IP Archives of Cytology and Histopathology Research

Print ISSN: 2581-5725

Online ISSN: 2456-9267

CODEN : IACHCL

IP Archives of Cytology and Histopathology Research (ACHR) open access, peer-reviewed quarterly journal publishing since 2016 and is published under the Khyati Education and Research Foundation (KERF), is registered as a non-profit society (under the society registration act, 1860), Government of India with the vision of various accredited vocational courses in healthcare, education, paramedical, yoga, publication, teaching and research activity, with the aim of faster and better dissemination more...


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Uniya, Shrivastava, Rai, and Rai: Histopathological evaluation of Endometrium hyperplasia and it’s correlation with the clinical parameters in a tertiary care hospital


Introduction

Endometrium biopsies & hysterectomies specimen for any abnormal bleeding are commonly received in the department of pathology. Their diagnosis made on the light microscopy is quite helpful in planning the treatment for the patient since in most of the patients who are having endometrial hyperplasia with atypia are prone to develop endometrial carcinoma.

Endometrium is constantly engaged in the dynamics of shedding & regrowth during active reproductive life, it is controlled by rise & fall of pituitary hormones .Alterations in the fine tuning mechanism may result in a spectrum of disturbances & endometrial hyperplasia is most important among them. Arising Endometrial hyperplasia often preceeds the development of endometrial carcinoma. More recently, studies have found that the risk of endometrial hyperplasia is associated with increasing body mass index & nulliparity.1 In addition to this increasing obesity, anovulatory cycles & exogenous hormones are associated with endometrial & endometrial carcinoma both. The role of unopposed estrogen has been supported by many studies since high levels of estrogen has been found in the patients with endometrial carcinoma.2, 3

Endometrial hyperplasia is defined as a proliferation of glands of irregular size & shape with an associated increase in gland to stroma ratio compared with proliferative endometrium. The process is generally diffuse but it may be focal also. The WHO classification, presently the most widely used, is a four –tier classification system takes into the account both cytologic & architectural abnormalities.4

In the past the terms “adenomatous hyperplasia “ & “atypical hyperplasia “were used to denote proliferative lesions of the endometrium with varying degrees of architectural complexity & cytological atypia5, 6, 7, 8, 9 in addition, the term “carcinoma in situ” was proposed to describe small lesions, with or without glandular crowding, having the cytologic features of carcinoma but lacking invasion.7, 9, 10 We used WHO Classification in our study. In addition, a more recent epidemiologic study added further support for this simplified classification by showing that the only lesions that significantly increased the relative risk of carcinoma with atypical hyperplasia.11

WHO classification of endometrial hyperplasia

  1. Hyperplasia without atypia, Simple hyperplasia without atypia, Complex hyperplasia without atypia.

  2. Atypical hyperplasia, Simple (atypical hyperplasia), Complex atypical hyperplasia.

Patients with endometrial hyperplasia typically have abnormal bleeding. Occasionally the lesion is detected by endometrial biopsy performed during the course of infertility workup or before the start of hormonal therapy in post menopausal females. Hyperplasia usually appears as a result of unopposed estrogen use. And so most patients have a history of either persistent anovulation or exogenous unopposed estrogen usage. Though anovulation occurs at menarche & perimenopausal women, hyperplasia is not usually found in young women.

Aims & Objectives

  1. To study the Histopathological patterns of endometrial hyperplasia.

  2. To correlate endometrial hyperplasia with clinical parameters.

Materials and Methods

This is a hospital based study done in the department of pathology at a tertiary care hospital.

Study was conducted on 125 cases of endometrial hyperplasia which were re-evaluated and their relevant clinical details like menstrual history including age of menarche, date of last menstrual period, number of children, any history of abortions, age of menopause if occurred, any history of taking HRT and were recorded. Histological typing of endometrial hyperplasia by re-evaluating them under light microscopy & typing was done depending on the criteria used in WHO classification.

Results

Table 1

Spectrum of lesions

S. No.

Histopathology

No. of cases

%

1.

Endometrial hyperplasia

53

42.4

2.

Proliferative phase

21

16.8

3.

Secretory phase

26

20.8

4.

Hormonal effects

12

9.6

5.

Atrophic endometrium

09

7.2

6.

Irregular shedding with endometritis

04

3.2

Total

125

100

Table 2

Distribution of cases according to the type of endometrial hyperplasia

S. No.

Type of hyperplasia

No. of cases

%

1.

Simple hyperplasia

24

45.2

2.

Complex hyperplasia

06

11.3

3.

Simple hyperplasia with atypia

14

26.4

4.

Complex hyperplasia with atypia

09

17

Total

53

100

Table 3

Age distribution in patients with endometrial hyperplasia

S. No.

Age of the patient

Total

%

1.

21-30yrs

02

4%

2.

31-40yrs

22

42%

3.

41-50yrs

21

39%

4.

> 50yrs

08

15%

53

Table 4

Distribution of cases according to clinical complains

S. No.

Clinical complains

No. of cases with Endometrial Hyperplasia

%

1

Menorrhagia

88

70

2

Post menopausal bleed

17

14

3

Continuous bleed

18

15

4.

Others

02

1

Figure 1

Pictomicrograph of the section showing endometrial glands in proliferative phase (H&E 10X)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/8891c33e-a763-4bac-bca9-c22eda645c1dimage1.png
Figure 2

Pictomicrograph of the section showing of endometrial glands in secretory phase (H&E 10x)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/8891c33e-a763-4bac-bca9-c22eda645c1dimage2.png
Figure 3

Pictomicrograph of the section showing of endometrial glands with simple hyperplasia (H&E 10x)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/8891c33e-a763-4bac-bca9-c22eda645c1dimage3.png
Figure 4

Pictomicrograph of the section showing of endometrial glands with complex hyperplasia without atypia (H&E 10x)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/8891c33e-a763-4bac-bca9-c22eda645c1dimage4.png
Figure 5

Pictomicrograph of the section showing endometrial glands with complex hyperplasia with atypia (H&E 10X)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/8891c33e-a763-4bac-bca9-c22eda645c1dimage5.png

Discussion

Endometrial hyperplasia is the most common gynaecological disorder, it is due to unopposed estrogen stimulation. Endometrial assessment is performed to diagnose malignant & premalignant conditions & to evaluate the hormonal influences on the endometrium. In this study a total of 125 cases were assessed.

In our study 53 cases presented with endometrial hyperplasia followed by secretory phase, then proliferative phase, 9cases presented with atrophic endometrium & four of them had irregular shedding with endometritis.

Out of 53 patients 24 (45%) patients presented with simple hyperplasia, 14 patients had simple hyperplasia without atypia, 9 presented with complex hyperplasia without atypia followed by 6 patients having complex hyperplasia without atypia.

The peak incidence of endometrial hyperplasia was noted in 3rd and 4th decade followed by 5th decade with only 2 patients lying in the age group of 21 to 30 years.

Gusberg & Kaplan 12 in their study (1963) of 191 cases the peak incidence of endometrial hyperplasia was noted in 4th decade followed by 5th decade.

The most common clinical complain in our study was menorrhagia followed by continuous bleeding, post menopausal bleeding in 17 patients our results were in concordance with the studies of Takreem et al.

Takreem et al 13 also found out that menorrhagia is the commonest complain in endometrial hyperplasia (53.3%) which is in concordance with our study that is 66.6%.

Conclusion

It is very important to know the histopathological pattern of endometrium especially the hyperplasia going in them and their correlation with clinical parameters .Since early and proper recognition of these conditions helps in the proper management, treatment avoid landing up of the patients into further complications.

Conflict of Interest

The authors declare that there are no conflicts of interest in this paper.

Source of Funding

None.

References

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2 

LA Brinton ML Berman R Mortel LB Twiggs RJ Barrett GD Wilbanks Reproductive, menstrual, and medical risk factors for endometrial cancer : results from a case -control studyAm J Obstect Gynecol1992167513172510.1016/s0002-9378(11)91709-8

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M Mckenna W G Mccluggage Signet ring cells of stromal derivation in the uterine cervix secondary to cauterization: report of a previously undescribed phenomenonJ Clin Pathol20086156485110.1136/jcp.2007.054767

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WG Mccluggage E Oliva CS Herrington CD10 and calretinin staining of endocervical glandular lesions, endocervical stroma and endometrioid adenocarcinomas of the uterine corpus: CD10 positivity is characteristic of, but not specific for, mesonephric lesions and is not specific for endometrial stromaHistopathology20034321445010.1046/j.1365-2559.2003.01684.x

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A Takreem N Danish S Razaq incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/menorrhagia in perimenopausal womenJ Ayub Med Coll Abbottabad200821s2603



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Article type

Original Article


Article page

187-190


Authors Details

Upasana Uniya, Archana Shrivastava, Tina Rai, G.S Rai


Article History

Received : 05-07-2021

Accepted : 05-08-2021

Available online : 16-09-2021


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