Endometrial Hyperplasia Research Articles

Cystic Spaces in the Endometrium on Ultrasound and Correlations With Pathological Diagnosis: AContemporary Retrospective Cohort Study in a Tertiary Centre.

To determine the correlation between the ultrasound finding of cystic spaces in the endometrium and endometrial hyperplasia or cancer. We performed a retrospective cohort study at a tertiary teaching hospital in Victoria, Australia, between January 2014 and December 2016. Patients who had a tertiary ultrasound where the endometrium was assessed and underwent endometrial sampling in the subsequent year were included. There were 1614 patients who were included, and 154 (9.5%) had endometrial cystic spaces on ultrasound. Sensitivity, specificity, positive predictive value and negative predictive value for a histological finding of polyps were 16.3%, 93.4%, 51.3% and 72.3%, respectively; for endometrial hyperplasia without atypia (EH no A) 40.7%, 91.0%, 7.1% and 98.9%, respectively; for hyperplasia with atypia (EH with A) 25.0%, 90.8%, 5.2%, 98.4%, respectively and for endometrial cancer were 19.5%, 90.7%, 5.2% and 97.7%, respectively. When adjusted for age, endometrial thickness and the presence of polyps on ultrasound, cystic spaces increased the odds of a histologic diagnosis of polyps (adjusted odds ratio (aOR) 2.13 (95% CI 1.41-3.21) P < 0.001) or EH no A (aOR 5.20 (95% CI 2.06-13.12) P < 0.001) and reduced the odds of endometrial cancer (aOR 0.26 (0.08-0.81) P = 0.02). Cystic spaces on ultrasound are more likely to indicate the presence of EH no A or an endometrial polyp than endometrial cancer. As one in ten patients who had cystic spaces on tertiary ultrasound had a pathologic diagnosis of EH with A or carcinoma, there remains a need for sampling in this group until better data are available.

The Role of M1 and M2 Macrophages in the Progression of Endometrial Hyperplasia to Endometrioid Adenocarcinoma

The Role of M1 and M2 Macrophages in the Progression of Endometrial Hyperplasia to Endometrioid Adenocarcinoma

Best Practice Recommendations for Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia in the Military Health System.

Endometrial cancer is the most prevalent gynecologic cancer in the United States and has rising incidence and mortality. Endometrial intraepithelial neoplasia or atypical endometrial hyperplasia (EIN-AEH), a precancerous neoplasm, is surgically managed with hysterectomy in patients who have completed childbearing because of risk of progression to cancer. Concurrent endometrial carcinoma (EC) is also present on hysterectomy specimens in up to 50% of cases. Conservative medical management with progestins and close surveillance can be employed for certain populations after evaluating for concurrent EC. Currently, national professional guidelines recommend an individualized approach based on community access to care and patient factors. There is, however, no US civilian consensus on who should primarily manage EIN-AEH: Physician gynecologic specialists (GSs) and/or gynecologic oncologist (GO) subspecialists. Military health care presents an additional challenge with beneficiaries stationed at remote or overseas locations. While patients may not have local access to a GO subspecialist, many locations are staffed with GSs. Travel for care with a GO incurs additional cost for the patient and the military health care system, removes patients from local support systems, and can impact mission readiness. To provide the best care, optimize clinical outcomes, and avoid over- or under-treatment, military-specific guidelines for EIN-AEH management are needed. We propose a clinical decision tree incorporating both GS and GO subspecialists in the care of military beneficiaries with EIN-AEH. The subject matter expert panel recommends referral of EIN-AEH to a military (preferrable) or civilian GO for management if local access is available within 100 miles[Q1] . If travel of >100 miles is required, the patient should be offered the choice of a military GO referral if available within 250 miles (preferred) versus management by a GS. If travel is >100 miles from a GO or the patient declines a GO referral, the panel recommends that the GS should attempt to exclude concurrent EC by performing a hysteroscopic assessment of the endometrium with a directed biopsy, if not already done. A pelvic ultrasound should be obtained to evaluate the endometrial thickness (>2 cm more likely to harbor EC) along with a secondary gynecologic pathology review with immunohistochemical testing for Lynch syndrome (MLH1, MSH2, MSH6, and PMS2) and p53 expression. If any major additional risk factors are uncovered, the patient should be referred to a GO subspecialist for further management. If no additional major risk factors for concurrent EC are identified and hysteroscopy with expert gynecologic pathology review confirms no presence of EC in the pathology specimen, a virtual consultation and counseling with a military GO can be offered, with local surgical and/or medical management provided by a GS. If on subsequent pathology, EC is identified, the patient should be referred to a GO for further treatment considerations and counseling. Determining the optimal treatment for patients with EIN-AEH is nuanced and, within the military health care system, is complicated by varied access to expert management by a GO subspecialist. Military beneficiaries with this diagnosis present a unique challenge and warrant a standardized approach to maximize clinical outcomes.

Clear cell borderline ovarian tumor: A retrospective study and literature review.

Clear cell borderline ovarian tumor is a rare subtype of borderline ovarian tumor for which the clinicopathological characteristics, management, and prognosis remain unclear. Herein, we describe the clinical features, treatment options, and prognosis of clear cell borderline ovarian tumors. This was a retrospective study of nine patients with pathologically confirmed clear cell borderline ovarian tumors treated at Peking Union Medical College Hospital between 2006 and 2023. Data regarding the patients' clinicopathological features, management, and prognosis were analyzed. We also reviewed previously published studies in English of patients with clear cell borderline ovarian tumors who underwent fertility-sparing surgery. The median age at diagnosis was 52years (range, 35-72) and the median tumor size was 6.5cm (range, 2.7-13). Seven patients had unilateral tumors and two patients had bilateral tumors. Seven patients underwent radical surgery and two patients underwent fertility-preserving surgery. All patients had stage I disease. Pathological analysis revealed synchronous endometriosis or adenomyosis in five patients. Endometrial hyperplasia with atypia was found in two of the seven patients who underwent hysterectomy. During a median follow-up time of 54months (range, 14-200), only one patient suffered a recurrence, which was treated successfully with secondary surgery. The prognosis of clear cell borderline ovarian tumors is favorable, and fertility-sparing surgery is acceptable for young patients who may desire future pregnancies. Unilateral salpingo-oophorectomy is recommended for patients in whom ovarian cystectomy was the initial surgery.

Fertility-sparing treatment outcomes using immune checkpoint inhibitors in endometrial cancer patients with Lynch syndrome.

To evaluate the efficacy of immune checkpoint inhibitors (ICIs) for fertility-sparing treatment in Lynch syndrome-associated endometrial cancer (LS-EC). Four LS-EC cases received programmed cell death protein 1 (PD-1) inhibitors for fertility preservation at the Obstetrics and Gynecology Hospital of Fudan University from 2017 to 2023. The clinical data and long-term outcomes were retrospectively reviewed. Case 1, carrying germline MLH1 mutation, was diagnosed with Stage IIAmMMRd (International Federation of Gynecology and Obstetrics 2023) endometrial cancer (EC) at 38 years old. She received PD-1 inhibitor treatment and achieved a pathological complete response (CR) at 42 weeks. Case 2, carrying MLH1 mutation, underwent colorectal cancer surgery at 22 years and was diagnosed with EC and synchronous ovarian cancer at 39 years. After 24-week PD-1 treatment, CR of EC and ovarian cancer was achieved. Case 3, carrying MSH2 mutation, was diagnosed with endometrial atypical hyperplasia (EAH) at 35 years. After receiving 7-month progestin, she had the progressed disease with Stage IA2mMMRd EC and colon cancer was found soon after. She received PD-1 treatment for 18 weeks and achieved a CR of EC. She conceived naturally with full term delivery. Case 4, carrying MSH2 mutation, had a recurrence of Stage IBmMMRd EC 15 months after CR from EAH treated with progestin at 40 years. She received PD-1 treatment for 18 weeks and achieved CR. No recurrence was found in all cases after 3-41 months of follow-up after CR. ICIs might be an effective choice for LS-EC patients desiring fertility preservation.

Evaluation of autophagy related ATG4B gene, protein and miR-655-3p expression levels in endometrial cancer and hyperplasia

Evaluation of autophagy related ATG4B gene, protein and miR-655-3p expression levels in endometrial cancer and hyperplasia

Outcomes of endometrial cancer prevention strategies in patients with Lynch syndrome: a nationwide cohort study in the Netherlands

Female Lynch syndrome carriers have an increased risk of developing endometrial cancer. Regardless, research on endometrial carcinoma tumorigenesis is scarce and no uniform, evidence-based gynaecological management guidelines exist. We therefore described gynaecological surveillance and surgery outcomes in a nation-wide Lynch syndrome cohort. For this retrospective cohort study, female Lynch syndrome carriers, prospectively registered in the Dutch Lynch syndrome database (StOET), were included up to February 28th 2022. Carriers were linked to the Dutch national pathology (PALGA) database. The number of carriers with/without gynaecological surveillance, number of index carriers with endometrial carcinoma before Lynch syndrome diagnosis were assessed, as well as uptake of risk-reducing surgery and characteristics of endometrial carcinomas including the requisite for adjuvant therapy according to current guidelines. Overall survival after endometrial carcinoma diagnosis was analyzed using Kaplan Meier time to event analyses, cumulative incidence was calculated after adjusting for competing risks (death and prophylactic hysterectomy). In total, 1046 registered female Lynch syndrome carriers were eligible for surveillance, of whom 313 (30.0%) did not have surveillance and 21.4% (n=224 of 1046) opted for prophylactic hysterectomy. In carriers with surveillance, more cases of endometrial carcinoma and hyperplasia were found than in those without (37 endometrial carcinomas (7.3%) and 28 hyperplasias (5.5%) in 506 carriers with surveillance versus 14 (2.6%) and 4 (0.7%) in 540 carriers without surveillance, respectively); carriers with surveillance were generally younger than those without (median 56 years [IQR 48-65] versus median 65 years [IQR 49-75] at database assembly, respectively; p<0.0001). Endometrial carcinomas were predominantly of endometrioid type and FIGO stage IA, regardless of surveillance. Adjuvant external beam radiotherapy was required in one patient in both groups. Overall survival after endometrial carcinoma diagnosis did not differ between carriers with or without surveillance or carriers with endometrial carcinoma before LS diagnosis (p=0.51). For all endometrial carcinomas together, including index carriers, cumulative incidence was 22.7% at age70. In a nation-wide cohort of Lynch syndrome carriers, nearly one-third of eligible carriers did not undergo gynaecological surveillance. Endometrial carcinomas diagnosed during surveillance were slightly more often stage FIGO IA, but this did not seem to substantially decrease the requisite for adjuvant therapy or affect overall survival, questioning effectiveness of current gynaecological management. Prospective research should further assess this, as well as patient preferences. None.

HOW MANY PREGNANCIES ARE ALLOWED AFTER FERTILITY PRESERVING MANAGEMENT OF ATYPICAL ENDOMETRIAL HYPERPLASIA?

Atypical endometrial hyperplasia,with fertility preserving management by hormonal IUS,and oral progesterone, natural conception three times,allowed for how many pregnancies before hysterectomy? To reduce the incidence of endometrial cancer.

Safety of Fezolinetant for Treatment of Moderate to Severe Vasomotor Symptoms Due to Menopause: Pooled Analysis of Three Randomized Phase 3 Studies.

This study evaluated the safety and tolerability of fezolinetant in women with vasomotor symptoms (VMS) due to menopause in a pooled analysis of data from three 52-week phase 3 studies (SKYLIGHT 1, 2, and 4). SKYLIGHT 1 and 2 were double-blind, placebo-controlled studies where women (≥40 to≤65years), with moderate to severe VMS (minimum average≥7 hot flashes/day) were randomized to once-daily placebo, fezolinetant 30mg or 45mg. After 12weeks, those on placebo were re-randomized to fezolinetant 30mg or 45mg, while those on fezolinetant continued on their assigned dose for 40weeks. SKYLIGHT 4 was a placebo-controlled, double-blind, 52-week safety study. Safety was assessed by frequency of treatment-emergent adverse events (TEAEs) and endometrial events. TEAEs of special interest included liver test elevations and endometrial hyperplasia or cancer or disordered proliferative endometrium. Totals of 952 participants receiving placebo, 1100 receiving fezolinetant 45mg, and 1103 receiving fezolinetant 30mg took≥1 dose of study medication. TEAEs occurred in 55.3%, 62.9%, and 65.4%, respectively; exposure-adjusted results were consistent with these results. Most frequent TEAEs in fezolinetant-treated participants included upper respiratory tract infection (7.7-8.3%), headache (6.8-8.2%), coronavirus disease 2019 (5.8-6.1%), back pain (3.1-3.7%), arthralgia (2.9-3.2%), diarrhea (2.3-3.2%), urinary tract infection (2.9-3.4%), and insomnia (2.0-3.0%). The incidence of drug-related serious TEAEs and associated treatment withdrawals was low. Elevations in liver transaminases occurred in 1.5-2.3% of fezolinetant-treated participants, were typically asymptomatic and transient, resolved on treatment or discontinuation, with no evidence of severe drug-induced liver injury (Hy's law). Endometrial safety results were well within US Food and Drug Administration criteria. Analysis of benign and non-benign neoplasm controlled for exposure demonstrated no increased risk versus placebo. Pooled data confirm the safety and tolerability of fezolinetant over 52weeks. ClinicalTrials.gov identifiers, NCT04003155, NCT04003142, and NCT04003389. Graphical abstract available for this article.

The significance of the immunohistochemical method in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia

The article explores the role of immunohistochemical methods in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia. Endometrial polyps are a widespread pathology among women of reproductive age, frequently accompanied by hyperplastic tissue changes. The aim of the work was to investigate the expression of diagnostic markers in endometrial polyps, which may be manifestations of local endometrial hyperplasia, with the aim of improving differential diagnosis in their atypia.. The research material consisted of histological samples from 37 patients aged 38 to 52 with abnormal uterine bleeding, treated at a clinical hospital in Dnipro. The methods included histological tissue analysis, immunohistochemical studies using a panel of antibodies, and statistical data analysis. Antibodies targeting markers such as ER, PR, PAX-2, PAX-8, PTEN, Ki-67, p16, and p53 were used to evaluate proliferative activity and the degree of tissue atypia. The results showed that polyps associated with atypical hyperplasia are characterized by complex morphological changes, including abnormal glandular architecture, stromal atypia, and increased mitotic activity in both glandular and stromal components. Epithelial differentiation of tubal, mucinous, or mixed types was frequently observed. More than half of the cases exhibited partial atypical changes, while diffuse atypia was noted in fewer instances. The control group of glandular-fibrous polyps with hyperplasia without atypia demonstrated low mitotic activity and no cellular atypia. Immunohistochemical studies confirmed the high sensitivity of markers in identifying pathological chan­ges, particularly in diagnostically challenging cases. The conclusions emphasize that immunohistochemistry is an effec­tive tool for detecting endometrial atypia, and the diagnosis of atypical polyps should be based on a comprehensive analysis of morphological and molecular changes. Polyps associated with hyperplasia and atypia require further observation due to the risk of recurrence and potential malignant transformation. Utilizing markers such as PAX-2, PTEN, and Ki-67 enhances diagnostic accuracy. Additional studies are needed to develop more reliable risk stratification models.

Predisposing Factors for Pseudoplacentational Endometrial Hyperplasia or Cystic Endometrial Hyperplasia in Dogs and Their Association with Pyometra.

Pseudoplacentational endometrial hyperplasia (PEH) and cystic endometrial hyperplasia (CEH) are both hyperplastic conditions that may occur in the canine uterus during diestrus. CEH can impair fertility, and, although the consequences of PEH are poorly known, this condition is significantly associated with pyometra. The aim of this study was to investigate frequencies of both PEH and CEH in female dogs according to age, size, breed, and breed group. Uteri from 300 female dogs were sampled and processed for histopathologic analyses. Lesions were identified, and frequencies were statistically compared. PEH was significantly more frequent in dogs between 4 and 12 years of age and significantly less frequent in Yorkshires than Shih-tzus, as well as in the breed group that includes Brazilian Terriers and Yorkshires. CEH was significantly more frequent in dogs older than 12 years, but no breed predisposition was observed. The frequency of PEH was significantly higher than that of CEH. The frequency of pyometra in PEH cases was significantly higher than endometritis or uterus without inflammation. This study identified age, breed group, and size as predisposing factors for PEH and further demonstrated the association between this condition and pyometra in dogs.

Atypical Uterine Leiomyoma: A Case Report and Literature Review

Introduction: Atypical leiomyomas are diagnosed histologically, showing pleomorphic atypical tumor cells with low mitotic counts and no coagulative necrosis. Surgical treatment is indicated when abnormal uterine bleeding or symptoms related to the size of the leiomyomas, infertility, or recurrent gestational loss are presented. Clinical case: A 40-year-old woman with a history of menstrual changes, abdominal pain, and intermenstrual bleeding was scheduled for surgery. Pathology reported an atypical leiomyoma (23x18x13 cm) with myxoid degeneration. Discussion: Uterine leiomyomas affect 70-80% of women in their reproductive age. Symptoms vary by size and location, including abnormal bleeding, pain, and pressure-related issues. This patient had a single pedunculated leiomyoma, no endometrial hyperplasia, negative cervical cytology, and uterine adhesions. Myomectomy was chosen to avoid organ damage. Conclusion: Atypical leiomyomas are rare tumors diagnosed through biopsy and histopathological examination, displaying 10 mitoses per field and no necrosis. Immunohistochemical studies are necessary to distinguish them from leiomyosarcoma. Long-term follow-up after myomectomy is essential to monitor for recurrence.

PCOS Influences the Expression of AMHRII in the Endometrium of AEH During the Reproductive Age.

Endometrial proliferative lesions (EPLs) encompass endometrial hyperplasia (EH) and endometrial carcinoma (EC). Atypical endometrial hyperplasia (AEH) is associated with an elevated risk of progression to EC. Patients with polycystic ovarian syndrome (PCOS) exhibit higher serum levels of anti-Müllerian hormone (AMH) and a correspondingly increased incidence of EPLs. AMH has the capacity to inhibit the cell proliferation of EPLs derived from Müllerian duct tissue through the AMH-AMH receptor (AMHR) signaling pathway. Pairs of samples matched by preference scores were randomly selected. Immunohistochemistry was employed to assess the expression levels of AMHR type II (AMHR2) in endometrial tissue. A comparative analysis was performed between tissues from individuals with PCOS and those without, as well as between a normal endometrium and endometrial tissue from individuals with EPLs. This study aimed to elucidate differences in AMHR2 expression among these tissue types. By focusing on AMHR2 expression, the impact of the PCOS-related background on the endometrial AMH-AMHR cascade signaling pathway was initially investigated. The AMHR2 protein was expressed in the endometrium of both the PCOS group and the non-PCOS group during the reproductive age (20-39 years). The expression of the AMHR2 protein in the AEH endometrium of PCOS patients did not differ significantly from that in the normal endometrium of PCOS patients; however, it was significantly higher than in the AEH endometrium of non-PCOS patients (p = 0.011). Conversely, the expression of the AMHR2 protein in the AEH endometrium of non-PCOS patients was significantly lower than that in the normal endometrium of non-PCOS patients (p = 0.021). Notably, there was no significant difference in AMHR2 protein expression in a normal endometrium between PCOS and non-PCOS patients. The involvement of the endometrial AMH-AMHR cascade signaling pathway and its biological effects in the pathogenesis of AEH are evident. The pathophysiological conditions associated with PCOS, such as elevated serum AMH levels and other pathological states, may directly or indirectly influence the AMH-AMHR cascade signaling pathway in the endometrium. This influence could contribute to the progression of AEH.

Improvement of Diagnosis by Transvaginal Ultrasound and Prognosis of Endometrial Cancer using miR-222-3p: A Prospective Cohort Study

Background: Noninvasive biomarkers need identification to enhance the diagnostic accuracy of endometrial cancer (EC) detection. The diagnostic and prognostic significance of serum miR-222-3p in EC was investigated in this study to provide a reference for clinical diagnosis and treatment. Methods: This prospective cohort study comprised 128 patients with EC and 65 patients with benign endometrial lesions (benign endometrial hyperplasia or polyps) admitted to Qionglai Medical Centre Hospital from January 2016 to December 2018. EC diagnosis was confirmed through endometrial biopsy and postoperative pathology. Serum miR-222-3p levels were quantified using the real-time reverse transcriptase-polymerase chain reaction (RT-qPCR). Pearson’s method was utilized to assess correlations between miR-222-3p and the resistance index (RI), pulsation index (PI), and mean blood flow velocity (MBFV). Diagnostic and prognostic assessments of miR-222-3p were conducted using receiver operating characteristic (ROC) curve analysis, Cox regression analysis, and Kaplan‒Meier curve analysis. Results: Serum miR-222-3p levels were higher in EC patients compared to controls and were correlated with RI, PI, and MBFV (p &lt; 0.001). Serum miR-222-3p enhanced the sensitivity (69.53% vs. 96.88%) and specificity (92.31% vs. 96.92%) of transvaginal ultrasound for EC diagnosis. Furthermore, serum miR-222-3p showed significant associations with lymph node metastasis (p = 0.002), degree of differentiation (p = 0.023), and the International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.001) in EC patients. It also predicted poor prognosis and served as an independent prognostic predictor (p = 0.036). Conclusions: The combination of miR-222-3p with transvaginal ultrasound enhanced the diagnostic efficiency of EC. Additionally, miR-222-3p holds promise as a biomarker for predicting the prognosis of EC patients.

Endometrial hyperplasia, benign endometrial tumors and endometrial carcinoma: A review study

Background. During the reproductive phase, the endometrium undergoes cyclical structural changes. Endometrial hyperplasia (EH) is a prevalent condition that arises from a combination of estrogen exposure and insufficient progesterone levels. Endometrial cancer (EC) is the second most common gynecologic malignancy, with the likelihood of EH progressing to EC ranging from 1% to 29%. The objective of this study is to conduct a comprehensive assessment of various forms of endometrial hyperplasia, benign endometrial tumors, and endometrial cancer (EC). Methods. A review of published papers from major databases, including PubMed, Scopus, and Google Scholar, was conducted. The search included original research articles and reviews on EH, benign endometrial tumors, and EC. Case reports, series, and clinical images were excluded. Results. Information on the selected topics was summarized, including epidemiology, etiology, histopathological classification, anatomy, biological and molecular characteristics, detection and prevention, clinical manifestations, staging, diagnostic workup, prognostic factors, and management. Conclusion. Endometrial hyperplasia and endometrial cancer are two of the most common problems in women. EH is a major precancerous condition for EC, and EC is associated with a poor prognosis if diagnosed late. The epidemiology and outcomes of both conditions vary according to several factors, including ethnicity, environment, socioeconomic status, heredity, drugs, hormones, and the aging process.

A CASE STUDY- AN AYURVEDA APPROACH ON POLYCYSTIC OVARIAN SYNDROME

A woman is the best and most precious creation of God. Women’s bodies undergo significant changes through-out their lives, leading to differences in health concerns for varying age groups. The reproductive cycle signifi-cantly affects in every stage of a woman’s life during the transition from a girl to a woman and a woman to a mother. PCOS is the most challenging lifestyle disorder that can affect women’s Multiple system and require a comprehensive perspective on health care for effective treatment. Metabolic derangement and associated com-plications include insulin resistance and diabetes, hyperlipidemia, fatty liver, hypertension, and sleep apnoea. Reproductive complications include oligomenorrhoea /amenorrhea, sub-fertility, endometrial hyperplasia, and cancer. Associate psychological concerns include depression and disordered eating. Additionally, cosmetic is-sues are hirsutism, androgenic alopecia, and acne. This particular feminine disorder is not described word for word in Ayurveda. Ayurveda literature is under the broad heading of Yoni vyapad, Artava dustya, and Artava kshaya. Analyzing the signs and symptoms of diseases, it can be assumed that vitiated Kapha causes Sroto-rodha (blockage of channels), resulting in Vata vaigunya. Agneya property of pitta depleted. Here is a case re-port of 25 a 25-year-old female patient who presented with irregular menstruation, rapid weight gain, and de-pression. On Ultrasonography, she has detected a bilateral polycystic ovary. Depending upon the clinical fea-tures, the patient was given Aampachan. Vatanuloman, Kaphavata hara, Medohara, and Artavajanana proper-ties of medicines and yoga. After almost three and half months of internal medicine, symptoms reduced marked-ly, and menstruation was normal.

ENDOMETRIAL HISTOPATHOLOGICAL PATTERNS IN PATIENTS WITH ABNORMAL UTERINE BLEEDING: A SIX MONTHS OBSERVATION OF 285 CASES IN A TERTIORY CARE HOSPITAL

Objectives: the objective of the study was to assess the histopathological patterns of endometrial lesions in patients with abnormal uterine bleeding (AUB) across different age groups. Methods: A descriptive cross-sectional study was conducted over 6 months at RNT Medical College, Udaipur after the approval of the Institutional Ethics Committee. A total of 285 cases presenting with AUB were analyzed through clinical history, physical examination, and endometrial biopsy. Cases were categorized into reproductive, perimenopausal, and postmenopausal groups for comparative analysis. Results: The perimenopausal group had the highest incidence of AUB (50.88%). The most common histopathological findings included secretory (39%) and proliferative (31%) phases. Senile cystic atrophy was prevalent in postmenopausal women (38.71%), while endometrial hyperplasia was observed more in perimenopausal and postmenopausal women. Malignant cases, including adenocarcinoma, were rare but significant, particularly in the postmenopausal group. Conclusion: Age-specific variations in endometrial patterns highlight the influence of hormonal changes and the increased risk of malignancy in postmenopausal women. The findings support the importance of endometrial histopathological evaluation in managing AUB, especially in perimenopausal and postmenopausal patients to identify potentially precancerous conditions.

An observational study of clinico-pathological characteristics of gynecological tumors and mode of treatment

Background: Gynecological malignancies are a group of various malignancies of the female reproductive system which included cancers of the ovary, cervix, uterus, vulva, vagina, and also gestational trophoblastic neoplasia. Aims and Objectives: The aim of this study was to study the clinical profile, different histopathological types of gynecological tumors, and mode of treatment. Materials and Methods: Study was conducted on 94 patients from June 2022 to December 2022. Results: Mean age of study population was 49.54±14.54 years. On radiological examination, out of total 52 ovarian cancers, cysts were present in 14 (14.89%) women, solid cysts in 16 (17.02%), papillary projections in 9 (9.57%), vascularity in 11 (11.70%), and lymphadenopathy in 2 (2.12%) women. The Pipelle biopsy results showed complex hyperplasia with atypia in 6 women (6.38%), endometrial carcinoma in 2 women (2.12%), focal atypia in 3 women (3.19%), and simple hyperplasia with atypia in 7 women (7.44%). On Pap smear/liquid based cytology, 1 (1.06%) woman each had atypical squamous cells, HSIL cannot be excluded, atypical squamous cells of undetermined significance, high-grade squamous intraepithelial lesion, and low-grade squamous intraepithelial lesion. No intraepithelial lesion or malignancy was found in 82 (87.23%) women. Present study showed that cervix cases was 10 (10.63%), endometrium 30 (31.91%), and vaginal 1 (1.06%). Majority of women in the present study, that is, 53 (56.38%) had ovarian tumors. In endometrial cancer, endometrioid adenocarcinoma, that is, 15 (50%) followed by simple endometrial hyperplasia without atypia and complex endometrial hyperplasia with atypia, that is, 4 (13.33%) each. Conclusion: Maximum number of patients having various gynecological tumors presented with stage II disease and above but maximum women with ovarian cancer reported with stage III and stage IV. These results clearly explained that ovarian cancer usually had non-specific or misleading symptoms as compared to cervical cancer which reported few specific symptoms.

Combining Ultrasonography and Endometrial Aspiration as a One-Stop Screening for Endometrial Neoplasia.

To assess the performance of simultaneous endometrial aspiration and sonohysterography to screen for endometrial cancer or hyperplasia in women aged 50 years or older. We conducted a prospective study from February 2014 to October 2020 at the ultrasound unit of a large urban academic medical center. The study included 1,635 women aged 50 years or older referred for endometrial evaluation, with follow-up through January 2021. Participants underwent saline infusion sonohysterography combined with ultrasound-guided endometrial aspiration. The primary outcome measured was a diagnosis of endometrial cancer or hyperplasia within 1 year from screening. The diagnostic accuracy of the combined evaluation method, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed. Of 1,170 women who completed the study protocol, 82 (7.0%) had endometrial cancer and 42 (3.6%) had endometrial hyperplasia. Of all patients who developed cancer during the follow-up period, 85.5% were diagnosed within 1 year after evaluation. The application of simultaneous endometrial aspiration and sonohysterography together demonstrated a sensitivity of 99.1%, specificity of 24.9%, PPV of 11.8%, and NPV of 99.6%. Using a theoretical sequential approach, assuming an endometrial aspiration is performed only in patients determined to be high risk by sonohysterography, demonstrated a sensitivity of 93.4%, specificity of 99.9%, PPV of 99.0%, and NPV of 99.3%. Simultaneous endometrial aspiration and sonohysterography is an effective one-stop outpatient screening tool for detecting endometrial cancer and hyperplasia in women aged 50 years or older. With the integration of two screening modalities into a single procedure, simultaneous endometrial aspiration and sonohysterography may overcome the limitations inherent in each of the currently recommended methods individually, potentially improving patient prognosis and streamlining the diagnostic process.

Uterine Adenosarcoma with Stromal Overgrowth: A Case Report with Review of Literature

Adenosarcoma of the uterus with Sarcomatous Overgrowth (SO) and Heterologous Elements (HE) is a rare and aggressive neoplasm that shares common clinical and radiological presentations. It is also referred to as Müllerian adenosarcoma, a slow-growing neoplasm characterised by a classical biphasic pattern comprising benign epithelial and malignant mesenchymal tissue. Adenosarcoma with a high-grade stromal component has an increased risk of recurrence. Hereby the authors present a case of 39-year-old female Who was nulliparous, reported to the Department of Obstetrics and Gynaecology with abdominal pain, menorrhagia, and burning micturition. Her medical history included diabetes, hypertension, hypothyroidism, and morbid obesity. She had a past history of similar complaints, during which an endometrial biopsy had shown hyperplasia without atypia. She was lost for follow-up and returned after one and a half years, having developed endometrial hyperplasia with atypia. She returned only after six months with similar but more severe complaints. Clinically and radiologically, there was a polypoidal mass protruding through the cervical canal. The hysterectomy specimen revealed a tumour with histopathological features of Müllerian adenosarcoma with SO. Interestingly, both ovaries were enlarged, exhibiting marked stromal hyperplasia. A panel of immunohistochemical markers, including CD10, Ki67, S-100, desmin, Estrogen Receptor (ER), and Progesterone Receptor (PR), was used, and the findings were unusual for an adenosarcoma with highgrade stromal histology. The chronological progression from endometrial hyperplasia without atypia to hyperplasia with atypia in a nulliparous woman, along with bilateral ovarian stromal hyperplasia, represents a classical pattern of events.