Histopathological spectrum of uterine lesions in perimenopausal and postmenopausal women: A retrospective study

 

 

Abstract              Background: This study was done to investigate various endometrial causes of abnormal uterine bleeding that comes to our hospital and its incidence mainly in the perimenopausal and postmenopausal females. Methodology: There were 166 cases submitted for HPE of uterine lesions including 140 cases of hysterectomy specimen,18 cases of endometrial biopsy,8 cases of cervical biopsy in a age of 41-80 years female patients. Results: In present study histological examination revealed 11% cases of Adenomyosis which is the most common lesion of uterus in our study, that too in perimenopausal women, cases of Brenner tumour and mucinous cystadenocarcinoma of ovary found to be rare cases forming 2% in postmenopausal women, rest of the cases fall in between including benign and malignant cases. Conclusion: Benign and Malignant lesions of uterus are found to be common in both age group of patients that is (41-50 years) and (50 years and above) but malignant conditions are more prevalent in postmenopausal females as in our study.                          

Keywords: Uterine Lesions, Perimenopausal, Postmenopausal.

              

INTRODUCTION

Perimenopausal and post menopausal women have various uterine lesions due to hormonal changes, immunological and inflammatory response.¹ This is due to inflammatory response to mainly bacteria, candida, trichomoniasis and due to low socioeconomic status and ignorant behavior toward general hygiene.¹                         

 

MATERIAL AND METHODS

This is a retrospective study of women presenting with abnormal uterine bleeding and abdominal mass, in Histopathology section Department of Pathology at GRMC Gwalior over a period of one year i.e. May 2020 to June 2021. All hysterectomy specimens including endometrial and cervical biopsy were also taken in to this study. The specimen are processed, stained and subjected to microscopic examination to arrive at histopathological diagnosis. Out of 166 cases of uterine lesions which included 140 cases of hysterectomy specimen, 18 cases of endometrial biopsy and 8 cases of cervical biopsy in age ranged from 41 to 80 years including perimenopausal (41-49 years) and postmenopausal (50 years and above).

 

RESULT

In present study, the most common finding in endometrial lesion is adenomyosis and leiomyoma that is 11% and 9.30% cases respectively in perimenopausal and 12% and 7.50% respectively in postmenopausal females. We have concluded rest of the cases by graphical representation as below.                            

Figure 1: Uterine lesions (Perimenopausal females 41 to 49 years)

 

Figure 2: Uterine lesions (Postmenopausal women (50 years ans above))

 

Images related to common uterine lesion in present study.

Figure 3: leiomyoma(10x)             Figure 4: Adenomyosis(40x)

 

Figure 5: Endometrial hyperplasia without atpia(40x); Figure 6: Endometriod adenocarcinoma(40x)

 

 

 

DISCUSSION

Abnormal uterine bleeding is a major gynaecological problem, accounting for 33% of outpatient referrals, including 69% of referrals² in peri-menopausal and postmenopausal age group. One third of patients attending gynaecology OPD present with complaints of abnormal uterine bleeding.³ The menstrual disorders increases with age and in our study the most common finding in uterine lesions are adenomyosis (11%) and leiomyoma (9.30%) mainly in the perimenopausal women this was consistent with the findings of Smriti S. Dwivedi et al.⁴ and Dalia M badary et al.⁵ Chronic Endometritis was reported in 1.40% of cases in perimenopausal group which was comparable with study conducted by Sudhamani et al.⁶ who reported in 2.43%. In our study 1.40% of cases in perimenopausal group showed tuberculous endometritis comparable to study conducted by Rajshri et al.⁷ reported in 1.1% of cases. Endometrial hyperplasia is more common that is 5.50% cases in perimenopausal as compared to postmenopausal females These findings were similar to the findings described in a research done by Sujata j et al. 10.9%.⁸ In present study atrophic endometrium is very common, while 2.80%cases of endometrial carcinoma is also seen. Similarily M. B. Swami et al.⁹ observed 5.0%cases and Kavita et al.¹⁰ noticed 6.2% cases of endometrial carcinoma respectively. Stromal tumour were observed in 1.50%cases which was comparable with M. B. Swami et al.9 1.7%cases. In adnexal lesions, surface epithelial tumour of the ovary are the most common finding in present study.                                                                                                                     

 

CONCLUSION

There is an age specific association of uterine lesions so histopathological examination will pin point the exact cause of abnormal uterine bleeding and abdominal masses and will help in proper management at its earliest by proper diagnosis.

 

REFERENCES

• Rosai J. Rosai and ackerman’s surgical pathology. 9th ed. vol 2. New Delhi: Eelseiver, A division of Reed Elsevier, India Private limited; 2004. Female reproductive system – Uterus – corpus. In: Rosai J Ed. pp. 1569–635.
• Mencoglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med. 1987; 32: 577-582.
• Awwad JT, Toth TL, Schiff I: Abnormal Uterine Bleeding in the Perimenopause. International Journal of Fertility and Menopausal Studies. 1993;38(5):261-69.
• Smriti S.Dwivedi Etal spectrum of endometrial lesions observed on histopathological examination of endometrial samples in women with abnormal uterine bleeding October 2019International Journal of Research in Medical Sciences 7(11):4124 DOI:10.18203/2320-6012.ijrms20194978.
• Histopathological Spectrum of Abnormal Uterine Bleeding in Upper.Egypt: A Study of 676 Cases Dalia M Badary Etal Correspondence: Dalia M Badary, Pathology Department, Faculty of Medicine, Assiut University, Egypt, Tel: 01 066189050
• Sudhamani.S, Sunila ,Sirmukaddam S, AgrawalD. Clinicopathological study ofabnormal uterine bleeding in perimenopausal women. Journal of the Scienti
  c Society2015; 42(1) :2-6.                                                    
• Rajshri P. D, N.V. Dravid, Suryawanshi KH, Gadre AS, Bagale PS, and Ahire N. JClinDiagn Res. 2013 December; 7(12): 2774–2776
• Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases. J mid-life Health. 2013;4(4):216
• Swami MB, Sharma P. Histopathological evaluation of endometrium in pre and postmenopausal uterine bleeding. Indian Journal of Obstetrics and Gynaecology Research. 2015;2(4):264-
• Kavita Babbar K, Jogi S, Arya RC. Clinical pattern and spectrum of endometrial pathologies in perimenopausal and post-menopausal women: Experience in a tertiary care institute. JSAFOMS. 2015;3(1):9-1.

 

 

 

 

 

 

Policy for Articles with Open Access
Authors who publish with MedPulse International Journal of Anesthesiology (Print ISSN:2579-0900) (Online ISSN: 2636-4654) agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.