Application of International Endometrial Tumor Analysis in Abnormal Uterine Bleeding: A Case Report

Abstract

BACKGROUND: Abnormal uterine bleeding (AUB) is one of the clinical symptoms found in malignant conditions where the incidence of newly diagnosed cancers reached 100,000 cases in Europe in 2012 with an incidence of around 14.7/100,000 women. The International Endometrial Tumor Analysis (IETA) group, formed in Chicago in 2008, published a consensus stating how to examine and measure the endometrium.

CASE REPORT: Mrs. M, 49 years old, came to Gynecology Clinic of USU Hospital on February 22, 2021, at 13.00 WIB with the complaints of prolonged menstruation for 2 months with a volume of >10 times changing pads. Menstrual pain was found. Low back pain was found. A history of bleeding between menstrual cycles was found. On ultrasound examination, anteflexed uterus was found with size of 6.95 × 4.2 × 3.85 cm, thickness of the endometrium: 1.64 cm and concluded as AUB-M (thickening of the endometrium). Then, the patient is diagnosed with AUB-M (thickening of the endometrium) and is planned to undergo a diagnostic curettage. Anatomical pathology results showed a complex hyperplasia endometrium without atypia cells. Acute AUB is defined as bleeding profusely so that prompt treatment is needed to prevent blood loss. Ultrasound examination is performed to assess the size, shape of the uterus, the presence of fibroids, polyps, adenomyosis, and uterine anomalies such as uterine didelphys, sometimes polycystic ovaries are also found. Endometrial biopsy can detect more than 90% of cancers. The pathology of the endometrium can diagnose endometrial cancer or determine the likelihood of cancer. These investigative modalities can assist in the diagnosis of endometrial polyps, adenomyosis, leiomyomas, uterine anomalies, and endometrial thickening associated with hyperplasia and malignancy. Curettage is considered to relieve ongoing menorrhagia. According to the SOGC, administration of nonsteroidal anti-inflammatory drugs can inhibit cyclo-oxygenase and reduce levels of endometrial prostaglandins.

DISCUSSION: Acute AUB is defined as bleeding profusely so that prompt treatment is needed to prevent blood loss. Ultrasound examination is performed to assess the size, shape of the uterus, the presence of fibroids, polyps, adenomyosis, and uterine anomalies such as uterine didelphys, sometimes polycystic ovaries are also found. Endometrial biopsy can detect more than 90% of cancers. The pathology of the endometrium can diagnose endometrial cancer or determine the likelihood of cancer. These investigative modalities can assist in the diagnosis of endometrial polyps, adenomyosis, leiomyomas, uterine anomalies, and endometrial thickening associated with hyperplasia and malignancy. Curettage is considered to relieve ongoing menorrhagia. According to the SOGC, administration of nonsteroidal anti-inflammatory drugs can inhibit cyclo-oxygenase and reduce levels of endometrial prostaglandins.

CONCLUSION: According to IETA, the vascular pattern in the endometrium is reported to be associated with the presence or absence of a “dominant vessel” or other specific pattern. Endometrial thickness is the maximum measurement in the sagittal plane. The accompanying ultrasound provides the measurement of endometrial thickness in the absence of intracavity fluid; the endometrium should be measured where it appears thickest. If intracavity pathology is present, total thickness of endometrium including the lesion should be recorded. Anatomic pathology by curettage is required in women with abnormal bleeding; histological evaluation of the endometrium may identify infectious or neoplastic lesions such as endometrial hyperplasia or cancer.