Evaluation of endometrium for chronic endometritis by using syndecan-1 in abnormal uterine bleeding
Vidyavathi Kannar1, Harendra Kumar Malligere Lingaiah, Venigalla Sunita
1Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs University, Tamaka, Kolar, India.
Insights
Syndecan-1 aids in diagnosing chronic endometritis in abnormal uterine bleeding (AUB) cases. This immunohistochemistry marker is useful when plasma cells are difficult to identify histologically in endometrial biopsies.
Area of Science:
- Gynecologic Pathology
- Reproductive Medicine
- Immunohistochemistry
Background:
- Chronic endometritis affects 3-10% of women with abnormal uterine bleeding (AUB).
- Histological diagnosis relies on identifying plasma cells in endometrial biopsies.
- Plasma cell identification can be challenging due to overlapping histological features.
Purpose of the Study:
- To evaluate the diagnostic utility of syndecan-1 for chronic endometritis in AUB patients.
- To correlate secondary histological features with plasma cell presence via immunohistochemistry (IHC).
Main Methods:
- Fifty endometrial biopsies from AUB patients were analyzed.
- Immunohistochemistry (IHC) using syndecan-1 was performed.
- Statistical analysis correlated histological features with plasma cell presence (P < 0.05).
Main Results:
- Plasma cells were detected in 69% of disordered proliferative endometrium and 66% of proliferative endometrium with breakdown.
- Stromal breakdown showed a significant association with plasma cells (P = 0.02).
- Glandular irregularity, stromal edema, and spindled stroma did not significantly correlate with plasma cells.
Conclusions:
- Plasma cells are significantly present in AUB patients.
- Syndecan-1 may assist in diagnosing chronic endometritis in challenging cases of AUB.
- Accurate diagnosis of chronic endometritis is crucial for managing abnormal uterine bleeding.
Context:
Chronic endometritis is a condition observed in 3-10% of women with abnormal uterine bleeding (AUB). Diagnosis depends upon the histological detection of plasma cells within the inflammatory infiltrate in the endometrium. Plasma cells on H and E may be obscured by a mononuclear infiltrate, plasmacytoid stromal cells, abundant stromal mitosis, a pronounced predecidual reaction, menstrual features or secondary changes due to exogenous progesterone treatment prior to biopsy.
Aims:
The objective of this study was to determine utility of syndecan-1 in diagnosis of chronic endometritis in patients with AUB, and to see if any of the secondary histologic features in endometrial biopsy, correlated with the presence of plasma cells on immunohistochemistry (IHC).
Materials And Methods:
Fifty endometrial biopsies with a clinical diagnosis of AUB were taken. Endometrium in proliferative phase, secretory phase, endometrial polyps, and disordered proliferative endometrium were studied for the presence of plasma cells. IHC was done using syndecan-1. The secondary histologic features of chronic endometritis like gland architectural irregularity, spindled stroma, stromal edema and hemorrhage with the presence of plasma cells was statistically analysed. Values of P < 0.05 were considered as significant.
Results:
Plasma cells were seen in 11 (69%) of DPE, 8 (66%) of PEB, and 1 (7%) of normal proliferative endometrium and in 2 (40%) of secretory endometrium. Presence of stromal breakdown showed a significant association with plasma cells (P = 0.02) whereas gland architecture irregularity (P = 0.28), stromal edema (P = 0.71) and spindled stromal (P = 0.72) did not show a significant association.
Conclusions:
Plasma cells were significantly present in AUB patients. Syndecan-1 maybe helpful in unusual cases, where chronic endometritis is suspected as the cause of clinically significant ongoing abnormal bleeding.
