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Correlation Between Hysteroscopic Findings and Histopathological Evidence of Chronic Endometritis in Reproductive Age
Ashu Rana1, Aruna Nigam1, Supriya Chaubey1
1Department of Obstetrics and Gynaecology (Drs. Rana, Nigam, Chaubey, Gupta, Roy, and Sharma), Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, New Delhi, 110062, India.
Study Objective:
To correlate 12 predefined hysteroscopic endometrial features with histopathological plasma cell grading (H&E) and dual immunohistochemical expression of CD138 and MUM-1 in reproductive-age women presenting with abnormal uterine bleeding (AUB), infertility, or recurrent pregnancy loss (RPL) at a tertiary care center in India, and to evaluate whether chronic endometritis (CE) prevalence differs across these 3 clinical indications.
Design:
Prospective cross-sectional observational study.
Setting:
Tertiary care academic hospital, New Delhi, India.
Patients:
Seventy consecutive women of reproductive age presenting with AUB (n = 40, 57.1%), infertility (n = 22, 31.4%), or RPL (n = 8, 11.4%), fulfilling predefined eligibility criteria, who underwent hysteroscopy with directed endometrial biopsy over 1.5 years.
Interventions:
Assessment of 12 predefined hysteroscopic features between days 7 to 11 of the menstrual cycle, followed by directed endometrial biopsy subjected to immunohistochemical (IHC) expression of CD138 (syndecan-1, a surface marker of fully differentiated plasma cells) and MUM-1 (IRF4, a nuclear marker active across late B-cell differentiation into plasma cells).
Measurements And Main Results:
CD138 positivity was identified in 90.0% of participants (low-grade 60.0%; high-grade 30.0%); MUM-1 in 74.3% (low-grade 50.0%; high-grade 24.3%). On H&E, Grade 1 plasma cell infiltration (PC-1) was present in 40.0% and Grade 2 in 14.3%. Micropolyps were significantly associated with Grade 2 plasma cell infiltration (PC-2) (p = .040; OR = 4.89, 95% CI 0.96-24.97) and CD138 high positivity (p = .019; OR = 3.63, 95% CI 1.20-10.94). Hysteroscopic evidence of endometrial hyperplasia correlated with PC-2 (p = .027; Cramér's V = 0.284). Localized hyperemia was associated with MUM-1 low positivity (χ² = 8.70, df = 2, p = .013). CE prevalence did not differ significantly across clinical subgroups (all p >.05). No granulomatous endometritis was identified.
Conclusions:
CE is common and equally prevalent across AUB, infertility, and RPL presentations at this center. Micropolyps and endometrial hyperplasia are the most informative hysteroscopic predictors of high-grade CE. CD138 is the more sensitive marker; MUM-1 adds complementary value by identifying earlier-stage B-lineage activation. Hysteroscopy with directed biopsy and dual CD138/MUM-1 immunohistochemistry is the recommended diagnostic approach.
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