Thickened Blood Vessels in Endometrial Curettings in Dysfunctional Uterine Bleeding – a pilot study

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Thickened Blood Vessels in Endometrial Curettings in Dysfunctional Uterine Bleeding – a pilot study

Anwar Ul Haque and Sara Haque
Islamabad Institute of Pathology, Islamabad, Pakistan

Background: Dysfunctional uterine bleeding (DUB) is common ailment. It accounts for about 10% of gynaecology outpatient department (OPD) registrants in developed countries. There is disturbance of rhythmic cyclic menstruation resulting in excessive and irregular hemorrhage. Anovulation or oligoovu-lation leads to the sustained estrogen effects with unopposed progesteronal effects. Other causes of estrogen dominance may also cause similar effects. The relative estrogen dominance results in various changes in the endometrial vasculature causing menorrhagia.
Objective: To determine the frequency and significance of thickened blood vessels in the endometrial curettings in dysfunctional uterine bleeding.
Study Design: Retrospective cross sectional pilot study.
Place of Study: Islamabad Institute of Pathology & Labs, Islamabad, Pakistan
Materials & Method: Hematoxylin and Eosin (H&E) stained sections of 30 consecutive random cas-es of the endometrial curetting from dysfunctional uterine bleeding were studied by light microscopy for with particular emphasis on numbers of thickened blood vessels.
Inclusion Criteria: All endometrial curetting with history of dysfunctional uterine bleeding
Exclusion Criteria: Endometrial curetting from patients with specific etiologies such as endometritis, atypical hyperplasia, retained products, Intra uterine devices (IUDS)
Results: Over 50% of the patients were in perimenopausal age group i.e. 40-55. All endometrial curet-tings contained thickened blood vessels. On average there were about 8 thickened blood vessels per endometrial curetting.
Conclusion: Estrogen induced vascular changes result in increased permeability which may in turn cause deposits of various plasma proteins in the wall with enhanced intramural vascular thickening. Such thickened vessels may not contract properly thus causing and prolonging excessive bleeding.
Key Words: Endometrial curetting, Dysfunctional uterine bleeding, Vascular Pathology

         

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