To Study the Histomorphological Spectrum and Role of BCl2 and Ki67 in Cases of Abnormal Uterine Bleeding at a Tertiary Care Centre

Introduction: Abnormal uterine bleeding (AUB) encompasses irregularities in menstrual frequency, duration, and volume, and is a common gynecological complaint, especially in perimenopausal women. The histopathological examination of endometrial biopsies plays a pivotal role in determining the underlying cause, whether functional or organic. Aims and Objectives: 1) To evaluate the clinical and histomorphological spectrum in cases of abnormal uterine bleeding. 2) To study the role of BCl 2 and Ki 67 in cases of abnormal uterine bleeding. Methodology: A prospective cross-sectional study was conducted in the Department of Pathology, LLRM Medical College, Meerut in collaboration with the Department of Obstetrics and Gynaecology, SVBP Hospital Meerut. A total of 150 endometrial biopsy samples from women aged above 18 years with AUB were analyzed over a period of one year. Patients with AUB due to gestational causes or inadequate samples were excluded. Histopathological and immunohistochemical analysis was performed. Results: Among the 150 patients, 76 cases (50.7%) were of perimenopausal age group, 60 cases (40%) of reproductive-age group, and 14 cases (9.3%) of postmenopausal age group. Menorrhagia was the most common bleeding pattern (67.3%), followed by metrorrhagia (17.3%). Functional causes were predominant (64%), including proliferative endometrium (24.7%) and disordered proliferative endometrium (20%). Organic causes constituted 36%, with endometrial polyps (16.7%) and endometrial hyperplasia (8.6%) being most frequent. Endometrial carcinoma was seen in 4% of cases. BCl 2 expression was most commonly observed in functional causes, where 43.8% of cases were positive while Ki 67 expression commonly seen in organic causes where 46.3% of cases were positive. Conclusion: AUB was most prevalent in the perimenopausal age group and was predominantly due to functional endometrial causes. Histopathological evaluation remains essential for accurate diagnosis and appropriate treatment, particularly to rule out hyperplasia and malignancy. Recommendations: Routine endometrial sampling and histopathological examination should be performed in all women with AUB, particularly in perimenopausal and postmenopausal groups. Immunohistochemistry should be considered in cases with atypia or suspicion of malignancy to enable timely diagnosis and intervention.