Kumari Anita, Pankaj Sangeeta, Choudhary Vijayanand, Kumari Jaya, Nazneen Syed, Kumari Anjili, Suman Sanjay Kumar, Kumar Shishir
1Gynecological Oncology, RCC, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar 800014 India.
2Pathology, IGIMS, Patna, India.
J Obstet Gynaecol India. 2019 Oct;69(Suppl 2):171-176. doi: 10.1007/s13224-018-1166-9. Epub 2018 Aug 21.
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.
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.
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.
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.
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.
异常子宫出血可定义为出血模式在频率、持续时间和出血量上与正常月经周期或绝经后观察到的模式不同。
本研究的目的是（1）确定围绝经期和绝经后妇女异常子宫出血的不同良性、癌前和恶性病因，以及（2）找出这些妇女子宫内膜和宫颈的不同组织病理学模式。
这是一项在妇科肿瘤门诊对100例患者进行的前瞻性研究。临床检查后进行巴氏涂片和宫颈活检，然后将患者送去进行腹部和盆腔超声检查。如果子宫内膜厚度相对于年龄增加，则进行子宫内膜活检。围绝经期妇女子宫内膜厚度的临界值为11毫米，绝经后妇女为4毫米。所有组织标本均送去进行组织病理学检查。
共评估了100名妇女，其中50%为围绝经期年龄组，50%为绝经年龄组。47%的病例存在宫颈病变，26%的妇女存在子宫肌瘤和子宫腺肌病等子宫体器质性病因，24%的病例可见子宫内膜增厚，仅3例有子宫内膜息肉。在本研究中，良性病例的发生率为49%，癌前病例为9%，恶性病例为42%。在42例恶性病例中，37例（88.09%）为宫颈癌，3例（7.14%）为子宫内膜癌，1例（2.38%）为外阴癌，1例为子宫肉瘤。关于子宫内膜的组织学，34.48%为单纯性增生无异型性，20.68%为非典型增生和分泌期子宫内膜，10.34%为子宫内膜癌。组织学上，94.59%的宫颈癌为鳞状细胞癌，5.40%为腺癌。
对围绝经期和绝经后出血病例的评估区分了子宫体、子宫内膜和宫颈的癌前和恶性病变。由于我们中心是比哈尔邦的区域癌症中心，我们中心恶性病变的发生率较高。
