Endometrial histopathology results and evaluation of endometrial cancer risk in geriatric women

Abstract

The incidence of premalignant and malignant endometrial disorders increases during the postmenopausal period. In the literature, endometrial disorders are usually discussed in the context of menopausal status. But there are limited data regarding endometrial disorders in geriatric patients. Early diagnosis of endometrial cancers with aggressive behaviour that increases during the geriatric period may allow simpler treatment options and also decrease the treatment-associated morbidity risk.Records of geriatric patients who underwent an endometrial histopathological evaluation between 2011 and 2016 were evaluated. Clinical findings, transvaginal ultrasonography findings, endometrial sampling methods, and histopathological results were evaluated.A total of 188 patients were included in the study (mean age 70.3 ±5.6 years). The most common histopathological results were endometrial polyp, atrophic endometrium, and surface epithelium (26.6%, 22.3%, and 12.8%, respectively). None of the 57 patients without vaginal bleeding had endometrial cancer. In 131 patients with vaginal bleeding, mean endometrial thickness was 9.8 ±8.1 mm (2-49 mm) and the rate of endometrial disorders was 56.5% (74 patients). Endometrial cancer was diagnosed in 19 patients (10.1%), and 36.8% of them had non-endometrioid cancers. The presence of vaginal bleeding was significantly associated with the diagnosis of endometrial cancer and any endometrial disorder (p = 0.001 and p = 0.000, respectively).The incidence of non-endometrioid endometrial cancers increased in the geriatric period. An endometrial histopathological examination should be considered, especially for patients with a history of vaginal bleeding. Further investigation of the endometrial thickness cut-off levels in the geriatric period will contribute to the literature.

Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps

“…It was found that, if EIN was detected in a polyp, concurrent malignant endometrial lesions were more likely to occur in postmenopausal or nulliparous women. Interestingly, many studies have reported that postmenopausal bleeding is associated with increased risk of neoplasia, 12–15 but neither in the present study nor in the Jacobs et al study 11 did such a relation occur. Jacobs et al 11 did not detect any prognostic factor that was related with malignancy, in the hysterectomy material of 39 polyps with atypical hyperplasia 11 .…”

Endometrial pathology in postmenopausal women: Analysis of 112 cases in tertiary care centre

“…Although vaginal bleeding is the most common symptom, patients may present with leucorrhoea, post-coital bleeding or spotting and pelvic pain, or may even have asymptomatic course. 6 The Postmenopausal bleeding may be a one of the manifestation of organic endometrial pathologies such as endometrial polyp, hyperplasia or carcinoma or may be of included in unexplained category if no obvious pathology is detected. 7,8 The endometrial evaluation method includes various modalities such as transvaginal sonography, hysteroscopy, endometrial biopsy, biopsy by pipelle, dilatation and curettage.…”

“…Surgical treatment is often required for premalignant or malignant endometrial diseases and exorbitant treatment can thus be avoided if diagnosed at early stage. 6,9 The most common age group of patients with postmenopausal bleeding was 46-50 year with the range of 41 to 80yrs. The youngest patient was 41 yrs while oldest patient was of 80 year.…”

Do endometrial lesions require removal? A retrospective study

“…A total of 188 patients were included in a study [18]. The most common histopathological results were endometrial polyp, atrophic endometrium, and surface epithelium (26.6, 22.3, and 12.8%, respectively).…”