title: Expression of ERα and PR in Various Morphological Patterns of Abnormal Uterine Bleeding-Endometrial causes in Reproductive Age Group.
abstract: BACKGROUND
  Abnormal Uterine Bleeding (AUB) is most common gynaecological problem but its management is not well defined. So FIGO/PALMCOEIN classification was developed to provide clear management options as treatment is different in PALM and AUB-E group. FIGO/PALM-COEIN classification and immunohistochemistry with ERα and PR expression in AUB-E group will be helpful in management of these patients, thus preventing surgical interventions.
  
  
  OBJECTIVE
  To study histomorphological classification according to FIGO/PALM-COEIN classification in patients presenting with AUB into PALM and AUB-E group. To study the receptor expression of ERα and PR in AUB-E group.
  
  
  METHODS
  This cross sectional study was performed in patients presenting with AUB in reproductive age group (15-45 years). Six hundred endometrial specimens were stained with H&E for histolomorphological examination and classified as per FIGO/PALM-COEIN classification of AUB in non-gravid women in reproductive age group. Fifty endometrial biopsies were of pregnancy and pregnancy related complications and were excluded from study. A total of 550 samples were evaluated in present study. IHC for quantification of ERα and PR expression was carried out in AUB-E (100) cases and control group endometrium (20) cases due to technical constraints.
  
  
  METHODS
  Unpaired student t-test was performed. p-value ≤ 0.05 was taken as critical level of significance.
  
  
  RESULTS
  Endometrial (58.19%) (AUB-E) causes were most common cause of AUB. Most common morphology was AUB-E (Proliferative endometrium), AUB-L (Leiomyoma) and AUB-E (Secretory endometrium) respectively. Statistically significant expression of ERα and PR was found in AUB-E endometrium as compared to control group endometrium. In Non secretory/Proliferative endometrium AUB-E group. Proliferative endometrium and hyperplasia without atypia had significant expression of ERα and PR in glands and stroma when compared with proliferative phase control group endometrium. But disordered proliferative endometrium had only significant PR expression in stroma. When secretory phase endometrium was compared with control group secretory phase significant expression for PR was noted only in stroma.
  
  
  CONCLUSIONS
  FIGO/PALM-COEIN classification will be helpful in deciding treatment of AUB cases. Study of receptor expression in AUB-E group will help in providing evidence based treatment and prevent from surgical procedures like hysterectomy and endometrial ablation.
authors.affiliation: Junior Resident, Department of Pathology, Moti Lal Nehru Medical College , Allahabad, U.P., India .
authors.forename: Priya
authors.initials: P
authors.lastname: Singh
authors.affiliation: Assistant Professor, Department of Pathology, Moti Lal Nehru Medical College , Allahabad, U.P., India .
authors.forename: Pallavi
authors.initials: P
authors.lastname: Singh
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, Moti Lal Nehru Medical College , Allahabad, U.P., India .
authors.forename: Amrita
authors.initials: A
authors.lastname: Chaurasia
authors.affiliation: Assistant Professor, Department of Pathology, Moti Lal Nehru Medical College , Allahabad, U.P., India .
authors.forename: Vishal
authors.initials: V
authors.lastname: Dhingra
authors.affiliation: HOD, Department of Pathology, Moti Lal Nehru Medical College , Allahabad, U.P., India .
authors.forename: Vatsala
authors.initials: V
authors.lastname: Misra
keywords: Adenomyosis; Coagulopathy; Endometrial; Estrogen receptor; Iatrogenic; Leiomyoma; Malignant and Premalignant Lesions; PALM-COEIN; Progesterone receptor