A REVIEW OF ENDOMETRIAL PATHOLOGY AT LAGOS UNIVERSITY TEACHING HOSPITAL (2007-2011)

Abstract

Background:
The endometrium is the mucosal lining of the uterus which is affected by a myriad of factors
such endocrine dysfunction, pregnancy and its complications as well as neoplastic
proliferations including cancer, there is need to use universal terms in diagnosis of these
lesions. The need to have a baseline of the distribution of the carcinoma seen in African
women using immunohistochemistry which will assist in health planning and choice of
therapy offered to patients.

Objective:
To determine the age distribution of patients with endometrial pathologies, review the cases
of endometrial hyperplasia and type endometrial carcinoma using immunohistochemistry.

Material and Methods:
The study was conducted at the Department of Anatomic and Molecular Pathology of the
Lagos University Teaching Hospital. Four hundred and seventy-six endometrial samples
seen between January 2007 and December 2011 had the haematoxylin and eosin stained
slides reviewed by the researcher and supervisors. Immunohistochemistry was done on
endometrial carcinoma cases. The data was analyzed using simple statistical methods to
determine the age distribution, histological correlation and association.

Results
The results of the study show the commonest presenting clinical indication is abnormal
uterine bleeding accounting for 39.6% of all the 476 patients. The peak age of presentation
for endometrial disorders was in the fifth decade, with ages ranging from 14 to 87 years and
a mean age of 43 years. The most common disorder in this study was simple endometrial
hyperplasia without atypia and endometrial polyp was the most common neoplastic
diagnosis; age at presentation was in the fifth decade with statistical significance (p=0.03).
The most common endometrial malignancy was endometrial adenocarcinoma accounting for
53.3% (8) of the 15 cases, the overall mean age for malignancies was 52 years.
Immunohistochemistry showed a Type II predominance in endometrial carcinomas
accounting for 50% (4) of the 8 cases using the panel of Oestrogen receptor, Progesterone
receptor, p53 and Ki-67, one case of Type I was seen in a 44 year woman with endometrioid
endometrial carcinoma and three cases were equivocal.

Conclusion
The most common clinical indication is abnormal uterine bleeding and the peak age at
presentation is in the 41-50 years age category. The most common endometrial disorder
remains simple endometrial hyperplasia; however the entire spectrum of hyperplasia is seen
in the study compared to a previous study a decade ago by Umobong.15 The need for
standard reporting of hyperplasias is necessary. The predominant endometrial
adenocarcinoma by immunohistochemistry is Type II endometrial carcinomas which is non
oestrogen dependent and more aggressive, more molecular studies may be needed to type
equivocal cases in order to treat properly.

A REVIEW OF ENDOMETRIAL PATHOLOGY AT LAGOS UNIVERSITY TEACHING HOSPITAL (2007-2011)