ENDOMETRIAL PATHOLOGICAL CHANGES IN PERIMENOPAUSE AND POSTMENOPAUSE - ASSOCIATION WITH SOME ANAMNESTIC AND ULTRASONOGRAPHIC PARAMETERS

  • Ana Kocevska Specialized Hospital for Gynecology and Obstetrics “Mother Teresa” , Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Dimche Zafirov Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Gordana Petrushevska Institute of Pathology, Faculty of Medicine , Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Bashkim Ismaili Specialized Hospital for Gynecology and Obstetrics “Mother Teresa” – Skopje, R. North Macedonia
  • Kristina Skeparovska Specialized Hospital for Gynecology and Obstetrics “Mother Teresa” – Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Dimitar Georgiev Specialized Hospital for Gynecology and Obstetrics “Mother Teresa” – Skopje, R.North Macedonia
  • Shenol Tahir University Clinic for Surgical Diseases "St. Naum Ohridski" - Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Tosho Plasheski University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia

Abstract

 Atypical endometrial hyperplasia is preneoplastic condition that precedes endometrioid adenocarcinoma. Postmenopausal women should not have bleeding; the thickness of the endometrium is normally below 5 mm and if it is above, the presence of a polyp, hyperplasia or cancer is suspected. To determine the histopathological changes of the endometrium, the prevalence of functional and organic changes and their association with history of previous childbirths and abortions, presence of bleeding, intensity of bleeding, anteroposterior uterine diameter and endometrial thickness. The study was performed in the Specialized Hospital for Gynecology and Obstetrics "Mother Teresa" - Skopje and involved a total of 120 respondents who underwent fractionated explorative curettage due to a medical indication. They were divided into 2 groups: with functional and organic changes of the endometrium. Ultrasonographic measurement of anteroposterior diameter of uterus and endometrial thickness was performed. The prevalence of functional changes was 30% and of organic changes 70%. The most common histopathological diagnosis was an endometrial polyp (45% of women). The mean value of endometrial thickness was 7.9 mm in the functional changes group and 13.6 mm in the organic changes group; this difference was statistically significant (p <0.0001). Perimenopausal patients had a significantly longer duration of bleeding than those in postmenopause (p = 0.0009). Endometrial adenocarcinoma was present in 3% of perimenopausal and in 5% of postmenopausal patients. Endometrium was significantly thicker in women with organic changes than in those with functional changes. Perimenopausal patients had a significantly longer duration of bleeding, more intensive bleeding, thicker endometrium and greater anteroposterior uterine diameter than those in postmenopause.


  Keywords: fractionated explorative curettage, endometrial thickness, uterine bleeding.


https://doi.org/10.55302/JMS2251028k

References

1. Droegemueller W, Katz V. Diagnostic procedures. In: Stenchever MA, Droegemueller W, Herbst AL, Mishell DR, Jr, eds. Comprehensive gynecology. 4th ed. St. Louis: Mosby; 2001: 219-49.
2.Butler WJ. Normal and abnormal uterine bleeding. In: Rock JA, Jones HW, III, eds. Te Linde’s operative gynecology. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003: 457-81.
3. Caron C, Tetu B, Laberge P, et al. Endocervical involvement by endometrial carcinoma on fractional curettage: A clinicopathological study of 37 cases. Mod Pathol 1991; 4:644-7.
4. Spencer CP, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynecol 1999; 106:623-632.
5. Dilation and Curettage. Standard of care. Available at: https:// https://standardofcare.com/dilation-and-curettage/]. Accessed on 08.04.2022.
6. What are the symptoms of menopause? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Available at: [htpp://nichd.nih.gov/health/topics/menopause/conditioninfo/Pages/symptoms.aspx]. Accessed on: 08.04.2022.
7. Clarke MA, Long BJ, Del Mar Morillo A, et al. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018;178(9):1210–22.
8. Pernick N. Dysfunctional uterine bleeding. PathologyOutlines.com website. Available at: https://pathologyoutlines.com/topic/uterusdub.html]. Accessed on 08.04.2022.
9. Radiology Reference Article – Radiopaedia.org – Endometrial thickness. Available at: http://radiopedia.org/articles/endometrial-thickness]. Accessed on 08.04.2022.
10. Sheth S, Hamper UM, Kurman RJ. Thickened endometrium in the postmenopausal woman-sonographic-pathologic correlation. Radiology 1993; 187:135-9.
11.Goldschmit R, Katz Z, Blickstein I, et al. The accuracy of endometrial Pipelle sampling with and without sonographic measurement of endometrial thickness. Obstet Gynecol 1993; 82:727-730.
12. Ilic-Forko J. Hiperplazija endometrija. In: Corusic A, Babic D, Shamija M, Shobat H, editors. Ginekoloska onkologija. Medicinska Naklada Zagreb; 2005.p 225-228.
13. Kurman RJ CM, Herrington CS, et al. WHO Classification of Tumours of Female Reproductive Organs. Lyon: International Agency for Research on Cancer; 2014.
14. Setiawan VW, Yang HP, Pike MC, McCann SE et al. Type I and II endometrial cancers: have they different risk factors? J Clin Oncol 2013; 31: 2607-18.
15.Defining Cancer. National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer]. Accessed on 09.04.2022
16. International Agency for Research on Cancer. World Cancer Report 2014. World Health Organization. Chapter 5.12.
17. Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG, eds. "Endometrial Cancer". Williams Gynecology (2nd ed.). McGraw-Hill. 2012; p. 817.
18. Стојовски М. Ендометријален канцер, Во: Антовска В. Стојовски М, Гинекологијa учебник наменет за студенти по медицина, специјализанти по гинекологија и акушерство и специјалисти гинеколози-акушери. Скопје; 2016, стр: 796-805.
19. Castaneda N. Sonographic Presentation of Endometrial Carcinoma Stage I: A Case Study. Journal of Diagnostic Medical Sonography 2018, Vol. 34(4) 292–7.
20. Hileeto WF, Fadare O, Martel M, Zheng W. Age dependent association of endometrial polyps with increased risk of cancer involvement. World J Surg Oncol 2005;3(1):8.
21. Стојовски М. Бенигни лезии на горен дел од генитален тракт. Во: Антовска В. Стојовски М, Гинекологијa учебник наменет за студенти по медицина, специјализанти по гинекологија и акушерство и специјалисти гинеколози-акушери. Скопје; 2016, стр: 771-84.
22. Goldstein SR, Monteagudo A, Popiolek D, et al. Evaluation of endometrial polips. Am J Obstet Gynecol 2002;186(4):669-74
23. Reslova T, Tosner J, Resl M, et al. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999;262:133-9.
24. Lieng M, Istre O, Qvigstad E. Treatment of endometrial polyps: a systematic review. Acta Obstet Gynecol Scand 2010;89:992-1002.
25. Abdelazim IA, Aboelezz A, Abdulkareem AF. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turkish German Gynecol Assoc. 2013;14(1):1-5.
26. Demirkiran F, Yavuz E, Erenel H, et al. Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obstet. 2012;286(5):1277-82.
27. Hwang WY, Suh DH, Kim K, et al. Aspiration biopsy versus dilatation and curettage for endometrial hyperplasia prior to hysterectomy. Diagnostic Pathology 2021; 16(1): 7
28. Sherman ME, Mazur MT, Kurman RJ. Benign diseases of the endometrium. In: Kurman RJ, editor. Blaustein’s pathology of the female genital tract. New York: Springer-Verlag; 2002. п.421-6.
29. Yuksel S, Tuna G, Goksever Celik H, Salman S. Endometrial polyps: Is there prediction of spontaneous regression possible? Obstet Gynecol Sci 2021;64(1):114-21.
30. Fernandez-Parra J, Rodriguez Oliver A, Lopez Criado S, et al. Hysteroscopic evaluation of endometrial polyps. Int J Gynaecol Obstet 2006;95(2): 144-8.
31. Ferazzi E, Zupi E, Leone FP, et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol 2009 Mar;200(3):235.e1-6.
32. Kurman RJ. Blaustein’s pathology of the female genital tract, 5th edition. New York: Springer – Verlag; 2002.
33. Mazur MT, Kurman RJ. Diagnosis of endometrial biopsies and curettings. New York: Springer Science + Business Media; 2005.
34. Milosevic J, Dzordzevic B, Tasic M. Uticaj menopauzalnog statusa na ucestalost i patohistoloske karakteristike hiperplazije i carcinoma endometrijuma kod bolesnica sa nenormalnim uterusnim krvarenjem. Acta Medica Medianae 2008;47(2):33-7.
35. Albers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Physician 2004 Apr 15;69(8):1915-26.
36. Schindler AE. Progesteron deficiency and endometrial cancer risk. Maturitas 2009; 62:334-7.
37. Goldstein SR. The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium. Am J Obstet Gynecol. 2009;201:5-11.
38. Elsandabesee D, Greenwood P. The performance of Pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynecol 2005;25:32-4.
39. Smith-Bindman R, Kerlikowske K, Feldstein VA, et al, Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. J Am Med Assoc. 1998;280:1510-7.
40. Tinelli R, Tinelli FG, Cicinelli E, et al. The role of hysteroscopy with eye-directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menopause 2008 Jul-Aug;15(4Pt1):737-42.
41. Abnormal vaginal bleeding in pre- and peri-menopausal women. A diagnostic guide for General Practitioners and Gynaecologists. Available at: [http://canceraustralia.gov.au/sites/default/files/publications/ncgc-vaginal-bleeding-flowcharts-march-20111_504af02038614.pdf]. Accessed on 09.04.2022.
42. Smith P, Bakos O, Heimer G, Ulmsten U. Transvaginal ultrasound for identifying endometrial abnormality. Acta Obstet Gynecol Scand. 1991;70:591–4.
43. Kupfer MC, Schiller VL, Hansen GC, Tessler FN. Transvaginal sonographic evaluation of endometrial polyps. J Ultrasound Med. 1994;13:535–9.
44. Serna Torrijos MC, de Merlo GG, Gonzalez Mirasol E, et al. Endometrial study in patients with postmenopausal metrorrhagia. Arch Med Sci 2016; 12(3):597-602.
45. Doraiswami S, Johnson T, Rao S, et al. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India. 2011 Aug; 61(4):426-30.
Published
2022-05-04
How to Cite
KOCEVSKA, Ana et al. ENDOMETRIAL PATHOLOGICAL CHANGES IN PERIMENOPAUSE AND POSTMENOPAUSE - ASSOCIATION WITH SOME ANAMNESTIC AND ULTRASONOGRAPHIC PARAMETERS. Journal of Morphological Sciences, [S.l.], v. 5, n. 1, p. 28-38, may 2022. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol5no1-4>. Date accessed: 03 dec. 2022.
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Articles