Endometrial Pathology Research Articles

The usefulness of p16 and COX-2 expression on the prediction of progression to endometrial cancer.

Endometrial cancer (EC) is the most commonly diagnosed gynecological cancer. Endometrial hyperplasia (EH) is a more common diagnosis than EC. Endometrial hyperplasia is found in approximately 1.5% of all women presenting with abnormal bleeding. Endometrial hyperplasia progresses to EC, and especially, cancer risk increases in cases with atypical hyperplasia. p16, one of the tumor suppressor proteins involved in the cell cycle, and COX-2, one of the key enzymes of prostaglandin synthesis, are important markers for the diagnosis of both EH and EC. There is lack of consensus in the classification, diagnosis and treatment of EH. The subject of changes in the cell cycle in the progression of endometrial pathologies may help to identify and prevent these affected pathways in the treatment stage. The aim of this study is to investigate the expression of p16 and COX-2 during the development of EC from EH. We investigated COX-2 and P16 expressions in patients with proliferative endometrium, complex/simple endometrial hyperplasia and endometrioid adenocarcinoma. p16 expression increased in EH and EC (p<0.001). COX-2 expression was increased in endometrial cancer compared to other groups, but this increase was not found to be statistically significant. Although p16 and COX-2 expression were increased in patients with advanced grade/stage, lymphovascular invasion, and >50% of myometrial invasion, this increase was not statistically significant. More detailed studies are needed to investigate the prognostic significance of the COX-2 molecule. COX-2 might be a potential biomarker for the prognosis of endometrial cancer and a potential therapeutic target for EC treatment. Also, it might be used to prevent the progression of precursor lesions to invasive EC.

AI-algorithm training and validation for identification of endometrial CD138+ cells in infertility-associated conditions; polycystic ovary syndrome (PCOS) and recurrent implantation failure (RIF)

BackgroundEndometrial CD138+ plasma cells serve as a diagnostic biomarker for endometrial inflammation, and their elevated occurrence correlates positively with adverse pregnancy outcomes. Infertility-related conditions like polycystic ovary syndrome (PCOS) and recurrent implantation failure (RIF) are closely associated with systemic and local chronic inflammatory status, wherein endometrial CD138+ plasma cell accumulation could also contribute to endometrial pathology. Current methods for quantifying CD138+ cells typically involve laborious and time-consuming microscopic assessments of only a few random areas from a slide. These methods have limitations in accurately representing the entire slide and are susceptible to significant biases arising from intra- and interobserver variations. Implementing artificial intelligence (AI) for CD138+ cell identification could enhance the accuracy, reproducibility, and reliability of analysis. MethodsHere, an AI algorithm was developed to identify CD138+ plasma cells within endometrial tissue. The AI model comprised two layers of convolutional neural networks (CNNs). CNN1 was trained to segment epithelium and stroma across 28,363 mm2 (2.56 mm2 of epithelium and 24.87 mm2 of stroma), while CNN2 was trained to distinguish stromal cells based on CD138 staining, encompassing 7345 cells in the object layers (6942 CD138− cells and 403 CD138+ cells). The training and performance of the AI model were validated by three experienced pathologists. We collected 193 endometrial tissues from healthy controls (n = 73), women with PCOS (n = 91), and RIF patients (n = 29) and compared the CD138+ cell percentages based on cycle phases, ovulation status, and endometrial receptivity utilizing the AI model. ResultsThe AI algorithm consistently and reliably distinguished CD138− and CD138+ cells, with total error rates of 6.32% and 3.23%, respectively. During the training validation, there was a complete agreement between the decisions made by the pathologists and the AI algorithm, while the performance validation demonstrated excellent accuracy between the AI and human evaluation methods (intraclass correlation; 0.76, 95% confidence intervals; 0.36–0.93, p = 0.002) and a positive correlation (Spearman's rank correlation coefficient: 0.79, p < 0.01). In the AI analysis, the AI model revealed higher CD138+ cell percentages in the proliferative phase (PE) endometrium compared to the secretory phase or anovulatory PCOS endometrium, irrespective of PCOS diagnosis. Interestingly, CD138+ percentages differed according to PCOS phenotype in the PE (p = 0.03). On the other hand, the receptivity status had no impact on the cell percentages in RIF samples. ConclusionOur findings emphasize the potential and accuracy of the AI algorithm in detecting endometrial CD138+ plasma cells, offering distinct advantages over manual inspection, such as rapid analysis of whole slide images, reduction of intra- and interobserver variations, sparing the valuable time of trained specialists, and consistent productivity. This supports the application of AI technology to help clinical decision-making, for example, in understanding endometrial cycle phase-related dynamics, as well as different reproductive disorders.

A comparison of uterine corpus and endometrium volumes measured in 2D and 3D modes

Objective: to compare the uterine corpus and endometrium volumes measured in 2D and 3D modes.Material and methods. The observational retrospective cohort study included 154 women of reproductive age with no myometrial or endometrial pathology. Pelvic ultrasound was performed with the use of the Affiniti70 (Philips, Netherlands) with a multifrequency 3D intracavitary probe. The uterine corpus volume and endometrial volume were measured both in 2D and 3D modes, followed by a calculation of the percentage ratio of endometrial volume to uterine corpus volume (endometrial/uterine corporeal volume ratio (EV/UCV)).Results. The values of uterine corpus volume measured in 3D mode were higher than in 2D mode, with a relative measurement error of 7.2%. The strength of the correlation turned out to be very high (r = 0.91, p = 0.458). According to the Bland-Altman plot, almost all values of the volume difference in pairwise measurements fell within the interval ±1.96 SD 95%; a low average difference indicates a low systematic discrepancy in measurements, and the degree of value scatter is quite acceptable. The values of endometrium volume in 3D mode were lower than in 2D mode; the relative error in 2D mode, regardless of the cycle phase, was -35.3%. There was a strong correlation between the two measurement methods (r = 0.81), but the differences in allocations were significant (p&lt;0.05).Conclusion. It is permissible to use the values of the uterine corpus volume obtained in 2D mode as an analogue of 3D mode volume in routine practice, while it is not acceptable in the assessment of endometrium volume and EV/UCV.

Clinical utility of office hysteroscopy following failed invitro fertilization-embryo transfer: A retrospective cohort study.

Despite its widespread use, invitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen-thawed embryo transfer (FET) in infertile women who experienced a failed IVF-embryo transfer (IVF-ET) cycle. We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A (n = 161) had CE with or without EPs, group B (n = 156) had EPs only, and group C (n = 260) had no CE or EPs. In the following FET cycle, the implantation rates were 47%, 51%, and 45% (P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% (P = 0.436); the live birth rates were 45%, 51%, and 42% (P = 0.205); and the miscarriage rates were 18%, 16%, and 22% (P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups (P > 0.05). OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET.

Correlation of Hysteroscopy With Histopathological Findings of the Endometrium in Women With Polycystic Ovary Syndrome (PCOS)-Related Infertility.

Introduction There have been numerous studies on the anovulatory factor, leading to infertility inwomen with polycystic ovary syndrome (PCOS); however, studies on the endometrium factor causing infertility in PCOS women are scarce. While hysteroscopy can accurately diagnose endometrial disorders such as endometrial polyps, it may be ineffective in detecting probable endometrial pathologies due to different hormonal habitats in these patients. Materials and methods Sixty patients with PCOS-related infertility were included in the study. All participants underwent hysteroscopic examination followed by endometrial biopsy and histopathological examination. The clinical and hormonal profiles of two main subgroups, that is, (a) normal endometrium (N), which included proliferative endometriumand secretory endometrium on histology, and (b) disordered endometrium (D), which included disordered endometrium on histology, were compared. Results There was no correlation between hysteroscopic and histopathological findings of PCOS infertile women. In the subgroup analysis of the two main histological types, that is, normal (proliferative and secretory) and disordered (disordered endometrium), age (28.70±4.66 vs. 32.9±5.61, p=0.012) and duration of amenorrhea (5.49±2.43 vs. 7.82±2.93, p=0.008) were significantly higher in the disordered group. There was a statistically nonsignificant higher BMI in the patients of the disordered endometrium group. Conclusion These findings suggest that endometrial biopsy and histopathological evaluation along with hysteroscopy should be desired in women with PCOS-related infertility, especially if they are in the late reproductive age group and have a longer duration of amenorrhea, regardless of endometrial thickening. This approach is essential to diagnose and treat endometrial disorder, which can be an additional cause of infertility, recurrent implantation failure, and recurrent pregnancy loss, in addition to ovulatory dysfunction.

A Comprehensive Approach: Correlating Ultrasound Imaging with Endometrial Histopathological Analysis in Perimenopausal Women with Heavy MenstrualBleeding.

Abnormal uterine bleeding (AUB) is a common troublesome symptom in the perimenopausal age group. The most common type of AUB in this age group is heavy menstrual bleeding. There is a risk of endometrial carcinoma and atypical endometrial hyperplasia in women with AUB in the age group of 40-50 years. Hence early evaluation is of paramount importance in managing women with perimenopausal heavy menstrual bleeding. The current study was undertaken to study the correlation between ultrasound findings and various benign and malignant endometrial histologies in perimenopausal women with heavy menstrual bleeding. Women aged 40-55 years presenting with heavy menstrual bleeding at the gynaecology outpatient department at Sree Balaji Medical College and Hospital, Chennai, India, were included in the study. Patients on anti-platelet and anti-coagulation therapy and patients already on hormonal treatment for heavy menstrual bleeding were excluded from the study. The demographic factors, symptom profiles, ultrasound findings, and histopathological reports were tabulated and analysed. Of the 147 women included in the study, 75 (51%) were aged 45-50 years and 107 (73%) had two or more pregnancies. Fibroid was the common non-endometrial cause of heavy menstrual bleeding in 52 (35%) cases. The proliferative pattern was the most common non-pathological histology identified in 46 (31%) cases. Endometrial hyperplasia without atypia was the most common pathological histology observed in the study population. Endometrial thickness of more than 8 mm was strongly associated with premalignant or malignant endometrial lesions. Our study has attempted to identify the correlation between ultrasound evaluation of perimenopausal women with heavy menstrual bleeding and endometrial pathology. Ultrasound, being cost-effective and widely available, is proven to be a tool for first-line investigation of perimenopausal women with heavy menstrual bleeding that guides further evaluation and management.

Preparation of the endometrium in the programs of auxiliary reproductive technologies for sterility in women

Background. The most important stage in the treatment of infertility is the introduction into clinical practice of the methods of in vitro fertilization (IVF), which made it possible to implement the function of childbirth in almost all forms of female infertility. The introduction of endoscopic technologies made it possible to significantly expand diagnostic possibilities and clarify the nature of intrauterine pathology when using assisted reproductive technologies. Purpose – of the research should be to increase the effectiveness of the treatment of female infertility when using assisted reproductive technologies and hysteroscopy by creating conditions in the endometrium for embryo implantation. Materials and Methods. A study was conducted in 42 patients with infertility aged 32 to 38 years. In all women, the morphological state of the endometrium was determined after diagnostic hysteroscopy. The patients were divided into 2 clinical groups. Group 1 included 28 women who were in a state of preparation for IVF after hysteroscopy with changes characteristic of endometrial pathology, which were found during ultrasound. The second group included 14 patients in whom, according to ultrasound, no structural changes of the endometrium were noted. These patients had a failed IVF attempt. In the next cycle, the women underwent a diagnostic hysteroscopy due to the lack of pregnancy after the first IVF attempt. Results. Group 1 patients (n = 28) with endometrial changes before IVF showed that the causes of pathology were: endometrial hyperplasia (53.6%); chronic endometritis (21.4%), endometriosis (25%). Therefore, before stimulation of superovulation, a hysteroscopy was performed to confirm the morphological diagnosis. In patients of the 2nd group (n = 14) after hysteroscopy and histological examination, pathological changes of the endometrium were found in all patients. Chronic endometritis occurred in 5 cases (35.7%), micropolyposis of the endometrium – in 6 (42.9%), endometriosis – 3 (21.4%). Clinical pregnancy occurred in 17 patients (60.7%) in the first group, in 9 (64.2%) in the second group. Conclusions. Hysteroscopy with morphological examination of the endometrium remains the main method of diagnosing intrauterine pathology. Diagnosis of infertility by hysteroscopy plays a very important role in the normalization of reproductive function during in vitro fertilization (IVF). After an unsuccessful IVF attempt, in the absence of pathological changes in the endometrium, a diagnostic hysteroscopy should be performed to rule out endometrial pathology.

Detection and Classification of Hysteroscopic Images Using Deep Learning.

Although hysteroscopy with endometrial biopsy is the gold standard in the diagnosis of endometrial pathology, the gynecologist experience is crucial for a correct diagnosis. Deep learning (DL), as an artificial intelligence method, might help to overcome this limitation. Unfortunately, only preliminary findings are available, with the absence of studies evaluating the performance of DL models in identifying intrauterine lesions and the possible aid related to the inclusion of clinical factors in the model. To develop a DL model as an automated tool for detecting and classifying endometrial pathologies from hysteroscopic images. A monocentric observational retrospective cohort study was performed by reviewing clinical records, electronic databases, and stored videos of hysteroscopies from consecutive patients with pathologically confirmed intrauterine lesions at our Center from January 2021 to May 2021. Retrieved hysteroscopic images were used to build a DL model for the classification and identification of intracavitary uterine lesions with or without the aid of clinical factors. Study outcomes were DL model diagnostic metrics in the classification and identification of intracavitary uterine lesions with and without the aid of clinical factors. We reviewed 1500 images from 266 patients: 186 patients had benign focal lesions, 25 benign diffuse lesions, and 55 preneoplastic/neoplastic lesions. For both the classification and identification tasks, the best performance was achieved with the aid of clinical factors, with an overall precision of 80.11%, recall of 80.11%, specificity of 90.06%, F1 score of 80.11%, and accuracy of 86.74 for the classification task, and overall detection of 85.82%, precision of 93.12%, recall of 91.63%, and an F1 score of 92.37% for the identification task. Our DL model achieved a low diagnostic performance in the detection and classification of intracavitary uterine lesions from hysteroscopic images. Although the best diagnostic performance was obtained with the aid of clinical data, such an improvement was slight.

STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING

Objective: Endometrial pathology is becoming the most common issue that affects women of reproductive age group worldwide. AUB encompasses a wide variety of presentations, for example, frequent menstrual cycles, frequent and heavy cyclical bleeding, irregular bleeding, and postcoital bleeding. This study was done to evaluate the endometrial causes of AUB and to determine the specific pathology in different age groups.&#x0D; Methods: This study was a prospective cross-sectional study conducted on 200 patients from January 2023 to October 2023 in the department of pathology in a reputed teaching hospital and research centre. All the endometrial biopsies/curretages and hysterectomy specimens sent for Histopathological examination with history of AUB were included in the study.&#x0D; Results: Age of the patients with AUB ranged from 17 to 71 y in our study. Out of 200 cases, 90 cases (45%) were seen in Perimenopausal group followed by 68 cases (34 %) in Reproductive age group and 42 cases (21%) in Postmenopausal age group. Menorrhagia was the most common bleeding pattern seen in 54% pf patient with AUB. In 28% in reproductive age group, hormonal imbalance was observed in 13% of reproductive age group and 6% in perimenopausal age group. Atrophic endometrium was observed in 7.5% of women in post-menopausal age group. Chronic endometritis was seen 3% of reproductive age group.&#x0D; Conclusion: Abnormal uterine bleeding in women belonging to different age group show variable endometrial pattern on histopathological examination. They are valuable in early detection of pre-cancerous endometrial lesions as well as malignancy.

Clinicopathological Analysis of Postmenopausal Bleeding and Endometrium

Highlights: 1. Malignancies in postmenopausal bleeding are not very common, yet it is necessary to evaluate the etiology and implement appropriate treatment strategies.2. The findings of this study highlight the need for early detection of benign, premalignant, or malignant cases to provide more effective management, prevent the development of cancer, and improve the prognosis of the condition. Abstract Bleeding from the genital organ after a year of menopause is called postmenopausal bleeding. The causes may be either benign or malignant, originating from genital (uterine or extrauterine) and extragenital sites. About 3% of postmenopausal women suffer from uterine cancer. This present study aimed to analyze the clinical significance of postmenopausal bleeding concerning the source, associated risk factors, and various endometrial pathologies, including malignant and premalignant conditions. This retrospective study was conducted over four years and featured postmenopausal bleeding patients who met the inclusion criteria. Different causes of bleeding were noted and managed. Data collection on the history, clinical examination, blood test, and endometrial biopsy was performed on women with endometrial bleeding. The collected data were analyzed using standard descriptive statistics and presented using frequency tables. A total of 88 women were admitted, of whom 73 (82.95%) had endometrial bleeding and 15 (17.05%) experienced bleeding from other sites. The endometrial bleeding group mostly consisted of women aged &gt;50–60 years (45.20%). Hypertension (26.03%), diabetes (21.91%), obesity (43.83%), and nulliparous (5.48%) were the risk factors present among the patients. The majority of the patients (41.10%) were within five years of menopause. The transvaginal ultrasound findings indicated that 56.16% of the women had an endometrial thickness of &gt;10 mm, while 9.59% had an endometrial thickness of ≤4 mm. Upon histological investigation, endometrial hyperplasia (34.24%), atrophy (38.36%), and cancer (4.11%) were detected. Furthermore, a prevalence of 16.44% was identified as proliferative endometrium, whereas polyps were found in 6.84% of cases. In conclusion, postmenopausal bleeding is mostly benign, but it may raise concerns about the possibility of malignancy, which can be distressing for women. Disregarding the amount and frequency, postmenopausal bleeding requires a thorough evaluation, primarily because adequate management can prevent the progression of many premalignant cases to be endometrial cancer.

The role of hysteroscopy with morcellator without anesthesia in the management of abnormal uterine bleeding.

To evaluate the feasibility of hysteroscopy with morcellator without anesthesia and the diagnostic accuracy of 2D, 3D and power Doppler transvaginal sonography (TVS) in patients with abnormal uterine bleeding (AUB). This was a retrospective study including women with AUB. All patients underwent 2D, 3D and power Doppler TVS evaluation of the uterine cavity, and patients with suspicion on ultrasound (US) of endometrial pathology (EP) underwent hysteroscopy with morcellator without anesthesia. The painful symptomatology was assessed during the procedure using a visual analogue scale (VAS). Additionally, histological evaluation was performed. A total of 182 women underwent US imaging, of whom 131 (72%) had hysteroscopy. 130/131 patients completed the hysteroscopic examination with good compliance (VAS <4). One patient (0.8%) was unable to complete the procedure due to nulliparity and cervical stenosis. Of the 130 patients the US diagnosis was confirmed in 120 (92.3%), while in 10 patients (7.7%) the hysteroscopic diagnosis was different from the US diagnosis. Histological examination confirmed benign endometrial polyps in 115/130 patients (88.5%), while premalignant conditions were diagnosed in 3/130 patients (2.3%) and malignant conditions in 2/130 (1.5%). Of the 10 patients with endometrial thickening, two were diagnosed with a malignant condition. This study confirmed the feasibility of managing patients with AUB and suspicion of EP using "see-and-treat" hysteroscopy with morcellator without anesthesia. This procedure has the potential to yield desired outcomes while minimizing pain and discomfort, presenting a feasible outpatient approach for both treating and preventing endometrial carcinoma without requiring anesthesia.

A GREB1-steroid receptor feedforward mechanism governs differential GREB1 action in endometrial function and endometriosis

Cellular responses to the steroid hormones, estrogen (E2), and progesterone (P4) are governed by their cognate receptor’s transcriptional output. However, the feed-forward mechanisms that shape cell-type-specific transcriptional fulcrums for steroid receptors are unidentified. Herein, we found that a common feed-forward mechanism between GREB1 and steroid receptors regulates the differential effect of GREB1 on steroid hormones in a physiological or pathological context. In physiological (receptive) endometrium, GREB1 controls P4-responses in uterine stroma, affecting endometrial receptivity and decidualization, while not affecting E2-mediated epithelial proliferation. Of mechanism, progesterone-induced GREB1 physically interacts with the progesterone receptor, acting as a cofactor in a positive feedback mechanism to regulate P4-responsive genes. Conversely, in endometrial pathology (endometriosis), E2-induced GREB1 modulates E2-dependent gene expression to promote the growth of endometriotic lesions in mice. This differential action of GREB1 exerted by a common feed-forward mechanism with steroid receptors advances our understanding of mechanisms that underlie cell- and tissue-specific steroid hormone actions.

The role of CD138 immunohistochemical marker in the diagnosis of chronic endometritis: causes of female infertility

This article focused on “The role of CD138 immunohistochemical marker in the diagnosis of chronic endometritis: causes of female infertility”. Aims: The aim of the study was to assess the diagnostic efficacy of CD138 in identifying chronic endometritis among infertile patients with endometrial pathology and to examine the association between CE and various factors related to infertility. Methodology: A cross-sectional observational study exploring the utility of the CD138 immunohistochemical marker in diagnosing chronic endometritis and its association with infertility in a sample of 63 couples. The t-test, chi-square test and logistic regression was applied using SPSS 26. Results: The study examined infertility characteristics and chronic endometritis in 63 infertile woman with pathology of endometrium. Results also established a significant association between CE and CD 138 presence, suggesting CD 138 as a potential diagnostic marker for CE. Additionally, the age was identified as a notable factor linked to CE. Factors such as abortion history, intrauterine interventions, delivery experiences, and cervical pathology, mycoplasma infections were found to have a significant correlation with CE. The logistic regression indicated a lower likelihood of CE in certain infertility types. It also identified a significant association between increased CE odds and longer fertility duration, while specific causes of fertility had a modest impact. Overall, CD 138 demonstrated its diagnostic potential for CE, age was associated with CE, and certain factors correlated with CE, emphasising the complexity of CE etiology in infertility patients with endometrial patology. Scientific Novelty: A Gateway to Understanding Female Infertility Conclusion: In conclusion, the research findings underscored the significance of CD 138 as a diagnostic marker for chronic endometritis in infertility patients. The age emerged as a notable factor associated with CE, while specific qualitative factors like delivery history exhibited a correlations with CE status, warranting further investigation

Focusing on the role of protein kinase mTOR in endometrial physiology and pathology: insights for therapeutic interventions.

The mammalian target of rapamycin (mTOR) is a serine/threonine protein kinase crucial for cellular differentiation, proliferation, and autophagy. It shows a complex role in the endometrium, influencing both normal and pathogenic conditions. mTOR promotes the growth and maturation of endometrial cells, enhancing endometrial receptivity and decidualization. However, it also contributes to the development of endometriosis (EMs) and endometrial cancer (EC), thus emerging as a therapeutic target for these conditions. In this review, we summarize recent research progress on the mTOR signalling pathway in the endometrium. This provides insights into female endometrial structure and function and guides the prevention and treatment of related diseases.

Replacement of Total Abdominal Hysterectomy by TLH in a Patient with Previous Pelvic Surgery

Background: In a patient who had previous pelvic surgery, total laparoscopic hysterectomy (TLH) has well-established advantages over total abdominal hysterectomy. The hysterectomy is a common gynaecological operation. Although the vaginal route is preferred for hysterectomy, the best route for women who are not candidates for the vaginal approach is unknown. Hysterectomies are increasingly being performed laparoscopically as technology advances and experience grows. Objectives: The aim of this study is to evaluate the replacement of total abdominal hysterectomy by TLH in a patient with previous pelvic surgery. Method: This observational study was carried out on 60 women admitted in the Department of obstetrics and gynaecology, Labaid specialized Hospital, Dhaka, Bangladesh during the study period. The duration of the period was from July 2021 to June 2022. The data for this study about had been accumulated from patients sociodemographic &amp; obstetrics information, physical examination and per-operative findings. Statistical evaluation of the results used to be got via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: A total of 60 patients were included in final analysis. According to the study population's age distribution of the study population, it was observed that 15(25.0%) were in group 35-38, 23(38.33%) were in group 39-42, 16(26.66%) were in group 43-46 and 6(10.0%) were in group 47-50. according to patient demographics, it was observed that 44(73.33%) were Leiomyoma, 29(48.33%) were Bleeding, 3(5.0%) were Pelvic pressure, 19(31.66) were Pelvic pain and 15(0%) were size growth. Conclusion: TLH for endometrial pathology has few problems and is well tolerated by a restricted group of patients. For suitable patients, the benefits include decreased blood loss and a shorter hospital stay. TLH can be performed effectively despite previous abdominal surgery. Patients who had previous .......

SDMS CME Credit – The Role of Elastography in Diagnosing Endometrial Pathology

SDMS CME Credit – The Role of Elastography in Diagnosing Endometrial Pathology

Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer?

The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA-125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients (p = 0.036). Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.

Risk factors of the endometrial pathology (including tamoxifen): Retrospective analysis of 664 biopsies

Risk factors of the endometrial pathology (including tamoxifen): Retrospective analysis of 664 biopsies

Histopathological spectrum of endometrial biopsies in abnormal uterine bleeding at tertiary care centre, Jodhpur

Introduction: Abnormal uterine bleeding (AUB) shows spectrum of patterns on histopathology and pathologist plays a vital role in reporting of endometrial biopsies and helps in differentiating nonneoplastic lesion from neoplastic lesions, early detection of the precursor lesions and exclusion of malignancy. Aim - The aim of this study is to study the spectrum of endometrial patterns in women with AUB and to correlate it with the different age groups. Materials and Methods: 200 samples of endometrial biopsies with AUB were received from the gynecology department, processed and stained with hematoxylin &amp; eosin and subjected to histopathological examination. Results: The peak incidence is observed in the age group of 41-50 years. The predominant histological pattern observed is secretory and proliferative pattern and disordered endometrium (68%) followed by endometrial hyperplasia (10%) and the least common pattern is atrophic endometrium (1%). 2% cases are of endometrial carcinoma found in our study. Conclusion: AUB significantly affects the quality life of women and leads to anemia. Hence histopathological examination should be considered which plays a critical role in early diagnosis of endometrial pathology and to provide appropriate gynecological management. Endometrial sampling is an effective diagnostic tool and it needs to be considered in all patients from peri- and post-menopausal age groups with AUB so to provide appropriate management.

Evaluation of Endometrial Histopathology of Patients Presenting with Abnormal Uterine Bleeding

Objective: Abnormal uterine bleeding is an important symptom frequently encountered in the gynecology outpatient clinic. In our study, it was aimed to determine the endometrial pathologies that cause abnormal uterine bleeding. Material and methods: The pathology results of patients who applied to our clinic with the complaint of abnormal uterine bleeding and underwent endometrial sampling were retrospectively analyzed. Findings were classified and compared according to whether the patients were in the postmenopausal or premenopausal period. Results: A total of 878 patients were included in the study. The mean age of the patients was 47.59±7.91/year. The most common symptom was menometrorrhagia 58.1%. The most common pathological finding was endometrial polyp in both premenopausal and postmenopausal patients (29.69% and 24.31%). The incidence of premalignant and malignant lesions was 2.7% in premenopausal patients and 8.25% in postmenopausal patients. Conclusion: Abnormal uterine bleeding may be associated with malignancies in both postmenopausal and premenopausal patients. Performing endometrial sampling in patients presenting with this symptom is of great importance in providing early diagnosis and treatment of malignant and premalignant lesions.