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21.08.2018 | Original Article

Ultrasonic and Histopathological Evaluation to Exclude Premalignant and Malignant Lesions in Perimenopausal and Postmenopausal Women Presenting as Abnormal Uterine Bleeding

Zeitschrift:
The Journal of Obstetrics and Gynecology of India
Autoren:
Anita Kumari, Sangeeta Pankaj, Vijayanand Choudhary, Jaya Kumari, Syed Nazneen, Anjili Kumari, Sanjay Kumar Suman, Shishir Kumar
Wichtige Hinweise
Dr. Anita Kumari is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Sangeeta Pankaj is an Additional Professor in Gynecological Oncology, RCC, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna; Dr. Vijayanand Choudhary is an Additional Professor, Pathology, IGIMS, Patna; Dr. Jaya Kumari is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Syed Nazneen is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Anjili Kumari is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Sanjay Kumar Suman is a HOD at Radiology, IGIMS, Patna; and Dr. Shishir Kumar is a Assistant Professor at Biostatics.

Abstract

Introduction

Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause.

Aim and Objective

The aim of this study was (1) to identify the different benign, premalignant and malignant conditions as the cause of abnormal uterine bleeding in perimenopausal and postmenopausal women and (2) to find out the different histopathological patterns of endometrium and cervix in these women.

Materials and Methods

This is a prospective study done in gynaecological oncology in 100 cases attending the OPD. Pap smear and cervical biopsy were done following clinical examination and then, the patients were sent for abdominal and pelvic ultrasound examination. Endometrial biopsy was done if endometrial thickness was increased with respect to age. The cut-off value of endometrial thickness in perimenopausal women was 11 mm, and for postmenopausal women, it was 4 mm, respectively. All the tissue specimens were sent for histopathological examination.

Result

A total of 100 women were evaluated in which 50% were in the perimenopausal age group and 50% in the menopausal age group. Cervical pathology was present in 47% of cases, organic cause of uterine body like fibroid and adenomyosis was present in 26% of women, and thickened endometrium was seen in 24% of cases and endometrial polyp in 3 cases only. In this study, the incidence of benign cases was 49%, premalignant 9% and malignant condition 42%, respectively. Out of 42 malignant cases, 37 (88.09%) were cervical cancer, 3 (7.14%) endometrial carcinoma, 1 (2.38%) vulval cancer and 1 sarcoma of uterus. With regard to histology of endometrium, 34.48% had simple hyperplasia without atypia, 20.68% hyperplasia with atypia and secretory endometrium, and 10.34% endometrial carcinoma. Histologically, 94.59% of cervical cancer was squamous cell carcinoma and 5.40% was adenocarcinoma.

Conclusion

Evaluation of cases of perimenopausal and postmenopausal bleeding differentiated premalignant and malignant lesions of the uterine body, endometrium and cervix. As our centre is a Regional Cancer Centre of Bihar, incidence of malignant lesions is higher in our centre.

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