# The Morphological Spectrum of Endometrial Biopsies in Nigerians: A Snapshot of a Review of Findings From a District Hospital

## TL;DR

This study analyzed endometrial biopsies in Nigerians and found that most cases were non-cancerous, with a high rate of pregnancy-related findings and fewer malignant cases in older women.

## Contribution

The study provides a detailed morphological spectrum of endometrial biopsies specific to Nigerian women, establishing baseline data for health planning.

## Key findings

- Non-neoplastic lesions, especially placental products of conception, were the most common findings.
- Endometrial polyps were frequently diagnosed in women aged 35-44 years.
- Malignant lesions were rare but more common in women over 44 years.

## Abstract

Introduction

Endometrial biopsies constitute a significant proportion of the work of pathologists. They are associated with a wide spectrum of diagnoses, including inflammatory, non-neoplastic, and neoplastic lesions. They are an invaluable procedure used by gynecologists in conjunction with pathologists to assess endometrial health. This study aimed to document the morphological spectrum of endometrial biopsies in Nigerians, compare these with findings in other populations, and establish baseline data that may aid in health systems planning and directing resource allocation for improvement in women's health.

Materials and methods

This was an eight-year retrospective study of all endometrial biopsy samples received in the anatomic pathology and forensic medicine department of Asokoro District Hospital, Abuja, Nigeria. Hospital records and surgical pathology reports were retrieved for patients’ biodata and clinical information. Appropriate slides were retrieved and reviewed, and fresh sections were made where necessary. We categorized the lesions as non-neoplastic, gestational trophoblastic disease (GTD), non-GTD neoplastic, normal, and others. The proliferative and neoplastic lesions were classified using the 2020 WHO classification of female genital tumors. Malignant lesions were also graded using the 2009 FIGO guidelines. Data obtained were analyzed, and results were presented as percentages/frequencies and displayed as tables and charts.

Results

A total of 1,506 cases met the inclusion criteria (age range: 13-84 years, median age: 34 years). The majority of cases (87.6%, 1319/1506) occurred in patients in the reproductive age range of 15-44 years, with 62.7% (945/1506) in the range of 34-44 years. Cases in patients aged 45 years and above constituted just 12.4% (186/1506). The most frequently reported symptoms were abnormal uterine bleeding (AUB) (42.2%, 635/1506), abdominal pain (10.7%, 161/1506), and amenorrhea (8.8%, 133/1506). Non-neoplastic lesions (79.4%, 1196/1506) dominated the diagnostic spectrum, and of these, 80.4% (961/1196) were placental (products of conception). The frequency of non-placental, non-neoplastic lesions was 19.6% (235/1196). They were mainly endometrial polyps (52.8%, 124/235), seen mostly (50.8%, 63/124) in the age range of 35-44 years. Inflammatory lesions (10.6%, 25/235) were least frequently diagnosed, occurring mostly (48.0%, 12/25) in the age range of 15-29 years. GTDs comprised 5.0% (75/1506) of total lesions, with 92.0% (69/75) of these patients younger than 45 years. Hydatidiform moles (88.0%,66/75) constituted the majority, while choriocarcinoma, the only malignant GTD diagnosed, occurred in 10.6% (8/75). Neoplastic lesions constituted 4.2% (63/1506) of cases and 76.2% (48/63) of mesenchymal leiomyomas. All the epithelial neoplasms (13/63, 20.6%) were malignant, occurring in 92.3% (12/13) of patients above 44 years.

Conclusions

Our study demonstrated significant similarities in the morphological spectrum of endometrial biopsies between Nigerians and people of other nationalities. These lesions were predominantly non-neoplastic and seen mostly in the reproductive age range, while lesions in peri and postmenopausal patients were fewer and more likely to be malignant. The predominance of products of conception signifying an unacceptably high rate of early pregnancy loss and a high percentage of endometrial polyps within the non-pregnancy-related biopsies warrant further research.