Pathology In Women Research Articles

The association of fibrocystic breast disease with endometrial histopathological results in abnormal uterine bleeding

Background/Aim: Fibrocystic breast disease (FBD) is the most frequent benign breast disease. Increased estrogen and decreased progesterone concentrations are thought to be involved in the pathogenesis of FBD. But there is insufficient data on benign breast disease and endometrial pathology. This study evaluates the association between FBD and endometrial pathology in women complaining of abnormal uterine bleeding.
 Methods: This study was designed as a retrospective case-control study. The medical records of women who had endometrial sampling for abnormal uterine bleeding between 2018 and 2020 were evaluated. Patients with FBD were included in the study group, while the first patients who had endometrial sampling after patients with FBD and without breast disease were recruited as the control group. Demographic, laboratory data, and endometrial histopathological results were obtained from hospital records and compared between the groups.
 Results: In total, 250 women (106 women with FBD and 144 without breast disease) were recruited for the study. There was no statistically significant difference in mean age, gravidity, parity, and BMI between FBD and control groups. Endometrial hyperplasia without atypia (19.8% versus 10.5%, respectively, P = 0.037) and endometrial polyp (12.2% versus 4.8%, respectively, P = 0.033) were found to be significantly increased in patients with FBD than women without the disease. There was no statistically significant difference in terms of other histopathological results between the groups.
 Conclusion: Evaluation of the endometrium for abnormal uterine bleeding is essential for early diagnosis and treatment of endometrial pathology, especially for endometrial cancer. In this study, we found that women with FBD have an increased risk for endometrial hyperplasia and endometrial polyp. As endometrial hyperplasia is a precursor lesion for endometrial cancer, clinicians should pay attention to and investigate menstrual bleeding abnormalities of women with FBD and should not delay the evaluation of the endometrium.

Clinical characteristics of women with endometrial hyperplasia on the background of thyroid dysfunction

The objective: to define the specificities of clinical characteristics in women of reproductive age with endometrial hyperplasia associated with hypothyroidism.Materials and methods. There were 180 women with endometrial hyperplasia under our supervision. In 120 women, the pathology of endometrium was associated with newly diagnosed hypothyroidism. The patients with the thyroid dysfunctions were divided into the following groups: asymptomatic persons – 48 cases; symptomatic ones – 45 women; compensated patients with mild symptoms – 27 individuals. The control group consisted of 60 patients with endometrial hyperplasia without thyroid pathology.The data of the somatic and gynecological anamnesis, the concentration of sex hormones and thyroid hormones, the results of histological examination of the endometrium were analyzed in all the women.Results. The following data were found: the age of women with hyperprolactinemia without thyroid pathology is younger than the age of those with hyperprolactinemia and thyroid pathology; hypothyroidism in women with endometrial hyperplasia is contingent on frequently growing body weight, but not obesity; the most common concomitant pathology in women with endometrial hyperplasia and hypothyroidism was mastopathy which was diagnosed almost in every third patient. The frequency of such endocrine pathologies as polycystic ovary syndrome and hyperprolactinemia in women with endometrial hyperplasia has almost increased twice in the presence of hypothyrosis. In case of endometrial hyperplasia and hypothyrosis there was a significant decrease of estradiol concentration with a preserved level of gonadotropic hormones (luteinizing hormone and follicle-stimulating hormone), and the lowest values were defined in women with symptomatic hypothyroidism. Chronic endometritis, the detection rate of which does not depend on thyroid dysfunction, was diagnosed in 61.5 % patients with endometrial hyperplasia.Conclusions. Thyroid dysfunction is involved in the mechanisms of development of hyperplastic processes of the endometrium, which is the basis for screening the functional state of the thyroid gland in women with endometrial pathology.

Differences between men and women in coupled subtalar and tibiofemoral joint kinematics during gait revealed through dynamic biplane radiography

It has been suggested that subtalar and tibiofemoral kinematics are coupled, such that abnormal subtalar inversion during the impact and push-off portions of stance may affect tibial rotation, leading to abnormal compensatory knee motion. This study aimed to characterize tibiofemoral and subtalar coupled motion and to determine if sex-dependent differences exist in lower extremity coupled motion. Twenty young adults were imaged at 100 frames/s using dynamic biplane radiography while walking. Lower extremity CT scans were obtained and segmented into subject-specific 3D bone models. Digitally reconstructed radiographs generated from the models were matched to the biplane radiographs via a validated tracking process to obtain tibiofemoral and subtalar joint kinematics. Subtalar inversion/eversion was strongly associated with tibiofemoral internal/external rotation and tibiofemoral ab/adduction during impact and push-off (P < 0.001). Men reached neutral subtalar and tibiofemoral orientation at midstance, while women remained more inverted at the subtalar joint and more externally rotated at the tibiofemoral joint. The rate of tibiofemoral ab/adduction to subtalar eversion differed between sexes during push-off (P = 0.005). Women underwent subtalar inversion, as well as tibiofemoral internal rotation and adduction during push-off, while men underwent only subtalar inversion and tibiofemoral internal rotation, with effectively no tibiofemoral adduction. These results provide the first quantitative evidence characterizing subtalar and tibiofemoral coupled motion. Differences in coupled motion trajectories between men and women may be associated with the higher incidence of knee-related pathology in women. These novel findings may serve as a standard for comparison when evaluating patients with patellofemoral pain.

Risk factors for endometrial pathology in women with breast cancer and tamoxifen treatment

Risk factors for endometrial pathology in women with breast cancer and tamoxifen treatment

Internalized Stigma as a Transdiagnostic Factor for Women with Eating Disorders

ABSTRACT This study aimed to examine how internalized weight bias (IWB), body surveillance, and body shame relate to eating pathology in women with diagnosed eating disorders (EDs) across the weight spectrum. Previous research has examined these variables in primarily non-clinical populations, binge eating disorder, and higher weight populations. In a sample of 98 women with diagnosed EDs, the association of IWB, body surveillance, and body shame on the severity of ED symptoms was examined with hierarchical multiple regression analyses. Results indicate that IWB, body surveillance, and body shame significantly predicted global eating pathology, F (4, 93) = 40.74, p < .001. IWB, body surveillance, and body shame related to global eating pathology, even after controlling for previous weight bias experiences. Analyses with specific symptom clusters found that only body surveillance predicted dietary restraint, only IWB and body shame predicted overvaluation of shape/weight, and only IWB predicted body dissatisfaction. The findings in this study provide initial support for internalized stigma variables (IWB, body surveillance, and body shame) related to ED pathology in a transdiagnostic clinical eating disorder sample across the weight spectrum. Results suggest that further examination of internalized stigma is needed within ED treatment.

There is no significant correlation of adenomyosis with benign, premalignant and malignant gynecological pathologies. Retrospective study on 647 specimens.

The aim of this study is to identify the prevalence of benign, premalignant and malignant gynecological pathologies in women with adenomyosis who underwent gynecological surgery. The medical records collected between 1985 and 2020 were retrospectively reviewed. The pathology reports were studied from 647 cases where adenomyosis was presented. The estimated prevalence of benign, premalignant and malignant gynecological disorders in the general population was further evaluated. The mean age of women with adenomyosis was 54.1 ± 10.4 years old. Out of 647 patients, in 18.5% of the specimens we detected isolated adenomyosis and in 81.5% of cases a coexistence of one or more gynecological diseases, while in 84 out of 647 patients (13%) there was coexistence of adenomyosis with more than one gynecological condition (benign or malignancy). Among all cases, uterine leiomyomas were observed in 61.3% of patients, followed by endometrial polyps (11.9%), endometriosis (11.6%), endometrial hyperplasia (7.1%), endometrial cancer (3.6%), ovarian (1.4%) and cervical cancer (0.8%) (p < 0.001).Additionally, we found that women with a simultaneous co-existence of adenomyosis, leiomyomas and endometrial polyps or hyperplasia were younger (p < 0.01) in comparison to cases with malignancy. Adenomyosis presents a common benign but often progressing myometrial condition that it is underestimated in clinical practice. Even though some studies suggest a potential association with several gynecological pathologies, we did not confirm a significant difference of adenomyosis prevalence between benign, premalignant and malignant gynecological conditions compared with the general population. Further investigation is required to confirm our results.

Current view on the problem of treating fibrocystic breast disease in terms of herbal medicine

Introduction: Fibrocystic breast disease, commonly called fibrocystic breasts or fibrocystic change, is a benign (noncancerous) condition, which is the most common pathology in women of reproductive age. Treatment of fibrocystic breast disease and concomitant pathologies can involve using herbs.&#x0D; Materials and Methods: To make an analysis of literary sources on the development of fibrocystic breast disease in the pathogenesis of diseases of the female reproductive system (clinical human (75%) and animal studies (25%)) were published in the period of 2017–2021.&#x0D; Results and discussion: The diversity of plants in the world is a promising ground for therapeutic improvisation, allowing for an individual approach to each patient, but, most importantly, creates possibilities for maneuvering in the event of ineffectiveness of any means. In some situations, herbal medicine is not only possible or permissible, but strictly mandatory, and is essentially the only effective therapeutic method, which is relatively safe provided the correct selection of combinations and control by a doctor who applies a certain method of phytotherapy, especially given a duration of treatment. The need for a deeper study is long overdue for the pharmacological capabilities of various plant raw materials in the treatment of not only this pathology, but others as well.&#x0D; Conclusion: The development of phytotherapy should be based primarily on scientific developments, but this area can not be considered the prerogative of only phytotherapists, as herbal medicines should be in the arsenal of doctors of all specialties.

Development of Histologically Verified Thyroid Diseases in Women Operated for Breast Cancer: A Review of the Literature and a Case Series.

Background: The possible relationships between breast and thyroid diseases have been reported in the literature. The purpose of our study was to evaluate the occurrence of histologically verified thyroid pathologies in women who were diagnosed with breast cancer and, after mastectomy/quadrantectomy complemented by oncological treatment, were thyroidectomized based on their periodic thyroid evaluation. Patients and Methods: Our series consist of 31 women with a mean age of 62.9 ± 10.9 years (range, 45–81) treated for breast cancer (18 right-sided, 11 left-sided, and 2 bilateral), of whom 29 were thyroidectomized, since two women who developed Graves’ disease refused thyroidectomy. These 31 women belong to a cohort of 889 women who referred to the Breast Surgery Unit of our university hospital during the period January 2010 through December 2020. Results: The mean time interval between breast cancer and thyroid pathologies was 48.1 ± 23.4 months (range, 12–95). The final diagnosis at histopathology was infiltrating ductal breast carcinoma in 26 women (with 2/26 patients having bilateral carcinoma) and infiltrating lobular breast carcinoma in the other 5 women. Ten of the twenty-nine thyroidectomized women (34.5%) had a thyroid malignancy on histology: five papillary carcinomas, three papillary micro-carcinomas and two follicular carcinomas. Two of the five women with papillary carcinoma also had histological evidence of chronic lymphocytic thyroiditis/Hashimoto’s thyroiditis, which was also detected in another five women with benign thyroid diseases. Conclusions: We suggest that breast cancer survivors should be made aware of the possible increased risk of thyroid pathologies (including thyroid malignancy) so that they can undergo screening and follow-up.

Acute urinary retention: causes, risk of complications, treatment methods (literature review)

Acute urinary retention (ischuria) is a pathological condition caused by the impossibility of emptying the bladder. The ischuria prevalence in men prevails over the prevalence of this pathology in women. The leading causes of acute urinary retention (AUR) in men are benign prostatic hyperplasia, early postoperative period, prostate cancer, and medications. AUR patients need emergency care, which consists of bladder decompression. The first stage of treatment (decompression) can be performed in three ways: catheterization, suprapubic capillary puncture, or epicystostomy. The second and third stages consist of the diagnosis and treatment of the underlying disease. The choice of treatment method depends on the patient's condition, his underlying disease and possible complications.

Sex-Specific Causes and Consequences of White Matter Damage in a Middle-Aged Cohort.

ObjectiveTo evaluate potential sex-specific effects of multiple cardiovascular risk factors on white matter pathology in normal aging men and women, as well as potential sex-differences in the association of white matter pathology and cognitive functions.MethodsWe analyzed cross-sectional data of 581 participants (median age: 53 years, 54% women) of the population-based cohort of the BiDirect Study who completed clinical examinations, five neuropsychological tests, and an 3T MRI examination. White matter pathology was determined by the extent of white matter hyperintensities (WMH) on FLAIR images as well as the magnitude of global fractional anisotropy (FA) based on diffusion tensor imaging. Main effects, interaction as well as sex-stratified generalized linear regression models were used to evaluate the moderating effect of sex on the association of hypertension, diabetes mellitus, smoking, and obesity with WMH and FA, respectively. Associations of imaging markers with cognitive test results were determined with linear regression models.ResultsHypertension showed stronger associations with more extensive WMH and less FA in women compared to men. Current smoking was associated with more severe WMH in women only. Adjusted for age and education, WMH were not significantly associated with cognitive tests, but higher FA was associated with better performance in motor function in both sexes and with executive functions in men, even after adjustment for cardiovascular risk factors.ConclusionWe observed a stronger association of hypertension and smoking with white matter damage in women, suggesting a higher susceptibility for vascular pathology in women. However, there was no association of WMH with cognition, and FA was associated with executive function tests only in men, suggesting a higher cognitive reserve in women.

Hysteroscopic Evaluation Of Abnormal Uterine Bleeding In A Tertiary Care Institute — An Observational Study

Abstract Objectives:To assess the feasibility of diagnostic hysteroscopy in the diagnosis of abnormal structure and pathological lesions in the uterine cavities of women presenting abnormal bleeding of the uterus. Methods: This is a Prospective Cross-sectional study conducted in the Department of Gynaecology at Prathima Institute Of Medical Sciences, Karimnagar: one hundred women presenting with Abnormal Uterine Bleeding, over a period of one year from December 2020 to November 2021, were subjected to the procedure. Results: The results of our study show that hysteroscopy has high accuracy for detecting the pathology in women with abnormal uterine bleeding, especially in benign lesions such as endometrial polyp and submucosal fibroid and it can be used as the first line diagnostic method for these abnormalities. Conclusion:Hysteroscopy provides a more accurate diagnosis than dilatation and curettage or ultrasonography alone to diagnose pathology in women with abnormal bleeding of the uterus. It is very sensitive for diagnosing intracavitary lesions like submucous myoma and endometrial polyp.

PECULIARITIES OF PREGNANCY AND DELIVERY IN WOMEN WITH HISTORY OF INFERTILITY

Institute of Hereditary Pathology of the National Academy of Medical Sciences of Ukraine, Lviv. Ukraine. Objective: to analyze data on somatic, reproductive, gynaecological history, pregnancy course and outcomes in women with a history of infertility residing in the Lviv region. Material and methods. The data and results of medical genetic counselling of 170 women aged 18-42 with a history of infertility (main group) were analyzed. The comparison was carried out with similar parameters of 80 healthy women aged 18-42 years in the control group. The data of somatic, reproductive, gynecological anamnesis, the pregnancy course and outcomes were studied. Statistical processing of the findings obtained was carried out by the Statistica 7.0 software package using the standard Excel 2013 statistical analysis package. Differences were considered statistically significant at p &lt;0.05. Results. The analysis of the data of the results of medical genetic counselling of 170 women with a history of infertility for 2019-2021 was carried out. The patients with a history of infertility were significantly more likely to be over 36 years of age compared to the same indicators in the control group. They had a complicated somatic anamnesis, 80.0% versus 20.0% in the control group, with a significant predominance of cardiovascular pathology (21.8% and 11.2%), and they also more often had reproductive history complications, 51 (30.0%) versus 11 (13.7%), mainly due to spontaneous miscarriages and missed pregnancies: 46 (27.0%) and 11 (13.7%), respectively. The gynaecological history in all these patients was complicated by infertility, and only infertility was in 113 (66.5%); infertility in combination with ovarian apoplexy was found in 17 (10.0%) and with ectopic pregnancy in 15 (8.8%) that was significantly higher in relation to respective data in the control group of women: 2 (2.6%) and 1 (1.3%), respectively. In women with a history of infertility, a high incidence of pregnancy complications was noted: 146 (85.9%) versus 39 (48.75%) in the control group: they more often gave birth for the first time: 110 (64.7%), and 35 (43.7%) in the control group. Analysis of the data obtained showed the presence of a large number of maternal risk factors for obstetric complications in this group of women. Conclusion. The study has demonstrated the risk factors for the occurrence of obstetric pathology in women with a history of infertility include presumably older age (over 36 years) (13.5%), a complicated reproductive history (30.0%) mainly due to spontaneous miscarriages and missed pregnancies (27.0%); complicated somatic history (80.0%) with a significant predominance of the pathology of the cardiovascular system (21.8%). A gynaecological history aggravated by infertility was found in all 170 (100.0%) women of the main group, and a significant increase in the combination of infertility with ovarian apoplexy was detected in 17 (10.0%) and with ectopic pregnancy in 15 (8.8%) women compared with the control group: 2 (2.6%) and 1 (1.3%), respectively. The complicated course of pregnancy was found in 85.9% of women with a history of infertility and in 48.75% of women in the control group; they more often gave birth for the first time: 110 (64.7%) versus 35 (43.7%) patients in the control group (p&lt;0.05). Women with a history of infertility are at risk for obstetric complications.

Genomics and Epigenomics of Gestational Diabetes Mellitus: Understanding the Molecular Pathways of the Disease Pathogenesis.

One of the most common complications during pregnancy is gestational diabetes mellitus (GDM), hyperglycemia that occurs for the first time during pregnancy. The condition is multifactorial, caused by an interaction between genetic, epigenetic, and environmental factors. However, the underlying mechanisms responsible for its pathogenesis remain elusive. Moreover, in contrast to several common metabolic disorders, molecular research in GDM is lagging. It is important to recognize that GDM is still commonly diagnosed during the second trimester of pregnancy using the oral glucose tolerance test (OGGT), at a time when both a fetal and maternal pathophysiology is already present, demonstrating the increased blood glucose levels associated with exacerbated insulin resistance. Therefore, early detection of metabolic changes and associated epigenetic and genetic factors that can lead to an improved prediction of adverse pregnancy outcomes and future cardio-metabolic pathologies in GDM women and their children is imperative. Several genomic and epigenetic approaches have been used to identify the genes, genetic variants, metabolic pathways, and epigenetic modifications involved in GDM to determine its etiology. In this article, we explore these factors as well as how their functional effects may contribute to immediate and future pathologies in women with GDM and their offspring from birth to adulthood. We also discuss how these approaches contribute to the changes in different molecular pathways that contribute to the GDM pathogenesis, with a special focus on the development of insulin resistance.

Contribution of ultrasound examination in the detection of unexpected uterine and adnexal findings in reconstructive surgery for pelvic organ prolapse.

The aim of the study was to evaluate the efficacy of ultrasound (USG) in dia-gnosing unexpected uterine and adnexal pathologies in women referred for POP. Furthermore, the benefit of USG examination by a specialist in gynaecology-oncology ultrasound was assessed. All women after a hysterectomy with or without adnexectomy in the course of a POP surgery at our tertiary centre in 2013-2018 with preoperative USG were enrolled in the study. Women with recurrent uterine bleeding, abnormal cytology, using tamoxifen, or women with already dia-gnosed uterine or adnexal pathology were excluded. 289 women were enrolled in the study - 157 (54.3%) expert USG vs. 132 (45.7%) non-expert USG. Abnormal findings were observed on the cervix in one case (non-expert USG), the endometrium 30 (10.4%) cases - 13 (8.3%) expert vs. 17 (12.9%) non-expert USG, the adnexa three (2.3%) cases (all non-expert USG), and no suspicion of malignancy on myometrium was observed. USG was false negative in four (1.4%) cases - two (1.3%) expert vs. two (1.5%) non-expert USG. Conversely, the examination was false positive in 34 (11.8%) cases - 13 (8.3%) expert vs. 21 (15.9%) non-expert USG. The risk of unexpected uterine or adnexal pathologies in POP surgery was 1.4%. The agreement between USG and histopathological benign, abnormal or malign findings was 87.2%. A sonographer specialized in oncologic sonography is able to reduce the number of false positive findings; however, this does not increase the sensitivity of the ultrasound.

Comparing endometrial biopsy results with hysteroscopic pathology in women presenting with abnormal and postmenopausal uterine bleeding

The primary objective of this study was to compare endometrial biopsy pathology results with subsequent operative hysteroscopy pathology in women undergoing evaluation for abnormal and postmenopausal uterine bleeding. The secondary objectives were to describe the length of time between the two procedures and to describe intermediate treatments utilized before hysteroscopy. This study is a retrospective cohort study of women presenting for evaluation of abnormal and postmenopausal uterine bleeding within a single hospital system between January 2015 and December 2018. Patients were identified by their Current Procedural Terminology codes for endometrial biopsy and surgical hysteroscopy. Women were included if they underwent endometrial biopsy followed by operative hysteroscopy within 24 months for abnormal uterine or postmenopausal bleeding. Women were excluded if they underwent more than one endometrial biopsy or hysteroscopy up to five years preceding or any time following the procedures, or who underwent endometrial biopsy followed by hysteroscopy after more than 24 months. We identified 2223 records of which 689 met criteria for inclusion. The mean age of the cohort was 49 (±10). 30.1% (206) were postmenopausal. The median duration of abnormal or postmenopausal bleeding leading up to time of biopsy was of 3.5 (1.5-9) months. Of the patients who had hysteroscopic pathology demonstrating endometrial polyp, 30.6% (81) had an endometrial polyp detected on biopsy. Of the patients who had hysteroscopic pathology demonstrating fibroid/smooth muscle/myometrium with fibroid visualized on hysteroscopy, 0% (0) were detected on biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6% (4) were detected on biopsy, and of the patients who had hyperplasia with atypia on hysteroscopy, 5.9% (1) was detected on biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopic pathology, of which 8.3% (1) was detected on biopsy. Of the patients who had insufficient specimen from endometrial biopsy, 21% (15) had insufficient specimen from hysteroscopy. The median number of days from endometrial biopsy to hysteroscopy was 48 (25-95) days. The most common non-surgical treatments used between time of biopsy and hysteroscopy were daily oral hormonal therapy at 11.3% (78), high dose oral hormonal therapy at 5.7% (39) and tranexamic acid at 1.5% (10). The overall adverse event rate for hysteroscopy was low at 1.3% (9). In this study of women with abnormal or postmenopausal uterine bleeding undergoing evaluation, the majority of endometrial polyps and fibroids found on hysteroscopic evaluation were not detected on endometrial biopsy. Hysteroscopy is a low-risk surgery that can be scheduled within a reasonable amount of time following endometrial biopsy to both evaluate and treat uterine bleeding.

The Risk of Endometrial Malignancy and Other Endometrial Pathology in Women with Abnormal Uterine Bleeding: An Ultrasound-Based Model Development Study by the IETA Group

Objectives: The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding. Design: The International Endometrial Tumor Analysis 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound examination (n = 2,417) were recruited. The histology was obtained from endometrial sampling, D&C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for >1 year. Methods: A model was developed using multinomial regression based on age, body mass index, and ultrasound predictors to distinguish between: (1) endometrial atrophy, (2) endometrial polyp or intracavitary myoma, (3) endometrial malignancy or atypical hyperplasia, (4) proliferative/secretory changes, endometritis, or hyperplasia without atypia and validated using leave-center-out cross-validation and bootstrapping. The main outcomes are the model’s ability to discriminate between the four outcomes and the calibration of risk estimates. Results: The median age in 2,417 women was 50 (interquartile range 43–57). 414 (17%) women had endometrial atrophy; 996 (41%) had a polyp or myoma; 155 (6%) had an endometrial malignancy or atypical hyperplasia; and 852 (35%) had proliferative/secretory changes, endometritis, or hyperplasia without atypia. The model distinguished well between malignant and benign histology (c-statistic 0.88 95% CI: 0.85–0.91) and between all benign histologies. The probabilities for each of the four outcomes were over- or underestimated depending on the centers. Limitations: Not all patients had a diagnosis based on histology. The model over- or underestimated the risk for certain outcomes in some centers, indicating local recalibration is advisable. Conclusions: The proposed model reliably distinguishes between four histological outcomes. This is the first model to discriminate between several outcomes and is the only model applicable when menopausal status is uncertain. The model could be useful for patient management and counseling, and aid in the interpretation of ultrasound findings. Future research is needed to externally validate and locally recalibrate the model.

Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding

Introduction: Transvaginal Sonography has emerged as important modality in investigating AUB, but it cannot diagnose endometrial pathology in absence of histopathology of endometrium. Addition of Color doppler (CDTU) to TVS can help in diagnosis by evaluation of blood flow through vascular patterns and Uterine artery indices. Objective: To evaluate the role of Trans vaginal Ultrasonography and Colour Doppler (CDTU) in abnormal uterine bleeding and correlating them with histopathological diagnosis. Methods: TVS and Colour Doppler were performed in 70 patients with AUB. TVS included evaluation of endometrium, size of uterus, any uterine or adnexal pathology. Vascular pattern of Spiral arteries of endometrium, and uterine arteries was analysed. Uterine artery indices (RI and PI) were calculated. 1.83 was taken as cut off for PI and 0.81 was taken as cut off for RI. The results were then compared with histopathology of endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI ( and PI ) were calculated. 1.83 was taken as cut off for PI and 0.81 was taken as cut off for RI. The results were then compared with histopathology of endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI (&lt;0.81 ) and PI (&lt;1.83) of uterine artery by CDTU. Specificity and Sensitivity of TVS with CDTU for AUB M was 100% and 90.77% respectively. Positive predictive value was 45.45% and negative predictive value was 100%. Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries with vascular impedance, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions.

The effectiveness of lifestyle modification on improving the typology of integration and pathology of women in the family

The effectiveness of lifestyle modification on improving the typology of integration and pathology of women in the family

Color Doppler and Transvaginal Sonography; Accuracy in the Diagnosis of Endometrial Pathologies in Women with Abnormal Uterine Bleeding: A Cross-sectional Study

Introduction: Abnormal uterine bleeding (AUB) can occur at any age in a woman’s life, and it is more prevalent in the premenopausal age group. Although anovulation is the most prevalent endometrial cause, other major reasons include endometrial hyperplasia, endometrial adenomatous polyps and cancer. For patients of all ages, it is one of the most prevalent presentations in Gynecology OPDs. AUB has a major impact on health-related quality of life, necessitating quick intervention. AUB treatment is difficult without a good diagnosis. As a result, pre-menopausal and post-menopausal women with AUB must have a thorough examination to rule out endometrial cancer. Aim: To assess the role of transvaginal ultrasound and color Doppler tomography (CDTU) in irregular uterine bleeding and correlate these findings with histological diagnosis. Methodology: The present study included 92 individuals with abnormal uterine bleeding (AUB), in those TVS, and Color Doppler was used to evaluate the endometrial pathologies. Endometrium, uterine size and any uterine or adnexal disease were evaluated during the TVS. Spiral arteries of the endometrium and uterine arteries were studied for their vascular patterns. The RI and PI of the uterine artery were determined. For PI, a cutoff of 1.83 was used, while for RI, a cutoff of 0.81 was used. The results were then compared to endometrial histology. Results: According to TVS, (see Table 1) the most common causes of AUB were leiomyoma (15.2%), polyp (12%), PCOS (9.8%), adenomyosis (5.43%) and endometrial development (3.3%). The uterine indicators of RI (0.81) and PI (1.83) of the uterine artery by CDTU revealed 11 patients with probable cancer. For AUB M, the TVS with CDTU specificity and sensitivity was 100 percent and 90.77 percent, respectively. The positive predictive value was 45%, whereas the negative predictive value was 100%. Conclusion: The use of vascular impedance and color Doppler of the uterine artery and endometrial spiral arteries improves the diagnostic accuracy of TVS for the prediction of endometrial diseases. It makes screening for malignant and premalignant lesions easier.

Is screening for endometrial cancer necessary in asymptomatic women treated with tamoxifen for breast cancer?

Objective: This study aimed to investigate the endometrial pathology findings and to determine the appropriate diagnostic approach to assess for potential endometrial malignancy or premalignant pathology in women treated with tamoxifen for breast cancer. Methods: We retrospectively reviewed the medical records of 162 patients taking tamoxifen and who underwent endometrial biopsy. We compared the clinical features of the patients with endometrial intraepithelial neoplasia or cancer (EIN/EC group) and the patients with other pathologic results (others group). Results: EIN or EC was found in ten patients (6.2%). While 70.0% of EIN/EC group received tamoxifen treatment for more than 3 years, 71.7% of the others group received less than 3 years (p &lt; 0.001). Regardless of the presence of vaginal bleeding, EIN/EC was not found in patients with endometrial thickness (ET) &lt;5 mm on transvaginal ultrasonography (TV-US). When ET was ≥5 mm, the incidence rates of EIN/EC were only 2.9% in asymptomatic patients and 11.6% in symptomatic patients, respectively (p = 0.002). When ET was ≥8 mm, the incidence rates of EIN/EC were 3.8% in asymptomatic patients and 12.0% in symptomatic patients, respectively (p = 0.002). When ET was &lt;8 mm, EIN/EC was not found in patients without vaginal bleeding, while EIN/EC was found in 7.1% of patients with vaginal bleeding. Conclusions: Indiscriminate endometrial evaluation should be avoided in women treated with tamoxifen for breast cancer. Patients taking tamoxifen who experience vaginal bleeding and have a thick endometrium (≥5 mm) on TV-US, they should undergo endometrial biopsy.