Secretory Endometrium Research Articles

Endometriosis Is Associated with a Significant Increase in hTERC and Altered Telomere/Telomerase Associated Genes in the Eutopic Endometrium, an Ex-Vivo and In Silico Study.

Telomeres protect chromosomal ends and they are maintained by the specialised enzyme, telomerase. Endometriosis is a common gynaecological disease and high telomerase activity and higher hTERT levels associated with longer endometrial telomere lengths are characteristics of eutopic secretory endometrial aberrations of women with endometriosis. Our ex-vivo study examined the levels of hTERC and DKC1 RNA and dyskerin protein levels in the endometrium from healthy women and those with endometriosis (n = 117). The in silico study examined endometriosis-specific telomere- and telomerase-associated gene (TTAG) transcriptional aberrations of secretory phase eutopic endometrium utilising publicly available microarray datasets. Eutopic secretory endometrial hTERC levels were significantly increased in women with endometriosis compared to healthy endometrium, yet dyskerin mRNA and protein levels were unperturbed. Our in silico study identified 10 TTAGs (CDKN2A, PML, ZNHIT2, UBE3A, MCCC2, HSPC159, FGFR2, PIK3C2A, RALGAPA1, and HNRNPA2B1) to be altered in mid-secretory endometrium of women with endometriosis. High levels of hTERC and the identified other TTAGs might be part of the established alteration in the eutopic endometrial telomerase biology in women with endometriosis in the secretory phase of the endometrium and our data informs future research to unravel the fundamental involvement of telomerase in the pathogenesis of endometriosis.

Expression of Cyclin D1 in Hyperplasia and Carcinoma of Endometrium and Its Correlation with Histologic Grade, Tumor Type, and Clinicopathological Features.

Background Endometrial carcinoma is often preceded by characteristic histopathologic lesions known as endometrial hyperplasia. Estrogen, p53, PTEN, and overexpression of cyclin D1 appear to be involved in the development of endometrial carcinogenesis. Design We evaluated and compared the expression profile of cyclin D1 expressions in 50 endometrial samples submitted as either endometrial curetting ( n = 34) or hysterectomy ( n = 16) specimens, which were diagnosed as simple hyperplasia ( n = 10), complex hyperplasia ( n = 06), atypical hyperplasia ( n = 04), and endometrial carcinoma ( n = 20). Ten cases of normal proliferative and secretory endometrium were selected as controls. Breast cancer with known cyclin D1 expression was selected as a positive control in each immunohistochemistry run. Results Cyclin D1 was significantly overexpressed in glands with complex hyperplasia and endometrial adenocarcinoma compared with proliferative or secretory endometrium and simple hyperplasia. A statistical difference was found in the extent of cyclin D1 positivity of simple hyperplasia and carcinoma of the endometrium ( p < 0.005). No statistical difference was seen between complex hyperplasia and carcinoma and clinicopathologic parameters in endometrioid carcinomas. All cases of clear cell carcinoma and serous carcinoma showed cyclin D1 immunoreactivity. Significant statistical difference was seen between cyclin D1 expression and only one clinicopathologic parameter, i.e., menopausal status in endometrial carcinomas Conclusion Cyclin D1 over expression may be an early event in endometrial carcinogenesis and cyclin D1 over expression may be an informative biomarker to recognize subsets of endometrial lesions that may be precancerous and therefore amenable to surgical therapy.

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive, perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social, emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and postmenopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma. Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology, Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and 17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7% and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormonedependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive, perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social, emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and postmenopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma. Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology, Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and 17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7% and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormonedependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.

Innate Immune Responses to Acute Viral Infection During Pregnancy.

Immunological adaptations in pregnancy allow maternal tolerance of the semi-allogeneic fetus but also increase maternal susceptibility to infection. At implantation, the endometrial stroma, glands, arteries and immune cells undergo anatomical and functional transformation to create the decidua, the specialized secretory endometrium of pregnancy. The maternal decidua and the invading fetal trophoblast constitute a dynamic junction that facilitates a complex immunological dialogue between the two. The decidual and peripheral immune systems together assume a pivotal role in regulating the critical balance between tolerance and defense against infection. Throughout pregnancy, this equilibrium is repeatedly subjected to microbial challenge. Acute viral infection in pregnancy is associated with a wide spectrum of adverse consequences for both mother and fetus. Vertical transmission from mother to fetus can cause developmental anomalies, growth restriction, preterm birth and stillbirth, while the mother is predisposed to heightened morbidity and maternal death. A rapid, effective response to invasive pathogens is therefore essential in order to avoid overwhelming maternal infection and consequent fetal compromise. This sentinel response is mediated by the innate immune system: a heritable, highly evolutionarily conserved system comprising physical barriers, antimicrobial peptides (AMP) and a variety of immune cells—principally neutrophils, macrophages, dendritic cells, and natural killer cells—which express pattern-receptors that detect invariant molecular signatures unique to pathogenic micro-organisms. Recognition of these signatures during acute infection triggers signaling cascades that enhance antimicrobial properties such as phagocytosis, secretion of pro-inflammatory cytokines and activation of the complement system. As well as coordinating the initial immune response, macrophages and dendritic cells present microbial antigens to lymphocytes, initiating and influencing the development of specific, long-lasting adaptive immunity. Despite extensive progress in unraveling the immunological adaptations of pregnancy, pregnant women remain particularly susceptible to certain acute viral infections and continue to experience mortality rates equivalent to those observed in pandemics several decades ago. Here, we focus specifically on the pregnancy-induced vulnerabilities in innate immunity that contribute to the disproportionately high maternal mortality observed in the following acute viral infections: Lassa fever, Ebola virus disease (EVD), dengue fever, hepatitis E, influenza, and novel coronavirus infections.

Densities of decidual high endothelial venules correlate with T-cell influx in healthy pregnancies and idiopathic recurrent pregnancy losses.

Do high endothelial venules (HEVs) appear in the uterus of healthy and pathological pregnancies? Our study reveals that HEVs are present in the non-pregnant endometrium and decidua parietalis (decP) but decline upon placentation in decidua basalis (decB) and are less abundant in decidual tissues from idiopathic, recurrent pregnancy losses (RPLs). RPL is associated with a compromised decidual vascular phenotype. Endometrial (n = 29) and first trimester decidual (n = 86, 6-12th week of gestation) tissue samples obtained from endometrial biopsies or elective pregnancy terminations were used to determine the number of HEVs and T cells. In addition, quantification of HEVs and immune cells was performed in a cohort of decidual tissues from RPL (n = 25). Position and frequency of HEVs were determined in non-pregnant endometrial as well as decidual tissue sections using immunofluorescence (IF) staining with antibodies against E-selectin, intercellular adhesion molecule, von Willebrand factor, ephrin receptor B4, CD34 and a carbohydrate epitope specific to HEVs (MECA-79). Immune cell distribution and characterization was determined by antibodies recognizing CD45 and CD3 by IF staining- and flow cytometry-based analyses. Antibodies against c-c motif chemokine ligand 21 (CCL21) and lymphotoxin-beta were used in IF staining and Western blot analyses of decidual tissues. Functional HEVs are found in high numbers in the secretory endometrium and decP but decline in numbers upon placentation in decB (P ≤ 0.001). Decidua parietalis tissues contain higher levels of the HEV-maintaining factor lymphotoxin beta and decP-associated HEVs also express CCL21 (P ≤ 0.05), a potent T-cell chemoattractant. Moreover, there is a positive correlation between the numbers of decidual HEVs and the abundance of CD3+ cells in decidual tissue sections (P ≤ 0.001). In-depth analysis of a RPL tissue collection revealed a decreased decB (P ≤ 0.01) and decP (P ≤ 0.01) HEV density as well as reduced numbers of T cells in decB (P ≤ 0.05) and decP (P ≤ .001) sections when compared with age-matched healthy control samples. Using receiver-operating characteristics analyses, we found significant predictive values for the ratios of CD3/CD45 (P < 0.001) and HEVs/total vessels (P < 0.001) for the occurrence of RPL. Analyses were performed in first trimester decidual tissues from elective terminations of pregnancy or non-pregnant endometrium samples from patients diagnosed with non-endometrial pathologies including cervical polyps, ovarian cysts and myomas. First trimester decidual tissues may include pregnancies which potentially would have developed placental disorders later in gestation. In addition, our cohort of non-pregnant endometrium may not reflect the endometrial vascular phenotype of healthy women. Finally, determination of immune cell distributions in the patient cohorts studied may be influenced by the different modes of tissue derivation. Pregnancy terminations were performed by surgical aspiration, endometrial tissues were obtained by biopsies and RPL tissues were collected after spontaneous loss of pregnancy. In this study, we propose an inherent mechanism by which the endometrium and in particular the decidua control T-cell recruitment. By demonstrating reduced HEV densities and numbers of T cells in decB and decP tissues of RPL samples we further support previous findings reporting an altered vascular phenotype in early pregnancy loss. Altogether, the findings provide important information to further decipher the etiologies of unexplained RPL. This study was supported by the Austrian Science Fund (P31470 B30 to M.K.) and by the Austrian National Bank (17613ONB to J.P.). There are no competing interests to declare. N/A.

Clinical and Histopathological Presentation of Abnormal Uterine Bleeding in Perimenopausal Women in Tertiary Center of Nepal.

Abnormal uterine bleeding is defined as any bleeding outside of normal menstruation pattern with excessive duration, frequency, and amount and it is a common problem among women of reproductive age group with varied presentations. The aim of the study was to correlate the histopathological finding in patients with abnormal dysfunctional uterine bleeding with the presenting clinical feature. A prospective cross sectional study was carried out at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu during the period of one year (February 2019 to January 2020). It included 77 perimenopausal women with abnormal uterine bleeding who presented in gynecology outpatient department and planned for dilatation and curettage. Then the participants were counselled and informed consent was taken. Histopathological reports reviewed and analysis done. The most common age group of women presenting with abnormal uterine bleeding was 40 to 44 years and the commonest clinical feature was menorrhagia (31/77, 40.3%) followed by menometrorrhagia (18/77, 23.4%). Majority of women were multiparous, parity 3 to 4 (38/77, 49.4%). Proliferative endometrium (29/77, 37.7%) was most common histopathological findings followed by secretory endometrium (24/77, 31.2%). Proliferative endometrium was more commonly associated with menorrhagia and menometrorrhagia whereas secretory endometrium with metrorrhagia (P-value 0.000). Menorrhagia and Menometrorrhagia are the most common clinical presentation among perimenopausal women with AUB, whereas proliferative endometrium and secretory endometrium were the common histopathological findings respectively.Accurate diagnosis is crucial for a selection of relevant treatment and avoidance of unnecessary major surgical procedure.

ENDOMETRIAL BCL6 EXPRESSION IS NOT ASSOCIATED WITH IMPLANTATION OUTCOMES

B-cell CLL/lymphoma 6 (BCL6) is a proto-oncogene that is overexpressed in the secretory endometrium of women with endometriosis. It has been postulated that BCL6 may serve as a surrogate marker for occult endometriosis, as well as a predictor of endometrial dysfunction and poor implantation. Therefore, BCL6 expression has been proposed as an adjunct test for women undergoing IVF. However, this test has not yet been validated in the general IVF population. The aim of this study was to determine whether increased endometrial BCL6 expression is associated with implantation failure in women undergoing IVF.

IFNs Drive Development of Novel IL-15-Responsive Macrophages.

Disruption in homeostasis of IL-15 is linked to poor maternal and fetal outcomes during pregnancy. The only cells described to respond to IL-15 at the early maternal-fetal interface have been NK cells. We now show a novel population of macrophages, evident in several organs but enriched in the uterus of mice and humans, expressing the β-chain of the IL-15R complex (CD122) and responding to IL-15. CD122+ macrophages (CD122+Macs) are morphologic, phenotypic, and transcriptomic macrophages that can derive from bone marrow monocytes. CD122+Macs develop in the uterus and placenta with kinetics that mirror IFN activity at the maternal-fetal interface. M-CSF permits macrophages to express CD122, and IFNs are sufficient to drive expression of CD122 on macrophages. Neither type I nor type II IFNs are required to generate CD122+Macs, however. In response to IL-15, CD122+Macs activate the ERK signaling cascade and enhance production of proinflammatory cytokines after stimulation with the TLR9 agonist CpG. Finally, we provide evidence of human cells that phenocopy murine CD122+Macs in secretory phase endometrium during the implantation window and in first-trimester uterine decidua. Our data support a model wherein IFNs local to the maternal-fetal interface direct novel IL-15-responsive macrophages with the potential to mediate IL-15 signals critical for optimal outcomes of pregnancy.

Vitamin D receptor and cellular retinol-binding protein-1 immunohistochemical expression in normal, hyperplastic and neoplastic endometrium: Possible diagnostic and therapeutic implications

BackgroundWe conducted this study to assess the effect of VDR and CRBP-1 immunohistochemical expression on the endometrium and to explore their role in endometrial cancer carcinogenesis. MethodsThis study comprised two hundred paraffin-embedded endometrial tissue samples diagnosed as 42 and 63 proliferative and secretory endometrium respectively, 45 endometrial hyperplasias with atypia and 50 endometrial carcinomas (25 low-grade and 25 high-grade endometrial carcinomas). The immunohistochemical method was done to determine the expression of VDR and CRBP-1. ResultsVDR was strongly expressed in 8 (17.8%) cases with endometrial hyperplasia, 15 (60%) cases with low-grade endometrial carcinoma, and 22 (88%) cases with high-grade endometrial carcinoma. While CRPB1 overexpression was noted in cases with proliferative endometrium, secretory endometrium and endometrial hyperplasia with atypia, 37 (88.1%), 56 (88.9%) and 3 (6.7%) cases respectively and all malignant cases showed negative expression. ConclusionsIncreased VDR expression and reduced CRBP-1 expression are associated with malignant features of the endometrium with a significant statistical difference of immunoreactivity between groups of normal endometrium, hyperplastic changes & carcinoma. Our data suggested that increased VDR expression is partly associated with endometrial cancers through a premalignant phase. Also, increased VDR and reduced CRBP-1 expression are associated with the progression of endometrial carcinoma with higher grades.

Study of endometrium in abnormal uterine bleeding at Patan Academy of Health Sciences, Patan Hospital Nepal

Introduction:Abnormal uterine bleeding (AUB) is considered as one of the most common and challenging problem presenting to the gynecologist. Establishing a cause of AUB is important, as medical therapy is effective in managing abnormal bleeding in most cases and should be attempted prior to surgical management. Endometrial biopsy is a safe and effective diagnostic step in evaluation of endometrium after ruling out any medical causes. The objective of this study is to evaluate the different histopathological patterns of the endometrial biopsy specimens in women presenting with AUBat Patan Hospital.&#x0D; Method: A two year retrospective study of AUB covering the year 2068 to 2069 . Patients charts were retrieved from the medical record section and reviewed.&#x0D; Result: The most common age group presenting with AUB was 41–50 years 58(49.1%).Among these patients,normal physiological patterns 62 (52.5%) with secretory endometrium(24.6%), proliferative endometrium 29 (22.9%) and menstrual phase 6 (5.1%) were observed. The commonest pathology irrespective of the age group was disordered proliferative pattern 23 (19.5%). Othercauses identified were endocervical polyp 8 (6.8%), hormonal effect 5 (4.2%), atrophic endometrium 5 (4.2%),endometrial carcinomas 5 (4.2%), complications of pregnancy 3 (2.5%), endometrial hyperplasias 3 (2.5%), endometritis 3 (2.5%) and endometrial polyp 1 (0.8%).&#x0D; Conclusion:Histopathological variations of the endometrium can detect the cause of the disorders taking into account the age and phase of a menstrual cycle. Timely evaluation of AUB by histopathology can be life saving diagnostic tool for early management.

A study of histomorphological patterns of endometrium in abnormal uterine bleeding

Abnormal uterine bleeding(AUB) is one of the most common gynaecological problems, which accounts for about 33% of out patient referrals. It is a debilitating condition with high direct and indirect costs. AUB is considered as a cause of significant health care burden for women, their families and society as a whole. To study the various histomorphological patterns of endometrium in AUB. This is a retrospective study done in Department of Pathology, tertiary care hospital, JJMMC Davangere for a period of 2 years from January 2016 to December 2017. 212 cases of endometrial biopsies were reviewed in AUB. The slides were obtained from departmental archives and clinical data from the histopathological forms. The data was entered and interpreted in Microsoft Excel and the analysis was done in percentages and proportions and was represented in tables, graphs and pie charts wherever necessary. A total of 212 cases were analysed and the age of females ranged from 20-62 yrs. The most common histomorphological pattern was Endometrial Hyperplasia without atypia in 43.0% of cases followed by Secretory endometrium in 15.6% of cases. Proliferative endometrium was seen in 14.6% of cases and Disordered proliferative endometrium was seen in 14.2% of cases. There were also 2 cases with Simple atypical hyperplasia. The cause of AUB can be identified by the histopathological study of endometrial curettages and biopsies. This helps to plan for successful management of the females presenting with AUB.

Clinicopathological analysis of abnormal uterine bleeding in reproductive and post menopausal women in a tertiary care centre of south eastern part of India

Abnormal uterine bleeding (AUB) is a common presentation of gynecologic disorder in Tropical countries like India. Though various underlying causes exists, endometrial pathology is the major reason for AUB and histopathological evaluation of endometrial biopsy samples remains main stay for diagnosis. To analyse the clinico-pathological spectrum of abnormal uterine bleeding with associated endometrial lesions in patients presenting to a tertiary care hospital in south eastern part of India Patients presenting to gynaecology OPD with AUB as presenting complaints were evaluated with Dilatation &amp; curettage and the endometrial samples obtained were analysed for histopathological evaluation Among 153 cases studied for a period of 2 years duration, majority of cases were non-neoplastic lesions (n=93) followed neoplastic lesions (n=60). Proliferative and secretory endometrium was the common condition among reproductive age group. Malignancy was predominantly noted among post menopausal age group and adenocarcinoma (TypeI) was the common endometrial malignancy noted The incidence of Abnormal uterine bleeding was higher than assumed among the study population and histopathological evaluation of endometrial biopsy samples serves as a mainstay in diagnosis and also in categorizing the underlying etiology.

A clinical study on abnormal uterine bleeding in premenopausal women

Background: Abnormal uterine bleeding is defined as any bleeding outside of normal menstrual cycle with excessive duration, frequency and amount of loss. AUB accounts about 70% in perimenopausal women in gynaecology OPD. Abnormal uterine bleeding is not a disease, it is a symptom. The aim of the study was to evaluate abnormal uterine bleeding in perimenopausal women and to study the various menstrual abnormalities and causes of AUB in perimenopausal women. Study design: This study was a hospital based cross sectional study which included 95 women in perimenopausal age group (40-51 years) with abnormal uterine bleeding. The history, clinical examination, USG and histopathological findings was collected. Clinical findings were classified by PALM-COEIN classification. All women underwent endometrial sampling to rule out endometrial pathology. Results: The mean age of the patients was 44.89(±2.93) years. Parity of more than 2 (46.3%) was most common. Menorrhagia (58.9%) was the most common bleeding pattern followed menometrorrhagia (23.2%). Leiomyomo 37 (38.9%) was the most common clinical finding followed by adenomyosis 29 (30.5%). Ultrasonographically fibroid uterus (37.8%) was the most common USG findings followed by Adenomyosis (30.5%). The most common endometrial thickness was 9-12mm (43.1%). Histopathological examination revealed secretory phase endometrium (35.8%) was the most common finding followed by proliferative endometrium (20%). Conclusion: Uterine fibroid was the leading cause of AUB. Clinical examination and ultrasound findings correlated well in the diagnosis of fibroids. Evaluation of the endometrium in perimenopausal women presenting with AUB is essential to rule out endometrial pathology.

Comparison of Endometrial Biopsy Results of Premenopausal and Postmenopausal Patients

Objective: To evaluate the histopathological results of endometrial biopsy specimens obtained from patients who referred to our clinic with a complaint of abnormal uterine bleeding (AUB) and to compare the results of premenopausal and postmenopausal patients.Methods: In this retrospective study, the records of patients who referred to our clinic due to AUB between 2013 and 2017, and who had undergone endometrial biopsy with pipelle were evaluated. Demographic data and menopausal status of the patients were recorded. Endometrial biopsy results of all patients were investigated. In addition, the patients were divided into two groups as premenopausal and postmenopausal. Endometrial biopsy results of both groups were compared.Results: While 2808 (56.1%) of the 5000 patients who referred with AUB and who had undergone endometrial sampling were premenopausal, 2192 (43.8%) were postmenopausal. The mean age of the premenopausal and postmenopausal groups was found to be 41.6 ± 1.8 and 54.2 ± 5.9, respectively. Secretory endometrium was significantly higher in the premenopausal group than the postmenopausal group (p &amp;lt;0.001). While atrophic endometrium and malignancy were significantly higher in the postmenopausal group than the premenopausal group, chronic endometritis was significantly higher in the premenopausal group.Conclusion: Endometrial biopsy, which is a simple, inexpensive and easy technique, is the most preferred method for the exclusion of malignancy in patients with complaint of AUB. In patients with complaint of AUB, malignancy exclusion decision by endometrial biopsy must be made considering the age interval, risk factors that may cause estrogen exposure, and menopausal status of the patients.

Correlation Between Endometrial Thickness By Ultrasonography and Histopathology in Abnormal Uterine Bleeding

Background : Abnormal uterine bleeding (AUB) is the most common presenting complaint of patients in Gynaecology Outpatient department. Early diagnosis of endometrial hyperplasia through ultrasongraphic measurement of endometrial thickness and definite diagnosis by histopathologic examination will help the clinicians to give appropriate treatment to the patients. The objective of this study was to correlate the histopathology findings in abnormal uterine bleeding with endometrial thickness by ultrasonography. Methods : This was a prospective study done from Nov 2016 to June 2018.A total of 382 cases of AUB presenting above 40 years of age were included. Endometrial thickness was measured by ultrasonography. Histopathological findings were studied and compared with the endometrial thickness. Statistical analysis were done using chi square test. Results : A total of 382 cases were analysed. Maximum number of cases were from peri menopausal age group (68.32%). Majority of the cases were due to non organic causes(85.34%). 46.86% of patients had endometrial thickness of 5-10mm followed by endometrial thickness of 11-15mm in 39.01%. Disordered proliferative endometrium was the most common pattern (38.34%) in our study followed by secretory endometrium (35.58%) and menstrual endometrium (18.71%). These findings were found to be statistically significant. Conclusion : A thorough histopathological work up and clinical correlation is mandatory in cases of abnormal uterine bleeding above 40 years to find out organic lesions. Careful screening can detect precursor lesions like endometrial hyperplasia and early cases of endometrial carcinoma which has excellent prognosis and it will help in further management.

Functions of Lysosomes in Mammalian Female Reproductive System

The lysosome is the most acidic membrane-bound intracellular organelle. Lysosomal acidity is primarily maintained by vacuolar H+-ATPase (V-ATPase) and counter ion channels. There are >60 hydrolytic enzymes in the lysosome for its fundamental digestive role. Lysosomes also play important roles in endocytosis, exocytosis, autophagy, and cell death. Studies that have implicated roles of lysosomes in the female reproductive system are reviewed here. In the ovary, lysosomes are implicated in the preparation of free cholesterol for steroidogenesis and degradation of regulators of steroidogenesis, regulation of follicular atresia, follicle rupture during ovulation, luteal cell survival, and luteal regression. In the oviduct, lysosomes are involved in endocytosis of both serum and oviductal luminal components. In the uterus during the menstrual/estrous cycle, lysosomes are associated with endometrial secretion, apoptosis, and menstruation. In the uterus during early pregnancy, lysosomes are involved in the temporal and directional changes of endocytosis, uterine epithelial acidification upon embryo implantation initiation, and embryo-maternal mutual communications via extracellular vesicles. In the placenta, lysosomes are implicated in nutrient transport and placental separation from the uterus for parturition. In the mammary gland, lysosomes are important for mammary gland development and involution. These findings suggest/demonstrate functions of lysosomes in multiple processes of female reproduction, from ovulation to ovarian steroidogenesis for pregnancy maintenance, and from essential in utero nurturing of developing embryos/fetuses via embryo/fetal-maternal communications, to optional postpartum nurturing of newborns via lactation. Future studies using genetically or modified animal models and pharmacological approaches will provide novel insights into the functions and mechanisms of lysosomes in the mammalian female reproductive system.

Role of Diagnostic D&amp;C and Histopathology of Endometrium in Perimenopausal Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding is common and important problem in perimenopausal women which has diverse etiology. Among different diagnostic procedures, Dilatation and Curettage (D&amp;C) with histopathology of endometrium has an important role in the detection of underlying cause in perspective of its availability, low cost, and high diagnostic yield. The objective of diagnostic curettage in perimenopausal women with abnormal uterine bleeding is to detect endometrial abnormality.&#x0D; Methods: It was a hospital based cross-sectional study among fifty patients of 45 to 60 years old with history of perimenopausal bleeding, attending the inpatient and outpatient department of Sir Salimullah Medical College and Mitford Hospital, Dhaka. The cases were selected according to inclusion and exclusion criteria. Routine investigations and pelvic ultrasonograpy were done. Endometrial biopsy were taken by Diagnostic D &amp; C. Chi-square test was used as test of statistical significance. Statistical Package of Social Science Software (SPSS, version 16.0) was used for statistical analysis of data.&#x0D; Results: Common histopathological pattern identified were endometrial hyperplasia (32%), and polyp (24%). Proliferative endometrium was found in 16% cases, secretory endometrium in 12%, endometrial carcinoma in 6%, endometritis in 4 % and atrophic endometrium in 6% patients.&#x0D; Conclusion: Endometrial biopsy is an essential step for all cases of perimenopausal and postmenopausal abnormal uterine bleeding to rule out malignancy.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(1): 7-14

Clinicopathological profile of uterine fibroid at a medical college hospital

Introduction: Leiomyomas are usually asymptomatic. Symptoms may be seen depending on their size, location and hormonal effects. It is the most common uterine tumour seen in gynaecological practice. Knowledge of clinical features and histopathological changes are helpful. Methods: The present cross-sectional study included 109 cases of uterine fibroid. Clinical details and findings of histopathological examination were noted. Results: Most of the patients belonged to the age group of 50-60 years. Menstrual irregularities were seen in 71.6% of cases. 39.4% suffered from abdominal pain and infertility was seen in 11.9% cases. In 70.6% of cases, proliferative endometrium was found. Secretory endometrium was seen in 13.8% and atrophic in 10.1%. Most of the cases had intramural fibroid (58.7%). It was subserosal in 19.3% cases and submucosal in 4.6%. Hyaline degeneration was seen in 20.2% cases, cystic degeneration in 4.6% and myxoid degeneration in 3.7%. 67.9% of cases did not show any degeneration. Conclusion: Hyaline degeneration, myxoid degeneration and cystic degeneration are the commonly seen secondary changes. Proper diagnosis and timely management are essential for the management of these tumours.

Comparing endometrial hysteroscopic and histological findings of infertile women with polycystic ovary syndrome and unexplained infertility: A cross-sectional study.

Background Infertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality.ObjectiveThis study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI).Materials and MethodsThis cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed.ResultsThe mean age of women with PCOS was significantly lower than that of women with UI (27.5 4.1 vs. 30 4.5 years, respectively) (p 0.001). The mean BMI was higher in women with PCOS than in women with UI (28.7 4.4 vs. 25.1 3 kg/m) (p 0.001). The hysteroscopic findings of all women with PCOS were normal, whereas 91.4% of women with UI had normal hysteroscopic findings, 2.9% had a polyp, and 5.7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54.3%, disordered proliferative endometrium in 17.1%, secretory endometrium in 8.6%, and endometrial polyp in 17.1%, whereas these percentages in women with UI were 28.6%, 0%, 54.3%, and 20%, respectively.ConclusionThe hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.