Keywords : Abnormal Uterine Bleeding

The Frequency of Histopathological Patterns in Endometriam Obtained from a Sample of Iraqi Women with Abnormal Uterine Bleeding

Farah Falah Hassan

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3846-3856

background: Abnormal uterine bleeding is one of the most common and challenging problems to the gynecologist regardless of the age of the women. Histopathological evaluation of endometrium regarded as an important step in the diagnosis and management of endometrial causes of Abnormal Uterine Bleeding.
Objective: To study the frequency of different histopathological patterns of endometrium in women with abnormal uterine bleeding across different age groups.
Materials and methods: A retrospective age specific comparative analysis was done using a total number of women (85) presenting with abnormal uterine bleeding who underwent endometrial sampling during one year period from January 2015 to march 2016 in the pathology department of AL elwia teaching hospital. Endometrial curettages done for evaluation of products of conception were excluded. Endometrial samples were sent for histopathological examinations and different histological patterns were noted.
Results: Abnormal uterine bleeding was found to be more frequent in women in age 41 to 60 years and less frequent in the age over 60 years. The most common histopathological feature present in the curetting materials of women with abnormal uterine bleeding was inadequate proliferative endometrium (which belong to inorganic cause of AUB*dysfunctional*) in both age group 20 to 40 years and 41 to 60 years, and represent (44.7%) of total samples, while none of the samples in women over 60 years showed inadequate proliferative endometrium. Endometrial carcinoma was diagnosed in five samples, representing (5.88%) of all samples, all were of grade I endometriod type and all were in the age group 41 to 60 years which represent (8.62% ) of all the samples in this age group. Only one sample (1.17%) showed malignant mixed Mullerian tumor. Regarding endometrial hyperplasia, 14 were simple hyperplasia without atypia representing 16.47% of all samples, all were without atypia, while only one sample (1.17%) showed complex atypical hyperplasia .This study also showed that 15 samples (17.64%) were due to endometrial polyps. Two samples (2.35%) showed irregular secretory endometrium. Three samples (3.52%) showed histological evidence of exogenous hormone administration, while six samples (7%) were not conclusive.
Conclusions: Abnormal uterine bleeding in women below 60 years old is most commonly dysfunctional in origin. In addition, a good number showed underlying organic pathology, thus highlighting the importance of endometrial curettage and biopsy as a diagnostic procedure in the evaluation of women (particularly over 40 years old) with abnormal uterine bleeding for an early detection of ominous lesions such as endometrial adenocarcinoma and its precursors since histopathological findings of endometrium regarded as the main basis of management desescin