Srpski Arhiv za Celokupno Lekarstvo (Jan 2002)
Results of histopathological findings of endometrial changes
Abstract
IN METRORRHAGIA Endometrium is a tissue which is in permament changes in the active gynecological period of a female. This can be followed-up through histological, custological and histochemical changes. In determing the morphologic changes and disturbances in endometrium, pathohistological examinations were and still are necessary and irreplaceable in defining the real causes of this phenomenon. The aim of our work is to show the pathohistological results of the material obtained by explorative curettage in metrorrhagia, to determine the aetiology of the pathological process in endometrium, which provokes irregular bleeding, and to check the possible increase in precancerogenic and malignant endometrial conditions over a period of three years. The examinations covered 786 patients who asserted that bleeding was the main symptom of their illness. In all of them explorative curettage was performed mainly in diagnostic and often in therapeutic purposes. The number of examinations are in constant increase. The age of the largest number of patiens was from 41 to 50 years, a period when the anovulary cycle is most frequent which, in turn, causes changes in endometrium which results in irregular bleeding i. e. in metrorrhagia (Tables 1, 2 and 3).The most frequent histopathological changes were manifested by adenomatic hyperplasia (160), then glandular (136) and cystic hyperplasia (92). Eleven cases of endometrial carcinoma were detected. In two of these patients the finding was not confirmed by pathohistological result after the operation or repeated explorative curretage. In 64 patients atypical hyperplasia i. e. Ca in situ was found. Acute endometritis followed by irregular bleeding was observed during inflammatory process of the internal genital organs. In 35 patients chronic endometritis was found after curettage following the extraction of the intrauterine device (in one case after 40 years of carrying). In 103 patients with hyperplasia myomatous changes were noted; this finding correlated with hyperoestrogenism, which is usually present in both disorders. All authors agree that pathohistological examination of endometrium is the most relayable in the search for a correct diagnosis. Despite of all modern diagnostic and technical means, difficulties always arise in the assessment of malignant potential of endometrial hyperplasia. Therefore, the patients with recurrent bleeding caused by hyperplasia should be under intensive gynaecological control.
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