nRAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and
Address
(in block letters) / DR. GALE KATHLEEN EDWARD
DEPARTMENT OF PATHOLOGY
NAVODAYAMEDICALCOLLEGE
RAICHUR.
2. / Name of the institution / NAVODAYA MEDICAL COLLEGE, RAICHUR
3. / Course of study and subjects / M.D.PATHOLOGY - 3 YEARS
4. / Date of admission to the
course / 15TH MAY 2009
5. / Title of the topic
HISTOPATHOLOGICAL PROFILE OF THE ENDOMETRIUM AMONG PRE AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING.
6. / Brief Resume of Intended work :
6.1 Need for the study
Abnormal uterine bleeding is one of the most common problems among pre and postmenopausal women. Virtually every woman will at some point in her lifetime experiences episodes of bleeding that are perceived as abnormal.
Menstrual abnormalities is the cause of discomfort, inconvenience and disruption of healthy social and physical lifestyles among millions of women worldwide.
It can be caused by a wide variety of disorders, some of which represent normal physiological process, while others are a sign of serious underlying pathology.
Vaginal bleeding that occurs before menarche is abnormal. In premenopausal women , abnormal uterine bleeding includes any change in menstrual period frequency or duration, or amount of flow, as well as bleeding between cycles.
In postmenopausal women, abnormal uterine bleeding includes
vaginal bleeding 12 months or more after the cessation of menses or unpredictable bleeding in those who have been receiving hormonal therapy for 12 months or more.
Among adolescents, dysfunctional uterine bleeding is more common, while pregnancy complications are the most common cause of abnormal uterine bleeding among women of child bearing age. The causes of bleeding in elderly women are hormonal, bleeding diathesis and more importantly local pathology including infections, benign tumours and malignancy.
Histological study of the endometrium is the most common investigation employed by Gynaecologists throughout the world to evaluate abnormal uterine bleeding, and is particularly important in postmenopausal women to rule out malignancy and thereby plan for treatment modalities.
Endometrium is the mirror of hormonal status in a woman.
Sampling of endometrium should be considered in all women over the age of 40 years with abnormal uterine bleeding in order to diagnose benign and malignant conditions that are very often found among postmenopausal women.
This study is therefore conducted in order to determine the various histologic variations in the endometrium among pre and postmenopausal women with symptoms of abnormal uterine bleeding in Navodaya Medical Medical College Hospital, Raichur.
6.2 Review of Literature
The term ‘menstruation’ is derived from the latin word ‘menstruus’ which means monthly1.
Sir John William stated that menstruation is a cyclical process2.
Olshausen gave the first histological description of the endometrium3.
The monumental work of Hitchman and Adler showed that the endometrium is a cyclic tissue undergoing biphasic change4.
Schroeder in his research stated the relationship between normal endometrial cycle to the ovarian cycle5.
Robert Meyer reported several cases of early carcinoma arising in ‘hyperplastic endometrium’6.
Hormonal theory and anovulatory cycle was described by Mayer , Ziserman and Novak 1.
Noyes gave the first detailed description on how to date the endometrium from histological criteria7.
The clinical presentations and bleeding patterns in Functional uterine bleeding was extensively studied by P. K .Devi and U. D. Sutaria8.
Recent studies of Charusheela and Doifode found increased incidence of hypothyroidism with dysfunctional uterine bleeding9..
Further several guidelines and recommendations were postulated by Obstetricians and Gynaecologists of Canada in 2001, for investigations and treatment modalities in menstrual abnormalities10.
Ariel Revel and Asher Shushan in their study, stated that hysteroscopy with endometrial biopsy is the gold standard investigation for abnormal uterine bleeding11.
Dangal .G, conducted a study of endometrium of patients with abnormal uterine bleeding at Chitwan valley and concluded that carcinoma of the endometrium occurred with increasing frequency with increasing age12.
Janet.R. Albers , Sharon.K. Hull and Robert.H. Wesley after extensive research concluded that hysterectomy is the treatment of choice when adenocarcinoma is diagnosed, and this procedure should also be considered when biopsy specimens contain atypia13.
6.3 Aims and Objectives of the study
1. To determine various histological patterns of endometrium in pre and postmenopausal women.
2. To study the spectrum of lesions of the endometrium with respect to age and clinical features.
7. / Materials and methods:
7.1 Source of data
All female patients in the premenopausal group (45 + 5 years) and postmenopausal group (50 years and above) with symptoms of abnormal uterine bleeding admitted in the Inpatient wards of Department of Obstetrics and Gynaecology, Navodaya Medical College Hospital, Raichur, and other peripheral centres attached to to Navodaya Medical College Hospital , are the subjects of this study.
7.2 Methods of collection of data(including sampling procedure,
if any)
Sample:-
-Clinical data of the study subjects received along with samples of the endometrial tissue obtained by:
-Dilatation and Curettage
-Endometrial Biopsy
-Hysterectomy
-Preparation of tissue samples for microscopic examination by a series of processes, namely fixation , dehydration , clearing , embedding , cutting and staining of the tissue sections with haematoxylin and eosin stain.
Inclusion Criteria:-
All patients in the premenopausal group (45 + 5 years) and post menopausal group (50 years and above) presenting with abnormal uterine bleeding.
Exclusion Criteria:-
- Patients less than 40 years of age.
- Patients presenting with abnormal uterine bleeding due to non
endometrial causes like lesions of the myometrium and adnexa.
- Patients with uterine bleeding due to Intra –uterine Devices.
Study design:-
A Cross Sectional study.
Study period:-
A one year study with sample size of approximately 140 cases.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes, intervention to be conducted on the study subjects with the help of Gynaecologists like :-
  1. Dilatation and Curettage
  2. Endometrial Biopsy
  3. Hysterectomy
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes.
8. / List of References
1.Fluhmann.C.F,Textbook of Menstrual Disorders and Treatment, 1956, pg 1,4.
2.William. B.J and Robertson, The Abnormal Menstrual Cycle,
Textbook of Endometrium ,Butterworth 1981, pg 45-72.
3.Schroeder.R, Endometrial Hyperplasia in relation to Genital Function, American Journal of Obstetrics and Gynaecology, 1954,68(1), pg 294-309.
4.Das Anusuya and Chugh.S, Dysfunctional Uterine Bleeding-A Clinicopathological Study, Journal of Obstetrics and Gynaecology India, 1964, 14(2) pg 343-347.
5.Traut.H.F and Kuder, Irregular Shedding and Irregular Ripening of the Endometrium, Surgical Gynaecology and Obstetrics, 1935, 61(2), pg 145-154.
6. Gusberg.S.B and Kaplan.A.L, Precursors of Corpus Cancer-4, Adenomatous Hyperplasia as stage 0 Carcinoma of Endometrium, American Journal of Obstetrics and Gynaecology 1963,87(5) pg 662-676.
7. Noyes. R.W, Hertig.A.T and Rock .J, Dating the Endometrial Biopsy, Fertil Steril, 1950,Vol 1, pg 3.
8.P.K.Devi, U.D.Sutaria, Functional Uterine Bleeding, Journal of Obstetrics and Gynaecology India, 1964, 14(2), pg 347-351.
9.Charusheela and Doifode, Fernandes.K, Study of Thyroid Dysfunction in patients with Dysfunctional Uterine Bleeding, Journal of Obstetrics and Gynaecology India, 2001,51(2), pg:93-95.
10.George. A. Vilos,Guylaine Lefebvre and Graves .G.R, Guidelines for Management of Abnormal Uterine Bleeding,SOGC, Clinical Practice Guidelines, Journal of Obstetrics and Gynaecology Canada, 2001,146:pg 1-4.
11. Ariel Revel and Asher Shushan, Hysteroscopy with Endometrial Biopsy is the Gold Standard Investigation for Abnormal Uterine Bleeding, Human Reproduction 2002,vol-17,No.8, pg1947-1949.
12. Dhangal.G, A Study of Endometrium of Patients with Abnormal Uterine Bleeding at Chitwan Valley, Katmandu University Medical Journal 2003,vol-1,No.2, pg 110-112.
13. Janet.R.Albers, Sharon.K.Hull and Robert.M.Wesley, Abnormal Uterine Bleeding , 2008 , downloaded from Assessed on 24-08-2009.
9. / Signature of the candidate
10. / Remarks of the Guide / Recommended and forwarded
11. / 11.1 / Name and Designation (in block letters)
Guide / DR. VIDISHA.S. ATHANIKAR, PROFESSOR & HOD, DEPT OF PATHOLOGY,NAVODAYA MEDICAL COLLEGE, RAICHUR.
11.2 / Signature
11.3 / Co-guide (if any)
11.4 / Signature
11.5 / Head of the Department / DR. VIDISHA.S.ATHANIKAR, PROFESSOR & HOD, DEPT OF PATHOLOGY,NAVODAYA MEDICAL COLLEGE, RAICHUR.
11.6 / Signature
12. / 12.1 / Remarks of the Chairman and Principal.
12.2 / Signature