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Published on: May 23, 2014
Spectrum of Histopathological Changes in Abnormal Uterine Bleeding with Estrogen and Progesterone Receptor Expression
Reeta Mohan1,2, Anand Mohanraj2, Anita Ramdas2
1Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
Background:
Abnormal uterine bleeding (AUB) is a common gynecological condition where there is an altered expression of estrogen receptors (ERs) and progesterone receptors (PRs) in the endometrium which may have a role in the etiology of abnormal bleeding.
Objectives:
The objective of the study was to study the histopathological findings of endometrium and expression of estrogen and PRs in the endometrium in patients with AUB.
Materials And Methods:
All endometrial tissue from curettage and hysterectomy specimens of patients presenting to our Institution with complaints of AUB were included from November 2019 to November 2020 (prospective) and November 2015 to October 2019 (retrospective). This comprised a study population of 380 patients in the reproductive age group. The samples were evaluated for the spectrum of endometrial histopathological changes. Fifty-eight cases of endometrial hyperplasia and seven cases of endometrial adenocarcinoma were selected for immunohistochemical testing of ER and PR expression status. The IHC-stained slides were assessed for positive staining and intensity. The intensity of nuclear staining of ER and PR was graded in the epithelium and the stroma. H scores were calculated taking both the intensity and percentage of stained cells into account. The results were statistically analyzed by SPSS version 20, P < 0.05 was considered significant.
Results:
AUB was more prevalent among age group 41-50 years. The predominant pattern observed was secretory and proliferative endometrium. Of the 58 nonatypical hyperplasia, 51 patients showed positive nuclear staining with moderate-to-high intensity of ER and PR in both epithelium and stroma. Among seven endometrial adenocarcinomas, five cases were Grade I, one case was Grade II, and one case was of a serous papillary adenocarcinoma. Of the five Grade I adenocarcinomas, 3 out of 5 had absent and the rest showed mild-to-moderate ER expression; while 2 out of 5 had absent and the rest showed moderate-to-high PR expression. Grade II adenocarcinoma showed negative ER and PR expression. Serous papillary-type carcinoma also showed negative expression.
Conclusion:
Endometrial carcinoma showed reduced hormonal expression compared to endometrial hyperplasia.
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