Immunohistochemical and histopathological analysis of hysterectomy cases

Abstract

To study the immunohistochemical role of PTEN in the diagnosis of endometrial hyperplasia, one of the challenging diagnoses in uterine diseases, we highlight the most important histopathological diagnoses underlying different types of uterine surgeries. Both benign and malignant diseases are now treated by hysterectomy, with an increasing number of such surgeries. The type of surgery depends on the medical staff's experience, facilities, provisional diagnosis, and the patient’s desire. Differentiation between typical and atypical endometrial hyperplasia is one of the challenging diagnoses in gynecological lesions, which can decrease the number of hysterectomies when precise. A total of 129 patients were enrolled in this study by collecting data on age, clinical presentation, type of surgery, and pathological diagnosis from hospital data. H&E-stained slides for each case were reviewed by two pathologists with re-diagnosis when needed. Statistical analysis was done with correlations. Cases of endometrial hyperplasia (EH), whether benign or atypical (endometrial intraepithelial neoplasia, EIN), were stained with the immunohistochemical marker for PTEN. The most common histopathological diagnosis was leiomyoma (31.8%), followed by adenomyosis (23.3%) and benign EH. Total abdominal hysterectomy was the most common type of surgery, and irregular vaginal bleeding was the most common complaint, both with significant correlation with the older age group (p-value <0.001, 0.013 respectively). About 58.3 % of cases of AEH showed loss or weak PTEN staining.  While benign pathologies (leiomyoma, adenomyosis, and typical EH) were the most common pathological findings, hysterectomy can be avoided when possible. PTEN loss may be of diagnostic value in addition to microscopical features in AEH cases, however, it cannot be depended on alone.