{"paper_id":"c6e74c1c-2964-4a39-aa2b-070dcde79f47","body_text":"International Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 1 \n \nSpectrum of Histopathological Findings in \nHysterectomy Specimens for Abnormal Uterine \nBleeding: A Clinicopathological Correlation \nStudy at a Tertiary Care Center \n \nDr. Ekta Jaiswal1, Dr. Honey Bhasker Sharma2, Dr. Tripti Singh3,  \nDr Nikhilesh Kumar4, Dr Monika Gupta5, Dr Megha Bansal6,  \nDr Parul Verma7, Dr Navdeep Kaur8 \n \n1Post graduate third year Junior Resident, Department of Pathology, T.S. Misra Medical College & \nHospital, Lucknow, India. \n2,5,6Professor, Department of Pathology, T.S. Misra Medical College & Hospital, Lucknow, India. \n3Assistant Professor, Department of Pathology, T.S. Misra Medical College & Hospital, Lucknow, India. \n4Professor & Head of Department, Department of Pathology, T.S. Misra Medical College & Hospital, \nLucknow, India. \n7Associate Professor, Department of Obs & Gyne, T.S. Misra Medical College & Hospital, Lucknow, \nIndia. \n8Post graduate third year Junior Resident, Department of Pathology, T.S. Misra Medical College & \nHospital, Lucknow, India. \n \nABSTRACT \nBackground: Abnormal uterine bleeding (AUB) is a common gynaecological complaint in reproductive \nand perimenopausal women, often requiring hysterectomy when refractory to conservative management. \nHistopathological examination of hysterectomy specimens is essential to confirm diagnoses and detect \nincidental pathologies. \nObjectives: This study evaluated the spectrum of diseases associated with AUB in hysterectomy \nspecimens and their clinico-pathological correlation. \nMethods: A cross-sectional study was conducted over 18 months at the Department of Pathology, T.S. \nMisra Medical College and Hospital, Lucknow. Eighty-seven hysterectomy specimens from women with \nAUB were included. Clinical details, ultrasonographic findings, and h istopathological features (H&E, \nspecial stains, ER/PR immunohistochemistry where indicated) were recorded and analysed. \nResults: Heavy menstrual bleeding was the commonest presentation (46.0%), followed by peri -\nmenopausal bleeding (21.8%). Ultrasonography most frequently showed uterine fibroid (34.6%) and \nthickened endometrium (33.3%). Histopathologically, leiomyoma predominated (37 .9%), followed by \nendometrial hyperplasia (17.2%), endometrial polyp (12.6%), and adenomyosis (11.5%). Cervical \ncarcinoma (3.4%) and endometrial carcinoma (2.3%) were also identified. Multiple pathologies coexisted \nin 45.5% of leiomyoma cases. A significan t association existed between clinical presentations and \nhysterectomy indications (p < 0.001). \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 2 \n \nConclusion: Leiomyoma was the most frequent histopathological diagnosis in AUB -related \nhysterectomies, followed by endometrial hyperplasia, with peak incidence in perimenopausal women. \nGood clinicopathological correlation was observed, particularly for benign lesions.  Routine \nhistopathological examination is recommended to identify unsuspected malignancies and coexisting \npathologies. \n \nKeywords: Abnormal uterine bleeding, Hysterectomy, Leiomyoma, Clinico -pathological correlation  \nHistopathology \n \nINTRODUCTION \nAbnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group \nand may also have a significant impact on their physical, social and emotional aspects directly affecting \ntheir quality of life. According to the International Federation of Gynecology and Obstetrics (FIGO) acute \nAUB could be classified as “an episode of bleeding in a woman of reproductive age, who is not pregnant \nthat is of sufficient quantity to require immediate intervention to prevent further blood loss.” I n the \npremenopausal period, it may cause anemia and in the postmenopausal period it may raise the suspicion \nof malignancy.1 It is estimated that about 10% to 30% of women will be affected by abnormal uterine \nbleeding during their lifetime.2 \nThe classification system is divided into nine categories that are arranged according to the acronym \nPALM-COEIN: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, \nOvulatory disorders, Endometrial, Iatrogenic and Not Classified.3 International federation of Gynecology \n& obstetrics (FIGO) proposed three main causes of classification for uterine disorders: coagulopathy \n(AUB-C), disorder of ovulation (AUB-O), primary endometrial disorder (AUB-E).4 \nThe histopathological examination of hysterectomy specimens is an essential component of the diagnostic \nworkup, treatment planning and follow-up of patients undergoing this procedure.5 \nThe burden of gynecological disorders in India is high with an estimated 25% of women suffering from \nmenstrual disorders, 20-25% from fibroids and 10% from endometriosis.  The prevalence of gynecological \ncancers is also increasing in India, particularly in urban areas.6 \nThe clinicopathological correlation was found good when the cases were classified under PALM–COEIN \nclassification. \n \nMATERIALS AND METHODS \nThe present study was a cross -sectional study conducted in the Department of Pathology, T.S. Misra \nMedical College and Hospital, Lucknow, over a period of 18 months. The study population included all \nfemale patients presenting with abnormal uterine bleedin g to the Department of Obstetrics and \nGynecology of the same institution, who were scheduled to undergo hysterectomy either by the abdominal \nor vaginal route. Patients with relevant laboratory and radiological investigations and those who provided \ninformed written consent were included in the study. The cases were recruited over a period of one year \nduring the study duration. Complete enumeration of all hysterectomy specimens with AUB complaints \nwithin the 18-month period was targeted, with a minimum of 87 cases or all eligible cases, whichever was \nachieved first. Ultimately, 87 cases were included. \nClinical data were collected from patient case sheets, including name, age, presenting signs and symptoms, \nclinical history, Pap smear results, ultrasonographic findings, and clinical diagnoses. These data were \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 3 \n \nrecorded using a standardized proforma and compiled into a Microsoft Excel spreadsheet for analysis. All \nhysterectomy specimens were processed following standard histopathological protocols. Special stains, \nsuch as Periodic Acid-Schiff (PAS), were applied when necessary to aid diagnosis. Immunohistochemical \n(IHC) assessment was performed for markers including estrogen receptor (ER) and progesterone receptor \n(PR) in cases with suspected malignancy to confirm diagnoses. IHC runs included negative and positive  \ncontrol slides, as recommended by the manufacturer, and were reviewed by an experienced pathologist. \nLesions associated with AUB were classified according to standard criteria, and tumors were categorized \nas per the World Health Organization (WHO) Classif ication. Histopathological evaluations were \nconducted on H&E-stained sections and independently reviewed by two pathologists to ensure diagnostic \naccuracy.. \n \nRESULT AND OBSERV ATION \nThe study included 87 patients who underwent hysterectomy for abnormal uterine bleeding. \n \nTable 1: Distribution of the studied patients based on age group \nAge group Number of patients (n=87) Percentage \n30-40 Year 28 32.2% \n41-50 Year 50 57.5% \n51-60 Year 7 8.0% \n>60 Year 2 2.3% \nMEAN±SD 44.11±5.8 \n \nTable 2: Distribution of the studied patients based on clinical diagnosis \nClinical Diagnosis Number of patients \n(n=87) Percentage \nAbnormal uterine bleeding 19 21.8 \nAdenomyosis 8 9.2 \nEndometrial polyp 16 18.4 \nCervical polyp 6 6.9 \nFibroids 33 37.9 \nPost menopausal Bleeding 4 4.6 \nSevere dysmenorrhea with AUB 4 4.6 \nOvarian cyst (Benign + Malignant) 3 3.4 \n \nTable 3: Distribution of the studied patients based on histopathological findings \nHistopathological findings Number of patients (n=87) Percentage \nLeiomyoma 33 37.9 \nEndometrial Hyperplasia 15 17.2 \nEndometrial polyp 11 12.6 \nAdenomyosis 10 11.5 \nCervical polyp 5 5.7 \nCIN/ Dysplasia 5 5.7 \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 4 \n \nOvarian tumor 3 3.4 \nCervical cancer 3 3.4 \nEndometrial cancer 2 2.3 \n \nTable 4: Association of diseases for leiomyoma in the study \nLeiomyoma findings Number of patients (n=33) Percentage \nNo association 5 15.2% \nAdenomyosis 4 12.1% \nEndometrial polyp 4 12.1% \nEndometrial Hyperplasia 2 6.1% \nChronic cervicitis 3 9.1% \nMultiple pathology 15 45.5% \n \nThe most common clinical diagnosis(reference table 2) was fibroids, assigned to 33 patients (37.9%), \nfollowed by abnormal uterine bleeding in 19 patients (21.8%) and endometrial polyp in 16 patients \n(18.4%). Adenomyosis was diagnosed in 8 patients (9.2%), cervical polyp in 6 patients (6.9%), and both \npost-menopausal bleeding and severe dysmenorrhea with AUB in 4 patients each (4.6%). Benign or \nmalignant ovarian cyst was the clinical diagnosis in 3 patients (3.4%). \nThe distribution of the studied patients based on histopathological findings (reference table 3) was \nanalyzed. The most common finding was leiomyoma, observed in 33 patients (37.9%) (reference table 4). \nThis was followed by endometrial hyperplasia (17.2%).  Endometrial Hyperplasia showed considerable \nmorphological variation among all 15 patients. \nThere were cases of ovarian tumour encountered in the present study, comprising two cases of benign \nserous cystadenoma and one case of dermoid cyst. \nThree cases of cervical squamous cell carcinoma were encountered in the present study. Of these, two \ncases were of the non-keratinizing type, characterized histologically by malignant squamous cells arranged \nin sheets and nests with marked nuclear pleomorp hism, hyperchromasia, increased mitotic activity, and \nabsence of keratin pearl formation. One case was of the keratinizing type, which on histopathological \nexamination showed prominent keratin pearl formation, individual cell keratinization, intercellular \nbridges, and malignant squamous cells exhibiting marked nuclear atypia and frequent mitoses. \nTwo cases of endometrial carcinoma were observed during the present study. One case was of \nvilloglandular carcinoma, which on histopathological examination showed complex villous and papillary \nglandular architecture lined by stratified malignant endometrial cells exhibiting mild to moderate nuclear \natypia and increased mitotic activity. The other case was mucinous endometrial carcinoma, characterized \nhistologically by glands and tumor cells containing abundant intracellular mucin, mucin -secreting \ncolumnar cells resembling endocervical epithelium, and varying degrees of nuclear atypia. \n \n \n \n \n \n \n \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 5 \n \nPHOTO PLATE \n \nPlate 1: A large subserosal leiomyoma \n \n \nPlate 2: Endometrial polyp \n\n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 6 \n \n \nPlate 3: Leiomyoma at 40X (H&E stain) \n \n \nPlate 4: Endometrial hyperplasia without atypia ER 20X strong gland and stroma positivity \n\n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 7 \n \n \nPlate 5- Cervix Squamous cell carcinoma keratinizing type at 20 X (H&E stain) \n \n \nPlate 6: Endometrial carcinoma (Villoglandular Variant) ER 20X faint \n \nDISCUSSION \nThe clinico-pathological correlation of AUB is vital, as clinical presentation alone may not reliably predict \nthe underlying pathology. Histopathological examination not only confirms the diagnosis but also \n\n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 8 \n \nidentifies incidental or coexisting lesions that may alter management strategies. Studies across diverse \npopulations have consistently demonstrated that the spectrum of diseases associated with AUB in \nhysterectomy specimens ranges from benign conditions su ch as leiomyomas, adenomyosis, and \nendometrial hyperplasia to malignant lesions including endometrial carcinoma. 7,8  A structured approach \nto establishing the cause using the FIGO - PALMCOEIN classification system facilitates accurate \ndiagnosis and treatme nt options. 9 Hysterectomy, which involves removing the uterus, is the most \ncommonly performed major gynecological surgery worldwide, with its prevalence varying by region. \nIn the present study, the mean age of the studied cases was 44.11±5.8 years, with the majority of the cases \nin the age range from 41-50 years (57.5%) followed by 30-40 years (32.2%), 51-60 years (8.0%) and more \nthan 60 years (2.3%). Our findings were compa rable to the findings of Sofiatamilarasi C et al 10 who \nreported that the mean age of the study participants was 45.41 ± 7.24 years. Majority of participants \n(n=145) were in 41 to 50 years age group, followed by 58 participants in 31 to 40 years age group. 31 \nparticipants were from 51 to 60 years of age, 9 participants were from 61 to 70 years of age and 6 \nparticipants were from 21 to 30 years of age. \nIn the present study, the predominant clinical presentation was heavy menstrual bleeding, accounting for \nnearly half of the cases (46%), underscoring its role as the most common indication for hysterectomy in \nwomen with abnormal uterine bleeding. Postmenop ausal bleeding was the second most frequent \npresentation (21.8%), highlighting its clinical importance as a potential marker of underlying pathology \nrequiring definitive evaluation. Abnormal uterine bleeding in general was noted in 13.8% of patients, while \nintermenstrual bleeding contributed to 8%. Our findings were consistent with the findings of Shah D et \nal11, who reported that heavy menstrual bleeding was the most common presenting symptom, accounting \n86 (29%) out of 300 women followed by Intermenstrual bleeding (25.0%), Frequent menstrual bleeding \n(21.0%), Postmenopausal bleeding (19.0%) and Heavy prolonged m enstrual bleeding (6.0%). In the \nKinake MS et al 12 study, predominant pattern of AUB were reported as menorrhagia in 338 cases \n(51.13%), followed b y intermenstrual bleeding in 115 cases (17.39%), polymenorrhagia in 79 cases \n(11.95%), while metrorrhagia was seen in 73 cases (11.04%). Bindu PJ et alError! Bookmark not defined. \nsaw heavy menstrual bleeding in 239 (75%) women, Intermenstrual bleeding was seen in 40 (12%) cases. \nPostmenopausal bleeding was seen in 31 (10%) women. Nine (3%) women showed breakthrough \nbleeding. \nIn the present study, the most frequent findings were endometrial pathology (39.1%) and uterine fibroids \n(34.5%), reflecting their dominant role in the etiological spectrum of AUB. Other notable diagnoses \nincluded bulky uterus (13.8%), cysts (12.6%), and adenomyosis (11.5%), all of which are common benign \nconditions contributing to menstrual disturbances. Less frequent but clinically significant findings were \npelvic inflammatory disease (2.3%), cervical cancer (1.1%), and isolated cases of IUCD -related changes \n(1.1%) and leiomyoma (1.1%). Our findings were in concordance with the findings of Kondareddy R, \nand Gomathy E14, who reported that 46.67% were diagnosed to have fibroid, 23.3% had Adenomyosis, \n12.22% had DUB, 5.56% had polyp, 3.33% had endometrial and 2.22% had cervical carcinoma. Similar \nstudy by Bharti M and Bhol SK15 the most common ultrasound diagnosis was leiomyoma/fibroid/AUB-\nL, followed by adenomyosis/ AUB -A i.e., structural causes were more common than non -structural. In \ncontrast to the study done, according to Anupamasuresh Y et al16 the most common USG diagnosis was \nnon-structural followed by structural causes (AUB-L, AUB-A). \n \nCONCLUSION \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 9 \n \nAUB comprises a wide spectrum of symptoms and presentations, taking into consideration various factors.  \nEvery case of AUB has its own characteristic findings on USG, endometrial biopsy and histopathology; \nhence a generalized or a single modality of treatment cannot be applicable for every patient. \nThe clinical findings suggest the different causes of AUB are narrowed by taking proper history, \nultrasonography and the confirmed diagnosis is achieved after histopathological examination. In patients \nwith AUB the most common complaint and clinical presentation is HMB. Among them the most common \nhistopathological diagnosis is Leiomyoma. \nThe present study confirms a good correlation between clinical findings and histopathology especially in \nbenign conditions. \n \nREFRENCES \n1. Singh K, Agarwal C, Pujani M et al. A Clinicopathological Correlation of International Federation of \nGynecology and Obstetrics's PALM -COEIN Classification of Abnormal Uterine Bleeding: Indian \nScenario. J Midlife Health. 2019;10(3):147-152 \n2. Banmeru AP, Narayanaswamy M. From symptoms to surgery: clinicopathological correlation in \nwomen undergoing hysterectomy for abnormal uterine bleeding. Int J ReprodContracept Obstet \nGynecol 2025;14:555-60. \n3. Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes \nof abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012; \n207: 259-265 \n4. Khrouf M, Terras K. Diagnosis and Management of Formerly Called \"Dysfunctional Uterine \nBleeding\" According to PALM -COEIN FIGO Classification and the New Guidelines. J Obstet \nGynaecol India. 2014;64(6):388-93 \n5. Gul G, Manzoor R, Lone IR. Abnormal uterine bleeding and hysterectomy: Insights from \nhistopathological analysis of hysterectomy specimens from a tertiary care hospital. Indian J Pathol \nOncol 2024;11(3):232-237 \n6. Maheshwari A, Kumar N, Mahantshetty U. Gynecological cancers: A summary of published Indian \ndata. South Asian J Cancer. 2016;5(3):112–20 \n7. Shrivastava K, Mishra RT, Tiwari P et al. Histopathological spectrum of uterine lesions in \nhysterectomy specimens of patients with abnormal uterine bleeding. Int J Clin Trials 2024;11(4):252-\n9 \n8. Dhakar JS, Shrivastava K, Mishra RT et al. Histopathological spectrum of uterine lesions in \nhysterectomy specimens of patients with abnormal uterine bleeding. Int J Clin Trials. 2024;11(4) \n9. Munro M. G., Critchley H. O. D., Border, M. S. Et al. FIGO Working Group on Menstrual Disorders. \nInternational Journal of Gynecology and Obstetrics. 2011;113(1):3–13. \n10. Sofiatamilarasi C, Umasamundeeswari R, Nithyananthinie V . Analysis of histopathological spectrum \nof hysterectomy specimens in Dindigul Medical College - a cross -sectional study. Int J Acad Med \nPharm 2023;5(6);9-13 \n11. Shah D, Savsaviya MJ, Patel NP. Histopathological spectrum of endometrium in hysterectomy \nspecimens from cases of abnormal uterine bleeding. International Journal of Clinical and Diagnostic \nPathology 2022; 5(1): 11-16 \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR260271746 Volume 8, Issue 2, March-April 2026 10 \n \n12. Kinake MS, Watane S, Deshpande S. Clinico -Pathological Study of Abnormal Uterine Bleeding -A \nTwo Year Study at Tertiary Care Center. International Journal of Medical Research & Health Sciences, \n2021;10(6):1-8 \n13. Bindu PJ, Madhavi BV , Vasundara G et al. Clinicopathological Correlation of Endometrial Lesions in \nAbnormal Uterine Bleeding at a Tertiary Care Hospital. International Journal of Current \nPharmaceutical Review and Research 2025; 17(3); 657-661 \n14. Kondareddy R, Gomathy E. Clinico -pathological correlation of AUB patients undergoing \nhysterectomy in a rural tertiary care centre. Indian Journal of Obstetrics and Gynecology Research \n2019;6(4):495–498 \n15. Bharati M, Bhol SK. Study of clinical and pathological correlation of AUB patients undergoing \nhysterectomy. Int J Gynaecol. 2017;3:13-8 \n16. Anupamasuresh Y , Suresh YV , Jain P. Abnormal uterine bleeding: a clinico- histopathological analysis. \nInt J Reprod Contracept Obstet Gynecol. 2014;3:656- 61","source_license":"CC0","license_restricted":false}