Endometrial Pattern Research Articles

Endometrial Patterns Among Rural Women Undergoing Gynecological Procedures in a Tertiary Care Hospital.

Introduction Women with endometrial diseases often present in outpatient departments, and outpatient procedures easily enable diagnosis. Histopathological patterns vary with age, menstrual cycle, drug use, and pathological state. Teaching hospitals are often located away from rural areas. Materials and methods An ambispective study was performed over 33 months in a rural medical college hospital by perusing the histopathological registers of the department. Details of history and endometrial samples (biopsy and hysterectomy) were obtained using biopsy numbers and requisition forms. Functional and organic histopathology findings were manually entered into a spreadsheet, and statistics were performed using Statistical Package for the Social Sciences (SPSS)for Windows version22 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 226 women, with total abdominal hysterectomies (TAH) performed in a significantly higher proportion of middle-aged women(range: 41-59 years). Of the middle-aged women, 70% presented with excessive menstrual bleeding, and a similar percentage of older women presented with uterovaginal (UV) prolapse. Hysterectomy specimens constituted most samples in this study. Proliferative endometrium was observed in 40% of patients andmetaplasia (papillary syncytial, tubal, and squamous)in only 1.7%.Normal proliferative and secretory endometrium wereobserved in91 (40.3%) and 41 (18.1%) patients, respectively. The presence of hyperplasia, decidualization, stromal breakdown, adenocarcinoma, adenomyosis, and endometrial polyps did not vary significantly among thethree agegroups (elderly, middle-aged, and young). Conclusion Most women in rural areas presented to the gynecologist with uterine bleeding; middle-aged women constituted most of those with gynecological complaints. Normal endometrium was observed in nearly half of the patients. Adenomyosis was the most common cause of uterine bleeding. Uterine endometrial malignancies were rare.

HISTOPATHOLOGICAL SPECTRUM OF ENDOMETRIAL LESIONS IN WOMEN PRESENTING WITH ABNORMAL UTERINE BLEEDING IN A TERTIARY CARE CENTRE.

Background: Abnormal uterine bleeding is one of the signicant gynaecological complaints, often related to endometrial pathology. It is important to differentiate non neoplastic lesion from neoplastic lesions as well as early detection of precursor lesions and exclusion of malignancy. Aim: Materials And Methods: To study the histopathological spectrum of endometrial lesions in women presenting with AUB in our population. It was a retrospective hospital based study, conducted among 200 patients in the Department of Pathology, AMCH, Dibrugarh from 1st July, 2021 to 30th June 2022. The samples included were curettage, biopsy and resection specimen. Most common cause of AUB in reproductive and Results: Perimenopausal women were normal cyclical endometrium, and in cases of post-menopausal women it was atrophic endometrium and nonatypical hyperplasia in all the age groups. Patients with AUB shows a va Conclusion: rying spectrum of endometrial pattern. Hence, It is important to evaluate endometrial pathology in all women presenting with AUB without a known cause.

Effect of dual trigger with chorionic gonadotropin hormone and follicle-stimulating hormone on endometrial thickness in infertile women who had superovulation with an aromatase inhibitor

Beginning in October 2020 and ending in April 2021, researchers from Al-Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies compared the success rates of two different methods of diagnosing and treating infertility. The major purpose of the research was to assess the impact of a combined trigger (follicle-stimulating hormone [FSH] and human chorionic gonadotropin [hCG]) on endometrial receptivity (endometrial thickness, endometrial pattern, sub-endometrial blood flow). A total of 100 females took part in the study. All patients gave their informed written consent, and the study was approved by the Al-Nahrain University Ethics Committee. Procedure Time To confirm ovulation, measure and analyze the endometrial pattern, and examine the sub-endometrial blood flow, a vaginal ultrasound was done 36 to 48 hours following trigger ovulation. All four hormones (FSH, LH, Progesterone, and E2) were tested in the blood at the same time to determine whether a couple was fertile, a complete medical history, and physical examination whereas performed on each member of the pair. An ultrasound vaginal probe was used to do the transvaginal examination. Patients were placed in the dorsal lithotomy position with an empty bladder for early follicular US (CD 2-3) to assess the number of antral follicles, measure endometrial thickness, and rule out ovarian cysts or other pathology. A second ultrasound was performed during the middle of the cycle (CD9-14) to determine whether a mature follicle had been found. A multiplanar image of the uterus was acquired after an ultrasound scan was swept across the mid-sagittal plane. Endometrial thickness in the median longitudinal plane of the uterus was calculated as the largest distance from one basal endometrial interface via the endometrial canal to the opposite endometrial-myometrial interface of the anterior-posterior uterine wall. A statistically significant difference was found between Group A's average E2 concentration of 69.62 pg/mL and Groups B and C's concentrations of 53.32 and 36.65 pg/mL. (P 0.001). In group C, there was a statistically significant difference in E2 levels on the day of the trigger and the day of the IUI (P = 0.036). On the day of IUI compared to the day of trigger, no statistically significant differences were seen between the study groups for any of the other hormonal indicators (P > 0.05). There were no significant differences (P > 0.05) in any of the baseline clinical measures between the research groups. All clinical indicators were comparable across groups (P > 0.05). There were no statistically significant differences (P > 0.05) between the research groups on any other clinical indicators. When comparing groups, A, B, and C on the decline in RI between the trigger and IUI days, group A significantly outperformed the others (P = 0.003). There was no statistically significant difference (P > 0.05) in any of the other clinical parameters between the IUI and trigger groups on the day of IUI.

An observational study of endometrial pattern in implantation

Background: Garbhasambhav Samugri is a concept in Ayurveda which describes factors to bring healthy offspring into the society. The kshetra is one of the four essential factors for the formation and development of the embryo, and the term kshetra is used grossly for women but is specifically used for garbhashaya (uterus). According to modern science, embryo implants in the endometrial lining of uterus. All components of the endometrium undergo cyclic changes which is called as endometrial cycle. The endometrial cycle prepares the endometrium for implantation of the fertilized ovum coming towards the uterus. The main changes in the endometrium are increase in thickness, growth of uterine glands and increase in thickness and fluid content of endometrial stroma. These changes are reflected as various pattern in the ultrasound. This study will give useful information about which morphological pattern of endometrium is best suitable for implantation.Objectives: The objective of this study is to understand effects of endometrial pattern on implantation, as fertilised egg implants in the endometrial lining of the uterus. Material & Methods: Anonymous data of transvaginal colour doppler ultrasound examination done, on the day of rupture of follicle of menstrual cycle, on 160 women, willing to conceive, has been collected from gynaecologist, from this collected data, results regarding endometrial pattern were derived. Results: It was observed that implantation occurs only in cases having endometrium with trilaminar pattern. Conclusion: Implantation occurs only when endometrium has a trilaminar pattern consisting of a prominent outer and central hyperechoic line and inner hypoechoic region.

Evaluation of tubal patency and its impact on ovarian blood flow and function: a comparison of hysterosalpingography and HyCoSy

Objective: To investigate Hysterosalpingo Contrast Sonography (HyCoSy) as a safe, effective, easy, and cheaper approach to measure tubal patency than hysterosalpingography (HSG) and to correlate better ovarian function, endometrial and ovarian blood flow, and conception rates in infertile women. Methodology: This cross-sectional study included 40 infertile women between 22 and 42 years age; 20 of them had HSG on day 6 or 7 of cycle and 20 HyCoSy with normal saline and 100 mg hydrocortisone. All underwent the protocol of 75 iu gonal F sc on days 2 and 3, with clomiphene 50 mg twice daily from days 2 to 7 or letrizole 2.5 twice daily from days 3 to 8 (around day 14). Evaluated criteria: resistance index (RI) and perfusion index (PI) of ovarian vessels by Doppler ultrasound, number and size of follicles for both groups, endometrial thickness, endometrial pattern, zones of blood flow to endometrium. Then HCG to promote ovulation and progesterone to support luteal phase. Results: HSG group mean age was 29.7 6 HYCOSY group age was 29 6 years. 82.1% of HSG females and 90.1% of HyCoSy females had 2nd infertility. Females undergoing HSG had 42.9% I zone and 65.6% IV zone. Females undergoing HSG and HyCoSy had 1 follicle, respectively. 68.8% of HyCoSy females were pregnant. HSG and HyCoSy had different RI, thickness. HyCoSy was thicker and had less RI than HSG. HSG and HyCoSy had similar numbers and sizes of follicles. Conclusion: HyCoSy was a safe, effective, easy, and cheaper way to evaluate tubal patency than HSG, less RI and increase endometrium thickness.

Effect of intrauterine infusion of autologous platelet-rich plasma in patients with refractory thin endometrium undergoing in vitro fertilization.

Treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of the critical factors for successful implantation and pregnancy. Autologous intrauterine platelet-rich plasma (PRP) infusion is an adjuvant therapeutic alternative for enhancing the endometrial thickness (EMT) and echo pattern. It was shown that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines, and its role in the regulation of the immunological interaction between the embryo and the endometrium. The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF. A prospective study in Ain Shams University Hospital including 66 infertile women with a refractory thin endometrium below 7 mm by ultrasound on the day of human chorionic gonadotropin injection in fresh embryo transfer (ET) cycle, who did not respond to standard medical therapies after more than 2 cycles of previous medical therapy, and who were candidates for IVF cycle were given intrauterine PRP. A significant increase in EMT was noted and enhancement of endometrial pattern after intrauterine PRP infusion in the days of ovum pick-up and ET. There was also a significant increase in ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, while the miscarriage rate decreased after PRP infusion. Intrauterine PRP infusion improved ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, in addition to EMT and pattern on the days of ovum pick-up and ET, while the miscarriage rate significantly decreased.

Comparison between Pipelle Sampling and Hysteroscopy Guided Biopsy in Histologic Evaluation of Endometrium in Tertiary Care Hospital in Pakistan

Introduction: Abnormal uterine bleeding is one of the commonest issues in perimenopausal age group. The proportion is 9-30% in reproductive age group. This extent rises to 70% in perimenopausal and postmenopausal women’s. Irregular uterine dying (AUB) warrants an intensive assessment in perimenopausal females and subsequently it’s vital to perform it in a cost-effective way with available resources. Objective: To compare the efficacy of Hysteroscopic guided biopsy and endometrial cytology To find out the efficacy of endometrial cytology in detecting different normal and abnormal endometrial patterns Study design & Settings: It is a prospective comparative study conducted at Social Security Hospital, Multan Road, Lahore included patients 30 years and above with the chief complaints of abnormal uterine bleeding. Study Duration: 01 year January 2020 to December 2020 Sample: 100 patients Inclusion Exclusion Criteria: Females having symptoms of abnormal uterine bleeding and age above than 30 years are included in the study. The females who are pregnant and having infection or malignancy are excluded from the research Results: This Planned comparative hospital-based study was done in one hundred patients with abnormal uterine bleeding taken after the informed consent, inclusion and exclusion criteria. Endometrial thickness was assessed and all cases with <5 mm thickness will be avoided from the study. Mean age of the patient was found 45 and standard deviation 7.43. Practical implication Conclusion: To get the endometrial sample by pipelle technique is a safe procedure. It has high specificity, sensitivity, positive and negative predictive values when compared to hysteroscopy. In this way, to obtain adequate endometrial sample, Pipelle biopsy should be considered as important way of investigation. Keywords: Abnormal uterine bleeding, Pipelle, Endometerial sampling, FIGO

Endometrial microstimulation effects on endometrial receptivity assessed by transvaginal color Doppler sonography.

This study investigated the effect of endometrial microstimulation (EM) on endometrial receptivity using transvaginal color Doppler sonography (TVCDS). Women of childbearing age who were preparing to conceive (n = 90) were randomly divided into the EM group (n = 30), who were examined by EM on days 3-5 of the menstrual cycle, and the control group (n = 60). TVCDS was conducted during the implantation window phase, and endometrial thickness, endometrial pattern, endometrial movement, blood flow type, and uterine and spiral arterial hemodynamic parameter measurements were made. The groups were compared to identify differences. Endometrial thickness (0.97 ± 0.18cm and 0.95 ± 0.17cm), endometrial movement (type 1: 46.7% and 51.7%; type 2: 30.0% and 28.3%; type 3: 6.7% and 5.0%; type 5: 16.7% and 15.0%), and hemodynamic parameters of the uterine (pulsatility index [PI]: 2.46 ± 0.50 and 2.41 ± 0.48; resistance index [RI]: 0.85 ± 0.05 and 0.84 ± 0.05) and spiral (PI: 1.11 ± 0.32 and 1.19 ± 0.33; RI: 0.48 ± 0.11 and 0.51 ± 0.08) arteries did not differ significantly between groups (P > 0.05). However, the endometrial pattern (a trilaminar pattern: 80.0% and 58.3%; P = 0.041) and blood flow type (type I: 16.7% and 43.3%; type II: 63.3% and 40.0%; type III 20.0% and 16.7%; P = 0.038) differed significantly between groups. Endometrial microstimulation did not alter endometrial pathological staging, endometrial thickness, or movement, nor did it affect uterine and spiral arterial blood flow parameters. However, it may be able to abrade abnormal endometrial tissue, optimizing the endometrial pattern. Endometrial microstimulation may support local spiral artery regeneration and increase endometrial blood supply in new cycles.

Various endometrial patterns and abnormalities in women with postmenopausal bleeding

Objective: To study the prevalence of various histopathological changes, patterns and lesions of endometrium in women with postmenopausal bleeding. Methodology: All the fixed specimens were processed and embedded in paraffin wax. Multiple serial sections of 4-5 microns thickness were obtained from the paraffin block and then stained with H & E. The observations in our study were analyzed using SPSS software version 11.5. The average values are statistically calculated using Microsoft Excel computer software. Results: This was a prospective, non interventional and observational hospital based cross sectional one year study carried out in histopathology department on endometrial biopsies and hysterectomy specimens. Out of 50 cases, postmenopausal bleeding presented at a mean age of 53.38 years and was most common within 5 years of attaining menopause. Among the endometrial causes of postmenopausal bleeding, 16% were due to benign conditions, 10% were due to malignancy and in 74 % of cases were because of non organic causes comprising of proliferative, secretory and atrophic endometrium. Atrophic endometrium was most common among non organic causes ,endometrial polyp was most common among the benign causes followed by endometrial endometrioid carcinoma was a major finding among the malignant causes.

Effects of acupuncture on the pregnancy outcomes of frozen-thawed embryo transfer: A systematic review and meta-analysis.

BackgroundAcupuncture is increasingly used as adjuvant therapy for infertile women undergoing frozen-thawed embryo transfer (FET); however, its effects and safety are highly controversial. This study aimed to evaluate the pooled effects of adjuvant acupuncture on FET pregnancy outcomes.MethodsWe considered only randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture or no adjuvant treatment during FET and the primary outcome was clinical pregnancy rate. Two authors separately selected studies, extracted data, and performed a risk of bias assessment. Pooled data were expressed as risk ratio (RR) or mean difference (MD), with a 95% confidence interval (CI). In addition, we conducted subgroup and sensitivity analyses to investigate the sources of heterogeneity, and we also constructed funnel plots to assess the likelihood of publication bias. Finally, Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of evidence.ResultsA total of 14 RCTs with a total of 1,130 participants were included in the study. We found significant effects of acupuncture adjuvant to FET on the outcomes of clinical pregnancy rate (RR = 1.54, 95% CI [1.28, 1.85], I2 = 34%; 14 trials), biochemical pregnancy rate (RR = 1.51, 95% CI [1.21, 1.89]; 5 trials), endometrial thickness (MD = 0.97, 95% CI [0.43, 1.51]; 12 trials), and endometrial pattern (RR = 1.41, 95% CI [1.13, 1.75]; 7 trials). For live birth rate (RR = 1.48, 95% CI [0.90, 2.43], 4 trials), there were no statistical effectiveness. For subgroup analyses, most variables had tolerable heterogeneity (I2 = 0%) except for trials that were sham-controlled, performed acupuncture only after FET, or <5 times, which appeared to interpret most of the heterogeneity. Additionally, the quality of evidence of all outcomes in this review ranged from low to moderate.ConclusionAcupuncture could be instrumental in the pregnancy outcomes of FET, and has very few risks of severe adverse events; however, the quality of evidence is unsatisfactory. Further research with rigorous methodological quality should be considered, and the protocols of acupuncture also need more investigations (e.g., appropriate control groups, sessions, and times).

Modern assessment of the endometrium (Literature review)

The article reviews the literature on various aspects of diagnosis, evaluation and treatment of pathological conditions of the endometrium. From a clinical point of view, the significance of such indicators as the thickness of the endometrium, the endometrial pattern, the volume and features of endometrium vascularization, the assessment of the microbial environment of the endometrium, and molecular studies of its receptivity are described. In particular, the impact of the endometrial microbiota on reproductive outcomes in patients starting infertility treatment was considered. Considerations regarding the analysis of endometrial receptivity to implantation, data on the personalized implantation window are given. Complex methods for assessing the state of the endometrium are considered: ERA (Endometrial Receptivity Assay), EMMA (Endometrial Microbiome Metagenomic Analysis), ALICE (Analysis of Infectious Chronic Endometritis). The article summarizes the results of the most effective diagnostic methods and the modern approach to the treatment of endometrial susceptibility. Over the past decade, studies have identified a potential link between poor reproductive outcomes and chronic endometritis. The review presents data on chronic endometritis and highlights recent advances in the study of this gynecological disease. Considerations on the feasibility of antibiotic therapy in chronic endometritis are presented.The studies were analyzed, which demonstrated the clinical value of evaluating the morphological markers of endometrial receptivity, pinopodia. From a clinical point of view, the importance of chronic endometritis as the cause of the formation of “thin” endometrium in infertility is presented. In particular, the effectiveness of hysteroscopy in chronic endometritis has been demonstrated to optimize the chances of successful embryo implantation. Data from foreign and domestic articles published over the past 10 years in the Scopus, Web of Science, MedLine, Cochrane Library, Embase, Global Health, Pubmed databases are included in the review.

CLINICO-HISTOPATHOLOGICAL STUDY OF ENDOMETRIUM WITH AND WITHOUT HORMONE THERAPY IN PATIENTS WITHABNORMAL UTERINE BLEEDING

Background: Abnormal uterine bleeding (AUB) is one of the most common problem for the patients and the gynecologists. Histological characteristics of endometrial biopsy material as assessed by light microscopy remains the diagnostic standard for the diagnosis of endometrial pathology. Material and Methods: In our prospective study of 100 patients of the age between 24-75 years, clinical characteristics and the pattern of endometrial histopathology and their association with hormone therapy administration were studied. Results: Total of 100 patients were divided into two subgroups one that received hormone therapy prior to endometrial biopsy and Group II in which hormone therapy was not administered prior to the said procedure. In both groups proliferative phase was the commonest followed by secretory endometrium in both groups. Pill change, Arias Stella reaction, tubercular endometritis, endometrial carcinoma was exclusively noted in the group in hormone therapy was administered prior to endometrial biopsy. Pill change endometrium was only significantly correlated with Group I (p=0.05). Simple hyperplasia, endometrial polyp, chronic endometritis, endocervical polyp, atrophic endometrium was noted in Group II of which simple hyperplasia (p=0.10) was not found to be clinically significant. Conclusions: The study of the endometrium in AUB revealed many structural and non-structural causes manifest in the form of different endometrial histopathological patterns in two groups with or without hormone therapy. Endometrial study gives significant etiological information in AUB when interpreted with relevance to age and other clinical data, thus guiding the appropriate management.

Effect of Dual Trigger with Follicle Stimulating Hormone and Chorionic Gonadotropin Hormone on Ovulation Rate in Infertile Women received Aromatase Inhibitor Superovulation in Kirkuk City, Iraq

A prospective during the period October 2020 to April 2021, a comparative study was conducted at the Al-Nahrain University’s High Institute for Infertility Diagnosis and Assisted Reproductive Technologies (HIIDART). The study’s primary goal was to determine whether using a dual trigger (FSH and hCG) could increase the likelihood of achieving pregnancy. The participants in this study totaled one hundred women. Before taking part in the study, each participant signed a written informed consent form that was approved by the Al-Nahrain University’s Ethics Committee before participating. A total of one hundred and one women participated in the study, who were chosen from among those who attended the consultant clinic of the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in New York City. On the day of the IUI An ultrasound scan of the vaginal cavity was performed after 36 to 48 hours of trigger ovulation to confirm ovulation, measure, and evaluate the endometrial pattern, and assess sub endometrial blood flow. FSH, LH, Progesterone, and E2 levels were determined in a blood sample drawn on the same day for hormonal testing. Luteal phase support was initiated on the day of the IUI and continued for two weeks by administering 400 mg of progesterone vaginal suppository daily to the patient. Estimation of Beta human chorionic gonadotropins 14 days after IUI. The distribution of study groups by general characteristics is shown in Table 1. Study patients’ age was ranging from 19 to 39 years with a mean of 29.98 years and a standard deviation (SD) of ± 5.3 years. The highest proportion of study patients in all groups was aged between 25–34 years, overweighed, and complained from infertility for less than five years’ duration. The comparison in hormonal parameters between study groups at day of IUI is shown in Table 4.5. Mean of FSH level was significantly lower (p = 0.031) in group C than that in groups A and B (6.98 versus 9.06 and 9.3 IU/L respectively). Mean of E2 level was significantly higher (p = 0.001) in-group A than that in groups B and C (69.62 versus 53.32 and 36.65 pg/mL, respectively). The comparison in percentage of change in hormonal parameters at day of IUI compared to that at day of trigger according pregnancy outcome is shown in table (4.16). No significant differences between women who get pregnant than that in those who didn’t, in percentage of change of all other hormonal parameters at day of IUI (p ≥ 0.05) compared to that at day of trigger.

Study of Histopathological Pattern of Endometrial Curettings and Healthcare Burden due to Inadequate Samples

Aim: To determine the frequency of different histopathological findings of endometrial curettings presenting to a tertiary care hospital with a special focus on the frequency of inadequate samples which impose a major healthcare burden. Methods: The data of 975 female patients whose EC samples were received in the Pathology Lab of King Edward Medical University (KEMU), Lahore from August 2019- August 2021 was included in this retrospective, descriptive study. A statistical analysis of endometrial findings according to age and their association with histopathological findings was determined. Results: A total of 975 cases were analyzed (average age, 42.95 years). 34.9% had hormone induced change (n=340), 235 had secretory endometrium (24.1%). Next in the list were Chronic Endometritis, proliferative phase and endometrial polyps accounting for 68(7%), 57(5.8%) and 16(1.6%) of the biopsies respectively. 1.6% patients had Endometrioid Carcinoma 16 and 9(0.9%) had Squamous cell carcinoma. 201(20.6%) of the total were inadequate biopsy specimens. There were 28 cases of hyperplasia, half of which were associated with atypia and half were without atypia, i.e., 14(1.4%). Atrophic endometrium and granulomatous inflammation accounted for 3(0.3%) and 2(0.2%) cases respectively. Conclusion: A diverse spectrum of endometrial patterns was observed that included physiological as well as pathological patterns. The pathologies ranged from benign conditions to malignancies. There was a huge frequency of inadequate biopsies that were indicative of wastage of the limited resources of healthcare system. Keywords: Dilatation and curettage, Endometrial carcinoma, Uterine diseases

UTERINE LEIOMYOMAS AND ASSOCIATED DEGENERATIONS – A ONE YEAR STUDY

Leiomyomas are the most common benign tumors seen clinically in 20 -30 % of women over 30 years of age and are hormone responsive. These tumors are found at different locations in the uterus and present with different clinical symptoms. Various degenerative changes are common in them. Methods: This is a descriptive study conducted in the department of Pathology in NRI Institute of Medical Sciences, Sangivalasa to estimate the incidence of leiomyomas and associated degenerative changes along with pattern of endometrium and other associated pathologies of cervix and myometrium. Results: Out of 82 hysterectomy specimens, 48 cases showed Leiomyomas. Leiomyomas were most common in multiparous women in the 41-50 years age group. Menorrhagia was the most common symptom seen in 33(68.75%) cases followed by dysmenorrhea in 7(14.58%) cases. 28(58.33%) cases showed multiple broids and 20(41.66%) showed single broids. The most common location was intramural with 38(79.16%) cases.13 cases showed degenerative changes with the commonest degeneration being Hyaline degeneration in 8 (16.66%) cases. Cystic change was seen in 2 cases (4.16%), myxoid change in 2(4.16%) cases and calcareous change were seen in 1(2.08%) cases. The most common endometrial pattern was proliferative phase, seen in 24 cases (50%).The other uterine pathologies associated with leiomyoma were, chronic cervicitis in 30(62.5%) cases and adenomyosis, seen in 8(16.66%) cases. Conclusion: Leiomyomas are the most common benign tumors of the myometrium. Degenerative changes occurring in them cause diagnostic difculties which can only be conrmed histologically.

Study of Endometrium’s Histopathological Pattern in Abnormal Uterine Bleeding

Background: Women of all ages may experience AUB, which is one of the most common and difficult conditions to diagnose. The diagnosis and treatment of endometrial etiology of AUB are primarily reliant on endometrial histopathology. The study's main purpose was to see how common different endometrial histological patterns were in individuals with abnormal uterine bleeding of various ages, as well as to learn more about the endometrial causes of AUB and how to treat them. Methods: From March 2019 to February 2020, 300 patients were studied in the department of Gynecology. Demographic data was gathered and documented. Different endometrial patterns were seen when endometrial samples were submitted for histological analyses. Results: The majority of patients with abnormal uterine haemorrhage were between the ages of 41 and 50 (48.6%), and the majority of them were multipara. Women suffering from menorrhagia (42% of patients) were following by polymenorrhagia (15%), menometrorrhagia (10.6%), continuing vaginal bleeding (9.6%), Polymenorrhagia (9.3%), and postmenopausal bleeding (8.6%). 8.6% of the population 4.6 percentage point. The most common histological characteristics in atypical uterine haemorrhage were proliferative and secretory endometrium (37 percent and 30 percent, respectively). A 22.6% prevalence of endometrial hyperplasia was detected. Conclusion: Endometrial assessment is used to rule out premalignant illnesses and cancer in women of all ages, especially those in the perimenopausal and postmenopausal periods of life. Keywords: uterine bleeding,menorrhagia, carcinoma

A CLINICO PATHOLOGICAL STUDY OF LEIOMYOMA UTERUS IN A TERTIARY CARE REFERRAL HOSPITALAND RESEARCH INSTITUTE

Background And Objectives: Leiomyoma of the uterus is the most common benign tumor of the uterus and also most common pelvic tumor in women. Surgery has been the main mode of therapy for the leiomyomas. Recent trend has been towards non surgical approaches. This study is an attempt to analyse the clinico pathological spectrum in cases of leiomyoma of the uterus in Vani Vilas Hospital and Bowring and Lady Curzon Hospital to know the pattern of presentation, pathological co relation with type of broid and endometrial and ovarian changes. Methods: A cross sectional study of 200 cases of leiomyoma uterus was made in Vani Vilas Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute, Bangalore, from November 2011 to August 2013. The cases were selected by random sampling. Detailed history, gynecological examination and relevant investigations including ultrasonography was done. Results: Leiomyoma is commonly found in the third decade in 58% cases. Most common mode of presentation is menstrual disturbances in 78% amongst which menorrhagia seen in 58% cases, intramural broids are the most common variety accounting for 60.8%, endometrial pattern was proliferative in 68%, cystic ovaries noted in 12% patients and adenomyosis in 19% cases. Interpretation And Conclusion: rd Leiomyoma commonly affects women of childbearing age, most common in 3 decade. Most common presentation is menstrual disturbances. Intramural broid is the most common variety. Presence of proliferative endometrium, adenomyosis and cystic ovaries are all indicative of hyperestrogenic state which is associated with development of leiomyomas.

Морфофункциональное состояние эндометрия у пациенток до и после органосохраняющих операций по поводу доброкачественных опухолей яичников

Benign ovarian tumors (BOT) have a significant impact on fertility and are associated with infertility, which, in turn, relates to endometrial receptivity and depends on the ovarian status, forming the so-called endometriopathy. Objective. To study the morphological and functional features of the endometrium in patients of reproductive age before and after ovary-sparing surgery for BOT according to 2D and 3D ultrasounds. Patients and methods. The study included 145 patients who underwent surgery for BOT. Patients were divided into two groups. Group 1 included 75 patients with diminished ovarian reserve (OR), group 2 included 70 patients with normal OR. Diminished OR was defined as serum Anti-Müllerian hormone (AMH) level &lt;1.1 ng/mL. Pelvic ultrasound (US) was performed in the mid-secretory phase before and 6–12 months after surgery. We measured endometrial thickness, endometrial pattern, visualization of basal and spiral arteries by 2D ultrasound, volume and volumetric blood flow in the endometrial and subendometrial regions by 3D ultrasound. Results. The analysis revealed endometrial dysfunction in patients with diminished OR before and after surgery, however there was a trend towards improvement in all the examined parameters after 12 months. In patients with normal OR before surgery, endometrial parameters did not differ from the population, but more persistent abnormalities were noted in the postoperative period. Conclusion. The 3D ultrasound technique provides an objective assessment of morphological and functional features of the endometrium and allows to identify markers of endometrial dysfunction. Key words: benign ovarian tumors, volumetric blood flow, ovarian reserve, 3D ultrasound, endometrium

Histopathological pattern of endometrial biopsies in patients with abnormal uterine bleeding

Introduction: Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and may occur often or randomly. In most women, AUB is caused by a hormone imbalance. Any woman over the age of 40 years with menorrhagia or any other forms of abnormal vaginal bleeding should undergo a gynaecological check and an endometrial biopsy as indicated, in order to detect a potentially treatable cause as atypical endometrial hyperplasia and early endometrial carcinoma. The present study was done on women with AUB to evaluate the histopathological patterns in endometrial biopsy among different age groups. Materials and Methods: A cross-sectional study was carried out in Department of Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. The clinical history and findings of 100 patients were collected and recorded. Histopathological study of endometrial patterns and age specific correlation was done. Results: Out of a total of 100 patients of AUB, 72 of them had a functional cause and the remaining 28 patients revealed an organic cause. The mean affected age was 40 years with youngest being 21 years old and the oldest patient was 57 years of age. Functional causes constituted 72% and organic lesions were seen in 28% out of which Proliferative phase endometrium was the most common functional lesion observed while endometrial hyperplasia was the commonest organic pathology seen. P value was calculated as <0.008 which was significant using chi square for trend seen in age. Conclusion: Histopathological examination of endometrial biopsy in patients of AUB is considered as a gold standard of patient evaluation, diagnosis and management and avoids any future complications.

Correlation of Abnormal Uterine Bleeding (AUB) with Thyroid Profile and Endometrial Biopsy

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of loss. Menstrual disturbances and different endometrial pattern may accompany and precede thyroid dysfunction. The objective of the study was to correlate thyroid profile with endometrial biopsy in cases of AUB. This study was conducted on 74 patients who presented with AUB, had undergone TFT and endometrial biopsy/hysterectomy. Among 74 patients, thyroid disorders were identified in 26 patients. Maximum number of patients with AUB belonged to the category of hypothyroidism (27%) and 8.1% of cases had hyperthyroidism. In the present study 29 (39.1%) had proliferative endometrium, followed by secretory pattern in 21 (28.4%) patients. Hormone induced changes was seen in 3 (4.1%) patients. Disordered proliferative endometrium and endometrial hyperplasia was observed in 6 patients (8.1%) each. Malignant lesion was not common and it comprised of only 1.4% cases. AUB is frequently seen in patients with thyroid dysfunction. Thyroid function test is a cost effective, easily available test and can detect a possibly curable cause of AUB and avoid unnecessary intervention like hormonal treatment and hysterectomy. AUB due to endometrial cause is an age related pathology. Histopathological examination of endometrial biopsy is a major diagnostic tool in evaluation of AUB. It helps the physician to plan therapy for successful management of AUB.