expression of erα and pr in various morphological patterns of abnormal uterine bleeding-endometrial causes in reproductive age group

Abstract

Introduction: Abnormal Uterine Bleeding (AUB) is most common gynaecological problem but its management is not well defined. So FIGO/PALMCOEIN classification was developed to provide clear management options as treatment is different in PALM and AUB-E group. FIGO/PALM-COEIN classification and immunohistochemistry with ERα and PR expression in AUB-E group will be helpful in management of these patients, thus preventing surgical interventions. Aim: To study histomorphological classification according to FIGO/PALM-COEIN classification in patients presenting with AUB into PALM and AUB-E group. To study the receptor expression of ERα and PR in AUB-E group. Materials and Methods: This cross sectional study was performed in patients presenting with AUB in reproductive age group (15-45 years). Six hundred endometrial specimens were stained with H&E for histolomorphological examination and classified as per FIGO/PALM-COEIN classification of AUB in non-gravid women in reproductive age group. Fifty endometrial biopsies were of pregnancy and pregnancy related complications and were excluded from study. A total of 550 samples were evaluated in present study. IHC for quantification of ERα and PR expression was carried out in AUB-E (100) cases and control group endometrium (20) cases due to technical constraints. Statistical Analysis: Unpaired student t-test was performed. p-value ≤ 0.05 was taken as critical level of significance. Results: Endometrial (58.19%) (AUB-E) causes were most common cause of AUB. Most common morphology was AUB-E (Proliferative endometrium), AUB-L (Leiomyoma) and AUB-E (Secretory endometrium) respectively. Statistically significant expression of ERα and PR was found in AUB-E endometrium as compared to control group endometrium. In Non secretory/ Proliferative endometrium AUB-E group. Proliferative endometrium and hyperplasia without atypia had significant expression of ERα and PR in glands and stroma when compared with proliferative phase control group endometrium. But disordered proliferative endometrium had only significant PR expression in stroma. When secretory phase endometrium was compared with control group secretory phase significant expression for PR was noted only in stroma. Conclusion: FIGO/PALM-COEIN classification will be helpful in deciding treatment of AUB cases. Study of receptor expression in AUB-E group will help in providing evidence based treatment and prevent from surgical procedures like hysterectomy and endometrial ablation.