YM Abdullahi1, MA Ajani2, O Iyapo3, KO Aramide2, CA Okolo3, and EEU Akang3
- Department of Histopathology, Federal Teaching Hospital, Gombe. Gombe State.
- Department of Histopathology, Babcock University, Ilishan-Remo, Ogun State.
- Department of Pathology, University College Hospital, Ibadan, Oyo State.
Background: Endometrium remains the most sensitive indicator of ovarian function and endometrial biopsy is one of the diagnostic procedures in endometrial pathology. The current study was carried out to examine the morphological pattern of endometrial biopsies in Ibadan, South-western Nigeria and compare the results with similar studies.
Method: A retrospective study was undertaken to review all cases of endometrial biopsies received in the Department of Pathology, University College Hospital, Ibadan between January 1999 and December 2008. The patients’ data were retrieved from the surgical pathology daybooks and Histology Request forms. The neoplastic lesions were classified according to 2003 World Health Organization classification for endometrial neoplasms.
Results: A total of 2,444 cases of endometrial biopsies were received during the 10-year study period. The functional endometrial changes were the most common histopathological diagnostic category, accounting for 53.8% (1035) of cases. Other pathological diagnoses included endometritis (7.8%), simple endometrial hyperplasia (5.8%), partial hydatidiform mole (2.3%), complete hydatidiform mole (2.1%) and malignant neoplastic lesions (3.9%). Infertility was the most common (57%) indication for endometrial biopsies followed by uterine bleeding (33%) while the least common clinical indication were the menstrual disorders (10%).
Conclusion: The functional endometrial changes account for the highest morphological patterns while malignant lesions account for the least pattern of the endometrial biopsies evaluated for etiological basis of infertility, uterine bleeding and menstrual disorders in Ibadan. Infertility was the commonest indication for endometrial biopsies while the least common clinical indication was menstrual disorders.
Keywords: Endometrium, Biopsies, Morphology, Ibadan
Dr. M.A. Ajani
Department of Histopathology,
Babcock University, Ilishan-Remo,
Endometrial biopsies are among the most common specimens submitted for histopathological analysis.1 Endometrial biopsy is a safe, efficient and cost-effective means of evaluating the uterine endometrium. The procedure is usually associated with minimal discomfort and is easily accomplished in the outpatient setting. In the United States of America (USA), endometrial biopsy is used most often in the perimenopausal or postmenopausal woman to evaluate abnormal uterine bleeding and to rule out endometrial cancer2, 3 while in Nigeria, it is used most often in the evaluation of infertility.4,5,6 It also serves to identify other hormonally induced changes in the uterine lining. In general, the biopsy assists in the identification of causes of abnormal uterine bleeding, evaluate dysfunctional uterine bleeding, rule out endometrial carcinoma and precancerous lesions, identify causes of postmenopausal bleeding, evaluate infertility (specifically short luteal phase) and follow up presence of endometrial cells on Pap smear. It is virtually indispensable for the diagnosis of genital tract infections including tuberculosis and as a means of culturing the mycobacterium for antibiotic sensitivity testing so that appropriate therapy can be given.2,3
Endometrial biopsy is sufficiently sensitive to allow accurate diagnosis of endometrial hyperplasia and or carcinomas. However, endometrial biopsy may fail to detect other uterine pathologies such as polyps and submucous leiomyomas.2,3
Few Nigerian studies have examined the morphological patterns of endometrial biopsies at different times, in different places. These include studies by Ekanem et al.4 in 2006, from Calabar, South-South Nigeria, Dauda et al.5 in 2005, from Jos, North-central Nigeria, Ikeme et al.6 in 2004, from Enugu, South-eastern Nigeria, Idrisa et al.7 in 2000, from Maiduguri, North-eastern Nigeria, Iyare 8 in 2005, from Lagos, South-western Nigeria, Ojo et al.9 in 1990, from Ilorin North-central, Nigeria, and Adewole et al.10 in 1989, from Ibadan Nigeria. Most of these studies reported low prevalence of endometrial hyperplasia and endometrial cancer. Howbeit, there still exists a paucity of studies on the general morphological pattern of endometrial biopsies in the Nigerian literature.
This study was therefore undertaken to analyse the morphological pattern of endometrial biopsies in women who presented with infertility, uterine bleeding and menstrual disorders at the hospital.
MATERIALS AND METHODS
A retrospective study was undertaken to review the histopathological reports of all endometrial biopsies at the Department of Pathology, University College Hospital, Ibadan from January 1999 to December 2008. Patients’ data were extracted from the surgical daybooks, case notes, Histology Request forms and from the Cancer Registry.
Individual cases were verified by retrieving and histologically examining the original glass slides. The paraffin blocks of cases in which the original slides could not be retrieved were re-cut and stained with haematoxylin and eosin. Histochemical stains to demonstrate acid-fast bacilli (Ziehl-Neelsen stain) or fungal organisms (Gomori methenamine silver and periodic acid-Schiff stains) were carried out on cases of chronic granulomatous inflammation for possible identification of the causative agent. Excluded from this study were products of conception for therapeutic purposes, cases where both slides and blocks could not be found or inadequate clinical details and endometrial specimens obtained other than by curettage or biopsy, e.g. hysterectomy specimens. The neoplastic lesions were classified using the 2003 World Health Organization Classification for endometrial neoplasms.11 The data obtained were analysed in terms of frequency and age distribution using the Statistical Package for Social Sciences, version 20. The data were presented in proportion, frequency tables and figures.
Ethical clearance for the study was obtained from the Joint University of Ibadan/University College Hospital Ethical Review Committee .