Evaluation of endometrium for chronic endometritis by using syndecan-1 in abnormal uterine bleeding

Vidyavathi Kannar, Harendra Kumar Malligere Lingaiah, Venigalla Sunita, Vidyavathi Kannar, Harendra Kumar Malligere Lingaiah, Venigalla Sunita

Abstract

Context: Chronic endometritis is a condition observed in 3-10% of women with abnormal uterine bleeding (AUB). Diagnosis depends upon the histological detection of plasma cells within the inflammatory infiltrate in the endometrium. Plasma cells on H and E may be obscured by a mononuclear infiltrate, plasmacytoid stromal cells, abundant stromal mitosis, a pronounced predecidual reaction, menstrual features or secondary changes due to exogenous progesterone treatment prior to biopsy.

Aims: The objective of this study was to determine utility of syndecan-1 in diagnosis of chronic endometritis in patients with AUB, and to see if any of the secondary histologic features in endometrial biopsy, correlated with the presence of plasma cells on immunohistochemistry (IHC).

Materials and methods: Fifty endometrial biopsies with a clinical diagnosis of AUB were taken. Endometrium in proliferative phase, secretory phase, endometrial polyps, and disordered proliferative endometrium were studied for the presence of plasma cells. IHC was done using syndecan-1. The secondary histologic features of chronic endometritis like gland architectural irregularity, spindled stroma, stromal edema and hemorrhage with the presence of plasma cells was statistically analysed. Values of P < 0.05 were considered as significant.

Results: Plasma cells were seen in 11 (69%) of DPE, 8 (66%) of PEB, and 1 (7%) of normal proliferative endometrium and in 2 (40%) of secretory endometrium. Presence of stromal breakdown showed a significant association with plasma cells (P = 0.02) whereas gland architecture irregularity (P = 0.28), stromal edema (P = 0.71) and spindled stromal (P = 0.72) did not show a significant association.

Conclusions: Plasma cells were significantly present in AUB patients. Syndecan-1 maybe helpful in unusual cases, where chronic endometritis is suspected as the cause of clinically significant ongoing abnormal bleeding.

Keywords: Abnormal uterine bleeding; chronic endometritis; syndecan-1.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Endometrium containing plasma cells showing membrane staining highlighted with Syndecan-1. ×400
Figure 2
Figure 2
(a) Plasma cells are not readily seen in H and E slide with mucosal odema of stroma H and E ×100; (b) Syndecan-1 showed numerous plasma cells in stroma. ×100; (c) H and E slide showing prominent spindle cell component. ×100; (d) Plasma cells easily identified in spindle cell component. ×100
Figure 3
Figure 3
(a) Irregular endometrial glands showing mild stromal breakdown. H and E, ×100; (b) IHC showing plasma cells concentrated beneath endometrial glands. ×100. (c). Plasma cells clearly seen on H and E, ×100; (d) Grade 3 plasma cells on IHC which are concentrated beneath glands ×100

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