopausal bleeding. Among the malignant causes, endometrial adenocarcinoma of endometroid type was most frequent with a lower mean age at presentation than other high grade cancers like papillary serous carcinoma & clear cell carcinoma.

Clinicopathological Pattern of Endometrial Specimens in Women with Abnormal Uterine Bleeding and Ultrasonography Correlation.

Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation. Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient's age and other data and evaluated with statistical analysis. During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age. Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps.

Post molar choriocarcinoma with solitary renal metastasis in the absence of primary uterine tumor: a case report and review of the literature

BackgroundChoriocarcinoma is a rare and highly malignant form of gestational trophoblastic disease that may develop following pregnancy, abortion, or a hydatiform mole. Renal metastatic involvement by post molar choriocarcinoma is even rarer. In this case report, we describe a unique case of post molar choriocarcinoma with a solitary renal metastasis in the absence of a primary uterine tumor and metastases in other sites, which presented with urological symptoms and spontaneous renal hemorrhage.Case presentationA 41-year-old Persian woman with history of complete hydatiform mole presented with severe flank pain, nausea, vomiting, gross hematuria, and vaginal bleeding. Laboratory tests demonstrated a serum beta human chorionic gonadotropin hormone level of 60,000 mIU/mL. Imaging studies showed a lesion at the lower pole of the left kidney with active bleeding surrounded by hematoma, as well as an empty uterine cavity. Additionally, bilateral pleural effusion was detected without any lesion within the lungs. Subsequently, the patient underwent laparotomy, partial nephrectomy, and left para-ovarian cystectomy. Endometrial curettage was also carried out. The histopathology report revealed choriocarcinoma renal metastasis with high expression of beta human chorionic gonadotropin, cytokeratin 7, and Ki 67. Moreover, there were no malignant cells in the endometrial curettage specimens, and a corpus luteum cyst was found within the para-ovarian cyst. Further investigations revealed that the pleural effusion was free of malignant cells, and there was no evidence of metastatic lesions in the brain. As a result, the patient was referred to the oncology department to receive chemotherapy, and the beta human chorionic gonadotropin levels dropped to 5 mIU/mL after receiving courses of a standard regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin over 3 weeks. Finally, monthly measurements of beta human chorionic gonadotropin levels for 6 months indicated that levels have constantly remained within normal ranges, showing no evidence of recurrence or new metastasis.ConclusionsUrological symptoms such as hematuria or spontaneous renal hemorrhage might be the only presentation of post molar choriocarcinoma with renal involvement. Thus, it can be beneficial to measure serum beta human chorionic gonadotropin levels among females of childbearing age who present with unexplained urological symptoms, especially if there is a history of prior hydatiform mole.

Histopathological profiling of endometrial biopsies in cases of abnormal uterine bleeding: Insights from a tertiary care center in India

ABSTRACT Introduction: Abnormal uterine bleeding (AUB), characterized by excessive, irregular, or prolonged uterine bleeding, is a prevalent gynecological concern, accounting for more than 30% of outpatient gynecological visits. Aim and Objective: This study aimed to assess: (A) The histomorphological patterns of the endometrium in cases of AUB. (B) The distribution of various endometrial pathologies across different age groups. (C) The occurrence of endometrial carcinoma among patients experiencing AUB. Materials and Methods: A prospective investigation was conducted among patients seeking care for AUB and infertility at a tertiary care center in northern India. A total of 130 endometrial specimens (collected through endometrial curettage, biopsy, or hysterectomy) were examined over a 2-year period. Tissue samples were preserved in 10% neutral buffered formalin, processed routinely, and examined using light microscopy. Results: The largest proportion of cases (36.2%) fell within the 31–40-year age group. The predominant histopathological pattern observed was secretory endometrium in 47 patients (36.2%), followed by proliferative endometrium in 44 cases (33.8%). Hyperplasia with atypia was more frequently noted in the perimenopausal age group; however, the incidence of malignancy in this subset of the population was relatively low. Conclusion: Histomorphological examination in cases of AUB contributes valuable insights for the diagnosis and management of AUB.

Histopathology of endometrium in women presenting with abnormal uterine bleeding in Vindhya region

: Any alteration in frequency, flow duration/blood loss amount of menstruation is known as Abnormal uterine bleeding/AUB. Almost 30% of all patient attending gynaecology OPD are for AUB. This study was conducted in Vindhya region to study endometrial histopathology amongst women complaining of abnormal bleeding pattern: This retrospective study was conducted on 200 women presenting with AUB who undergone endometrial biopsy or hysterectomy in the Obstetrics and Gynaecology Department and sent to Histopathology section of Pathology department, SSMC, Rewa (MP) from Jan 2020 to June 2021. The formalin fixed specimens were received grossing done, followed by processing and then staining with H&amp; E stain, followed by microscopy. Data &amp; history was taken from the patient herself and attenders.: AUB was observed in all age groups. Menorrhagia (105 patients, 52.5%) was commonest bleeding pattern observed in cases of AUB, followed by Metrorrhagia (54 patients, 27%). In our study Proliferative endometrium (71 patients,35.5%) was most common histopathological diagnosis found, followed by Non-Atypical endometrial Hyperplasia (45 patients, 22.5%), Secretory phase (20 patients,10%), DPE (20 patients,10%), Atrophic endometrium (12 patients,6%), Exogenous hormone (pill endometrium 10 patients, 5%), Benign Adenomatous polyp (9 patients, 4.5%), Atypical endometrial Hyperplasia (5 patients, 2.5%), chronic endometritis (5 patients, 2.5%), Endometrial carcinoma (3 patients, 1.5%).Variable Histopathological findings are found in endometrial biopsy and curettage done in AUB patient. This study emphasizes the significance of endometrial biopsy and its histopathological diagnosis for proper patient management.

#18 : Risk Factors for Placenta Accreta Spectrum in Pregnancies Conceived after Frozen-Thawed Embryo Transfer in a Hormone Replacement Cycle

Background and Aims: Assisted reproductive technology (ART), especially frozen–thawed embryo transfer (FET) in a hormone replacement cycle (HRC) is a risk factor for placenta accreta spectrum (PAS). This study aimed to clarify the risk factors for PAS related to the maternal background and ART techniques in pregnancies conceived after FET in an HRC. Method: We performed a case–control study in two tertiary perinatal centers in Japan. Among 14,028 patients who delivered at ≥24 weeks of gestation or were transferred after delivery to two tertiary perinatal centers between 2010 and 2021, 972 conceived with ART and 13,056 conceived without ART. PAS was diagnosed in patients 1) with histopathological findings of placenta increta/percreta, 2) those requiring manual evacuation of the placenta after delivery, or 3) those with retained placental tissue. Among women who conceived after FET in an HRC, 62 with PAS and 340 without PAS were included in this study. Multivariate logistic regression models were used for case–control comparisons, with adjustment for maternal age at delivery, parity, endometriosis or adenomyosis, the number of previous uterine surgeries of cesarean section, myomectomy, endometrial polypectomy or endometrial curettage, placenta previa, the stage of transferred embryos and endometrial thickness at the initiation of progestin administration. Results: PAS was associated with [Formula: see text]2 previous uterine surgeries (adjusted odds ratio [OR], 3.57; 95% confidence interval [CI], 1.60–7.97) and the number of blastocysts transferred (adjusted OR, 2.89; 95% CI, 1.15–7.26). In patients with &lt;2 previous uterine surgeries, PAS was associated with an endometrial thickness of &lt;7.0 mm (adjusted OR, 5.18; 95% CI, 1.10–24.44). Conclusion: A history of multiple previous uterine surgeries, the number of blastocysts transferred and a thin endometrium before ET are risk factors for PAS in pregnancies conceived after FET in an HRC.

Clinical Profile and Treatment Outcomes of Malignant Mixed Mullerian Tumors of the Uterus: A Single-Center Experience.

Background A malignant mixed Mullerian tumor (MMMT), otherwise known as carcinosarcoma, is a rare and aggressive malignancy involving the uterus. Despite aggressive treatment, they have poor outcomes. We performed this study to analyze the clinical profile, prognostic features, and treatment outcomes of patients treated for MMMT of the uterine corpus in our center. Methodology A study sample from a database of patients treated at a tertiary care center in South India between January 2015 and December 2019 was analyzed retrospectively. A total of 29 non-metastatic patients were included in the study. The diagnosis of MMMT was confirmed by a pre-operative biopsy specimen or endometrial curettage. Information regarding the patient, tumor characteristics, details of the surgery, adjuvant therapy, and follow-up details were collected retrospectively. Disease-free survival (DFS) and overall survival (OS) were plotted using the Kaplan-Meier method, and the log-rank test was used to identify any significant prognostic factor. Statistical analyses were performed using IBM SPSS software, version 21 (IBM Corp., Armonk, NY). Results The population's median age was 60 years (interquartile range (IQR): 52-65). The homologous type was the most common pathology seen in 21 patients. The median size of the tumor was 7 centimeters (cm) (IQR: 6-10). Around two-thirds of the patients received adjuvant radiation therapy. Paclitaxel and carboplatin-based adjuvant chemotherapy were used in 60% of the patients. Nearly 90% of the recurrences were distant recurrences. During the follow-up, 17 patients developed a recurrence. The median DFS was 12 months (95% CI: 7.7-16.2). The median OS was 26 months (95% CI: 10.6-41.3). The three-year OS rate was 42%. Patients with an age >60 years had a median overall survival of 11 months, compared to 37 months for patients <60 years (p = 0.026). The median overall survival of patients with tumor sizes >10 cm was 12.5 months, and it was 35 months when the tumor size was less than 10 cm (p = 0.03). Patients receiving radiotherapy (RT) had an improved survival (39 months) compared to those who did not receive RT (12.5 months) (p = 0.046). The median overall survival for patients after the recurrence was 12 months. As most patients were elderly with an Eastern Cooperative Oncology Group (ECOG) performance status of two at baseline, only a few patients were fit for second-line chemotherapy. Conclusion A malignant mixed Mullerian tumor is an aggressive tumor of the uterine corpus with poor survival rates. Surgical resection remains the mainstay of treatment. Adjuvant radiation therapy improves survival. The age of the patient, myometrium invasion, tumor size, and positive peritoneal cytology were found to be prognostic factors.

Pregnancy Rates after Hysteroscopic Endometrial Polypectomy versus Endometrial Curettage Polypectomy: A Retrospective Study.

Background and Objectives: A relationship between endometrial polypectomy and in vitro fertilization (IVF) pregnancy outcomes has been reported; however, only a few studies have compared polyp removal techniques and pregnancy rates. We investigated whether different polypectomy techniques with endometrial curettage and hysteroscopic polypectomy for endometrial polyps affect subsequent pregnancy outcomes. Materials and Methods: Data from 434 patients who had undergone polypectomy for suspected endometrial polyps using transvaginal ultrasonography before embryo transfer in IVF at four institutions between January 2017 and December 2020 were retrospectively analyzed. Overall, there were 157 and 277 patients in the hysteroscopic (mean age: 35.0 years) and curettage (mean age: 37.3 years) groups, respectively. Single-blastocyst transfer cases were selected from both groups and age-matched to unify background factors. Results: In the single-blastocyst transfer cases, 148 (mean age: 35.0 years) and 196 (mean age: 35.9 years) were in the hysteroscopic and curettage groups, respectively, with the 148 cases matched by age. In these cases, the pregnancy rates for the first embryo transfer were 68.2% (odds ratio (OR): 2.14) and 51.4% (OR: 1.06) in the hysteroscopic and curettage groups, respectively; the resulting OR was 2.03. The pregnancy rates after up to the second transfer were 80.4% (OR: 4.10) and 68.2% (OR: 2.14) in the hysteroscopic and curettage groups, respectively, in which the OR was 1.91. The live birth rates were 66.2% (OR: 1.956) and 53.4% (OR: 1.15) in the hysteroscopic and curettage groups, respectively, in which the odds ratio was 1.71. These results show the effectiveness of hysteroscopic endometrial polypectomy compared to polypectomy with endometrial curettage. No significant difference was found regarding the miscarriage rates between the two groups. Conclusions: Hysteroscopic endometrial polypectomy resulted in a higher pregnancy rate in subsequent embryo transfer than polypectomy with endometrial curettage. Therefore, establishing a facility where polypectomy can be performed hysteroscopically is crucial.

Moesin and Ezrin as New Promising Markers for Early Detection of Endometrial Carcinoma: An Immunohistochemical Study.

the aim of this study is to evaluate immunohistochemically the expression of ezrin, and moesin, in endometrial lesion cases in order to detect EC at early stages which will have an important implication on the patients' outcome. 100 stored, formalin-fixed, paraffin-embedded tissue blocks of endometrial curettage obtained due to abnormal uterine bleeding or postmenopausal bleeding were collected. Each paraffin block was re-cut by rotatory microtome at 4 μm thickness then mounted on a glass slide and stained by hematoxylin and eosin for routine histopathological examination and on charged slides for immunohistochemistry using an automated staining system (Dako autostainer link 48) with antibodies against Moesin and Ezrin. Cytoplasmic staining was evaluated for both Moesin and Ezrin based on the intensity and extent of staining and scored for each sample. Both Moesin and Ezrin were significantly higher in atypical endometrial hyperplasia compared to benign hyperplasia and significantly higher in endometrial carcinoma compared to atypical hyperplasia. Moesin also significantly correlated with higher tumor grades while Ezrin was significantly higher in postmenopausal women denoting their role in tumor progression and poor prognosis. Both Moesin and Ezrin could be potentially used as predictive markers for endometrial carcinoma screening programmes as well as indicators for cancer progression.

Endometrium Ablation using a Foley catheter with a cost-effective technique in a hospital environment.

Objective: To evaluate the effectiveness of employing Foley’s catheter and modified thermal balloon ablation to treat heavy menstrual bleeding (HMB). Study Design: Prospective Interventional Randomized Control study. Setting: Departments of Gynecological of Three Semi Government Hospitals of the City. Period: January 2021 to September 2022. Material &amp; Methods: In the study, 12 patients between the ages of 42 and 50 who complained of menorrhagia and who had not responded to treatment for at least 6 months were recruited. Pre-ablation endometrial curettage was performed on each patient. A 30-50 ml latex covered Foley’s Catheter was evaluated after being introduced into uterine cavity, inflated as much as the cavity would allow under moderate pressure, and changed every two minutes with fresh boiling saline for eight minutes. Following that, hysteroscopic examination and a 6-month follow-up were performed to look for endometrial scarring. Results: Significantly shorter hospital stays, shorter recovery times following surgery, and quicker return to normal daily and sexual activities. Regarding problems, menstrual alterations, amenorrhea rate, and failure rate during the course of follow-up, there was no discernible difference between patients. This method has a success rate of almost 88%. Conclusion: In situations with limited resources, improved thermal balloon ablation with a Foley’s catheter can be a potential treatment for HMB. It is a more affordable option that the preliminary endometrial ablation approaches.

Evaluation of endometrial thickness in breast cancer patients with tamoxifen treatment – Difference between 2-dimensional ultrasonography and elastosonography

ObjectiveThis study aimed to confirm the clinical significance of elastographic endometrium measurement in comparison with conventional ultrasonography for tamoxifen users with breast cancer. Materials and methodsIn this retrospective analysis, 98 women receiving tamoxifen as postoperative breast cancer treatment were included. Patient medical charts were reviewed, and related medical, obstetric, and gynecological information and histories relevant to breast cancer were evaluated. Patient clinical imaging data included endometrial thickness measurements using both conventional ultrasonography and elastography, and the differences between these two modalities in delta values were statistically analyzed along with possible influencing factors. ResultsEndometrial thickness measured using 2-dimensional ultrasonography had a mean value of 5.81 mm (standard deviation [SD] = 3.09), and elastosonography showed a mean value of 3.07 mm (SD = 1.62). A paired t-test was conducted and a significant difference between them was confirmed (P-value <0.001). Logistic regression analysis revealed that age and duration of tamoxifen treatment significantly influenced the degree of difference between endometrial thickness measurements. ConclusionsElastosonography may be a more successful and useful tool for measuring actual endometrial thickness than generalized 2-dimensional ultrasonography. In clinical cases with limited use of elastosonography and consequent inability for thorough evaluation of endometrial thickness, practitioners should exercise caution in deciding whether or not to adopt invasive diagnostic procedures, such as endometrial curettage, especially for young patients of reproductive age or those with prolonged treatment of breast cancer with tamoxifen.