HISTOPATHOLOGICAL FINDINGS IN HYSTERECTOMIES DONE FOR ABNORMAL UTERINE BLEEDING

Rupali Awale*, Roma Isaacs, Kavita Mandrelle and Shavinder Singh

ABSTRACT

Background: Abnormal uterine bleeding is the bleeding from uterus, abnormal either in amount, duration,frequency, regularity or in its relation to menstruation in the absence of any palpable or detectable pelvic pathology. Hysterectomy is done in situations where medical management can no longer be used. The underlying pathology causing bleeding is categorised as per the FIGO PALM-COEIN guidelines. Material and Methods: The study was conducted at a tertiary care Hospital over a period of two and half years. During this period one hundred and six hysterectomies with clinical indication of abnormal uterine bleeding (AUB) were included in the study. The specimens were received in 10% formalin saline, macroscopic findings noted. Representative sections were taken. Tissue processed, paraffin blocks made, staining done, histopathology findings noted and data analyzed. Results: About 11.5% (106/915) of total hysterectomies were done with clinical indication of abnormal uterine bleeding. Patients’ age ranged from 28 to 58 years; mean 43.7 ± 6.4 years. On histopathological examination 64(60.4%) cases had identifiable cause of bleeding while it was not found in 42(39.6%) cases. Of the cases with identifiable causes abdominal approach was preferred in all 64(100%) cases; adnexae were removed in 52(81.2%) patients. Identifiable causes were adenomyosis in 31(48.4%), leiomyoma in 22(34.3%). About 19(29.6%) cases had dual pathology of leiomyoma and adenomyosis. If the leiomyoma was small or single then bleeding was attributed to adenomyosis. Polyp was seen in 5(7.8%). Other causes included were chronic endometritis in (6; 9.3%) and ovarian malignancy in 1 (1.5%) case. Conclusions: Patients with abnormal uterine bleeding should be thoroughly investigated for coagulation, ovulation and endometrial lesions as no histopathological lesion is detectable in these cases while with detectable lesion adenomyosis and leiomyoma were the most common non neoplastic and neoplastic lesions respectively.

Keywords: Abnormal uterine bleeding, Adenomyosis, Histopathology, Hysterectomy, Leiomyoma.