Histopathological study of endometrial lesions in tertiary care hospital

Objective : To study the clinico-pathological aspects and the histo-pathological patterns of endometrial lesions. Methodology: Study includes hysterectomy specimens, dilatation & curettage samples (D&C) andbiopsies, received to the department of pathology. Results : Total 542 endometrial samples were received in department of Pathology during September 2013 to September 2015. Out of 542 endometrial samples, 131 are endometrial lesions. Among 131 endometrial lesions, 115 are non-neoplastic while 16 are neoplastic lesions. Most common age group for non-neoplastic lesions is 41-50 years while for neoplastic lesions it is about 51-60 years. Adenomyosis the most common (11.99%) non-neoplastic lesion while endometrioid adenocarcinoma (46.67%) ismost common neoplastic lesion. Conclusion: In present study, non- neoplastic lesions were more common out of all endometrial lesions. Among neoplastic lesions malignant lesions were more common than benign lesions; histopathology is important for ensuring diagnosis and deciding management, particularlyfor malignant diseases.


Introduction
The internal cavity of the uterus is lined by the endometrium, composed of glands embedded in a cellular stroma [1]. The function of the normal endometrium is to produce a satisfactory substrate in which a healthy blastocyst may implant and flourish [2]. During active reproductive life, the endometrium is in a dynamic state of proliferation, differentiation and shedding, in the preparation for implantation of an embryo. This cycle is exquisitely controlled by the rise and fall of pituitary and ovarian hormones. Abnormalities in this system result in abnormal uterine bleeding. Various causes of abnormal uterine bleeding are chronic endometritis, endometrial polyps, sub mucosal leiomyoma's and endometrial neoplasms. The largest single group encompasses functional disturbances, referred to as dysfunctional uterine bleeding. "Dating" the endometrium by its histologic appearance is often used clinically to assess hormonal Manuscript received: 10 th October 2017 Reviewed: 20 th October 2017 Author Corrected: 28 th October 2017 Accepted for Publication: 1 st November 2017 status, document ovulation, and determine causes of endometrial bleeding and infertility [1,3]. Endometrial biopsy is a currently preferred alternative to dilatation and curettage [D&C] for the evaluation of infertile or dysmenorrheic patients.
In addition, this procedure has become the choice method for the initial approach to patients with suspected endometrial hyperplasia or carcinoma [4].
Accurate histopathological diagnosis is important in the management of endometrial conditions and lesions [5].

Results
Clinico-histopathological study of endometrium in 542 cases was done.

Total cases 542 100
The most common clinical presentation was increased PVB, seen in 343 (63.28%) cases followed by mass coming out of vagina in 131 (24.17%) cases, pain in abdomen in 52 (9.60%) cases, menorrhagia in 12 (2.22%) cases, white discharge per vagina in 2 (0.37%) cases and amenorrhea & irregular bleeding in 1 (0.18%) case each respectively.  Among 542 cases studied, excluding those cases that were not having any cyclical phase, most common cyclical phase observed was the secretory phase [ Fig.1 Fig.3B], cysto-glandular hyperplasia was seen in 1 (0.18%) case each respectively. There were 38 (7.01%) cases with inadequate samples.
All the 4 cases in the benign endometrial neoplasms category were adenomyoma found in 41-50 years age group with a common clinical presentation of raised PVB. Most common age group affected in malignant endometrial neoplasms was 51-60 (41.66%) years followed by 61-70 years (33.34%).

Discussion
The present study comprises the clinico-histopathological study of 542 endometrial cases, out of which 131 endometrial lesions (neoplastic & nonneoplastic) were studied in the department of pathology in a tertiary care hospital for a period of two years.
Out of 542 endometrial cases, 131 (24.16%) were organic lesions (115 neoplastic & 16 non-neoplastic) and the remaining were functional ones, similar observation were found by Vaidya S et al [6]. Nonneoplastic lesions were more common in the present study.
TAH was the most common surgical specimen received comprising 255 ( In the present study, the most common cyclical status was secretory phase seen in 172 (31.74%) cases similar observation was found in other study by Vaidya et al [6] followed by proliferative phase, seen in 151 (27.86%) cases. Atrophic endometrium was seen in 21.4% of cases in our study, near similar observation was found in other study by Gowari M et al [8]. In the present study, the most common clinical presentation was increased PVB (63.28%), similar observation was found in other study by Kartikeyan et al [9]. This is followed by mass coming out of vagina (24.17%), pain in abdomen (9.60%), similar observation were found in other study by Zill-E-Huma et al [10].
In the present study, the most common age group affected in non-neoplastic endometrial lesions was 41-50 years (47.83%), similar observation was found in other study by Tiwana K et al [11].
Out of 542 total cases, adenomyosis was the most common non-neoplastic endometrial lesion comprising 65 (11.99%), similar observation was found in other study by Kartikeyan et al [9]. This isfollowed by simple hyperplasia without atypia, comprising 18 (3.32%) cases.Similar observation was found in other studies by Pessoa et al [12]& Seda A et al [13].
In the present study of 542 total cases studied, there were 11 (2.02%) cases of endometrial polyps, similar observation was found in other study by Surti et al [14].  [17].

Original Research Article
Out of total 542 cases, 12 (2.21%) cases of endometrial malignancies were observed, similar observation was found in other studies by Pessoa et al [12] & Zill-E-Huma et al [10] In present study, most common type of endometrial malignancy was endometrioid adenocarcinoma comprised of 7 out of 12 (58.34%) cases, which was comparable with studies done by Himel B et al [19] and Deodhar KK et al [18].

Conclusion:
In present study, non-neoplastic lesions were more common out of all endometrial lesions. Among neoplastic lesions malignant lesions were more common than benign lesions. Histopathology is important for ensuring diagnosis and deciding management, particularly for malignant diseases.
All the authors have taken near equal efforts in design and concept of this manuscript, literature search, data acquisition and analysis and in overall preparation and editing of this manuscript.
In this molecular era of diagnosis, present study still helps in ensuring diagnosis of endometrial lesions in the rural based health care institutes, tertiary health care centres where adequate facilities are not available and in similar scenario in developing countries.