Role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding

Background: Abnormal uterine bleeding is a bleeding from uterine compose that is abnormal in volume, regularity and/or timing that has been present for the majority of the last 6 months. Evaluation of women with abnormal uterine bleeding should comprise history taking, systemic and local examination, laboratory investigations, imaging and different diagnostic procedures including hysteroscopy

Aim of the Work: to assess the accuracy of hysteroscopy in the diagnosis of the cause of bleeding in women with abnormal uterine bleeding

Patients and Methods: This prospective observational study was conducted on 114 patients attended the Early Cancer Detection Unit, Faculty of Medicine, Ain Shams University between July 2017 and April 2018, to assess the role of diagnostic hysteroscopy and histopathology in evaluation of abnormal uterine bleeding

Results: Hysteroscopy had a sensitivity of 91.9%, specificity of 86.5%, positive predictive value of 93.2%, and negative predictive value of 84.2% and diagnostic accuracy of 90.1% for diagnosing the etiology of abnormal uterine bleeding

Conclusion: Hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding especially with patient with thick endometrium, in any age group. Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value and the results of hysteroscopy are immediately available. Hysteroscopy and histopathology complement each other in evaluating patients with abnormal uterine bleeding for accurate diagnosis and further treatment

Serum and tissue CEA in gastric mucosa of patients with hepatosplenomegaly

This work was carried out to clarify the possibility of neoplastic transformation in patients with atrophic gastritis complicating endemic hepatosplenomegaly and to identify those with or at a special risk of developing premalignant or malignant gastric lesions. Estimation of CEA in the gastric tissue and serum of these patients will be our tool. This study was carried out on 3 groups. The study group included 35 patients having endemic hepatosplenomegaly associated with atrophic gastritis, the control group one comprised 10 normal individuals and control groups II included 18 patients with gastric adenocarcinoma. After detailed history, full clinical examination all study groups were subjected to complete urine and stool analysis and gastric biopsies were taken by endoscopy and stained by H and E. Paraffin section were further stained by tissue CEA and lastly serum estemation of CEA level was evaluated. These results were statistically analysed tissue CEA was positive in [37.1%], study group compared to 0% in normal individuals and [100%] in control group in having gastric adenocarcinoma while serum CEA was insignificantly higher than in normal group and significantly lower than control group II. No significant association was found between serum CEA and degree of mucosal atrophy. More over no significant association was found between serum CEA and tissue CEA in study group. These data conclude that atrophic gastritis complicating hepatosplenomegaly have increase incidence of tissue CEA than normal. Twenty per cent of those patients had level serum CEA higher than the cut off value denoting that these patients are at higher risk of developing carcinoma

Comparison between colposcopically directed punch biopsy and large loop excision of the transformation zone [LLETZ]

The study comprises [40] women with suspected cervical intraepithelial neoplasia CIN attending the colposcopy clinic at Ain Shams Early Cancer Detection unit. All women were subjected for colposcopy. directed punch biopsy and large loop excision of the transformation zone [LLETZ]. Colposcopy was satisfactory in all women, punch biopsies were adequate for pathological examinations, the excised transformation zones were also adequate. The results of LLETZ did not agree with that of punch biopsies in [25% of cases. The pathology detected by punch biopsy was superior than LLETZ in 20% of cases. LLETZ revealed pathology greater than punch biopsy in [5%] of cases. Punch biopsy is an adequate method of diagnosis specially for smaller lesions, concerning larger, ones, it is better to have more than one biopsy or LLETZ

Criteria for diagnosis of hepatocellular carcinoma and metastatic liver disease by fine needle aspiration biopsy

Fine needle aspiration biopsy [FNAB] of masses in the liver is gaining wide use. In this study we examined 32 FNAB smears [sonar guided] followed by liver biopsy in order to identify helpful criteria for diagnosis of primary and metastatic liver tumours. FNAB confirmed the diagnosis in 22 out of 28 patients with hepatocellular carcinoma [HCC] with diagnostic accuracy of 78.57 percent, and 4 metastatic adenocarcinoma with accuracy of 100 percent. The diagnosis was made by cytologic examination of the FNAB smear and confirmed by histopathologic examination of liver biopsy. For diagnosis of HCC we recommend the criteria of Cohen et al., 1991 that applied very well to all cases. The diagnosis of metastases was based on the exclusion of the criteria for HCC, the absence of atypical naked nuclei, presence of 2 cell populations and the presence of normal hepatocytes. FNAB proved to be a reliable method for evaluation of mass lesions in the liver