Simple Endometrial Hyperplasia Research Articles

The analysis of IVF outcomes after fertility-preserving therapy for endometrial hyperplasia or carcinoma.

This study aimed to evaluate the clinical efficacy of fertility-preserving therapy through in vitro fertilization (IVF) procedures in women who were pathologically diagnosed with endometrial hyperplasia or carcinoma. A retrospective cohort study on fertility-preserving therapy was conducted. Participants/Materials, Setting: A total of 82 women were enrolled who had simple endometrial hyperplasia (SH), complex hyperplasia (CH), complex atypical hyperplasia (CAH), and endometrioid endometrial carcinoma stage IA (EC IA) and underwent IVF at Gangnam CHA fertility center between January 2008 and December 2020. The primary endpoints were oncologic outcomes and subsequent reproductive outcomes of patients who underwent fertility-preserving treatments analyzed by χ2 test (chi-square test) or Fisher's exact test. Of the 82 patients, 33 had a cumulative clinical pregnancy (40.2%), and 25 had a cumulative live birth (30.5%) through IVF procedures following pathologic confirmation of complete remission or non-progressive status. The cumulative clinical pregnancy rates and live birth rates for, SH were 50.0% and 30.0%, for CH were 37.8% and 28.9%, for CAH were 25.0% and 25.0%, and for EC were 38.5% and 38.5%, respectively. There were no significant differences in cumulative clinical pregnancy rates or live birth rates when comparing the four groups. There was a difference in endometrial thickness between MPA treatment group and IUD group (p=0.036); however, there were no significant differences in clinical pregnancy rates among MPA, IUD, and MPA+IUD groups. Because of the retrospective nature of the study, many factors relevant to the treatment decision were not strictly controlled. All endometrial hyperplasia and carcinoma groups had competent cumulative live birth rates by IVF procedures. There may be differences in endometrial thickness depending on the treatment methods, but this does not affect clinical pregnancy rates. Therefore, the fertility-preserving treatment for endometrial hyperplasia and carcinoma is a safe and feasible method that results in good IVF outcomes.

Evaluation of The Effect of Metformin and Progesterone on The Endometrium in Cases of Peri Menopausal Bleeding

Background: Numerous epidemiologic and experimental studies have suggested that unopposed estrogen may be a major factor in the development of benign, premalignant, and malignant endometrial lesions. Objective: To assess the unique effects of progesterone and metformin on simple endometrial hyperplasia and disorganized proliferative endometrium, and to ascertain if metformin is clinically helpful in this situation. Patients and Methods: The study was conducted between April 2023 and September 2023 at the obstetrics and gynecology department of Damanhur Medical National Institute. The study was a double blinded randomized study. 100 patients were involved in this study who were divided into 2 groups: The 1st one (50 cases) was treated with metformin (Glucophage) 500 mg in the first week then raise the dose to reach 1000 mg in the 4th week, for three months long. The 2nd group (50 cases) was administered medroxy progesterone acetate (Provera) 4mg once per day for 3 months long. Next 3 months all cases in both groups were gone for 2nd time endometrial biopsy for assessment of response of treatment and will have ultrasound examination every three months also. Result: Uterine hemorrhage after treatment and endometrial thickness after treatment did not statistically differ between the two study groups. Additionally, there was no statistically significant difference in patient satisfaction or hysterectomy between the two study groups. There was no discernible difference in the two groups' treatment lengths. While there was a high statistical rise in the incidence of nausea, vomiting, and diarrhea in group 2 compared to group 1, there was a strong statistical increase in the incidence of sore breasts, weakness, and metallic taste in group 1 compared to group 2. Conclusion: Progesterone and metformin may both be useful in treating benign endometrial proliferative lesions. To prevent its problems, endometrial proliferative lesions should be identified and treated properly.

Correlation of endometrial thickness using transvaginal sonography with histopathology in women with abnormal uterine bleeding: A cross-sectional study

Background: Abnormal uterine bleeding (AUB) is one of the most common complaints seen in gynecological practice, and transvaginal sonography (TVS) remains the first-line, non-invasive diagnostic tool in these women. Aims and Objectives: The aim was to study the endometrial thickness (ET) using TVS and correlate it with histopathological findings obtained through endometrial biopsy in patients with AUB. Materials and Methods: This was a prospective observational study conducted in a tertiary care center in Northern India, from January 2018 to June 2019. One hundred and sixty women in the reproductive age group presenting AUB were recruited. TVS was done to note (ET) and its echotexture with additional findings such as uterine, adnexal, or other pelvic pathology. The patient underwent endometrial aspiration using Karman Cannula, and its findings were correlated with TVS. Results: In our study, a majority of patients (40%, n=64) presenting with AUB belonged to the age group of 41–45 years, with fibroid being the most common cause (39.3%, n=63). Thickened ET (>12 mm) was noted in 44 (27.5%) patients and 4 had an endometrial polyp. The mean ET was 11.48±5.11 mm (range: 4–35 mm). The most common normal histopathology noted was secretory endometrium (29.37%, n=47), followed by proliferative endometrium (20.6%, n=33). The abnormal changes included disordered proliferative endometrium (23.1% n=37) and simple endometrial hyperplasia (6.8%, n=11). Four cases were found to have endometrial adenocarcinoma. On correlating TVS with histopathology, it was noted that out of 8 patients with ET of >20 mm, 3 patients had endometrial carcinoma, 2 had disordered proliferative endometrium, and 1 each had pill endometrium, normal secretory, and atypical hyperplasia. Conclusion: TVS provides crucial information on echo-morphological features of the uterine cavity, and increasing ET mandates histopathological confirmation for ruling malignancy.

D-Chiro-Inositol in Endometrial Hyperplasia: A Pilot Study.

Endometrial hyperplasia is a threatening pathology driven by unopposed estrogen stimulus. Moreover, insulin may act on the endometrium, prompting further growth. We aimed at assessing whether D-chiro-Inositol, an insulin sensitizer with estrogen-lowering properties, might improve the condition of patients with simple endometrial hyperplasia without atypia. We enrolled women with simple endometrial hyperplasia without atypia and related symptoms, including abnormal uterine bleeding. We treated the patients with one tablet per day, containing 600 mg of D-chiro-inositol for six months. Patients underwent ultrasound to assess the thickness of the endometrium at baseline, after three months, and at the end of this study. Endometrial thickness went from 10.82 ± 1.15 mm to 8.00 ± 0.81 mm after three months (p < 0.001) and to 6.9 ± 1.06 mm after six months (p < 0.001 versus baseline; p < 0.001 versus three months). D-chiro-inositol treatment also improved heavy menstrual bleeding and the length of menstruation. Despite the fact that our data should be validated in larger studies with appropriate control groups, our promising results support the hypothesis that D-chiro-inositol may represent a useful treatment in the case of endometrial hyperplasia without atypia.

The Study of Different Endometrial Pattern in Dysfunctional Uterine Bleeding of Women in Western Rajasthan

Background: Dysfunctional uterine bleeding is one of the most frequently encountered conditions in gynaecological practice world over and is defined as bleeding from the uterine corpus that is abnormal in volume, regularity and /or timing and has been present for majority of the past 6 months. This study was done to evaluate histology of endometrium for identifying the endometrial causes of DUB. Material and Methods: This was a retrospective study done at Dr S N Medical College, Jodhpur, Rajasthan on 250 patients who presented with DUB from June 2020– September 2022. The endometrial changes were observed by reviewing and studying the histological slides, prepared through routine processing channels which includes fixation, grossing, tissue processing, dehydration, paraffin embedding, cutting and H&amp;E staining procedures. Results: The commonest endometrial pattern was proliferative pattern in 145(58.00%) cases. Followed by secretary pattern in 34(13.60%), disordered proliferative pattern 19(7.60%). Cystic Dilatation11 (4.4%), Simple Endometrial Hyperplasia 9 (3.6%), Atrophic Changes 9(3.6%), Late Proliferative Pattern8 (3.2%), Early Secretory Pattern 6(2.4%), Hyperplasia without atypia5 (2%), Arias Stella reaction3 (1.2%), Cystic Hyperplasia1(0.4%). Conclusion: The incidence of proliferative pattern was significantly high in this study, suggesting an early presentation of these patients.

Role of transvaginal ultrasonography in determining endometrium cancer risk in asymptomatic postmenopausal women with thickened endometrium

The aim of this study is to determine the cut-off value for the histopathological evaluation of premalignant-malignant endometrial pathologies from benign pathologies in postmenopausal asymptomatic patients with increased endometrial thickness. This cross-sectional study included a population that included asymptomatic 481 postmenopausal women with an endometrial thickness of more than 5mm in TVU who underwent diagnostic/ operative hysteroscopy and full curettage between January 2015 and January 2018. Demographic characteristics TVU, hysteroscopy findings of patients were recorded. As a result, in the histopathological outcome, 154(3%) women were evaluated as having normal endometrium, 189(39.3%) women as having endometrial polyps, 93(19.3%) women as having endometrial atrophy, and 23(4.6%) women as having endometrial simple hyperplasia, 5(1%) women as having endometrial simple hyperplasia, 17(3.5%) women as having endometrial atrophy and only one (0.1%) woman as having fibroids. In the 187 postmenopausal women with normal diagnostic hysteroscopic evaluation, histopathological findings were: 13(7%) endometrial hyperplasia, 2(1.1%) atypical endometrial hyperplasia, 27(14.4%) endometrial polyps, 4 2.1%) endometrial atrophy, and 2(1.1%) endometrial carcinoma. The endometrial thickness was analyzed with the ROC curve for cutoff value differentiating atypical endometrial hypreplasia/endometrial carcinoma from benign lesions and 10.5 mm was found with 90% sensitivity and 63% specificity. In conclusion, hysteroscopy is highly effective for identifying the endometrium and focal intracavitary pathologies such as polyps, myomas and foreign bodies in women with abnormal uterine bleeding. However, for the diagnosis of endometrial hyperplasia and cancer, hysteroscopic-guided biopsy with uterine curettage seems to be the best method.

ПАТОЛОГИЯ ЭНДОМЕТРИЯ ПРИ СИНДРОМЕ ПОЛИКИСТОЗНЫХ ЯИЧНИКОВ У ЖЕНЩИН С БЕСПЛОДИЕМ

Polycystic ovary syndrome (PCOS) is one of the most common endocrine dis-orders in women of reproductive age. In this pathology, the morphofunctional characteristics of the endometrium have features that cause violations of the real-ization of reproductive function and unfavorable outcomes of gestation, as well as the risk of developing endometrial cancer. According to the study, the normal characteristic of the endometrium was found in 22 (44.9 %). In the structure of endometrial pathology in patients with PCOS, endometrial polyps accounted for a significant proportion – 16 (32.6 %) patients, chronic endometritis – 30 (61.2 %), simple endometrial hyperplasia – 7 (14.2 %). Functional pathology was also noted: proliferative endometrium with pathology (anovulatory endome-trium) was found in 9 patients (18.3 %), endometrial hypoplasia - in 7 (14.2 %). PCOS has a high incidence of endometrial pathology, which necessitates the de-velopment of clinical approaches for the diagnosis and correction of the patholo-gy.

Expression of laminin-1 and matrix metalloproteinase-9 in benign and malignant endometrium.

Laminin-1 and matrix metalloproteinase (MMP)-9 may play roles in the progression from benign to malignant endometrium, so we aimed to investigate their levels of expression in these tissues. This case-control study was conducted at a tertiary care center between January 2014 and December 2016. Paraffin blocks of 50 specimens of benign endometrium with proliferative (n = 20), secretory (n = 11), and atrophic (n = 5) endometrium; simple endometrial hyperplasia without atypia (n = 12); and endometrial polyp (n = 2) histology and 49 specimens of malignant endometrium with endometrioid (n = 40), serous (n = 7), clear cell (n = 1), and undifferentiated (n = 1) types were immunostained with laminin-1 and MMP-9 antibodies and assessed for basement membrane continuity for laminin-1 and the percentage and intensity of MMP-9 expression in epithelial cytoplasm. : Laminin-1 continuity in the basement membrane was higher in benign (92%) compared to malignant (16.3%) endometrium (p < 0.0001) without any difference between the subgroups within each group (p > 0.05). All atrophic endometria and endometrial polyps and 23.5% of low grade endometrioid and none of the other endometrial cancers showed uninterrupted basement membrane staining with laminin-1. All cases in malignant endometrium expressed MMP-9 with either low or high immunoreactivity while none of the cases in benign endometrium showed a high staining with MMP-9 (p < 0.01). Proliferative and hyperplastic endometrium together with grade 1 endometrioid cancer expressed MMP-9 better than the atrophic endometrium (p < 0.05). The immunoreactivity with MMP-9 increased gradually from secretory to hyperplastic endometrium and serous carcinoma (p < 0.05). MMP-9 expression in all types of cancers except grade 1 endometrioid and clear cell compared to proliferative endometrium was significantly higher (p < 0.05) and increased from proliferative to grade 2 endometrioid, grade 3 endometrioid, serous and undifferentiated endometrial carcinoma. Gradual increments in MMP-9 expression and basement membrane laminin-1 discontinuity may indicate progression from normal to hyperplastic and to low- and high-grade cancerous endometrium.

XPO1-Mediated EIF1AX Cytoplasmic Relocation Promotes Tumor Migration and Invasion in Endometrial Carcinoma.

Dysregulation of eukaryotic translation initiation factor 1A, X-linked (EIF1AX), has been implicated in the pathogenesis of some cancers. However, the role of EIF1AX in endometrial carcinoma (EC) remains unknown. We investigated the EIF1AX expression in EC patients and assessed its tumorigenesis-associated function and nucleocytoplasmic transport mechanism in vitro and in vivo. The results indicated that the cytoplasmic EIF1AX expression showed a gradual increase when going from endometrium normal tissue, simple endometrial hyperplasia, complex endometrial hyperplasia, and endometrial atypical hyperplasia to EC, while vice versa for the nuclear EIF1AX expression. In addition, the cytoplasmic EIF1AX expression was positively correlated with histologic type, high International Federation of Gynecology and Obstetrics (FIGO) grade, advanced FIGO stage, deeper infiltration, high Ki67 index, and shorter recurrence-free survival in EC patients. In vitro, short hairpin RNA-mediated EIF1AX depletion or SV40NLS-mediated EIF1AX import into the nucleus in multiple human EC cells potently suppressed cell migration and invasion, epithelial-mesenchymal transition, and lung metastasis. Moreover, exportin 1 induced the transport of EIF1AX from the nucleus to the cytoplasm that could be inhibited by leptomycin B treatment or the mutation in the EIF1AX location sequence. These results demonstrate that cytoplasmic EIF1AX may play a key role in the incidence and promotion of EC, and thus, targeting EIF1AX or its nucleocytoplasmic transport process may offer an effective new therapeutic approach to EC.

Possible Role of PTEN Expression in Discriminating Benign Endometrial Hyperplasia from Atypical Hyperplasia/Endometrial Intraepithelial Neoplasia in a Series of Egyptian Patients

Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to the unopposed growth-promoting action of estrogen. WHO classified endometrial hyperplastic lesions into Benign Hyperplasia (BH) and atypical hyperplasia/ endometrial intraepithelial neoplasia AH/EIN. Phosphatase and tensin homolog (PTEN) is one of the earliest and most common genetic abnormalities detected in endometrioid adenocarcinoma (type I) and even in its precursors. This study aimed at histological evaluation of hyperplastic endometrial lesions according to WHO 2014 and investigating the role of PTEN expression in highlighting the precancerous group (AH/EIN). Patient and Method: This study included a series of 70 Egyptian patients suffered from hyperplastic endometrial lesions. They were previously diagnosed according to WHO1994 schema simple endometrial hyperplasia without atypia (n=18), simple endometrial hyperplasia with atypia (n=2), complex hyperplasia without atypia (n=25), complex hyperplasia with atypia (n=5) and hyperplastic endometrial polyps (n=20). Results: Cases were histologically re-evaluated according to WHO 2014 classification; BH (62 cases) and eight cases of AH/EIN. A significant difference in PTEN expression (regarding percentage and intensity of staining) in relation to histopathological diagnosis was detected (P-value 0.02 and &lt;0.05, respectively). The sensitivity and specificity of the absence of diffuse PTEN protein expression (&gt;50%) to detect AH/EIN were 100% and 77.4%, respectively. Conclusion: Diffuse, dim or loss of immunohistochemical expression of PTEN protein is significantly correlated with the new WHO classification segregation of AH/EIN as precancerous lesions. However, further studies are recommended to confirm this association.

SURGICAL TREATMENT OF OBESITY AS A RISK FACTOR FOR ATYPICAL HYPERPLASIA AND ENDOMETRIAL CANCER

The aim of the study is to analyze the literature available, to examine bariatric surgery as a treatment for people with metabolic syndrome (a risk factor for atypical endometrial hyperplasia), and to evaluate bariatric surgery significance in reducing endometrial cancer incidence.&#x0D; Materials and Methods. The authors scanned the platforms Springer, Pubmed, IFSO, and Google Scholar using such key words as metabolic syndrome, simple and atypical endometrial hyperplasia, endometrial cancer and bariatric surgery, methods for the metabolic syndrome correction in patients with endometrial cancer, effects of bariatric surgery on endometrial cancer, treatment of metabolic syndrome in patients-at-risk for endometrial cancer. The authors examined the articles published in English and Russian no longer than 10 years ago.&#x0D; Results. Metabolic syndrome is a risk factor for endometrial cancer and comorbidity. It expands the bariatric surgery alternatives for patients with Class 1 and Class 2 obesity.

The proliferation markers in patients with different forms of hyperplastic endometrial processes

Introduction: Endometrial hyperplastic processes (EHP) are characterized by recurrent course, high risk of malignancy, difficulties in diagnosing and predicting the course, which determines their great medical and social significance&#x0D; Objective: To evaluate the levels of proliferation markers Ki-67 and APRIL in serum of women with various forms of endometrial hyperplastic processes (EHP) and their correlation with clinical and anamnestic features.&#x0D; Materials and Methods: The study examined 95 women with endometrial hyperplasia and endometrial adenocarcinoma who underwent treatment in the gynecology department "City Clinical Hospital №7» in Zaporizhzhya and "Zaporozhye Regional Clinical Oncology Center". The first group consisted of 32 women with simple endometrial hyperplasia. The second group included 43 patients with complex endometrial hyperplasia. The third group consisted of 22 women with endometrial adenocarcinoma.&#x0D; Results: The analysis of Ki-67 level revealed an increasing in the patients with simple hyperplasia (p &lt;0.05) and complex hyperplasia of endometrium (p &lt;0.05) compare with control group. The level of the APRIL in serum is increased in group of complex hyperplasia compared with the control group (p &lt;0,05) and simple hyperplasia (p &lt;0,05). &#x0D; Conclusions: Level of APRIL in serum increased in patients with complex endometrial hyperplasia and endometrial adenocarcinoma. Level of Ki-67 in serum was highest in patients with complex endometrial hyperplasia. We found a significant positive association between Ki-67 levels in serum and thickness of M-echo in endometrium, duration of hyperplastic endometrial processes anamnesis, between APRIL in serum and age of patients, duration of hyperplastic endometrial processes anamnesis.&#x0D;

Individualised homoeopathic approach for simple endometrial hyperplasia presenting with post-menopausal bleeding – A case report

Introduction: Post-menopausal bleeding (PMB) is defined as bleeding per vagina occurring after 1 year of amenorrhoea in a menopausal woman who is not receiving hormonal therapy. Case Summary: This is a case report of a nulliparous woman aged 61 years, having PMB due to simple endometrial hyperplasia (EH) after 10 years of menopause. She was treated with individualised homoeopathic medicines. Trans-abdominal USG of lower abdomen showed complete resolution of hyperplastic endometrium from hyperplastic state (14 mm) to normal thickness (4 mm) after treatment for 11 months. Possible causal attribution of changes was assessed by Modified Naranjo Criteria (Score-10 out of 13). Follow-up over a period of 1 year of treatment, reflected no recurrence of symptoms, thus demonstrating a positive role of individualised homoeopathic treatment in simple EH having PMB.

HISTOPATHOLOGICAL STUDY OF ENDOMETRIALBIOPSIES IN ABNORMAL UTERINE BLEEDING

Introduction: Excessive and painful bleeding from uterus is a common cause for distress among menstruating women, perimenopausal as well as post-menopausal. There are innumerable causes for abnormal bleeding from uterus. We carried out a retrospective study to enumerate the causes of abnormal uterine bleeding. Materials And Methods: Consecutive 200 slides of endometrial biopsies done for abnormal uterine bleeding were evaluated over a period of two years between June 2019 to May 2021. The slides were stained with haematoxylin and eosin stain. All the slides were evaluated, examined and reported by two experienced pathologists. The results were tabulated depending upon the age and diagnosis. Results: Commonest age group noted for abnormal uterine bleeding was between 41-50yrs. Disordered proliferative phase was the commonest (16%) functional cause of abnormal bleeding and diagnosis. The most common organic cause of abnormal bleeding was simple endometrial hyperplasia without atypia (28%). Endometrial carcinoma was diagnosed in 2 cases above 50yrs. Conclusion: Simple endometrial hyperplasiawas the most common cause of abnormal bleeding from uterus in our series. Atypical hyperplasia or endometrial carcinoma should be ruled out in post-menopausal age group.

Non-hormonal therapy of patients with fibrocystic mastopathy in combination with endometrial hyperplasia

Introduction. The article presents a comparative analysis of the treatment of patients with combined estrogen-dependent pathology of female reproductive system: fibrocystic mastopathy and endometrial hyperplasia without atypia. The experience of treatment with an indole-carbinol-containing drug as monotherapy while using a levonorgestrel-releasing intrauterine system is presented.Aim. To evaluate the clinical efficacy of indolecarbinol in the treatment of patients with combined estrogen-dependent pathology of the female reproductive system.Materials and methods. The authors studied the responses to the treatment of patients with fibrocystic mastopathy and simple endometrial hyperplasia (n = 65) with the indole-carbinol-containing drug at a dose of 400 mg once daily for 12 months. All patients were divided into two groups: Group I (n = 32) – women who refused hormone therapy (indole-carbinol monotherapy); Group II (n = 33) – the use of indole-carbinol while using the levonorgestrel-releasing intrauterine system. Diagnostic methods: clinical and laboratory examination, ultrasound examination of mammary glands and pelvic organs, mammography, nipple discharge cytology at baseline and 6 and 12 months after the start of therapy. Before study group assignment to treatment, all patients underwent hysteroscopy with endometrial biopsy and histological examination. Descriptive statistics were used to evaluate the data: p-values below 0.05 were considered statistically significant.Results and discussion. The presented experience in treating women with combined pathology of the female reproductive system (fibrocystic mastopathy and endometrial hyperplasia without atypia) with the indole-carbinol-containing drug showed high clinical efficacy in mastopathy (relief of mastodynia (83.0 ± 1.6%), improvement of the ultrasound view of BI-RADS (66.1 ± 1.4%), reductions in mammographic density (66.1 ± 2.1%, p &lt; 0.05)), high tolerability and satisfactory compliance. This drug combined with hormone therapy is recommended for the treatment of endometrial hyperplasia.Сonclusion. The use of indole-carbinol in the treatment of benign hyperplastic processes in mammary glands and endometrial hyperplasia is pathogenetically substantiated and shows high clinical efficacy

DOUBLE J STENTING IN A DELAYED URETER INJURY DUE TO THERMAL NECROSIS FOLLOWING LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY

The presenting symptom to a gynecologist for postoperative vaginal discharge, which may or may not be related to the gynecologic diagnosis. A 40-year-old woman with abnormal uterine bleeding came to ObGyn Opd. The diagnosis was simple endometrial hyperplasia for which laparoscopic assisted vaginal hysterectomy with bilateral salphingo oophorectomy was done. Post-Operative Day 18 patient developed vaginal discharge suggestive of urinary leakage. The postoperative delayed ureter injury is an unusual association with laparoscopic assisted vaginal hysterectomy. The management was ureter stent insertion. This case report could be guidance to surgeons about the postoperative management of ureter injury. Gynecologists should consider the presenting symptom of vaginal discharge in formulating their differential diagnosis.

“STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING”

CONTEXT - Histopathological analysis of endometrial samples in various forms of abnormal uterine bleeding in adjunction with clinical history of patient to identify underlying cause of bleeding. This also helps in early diagnosis of premalignant and malignant lesions leading to their proper follow up and improved prognosis. AIMS - Histopathological analysis of causes of abnormal uterine bleeding with their clinical correlation. SETTINGS AND DESIGN -A prospective observational study MATERIAL AND METHODS - This study was done in department of pathology, GSVM medical college, Kanpur. This was a prospective study from year 2017-2018. A total of 300 cases were studied. Specimen received were xed in 10% formalin, processed and sections of 3-4 micron were prepared, stained with H and E. Histopathological examination was done. RESULTS - It was observed that the highest number of patients were between 41-50 years of age. (44.33%). Menorrhagia is the most common symptom accounting for 135 (45%) patients followed by metrorrhagia accounting for 135 (45%) patients and hypomenoorhea is the least common complaint. It was observed that there were signicantly higher number of patients with proliferative phase – 68 (22.67%) and in endometrial hyperplasia 35 (33.66%) patients. The least common cause were endometrial polyp, seen in 4 (1.33%) patients, gestational endometrium and gestational trophoblastic tumor accounted for 2 ( 0.67%) patients. In patients who presented with metrorrhagia, secretory phase endometrium was the most common histopathological nding accounting for 34.62% followed by proliferative phase. In cases of endometrial hyperplasia, 28 (80%) cases were simple cystic type, 5 ( 14.29%) cases were of simple endometrial hyperplasia with atypia and complex endometrial hyperplasia with atypia was found in 2(5.71%) cases. Among cases of endometrial hyperplasia, 28 (80%) cases were simple cystic type, 5 ( 14.29%) cases were of simple endometrial hyperplasia with atypia and complex endometrial hyperplasia with atypia was found in 2(5.71%) cases. Endometrial carcinoma is commonest complain in 51-60 years and &gt;60 years age group. CONCLUSION - Histopathological analysis of AUB causes helps in identifying the cause and early diagnosis of premalignant and malignant cases.

Unexpected endometrial malakoplakia in a 74-year-old-female: A case report

Abstract Introduction/Objective Malakoplakia is a chronic inflammatory disease, usually associated with bacterial infection. The urinary system is the most commonly involved site. Involvement of the female genital tract is extremely rare. Histopathologically, the disease is manifested by solid sheets of histiocytes with abundant granular eosionophilic cytoplasm, and intra- and extracellular basophilic bodies. It should be differentiated from other types of granulomatous inflammation and from signet ring cell carcinoma. Treatment consists of antibiotics, but surgery is sometimes necessary. Methods/Case Report A 74-year-old woman experienced postmenopausal bleeding for several years. A previous endometrial biopsy showed a mucinous glandular proliferation of uncertain etiology. She also had coronary heart disease, hypertension, diabetes mellitus and hyperlipidemia. A prior urinalysis showed abundant bacteria, and she had been hospitalized recently for urinary tract infection (UTI). She underwent laparoscopic total hysterectomy. Grossly, the endometrium was mostly uniform, 0.1 cm in thickness, with one 0.4-cm polyp. Microscopically, the endometrium showed simple hyperplasia without atypia, benign endometrial polyp, and multifocal malakoplakia, manifested by sheets of histiocytes with granular eosinophilic cytoplasm, many of them containing variably-sized basophilic spherules imparting to them a targetoid, or bull’s eye, appearance. Multiple endometrial plasma cells were also seen. Results (if a Case Study enter NA) NA Conclusion Very few cases of endometrial malakoplakia have been reported in the medical literature. Here we present unexpected malakoplakia coexisting with endometrial simple hyperplasia without atypia. Reports from the electron microscopy literature suggest that the basophilic spherules, named Michaelis-Gutmann inclusion bodies, are electron-dense granules that result from coalescence of phagolysosomes, reflecting failed digestion of bacteria. In our patient, longstanding chronic endometritis, confirmed by the presence of endometrial plasma cells, possibly coexisting with chronic UTI, culminated in malakoplakia, which clinically and pathologically mimicked endometrial hyperplasia or even carcinoma, given her old age, chronic bleeding, and the mucinous epithelium in the endometrial biopsy. The finding of endometrial malakoplakia should remind us of the bacterial etiology of chronic endometritis and the need for timely treatment of urogenital infections with antibiotics.

ENDOMETRIAL BIOPSIES PATTERNS AMONG WOMEN ATTENDING MOI TEACHING AND REFERRAL HOSPITAL, KENYA

Background: Endometrial diseases are among the most common gynecological disorders affecting women both globally and locally;accounting for 60% of global maternal deaths.Kenya is ranked thirteenth out of 181 countries with the highest maternal mortality globally. Endometrial disorders such as hyperplasia's, neoplastic, inflammatory and pregnancy related conditions of the endometrium have been reported to increase with demographic traits such as maternal age and parity. Objective: To determine histopathological patterns of endometrial biopsies among women attending Moi Teaching and Referral Hospital,Kenya. Methods: This was a retrospective laboratory-based study where 121 banked endometrial biopsy blocks collected from participants aged 19 to 70 years between August 2014 and August 2016 were retrieved, re-sectioned and stained using routine histological (Hematoxylin and Eosin) stains in the histology laboratory before being sent to the pathologist for examination. Sociodemographic and reproductive history data were collected from the medical records. Descriptive statistical techniques such as cross-tabulation were used.The median age of all the study participants was 44 years. Results: Most of the study participants (39.2%;n=38) presented with simple endometrial hyperplasia.The endometrial patterns were categorized as Hyperplasias (50.4%; n=61), Inflammatory disorders (7.4%; n=9), Neoplastic Disorders (14.9%;n=18),Pregnancy related disorders (20.7%;n=25) and other patterns (6.6%;n=8) Conclusion: Majority of the study participants presented with simple endometrial hyperplasia followed by complex hyperplasia and adenocarcinoma,respectively.

Lymphotoxin-α C804A polymorphism and the presence of simple endometrial hyperplasia in Egyptian women

ABSTRACT Endometrial hyperplasia (EH) is found to be a common diagnosis in women presenting with abnormal uterine bleeding, in advanced stages leading to cancer. To test the association of endometrial hyperplasia with the lymphotoxin-α (LT-α) C804A polymorphism, a case–control study was performed in Egyptian subjects. The cases comprised 100 endometrial hyperplasia patients, and the controls were 120 females served as control. Results showed that C allele versus A allele was compared in Simple Endometrial hyperplasia (SEH) cases compared to controls, there was no significant difference. In pre-menopausal cases, using the CC genotype as the reference genotype, the CA genotype was associated with a significantly elevated OR of 3.36 (95% CI =1.3–8.2, P = 0.007) in SEH cases compared to control. In addition, dominant genotypes (AA plus CA) were significantly increased in SEH cases compared to controls (OR =0.36, 95% CI =0.15–0.84, P =0.01). In conclusion, the common Lymphotoxin- α C804A polymorphism gene is associated with an increased risk of simple endometrial hyperplasia.