Sentinel lymph node biopsy in early-stage endometrium cancer using methylene blue dye

Background: The nodal evaluation of early-stage carcinoma endometrium has evolved rapidly, with various methods and dyes explored for sentinel lymph node biopsy (SLNB). Our study specifically aims to investigate the utilization of 1% methylene blue in SLNB for carcinoma endometrium at our center.Methods: In our prospective study of 105 patients with early-stage CA endometrium in our center between June 2021 and August 2022, we used 1% methyl blue dye for SLNB identification. We followed each patient for a minimum of 6 months. We documented demographic characteristics, SLNB features, and postoperative outcomes.Results: Out of 105 patients,94 patients (93%) of the study population belong to clinical FIGO stage IA disease.82 patients (81%) had biopsy specimens that showed endometrioid variant grade 1, followed by grade 2 in 13 patients (12.9%). 82 patients (81.2%) had unilateral SLNB visualisation 48 patients( 47.5%) had bilateral visualization of nodes. 19 patients (18.8%) of the study population had negative visualization of nodes on both sides. The average number of sentinel nodes retrieved was 2 nodes in 48 patients (45.5%), with a false negative rate of 4%.Conclusion: In our study, using a 1% methylene blue dye for an SLNB in Ca endometrium showed less than 50% success in visualizing both sides. Therefore, we do not recommend using it as a standard method. However, in resource-limited settings where indocyanine green (ICG) and radiocolloid are not available, considering methylene blue as an alternative is a viable option provided the SLNB algorithm is followed.

Características clínicas en pacientes con menos de 12 folículos ováricos como hallazgo ecográfico / Clinical and ultrasound findings in patients with ovaries with a count of less than 12 follicles

Introducción y objetivos: Determinar los hallazgos clínicos y ecográficos en pacientes que presentan menos de 12 folículos ováricos. Método: Estudio observacional (cohorte histórica) con 505 pacientes seleccionadas mediante muestreo consecutivo, entre el 14 de enero del 2019 y el 15 de marzo del 2021, que consultan por diversas alteraciones ginecológicas. Se generan dos grupos de pacientes, las que presentaron uno a tres folículos en uno de los ovarios (n = 377) y las que presentaban 4 a 11 folículos (n = 128). Se midió como resultado primario la presencia de al menos un signo clínico de hiperandrogenismo. Resultados: De 505 pacientes analizadas, al comparar las que presentaron 4 a 11 folículos en uno de los ovarios (n = 377) con las que presentaban 1 a 3 folículos (n = 128), las primeras mostraron mayor presencia de signos de hiperandrogenismo, endometrio en fase lútea de mayor espesor y un patrón menstrual con uno a cuatro días de sangrado menstrual abundante, diferencias todas estadísticamente significativas (p < 0,05). Conclusión: En pacientes con 4 a 11 folículos en uno de sus ovarios, se observaron signos de hiperandrogenismo, similares al síndrome de ovario poliquístico.

Introduction and objectives: Determine the clinical and ultrasound findings in patients who present less than 12 ovarian follicles in the ultrasound count. Method: Observational study (historical cohort) with 505 patients selected by consecutive sampling, between January 14, 2019 and March 15, 2021, who consulted for different gynecological disorders. Two groups of patients were generated: those with 1 to 3 follicles in one of the ovaries (n = 377) and those with 4 to 11 follicles (n = 128). The primary outcome was the presence of at least one clinical sign of hyperandrogenism. Results: Of 505 patients analyzed, when comparing those who presented 4 to 11 follicles in one of the ovaries (n = 377) with those who presented 1 to 3 follicles (n = 128), the first group showed a greater presence of signs of hyperandrogenism, thicker endometrium in luteal phase and a menstrual pattern with one to four days of heavy menstrual bleeding, all differences were statistically significant (p < 0.05). Conclusion: In patients with 4 to 11 follicles in one of their ovaries, signs of hyperandrogenism, similar to polycystic ovary syndrome, were observed.

Histopathological spectrum in cases of abnormal uterine bleeding: a cross sectional study in tertiary care hospital in Tripura

Background: Majority women encounter abnormal uterine bleeding in their life where the causes are not limited to cancer even unknown. The actual cause has not been studied in north-east part of India. This data is scarce in State of Tripura. The present study aims to find out histomorphological patterns of AUB reported in AGMC & GBP Hospital in a calendar year. Methods: A cross sectional study was conducted over 2 calendar year from 2021 to 2022 where the cases of AUB irrespective of age, who had undergone endometrial biopsy, endometrial curettage and hysterectomy in Obstetrics and Gynaecology department, AGMC were examined histomorphologically in the dept of Pathology, AGMC. Data were collected in predesigned proforma and analysed using SPSS 21.0 and expressed in both descriptive and inferential statistics. Ethical approval was taken. Results: Total 220 cases of AUB specimens were examined. Among the reported AUB cases, the mean age is 42.5�42 year. Overall, 16.81% of the cases of AUB shows normal tissue pattern and 83.19% with abnormal endometrial tissue. Out of 220 sample of AUB, the commonest cause was leiomyoma (20.45%) followed by endometrial hyperplasia (17.27%), adenomyosis (14.54%), mixed tumour lesion (9.09%), endometrial carcinoma (4.54%) and 1.35% shows cervical cancer. Conclusions: Study concluded that In Tripura, majority AUB cases are due to leiomyoma, endometrial hyperplasia, adenomyosis and mixed inflammation indicating proper screening during reproductive stage of the women.

Outcome of office hysteroscopy in postmenopausal women with red flag signs: a single centre-based study from Northern Ireland

Background: Assessment of postmenopausal women with red flag signs like postmenopausal bleeding/ endometrial thickness ?5 mm is needed for early detection of any pathology. Early-stage endometrial cancer detection through office hysteroscopy is one of crucial modality for effective management. Objective was to assess the outcome of office hysteroscopy in postmenopausal women with red flag sign and correlated with histopathology findings. Methods: A prospective observational study at a single facility in Northern Ireland involving 122 post-menopausal women aged ?45 years subjected to AUB/increased endometrial thickness. Advance diagnostic examination by office hysteroscopy followed by histopathology to detect and rule out endometrial cancer and related ailments.Results: The mean age of the study population was 63.07±10.317 SD years and 91.8% were over-weight. 71.3% women had endometrial thickness <5 mm. Hysteroscopic reported for 8.2% (10 cases) endometrial cancers having diagnostic accuracy of 98.36%. The histological and hysteroscopic diagnoses were having significantly similar outcomes. Office hysteroscopy has 100% specificity and positive predictive value in detecting normal endometrium whereas 98.25% specificity and 100% negative predictive value in case for cancer detection.Conclusions: In Irish women, office hysteroscopy proved helpful in determining the pathologies that cause postmenopausal bleeding. Correlating hysteroscopic and histological findings with red flag indications should be the focus of future explorations.

Transcriptome Sequencing on Treatment of Kidney Deficiency and Blood Stasis-thin Endometrium in Rats with Bushen Huoxue Prescription Through Enema / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Bushen Huoxue enema in treating the rat model of kidney deficiency and blood stasis-thin endometrium （KDBS-TE） by transcriptome sequencing. MethodThe rat model of KDBS-TE was established by administration of tripterygium polyglycosides tablets combined with subcutaneous injection of adrenaline. The pathological changes of rat endometrium in each group were then observed. Three uterine tissue specimens from each of the blank group， model group， and Bushen Huoxue enema group were randomly selected for transcriptome sequencing. The differentially expressed circRNAs， lncRNAs， and miRNAs were screened， and the disease-related specific competitive endogenous RNA （ceRNA） regulatory network was constructed. Furthermore， the gene ontology （GO） functional annotation and the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment were performed for the mRNAs in the network. ResultCompared with the blank group， the model group showed endometrial dysplasia， decreased endometrial thickness and endometrial/total uterine wall thickness ratio （P<0.01）， and differential expression of 18 circRNAs， 410 lncRNAs， and 7 miRNAs. Compared with the model group， the enema and estradiol valerate groups showed improved endometrial morphology and increased endometrial thickness and ratio of endometrial to total uterine wall thickness （P<0.05）. In addition， 21 circRNAs， 518 lncRNAs， and 17 miRNAs were differentially expressed in the enema group. The disease-related specific circRNA-miRNA-mRNA regulatory network composed of 629 nodes and 664 edges contained 2 circRNAs， 34 miRNAs， and 593 mRNAs. The lncRNA-miRNA-mRNA regulatory network composed of 180 nodes and 212 edges contained 5 lncRNAs， 10 miRNAs， and 164 mRNAs. The mNRAs were mainly enriched in Hippo signaling pathway， autophagy-animal， axon guidance， etc. ConclusionBushen Huoxue enema can treat KDBS-TE in rats by regulating specific circRNAs， lncRNAs， and miRNAs in the uterus and the ceRNA network.

Effect of culture supernatant of human umbilical cord mesenchymal stem cells on survival,apoptosis and endometrium receptivity of human endometrial stromal cells after treated with mifepristone / 吉林大学学报(医学版)

Objective:To discuss the effect of human umbilical cord mesenchymal stem cells culture supernatant(hUCMSCs-Sup)on the proliferation,apoptosis,and endometrium receptivity of the human endometrial stromal cells(hEndoSCs)treated with mifepristone(Ms),and to clarify the possible mechanism.Methods:The hEndoSCs were cultured in vitro and divided into control group and 40,60,80,and 100 μmol·L-1 Ms groups.The survival rates of the cells in various groups were detected by MTT assay.The hEndoSCs were divided into control group,40 μmol·L-1 Ms group,and 60 μmol·L-1 Ms group.The apoptotic rates of the cells in various groups were detected by flow cytometry;the expression levels of apoptosis-related protein B-cell lymphoma-2(Bcl-2)and Bcl-2-associated X protein(Bax)proteins in the cells in various groups were detected by Western blotting method,and the ratio of Bcl-2/Bax was calculated.After treated with hUCMSCs-Sup,the hEndoSCs were divided into control group,Ms group,Ms+hUCMSCs-Sup group,and Ms+hUCMSCs-Sup+3-methyladenine(3-MA)group.The survival rates of the cells in various groups were detected by MTT assay;the apoptotic rates of the cells in various groups were detected by flow cytometry;the expression levels of microtubule-associated protein 1 light chain 3B-Ⅱ(LC3B-Ⅱ)and microtubule-associated protein 1 light chain 3B-I(LC3B-Ⅰ)proteins in the cells in various groups were detected by Western blotting method,and the ratio of LC3B-Ⅱ/LC3B-Ⅰwas calculated;the expression levels of endometrium receptivity marker molecules mRNA in the cells in various groups were detected by real-time fluorescence quantitative PCR(RT-qPCR)method.Results:Compared with control group,the survival rates of the cells in 40,60,80,and 100 μmol·L-1 Ms groups were significantly decreased(P<0.05)in a time-dependent and dose-dependent manner.Compared with control group,the apoptotic rates of the cells in 40 and 60 μmol·L-1 Ms groups were significantly increased(P<0.05),and the ratios of Bcl-2/Bax were significantly decreased(P<0.05).After treated with hUCMSCs-Sup,compared with control group,the survival rate of the cells and ratio of LC3B-Ⅱ/LC3B-Ⅰ in the cells in Ms group were significantly decreased(P<0.05),the apoptotic rate was significantly increased(P<0.05),and the expression levels of homeobox A10(HOXA10),leukemia inhibitory factor(LIF),and integrin subunit beta 3(ITGB3)mRNA in the cells were significantly decreased(P<0.05);compared with Ms group,the survival rate of the cells and ratio of LC3B-Ⅱ/LC3B-Ⅰin the cells in Ms+hUCMSCs-Sup group were significantly increased(P<0.05),the apoptotic rate was significantly decreased(P<0.05),and the expression levels of HOXA10,LIF,and ITGB3 mRNA in the cells were significantly increased(P<0.05);compared with Ms+hUCMSCs-Sup group,the survival rate of the cells and ratio of LC3B-Ⅱ/LC3B-Ⅰ in the cells in Ms+hUCMSCs-Sup+3-MA group were significantly decreased(P<0.05).Conclusion:hUCMSCs-Sup can increase the survival rate and decrease the apoptotic rate of the hEndoSCs after treated with Ms,and increase the endometrium receptivity,and its mechanism may be associated with the activation of autophagy of the hEndoSCs by hUCMSCs-Sup.

Anti-fibrosis Action of Therapy of Tonifying Kidney and Removing Stasis on Moderate-to-Severe Intrauterine Adhesions and Its Influence on Extracellular Matrix Degradation Related Factors in Menstrual Blood / 广州中医药大学学报

Objective To investigate the anti-fibrosis action of the therapy of tonifying kidney and removing stasis(shortened to Bushen Quyu method)on moderate-to-severe intrauterine adhesion and its influence on extracellular matrix degradation related factors in menstrual blood.Methods A total of 124 patients with moderate-to-severe intrauterine adhesions of kidney deficiency and blood stasis syndrome who were to undergo transcervical resection of adhesion(TCRA)were randomly divided into a study group and a control group,with 62 patients in each group.Both groups were given TCRA treatment.After the operation,the control group was treated with Progesterone + Estradiol Valerate Tablets,and the study group was treated with the combination of the Bushen Quyu method by using modified Guishen Decoction based on the treatment of the control group.The treatment covered 3 menstrual cycles.The changes in menstrual status,transvaginal color Doppler sonography parameters,scores of kidney deficiency and blood stasis syndrome,and scores of uterine adhesion in the two groups were observed before and after the treatment.Moreover,the two groups were observed before and after treatment in the changes of vascular endothelial growth factor(VEGF),transforming growth factor β1(TGF-β1),platelet-derived growth factor(PDGF),and connective tissue growth factor(CTGF)as well as the mRNA expression levels of matrix metalloproteinase 9(MMP-9),matrix metalloproteinase inhibitory factor 1(TIMP-1),phosphatidylinositol-3-hydroxykinase(PI3K)and collagen type I A1 protein(COL1A1).After treatment,the clinical efficacy and safety of the two groups were assessed.Results(1)After 3 menstrual cycles of treatment,the total effective rate in the study group was 93.55%(58/62),and that in the control group was 80.65%(50/62).The intergroup comparison showed that the therapeutic effect of the study group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the menstrual flow,menstrual cycle and menstrual period of the two groups were significantly improved compared with those before treatment(P＜0.05),and the recovery of menstrual flow,menstrual cycle and menstrual period in the study group was significantly superior to that in the control group after treatment(P＜0.05).(3)After treatment,the transvaginal color Doppler sonography parameters of uterine blood flow index(FI),pulsatility index(PI),resistance index(RI),uterine cavity volume,and endometrial thickness in the two groups were significantly improved compared with those before treatment(P＜0.05).And the study group had significantly higher FI,uterine cavity volume,and endometrial thickness and had lower PI and RI than the control group(P＜0.05 or P＜0.01).(4)After treatment,the scores of uterine adhesion and the scores of kidney deficiency and blood stasis syndrome in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the above scores in the study group were significantly lower than those of the control group after treatment(P＜0.01).(5)After treatment,the levels of VEGF,TGF-β1,PDGF,and CTGF in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the levels of the above cytokines in the study group were significantly lower than those in the control group after treatment(P＜0.01).(6)After treatment,the relative mRNA expression levels of MMP-9 and PI3K in the menstrual blood of the two groups were significantly higher and the mRNA expression level of COL1A1 was significantly lower than that before treatment(P＜0.05).And the study group had higher mRNA expression levels of MMP-9 and PI3K in the menstrual blood than the control group after treatment(P＜0.05 or P＜0.01).(7)The total incidence of adverse reactions in the control group was 25.81%(16/62)and that in the study group was 16.13%(10/62).The intergroup comparison showed that the difference between the two groups was not statistically significant(P＞0.05).The symptoms of adverse reactions in the two groups disappeared after symptomatic treatment,and there were no adverse reactions related to the medication of Chinese medicine during the study.Conclusion The combination of Bushen Quyu formula combined with western medicine is more effective than western medicine alone for the treatment of patients with uterine adhesions after TCRA.The application of Bushen Quyu formula can further promote the recovery of menstruation in the patients,improve the circulation of blood flow in the endometrium,increase the endometrial thickness,regulate the expression of fibrosis factors,up-regulate the mRNA expressions of PI3K and MMP-9,restore the balance of the extracellular matrix(ECM),and prevent the reoccurrence of intrauterine adhesions.And its clinical medication is safe.

Application of Allograft Endometriosis Rat Model in Pharmaco-dynamic Evaluation of GnRH Agonists / 实验动物与比较医学

Objective To establish an allogeneic rat model of endometriosis and to evaluate the effects of gonadotropin-releasing hormone (GnRH) agonist GenSci006 on experimental rat endometriosis. Methods Endometrium from SPF grade donor female SD rats were transplanted onto the abdominal wall of recipient female rats to construct an allogeneic endometriosis model. The rats undergoing sham surgery were divided into the sham group. Three weeks later, the length, width and height of the ectopic endometrium were measured, and the volume of the endometrium (V1) was calculated before drug administration. The modeling rats were randomly divided into four groups: model group, triptorelin group (0.25 mg/kg), GenSci006-1 group (0.125 mg/kg) and GenSci006-2 group (0.25 mg/kg). Each group had 16 rats and received a single dose of the corresponding drug. The sham group and model group were administered an equal volume of solvent. Three weeks after administration, ectopic endometrium was measured to calculate the volume V2 and inhibition rate. The effect of GenSci006 on rat uterus and ovarian tissues was assessed by comparing organ coefficients and changes in pathological sections. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of serum estradiol (E2), progesterone (P4), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Real-time fluorescent quantitative PCR was used to detect the expression of GnRH receptor (GnRHR) mRNA in the hypothalamus and pituitary. Western blot was used to detect the expression of estradiol receptor alpha (ERα), beta (ERβ) and progesterone receptor (PR) in ectopic endometrium. Results Three weeks after administration, compared with the model group, the body weight of rats in the triptorelin and GenSci006-2 groups significantly increased (P < 0.05), while the volume of ectopic endometrium significantly decreased (P < 0.05). Compared with the sham group, the model group showed no significant changes in uterine and ovarian organ coefficients or endometrial thickness (P > 0.05). Compared with the model group, the uterine organ coefficients and endometrial thickness were significantly reduced in the triptorelin and GenSci006-2 groups (P < 0.05). Compared with the sham group, the serum levels of E2, P4, FSH and LH in the model group showed no significant changes (P > 0.05). Compared with the model group, the ovarian organ coefficient and serum P4 levels of rats in the Triptorelin, GenSci006-1, and GenSci006-2 groups were significantly reduced (P < 0.05), while the serum LH levels of rats in the GenSci006-1 group were significantly increased (P < 0.05). However, there were no significant changes in serum E2 and FSH levels in each group (P > 0.05). Compared with the model group, the expression levels of GnRHR mRNA in the pituitary tissue of rats in the triptorelin and GenSci006-2 groups were significantly downregulated (P < 0.05), with no significantly changes in the hypothalamus (P > 0.05). There were no significant changes in the expression level of GnRHR mRNA in the hypothalamus or the protein levels of ERα, ERβ and PR in the ectopic endometrial tissue in any group (P > 0.05). Conclusion The allogeneic endometriosis rat model is a suitable animal model for screening and evaluating drugs for treating endometriosis. The volume of ectopic endometrium, inhibition rate, uterine and ovarian organ coefficients, and serum E2 levels may serve as indicators for detecting drug efficacy.

Yiqi Huoxue Formula （益气活血方） for Intrauterine Adhesion with Syndrome of Qi Deficiency and Blood Stasis： A Randomized Controlled Trial / 中医杂志

ObjectiveTo observe the effectivenss and safety of Yiqi Huoxue Formula （益气活血方） combined with surgery and sequential therapy of estrogen and progesterone for the treatment of intrauterine adhesion with syndrome of qi deficiency and blood stasis. MethodsSixty-four patients with intrauterine adhesions were recruited in Guang'anmen Hospital， China Academy of Chinese Medical Sciences during 1st June 2021 to 31st December 2022， and they were randomly divided into two groups， with 32 patients in each group， all receiving transcervical resection of adhesions （TCRA）. The control group was treated with sequential therapy of estrogen and progesterone after surgery， taking 1 tablet orally daily， estradiol tablets for the first 14 days， and estradiol dydrogesterone tablets for the last 14 days. In the treatment group， the postoperative treatment was combined with Yiqi Huoxue Formula on the basis of the treatment in the control group， and 1 dose was taken daily. The treatment course of both groups was 3 months. We observed the clinical effectiveness， syndrome scores of traditional Chinese Medicine （TCM）， endometrial thickness， uterine adhesion score， menstrual flow points， and the re-adhesion rate and pregnancy rate 3 months after the end of treatment of the two groups， and conducted evaluation on safety. ResultsThe total clinical effectiveness rates of the treatment group and the control group were 90.63% and 75.00%， respectively， significantly better in the treatment group （P＜0.05）. The endometrial thickness and menstrual flow of patients in both groups increased after treatment， and the scores of uterine adhesion and TCM syndrome scores decreased significantly （P＜0.05 or P＜0.01）. After treatment， the uterine adhesion score and TCM syndrome scores of the treatment group decreased significantly compared with the control group （P＜0.05）. The 6-month postoperative pregnancy rate in the treatment group was 37.50%， higher than the 12.50% in the control group （P＜0.05）. The re-adhesion rate was 3.13% in the treatment group and 9.38% in the control group， and the difference between the two groups was not statistically significant （P＞0.05）. No adverse events occurred in both groups. ConclusionYiqi Huoxue Formula combined with surgery and sequential therapy of estrogen and progesterone for treating intrauterine adhesion patients with syndrome of qi deficiency and blood stasis can promote endometrial recovery， increase menstrual flow， improve patients' clinical symptoms， and improve pregnancy rate， showing certain clinical effectiveness and safety.

Value of ultrasound monitoring of endometrial thickness in assessing pregnancy rate improvement after estrogen administration following a missed abortion / 中国基层医药

Objective:To analyze the clinical value of ultrasound monitoring of endometrial thickness in assessing pregnancy rate improvement after estrogen administration following a missed abortion.Methods:A retrospective study was conducted on 86 patients who underwent surgical abortion at Cixi Maternal and Child Health Hospital from January 2022 to June 2023. Based on the treatment received, the patients were divided into two groups: a control group and an observation group, with 43 patients in each group. The control group received only routine postoperative care without any medication, while the observation group received estrogen treatment after surgery. The clinical efficacy, endometrial thickness, intrauterine adhesion and re-pregnancy rate were compared between the two groups.Results:In the observation group, there was significant difference in endometrial thickness in terms of intergroup, group-by-time interaction, and time effect ( Fintergroup =129.49, Finteraction =14.25, Ftime =146.64, all P < 0.001). Intrauterine adhesions were less severe in the observation group compared with the control group ( χ2 = 4.34, P < 0.05). The clinical effective rate was significantly higher in the observation group than in the control group [88.37% (38/43) vs. 69.76% (30/43), Z = 2.35, P = 0.019]. Additionally, the rate of re-pregnancy was significantly higher in the observation group than in the control group [46.54% (20/43) vs. 13.95% (6/43), χ2 = 10.81, P < 0.05]. Conclusion:Patients who have retained abortion can benefit from ultrasound examination to assess endometrial thickness after estrogen administration. This approach significantly enhances endometrial thickness, promotes menstrual recovery, and reduces intrauterine adhesions. It also improves the rate of re-pregnancy and is highly valuable in clinical settings.

Robotic sentinel lymph node dissection experiences in endometrial cancer at our tertiary cancer treatment institution

SUMMARY OBJECTIVE: In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data. METHODS: Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024. RESULTS: In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36). CONCLUSION: After evaluating our data retrospectively, we determined that we were compatible with the current literature.

A randomized clinical trial of transdermal (gel) versus oral estrogen for endometrial preparation in frozen embryo transfer cycle

SUMMARY OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.

Identification of a rare copy number polymorphic gain at 3q12.2 with candidate genes for familial endometriosis

Abstract Endometriosis is a complex disease that affects 10-15% of women of reproductive age. Familial studies show that relatives of affected patients have a higher risk of developing the disease, implicating a genetic role for this disorder. Little is known about the impact of germline genomic copy number variant (CNV) polymorphisms on the heredity of the disease. In this study, we describe a rare CNV identified in two sisters with familial endometriosis, which contain genes that may increase the susceptibility and progression of this disease. We investigated the presence of CNVs from the endometrium and blood of the sisters with endometriosis and normal endometrium of five women as controls without the disease using array-CGH through the Agilent 2x400K platform. We excluded common CNVs that were present in the database of genomic variation. We identified, in both sisters, a rare CNV gain affecting 113kb at band 3q12.2 involving two candidate genes: ADGRG7 and TFG. The CNV gain was validated by qPCR. ADGRG7 is located at 3q12.2 and encodes a G protein-coupled receptor influencing the NF-kappaβ pathway. TFG participates in chromosomal translocations associated with hematologic tumor and soft tissue sarcomas, and is also involved in the NF-kappa B pathway. The CNV gain in this family provides a new candidate genetic marker for future familial endometriosis studies. Additional longitudinal studies of affected families must confirm any associations between this rare CNV gain and genes involved in the NF-kappaβ pathway in predisposition to endometriosis.

Histopathological examination of endometrium in menorrhagia patients

Introduction: Menorrhagia is one of the commonest clinical conditions for which patients seek advice in the gynecological outpatient department. Aim and objectives of study: To determine the prevalence of various histopathological changes, patterns and lesions of endometrium associated with menorrhagia in the women of different age groups; to describe the morphological features of various lesions of endometrium; to assess demographic pattern of various types of endometrium lesions in this part of our country and to do clinicopathological correlation and give diagnosis based on it. Materials and methods: This was a prospective, non-interventional and observational hospital based crosssectional one year study carried out between January 2020 to June 2021 in Histopathology Department of Dhiraj Hospital on 52 cases of D & C and hysterectomy specimens. All the specimens were fixed in 10% formalin were received in the department of Pathology and processed and embedded in paraffin wax. Multiple serial sections of 4-5 microns thickness were obtained from the paraffin block and then stained with H & E. Detailed study of the sections was done by light microscopy. Results: 52 cases of menorrhagia were studied clinically and histopathologically. In present study, large proportion of patients with menorrhagia showed proliferative endometrial pattern (38.46%) followed by secretory phase (34.62%). Hyperplastic pattern was seen in 13.46% of patients. Non hyperplastic endometrial pattern was more common than hyperplastic pattern. Simple hyperplasia was more commonly seen than complex and atypical hyperplasia. Overall incidence of atypical hyperplasia was low (28.57%) and atrophic endometrium seen in 5.7% of cases. Endometrial polyp was seen in 3.84% cases and endometrial carcinoma was seen in 3.84% cases. Conclusion: Histopathological study of endometrium is very useful to reveal different endometrial patterns in menorrhagia and to distinguish between anovulatory and ovulatory causes. It is also useful for the diagnosis of endometrial hyperplasia and endometrial carcinoma.

Histopathological evaluation of abnormal uterine bleeding with immunohistochemical study of significant estrogen receptor expression in endometrium of women with different age groups

Background: Abnormal uterine bleeding is symptom, not disease. Bleeding per vaginum is labelled to be pathological when there is constant irregularity in pattern and flow of bleeding, altered duration or increased amount of menstrual blood. Histopathological examination of endometrium biopsies remains a gold standard diagnostic tool. Methods: A prospective study was done on 150 patients presenting with AUB over the period January 2022 to December 2022 in the department of pathology, Hind institute of medical sciences, Sitapur, Uttar Pradesh, India. The sections were stained with hematoxylin and eosin and special stain estrogen receptor was used. Results: Majority of the patients were seen in the perimenopausal age group and most common complaint was menorrhagia in 73 patients (48%). The commonest pathology observed in our study was proliferative phase endometrium in 48 patients (32%). Most of the endometrial carcinoma (4%) were presented after the age of 50 years. The association between histopathological patterns and estrogen receptor category were found to be statistically significant as the p<0.05. Conclusions: Disease burden on a global scale is witnessed by women affected by AUB thus having a detrimental impact. Accurate diagnosis of AUB in women over the age of 35yrs is important to rule out preneoplastic lesions and malignancies so that surgical interventions can be avoided by initiating proper medical management. Comparing the hyperplastic and neoplastic endometrium to that of the proliferative phase, ER expression was lower. Endometrial carcinoma with advanced stage often lacks the expression of the receptors.

Histopathological evaluation of abnormal uterine bleeding with immunohistochemical study of significant estrogen receptor expression in endometrium of women with different age groups

Background: Abnormal uterine bleeding is symptom, not disease. Bleeding per vaginum is labelled to be pathological when there is constant irregularity in pattern and flow of bleeding, altered duration or increased amount of menstrual blood. Histopathological examination of endometrium biopsies remains a gold standard diagnostic tool. Methods: A prospective study was done on 150 patients presenting with AUB over the period January 2022 to December 2022 in the department of pathology, Hind institute of medical sciences, Sitapur, Uttar Pradesh, India. The sections were stained with hematoxylin and eosin and special stain estrogen receptor was used. Results: Majority of the patients were seen in the perimenopausal age group and most common complaint was menorrhagia in 73 patients (48%). The commonest pathology observed in our study was proliferative phase endometrium in 48 patients (32%). Most of the endometrial carcinoma (4%) were presented after the age of 50 years. The association between histopathological patterns and estrogen receptor category were found to be statistically significant as the p<0.05. Conclusions: Disease burden on a global scale is witnessed by women affected by AUB thus having a detrimental impact. Accurate diagnosis of AUB in women over the age of 35yrs is important to rule out preneoplastic lesions and malignancies so that surgical interventions can be avoided by initiating proper medical management. Comparing the hyperplastic and neoplastic endometrium to that of the proliferative phase, ER expression was lower. Endometrial carcinoma with advanced stage often lacks the expression of the receptors.

Study of histopathological findings of endometrial biopsy in women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most common problems presenting in OPD to the gynecologist regardless of the age of the women. The main aim was to study the frequency of different histopathological findings of endometrial sample in patients with abnormal uterine bleeding.Methods: This study was conducted on 82 patients from December 2021 to November 2022 in the department of obstetrics and gynecology. Patients with AUB due to gestational cause like missed abortion, incomplete abortion, retained products of conception and with uterine fibroid were excluded from study.Results: Abnormal uterine bleeding (AUB) presented mostly in the 41-50 years of age. The commonest histopathological pattern in abnormal uterine bleeding was normal physiological changes of menstrual cycles secretory phase (29%). Endometrial hyperplasia was the most common endometrial pathology observed in 11% patients.Conclusions: Endometrial evaluation in abnormal uterine bleeding helps in early detection of pre-neoplastic conditions and malignancy to provide early treatment and avoid further complications.

Sensitivity of ultrasound scan and hysteroscopy with histopathological correlation in identifying endometrial pathology for a mixed group of symptomatic and asymptomatic patients

Background: We wished to correlate abnormal findings on hysteroscopy with abnormal findings on Ultrasound. To study the accuracy of ultrasound for detection of uterine polyps using hysteroscopy as gold standard. Analyse the cases detected with Carcinoma Endometrium and other endometrial pathology.Methods: In this retrospective study, we summarized data from 125 patients who underwent TVS examination followed by hysteroscopy under 2 consultants from 2017 to 2020. Specimens were obtained and sent for histopathological examination. Sensitivity, specificity, positive and negative predictive values for diagnosing uterine pathology were calculated for each method.Results: The sensitivity and specificity of ultrasonography for identifying polyps is 27.03% and 98.04% respectively The sensitivity of ultrasonography for identifying any abnormal pathology is 90.08%. A total of 74 hysteroscopy identified and histology confirmed polyps were identified with no incidence of cancer in all the polyps. A total of 8 patients were diagnosed to have Endometrial Cancer on endometrial biopsy. Of these 8, 7 were postmenopausal and 1 premenopausal. 2 patients of these were asymptomatic with incidental finding of thickened endometrium on ultrasonography.Conclusions: Transvaginal ultrasound is a practical approach for initial evaluation of abnormal uterine bleeding, however a hysteroscopy would be necessary in most of the suspicious cases due to better diagnostic accuracy. A unique feature of this study is the inclusion of a group of asymptomatic women incidentally detected to have uterine pathology including uterine carcinoma on routine health examination hence highlighting the importance of routine gynaecological check especially in the peri and post-menopausal age group.

Study of histopathological pattern of endometrium in abnormal uterine bleeding in a tertiary care center

Background: It is estimated that 9-30% of women of reproductive age suffer from abnormal uterine bleeding. As most cases are associated with anovulatory menstrual cycles, adolescent and perimenopausal women are particularly vulnerable to this particular condition. The aim of this study was to evaluate the histopathological pattern of endometrial biopsy from patients presenting with abnormal uterine bleeding. Methods: The retrospective study was conducted in the Department of Pathology in tertiary care centre from 1st January 2021 to 31 December 2022. All the patients presenting with abnormal uterine bleeding and who underwent endometrial biopsy were included in this study. Distribution of various histopathological patterns was observed in the different age groups. Results: A total of 260 cases were included in the study. The commonest pattern in these patients was proliferative endometrium (31 %) and products of conception (31%), hyperplasia without atypia (13.7%). Other patterns identified were secretory endometrium, chronic endometritis, endometrial polyp, complete mole, partial mole, and Ca endometrium. Conclusions: As observed from the study, there is an age specific association of endometrial bleeding, with highest incidence in 21-30 years of age group. Hence, dilatation and curettage are helpful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of abnormal uterine bleeding.

Histopathological changes in the uterus in women with abnormal uterine bleeding – A 2-year hospital-based retrospective study in a tertiary care center in Assam, India

Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.