Even among low grade bladder tumors, there are some which have been found to carry bad prognosis for progression, recurrence and survival. Accurately pinpointing these cases at the time of diagnosis just with the help of routine histopathology is problematic. Ki-67 immunostaining may potentially be of help in identifying such cases, making administration of additional treatment modalities like chemotherapy and radiotherapy possible. There is scarcity of such studies in our country. The present study aims to correlate Ki-67 labeling index with the histopathological type and grade, pathological stage and mitotic index of urinary bladder tumors. Objective: Objective of the study is to consider the possibility of using Ki-67 labeling index to identify those low grade urinary bladder tumors which carry bad prognosis. Materials and Methods: All trans-uretheral resection of bladder tumor (TURBT) specimens in our institute were analyzed for their histopathological grade, pathological stage, mitotic index and Ki-67 labeling index in the period extending from from August 2015 to December 2016. The clinical data were analyzed retrospectively and statistically. SPSS Version 23 (SPSS Inc.,Chicago, IL, USA) software was utilized for all statistical analyses. Chi-square analysis was utilized for comparison of groups. Results with P <0.05 were taken as statistically significant. Results: Ki-67 expression in Low grade urothelial carcinoma (LGUC) showed variation from 1.4% to 41%. The papillary urothelial neoplasm of low malignant potential (PUNLMP) cases showed variation from 16 -17%. And the only case of transitional cell papilloma in the study was found to have expression of 9%. Conclusion: Cases of high (more than 20%) Ki-67 MIB-1 labeling index can be segregated even from among those cases with low histopathological grade, low mitotic index and pTa histopathological stage. Such cases are candidates for multimodality treatment including radiotherapy, chemotherapy etc.
Background: AUB is a common problem encountered by women of reproductive age group with increased risk during perimenopausal period. International Federation of Gynecology and Obstetrics (FIGO) has designed a new classification system PALM-COEIN in order to standardize the causes of AUB. Aims and Objectives were to stratify causes of AUB in women of reproductive age group in context to PALM-COEIN classification system. To establish a clinico-pathological correlation among causes of AUB taking aid of radiology wherever required.
Methods: All women of reproductive age group presenting with complaints of AUB in department of gynecology from January 2018 to December 2021 were included in the study. The cause were classified based on PALM-COEIN classification both clinically and histopathologically. Radiological investigation was carried out wherever required.
Results: Total 560 women of reproductive age group were registered. Majority 321 (57.32%) women were between 41-50 years of age and commonest complaint was heavy menstrual bleeding in 401 (71.60%). PALM and COEIN groups accounted for 40% and 60% respectively. Among structural causes, leiomyoma was the commonest cause 153 (27.32%) of AUB whereas among the functional causes most common was endometrial 188 (33.57%). The clinico-histopathological correlation was statistically significant in cases of AUB-P, AUB-A, AUB-O and AUB-E.
Conclusions: The PALM-COEIN classification system helps to understand the causes of AUB and gives simpler terminology, diagnosis and investigations of the causes of AUB and offers better patient management. It can provide better means of quality assurance and appropriateness of treatment.
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