Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness
Diagnosis: Endometrial Hyperplasia | ICD-10 Code N85. 00
The 55-year-old postmenopausal woman, Mrs. Parker, is on daily estrogen and progesterone and has a history of hypothyroidism for which she uses replacement therapy. She stated that she has had slight brownish vaginal discharge for the last two weeks with no lower abdominal pain. Her last menstrual period was about three years ago. She has been pregnant twice and has delivered two babies (G2P2); she started her menses at the age of 11 years. There is no record of any previous atypical Pap smear results or a family history of cancer. This paper will consider the three differential diagnoses that need to be excluded before arriving at the diagnosis, which is endometrial hyperplasia. This article will also address diagnostic tests, treatment approaches, patient counseling, and management of follow-up for endometrial hyperplasia.
Differential Diagnoses
Endometriosis | ICD-10 CODE N80. 9
Rationale: Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity resulting in pain, dysmenorrhea, infertility, and GI/urinary problems, as indicated by Smolarz et al. (2021). Confirmation of the diagnosis can be done through laparoscopic surgery and imaging. However, endometriosis and endometrial hyperplasia are two different diseases that require different treatments. Endometrial hyperplasia results from hormonal changes, especially increased levels of estrogen, and is diagnosed using endometrial biopsy, transvaginal ultrasound, or hysteroscopy. Due to differences in location and diagnostic criteria, endometriosis should be excluded in this case of endometrial hyperplasia.
Endometrial Cancer | ICD-10 CODE C54.1
Rationale: Endometrial cancer is carcinoma that arises from the endometrial cells; it is manifested by non-cyclic uterine bleeding; postmenopausal bleeding or breakthrough bleeding in the premenstrual syndrome are usual symptoms of endometrial cancer (Makker et al., 2021). Pelvic pain, pain during intercourse sex, and sudden weight loss are some of the symptoms. Endometrial hyperplasia, although closely associated with it, is not the same as endometrial cancer, which also presents in its early stages as irregular uterine bleeding. Additional surgery is not required if a diagnosis of benign hyperplasia is made; however, an endometrial biopsy or a hysteroscopy is necessary to reduce the likelihood of misdiagnosing malignant growth. The biopsy can determine atypical hyperplasia, which is often related to CANCER. Hence, by performing some diagnostic examinations, endometrial cancer can be excluded.
Final Diagnosis: Endometrial Hyperplasia| ICD-10 CODE N85.00
Rationale: Endometrial hyperplasia is diagnosed by the over-proliferation of the endometrium, creating tissues that interfere with the normal menstrual cycle and cause irregular bleeding (Nees et al., 2022). This condition is rather concerning, firstly, since if not treated, it may evolve into endometrial cancer. The continuous discharge of blood per vaginal in a postmenopausal woman renders a diagnosis of hyperplasia of the endometrium almost mandatory.
Plan
- Diagnostics: A consultation with a gynecologist should preferably perform an endometrial biopsy to confirm that, indeed, there is endometrial hyperplasia (Will & Sanchack, 2020). In this process, a tissue sample is taken from the endometrium for pathological assessment, and the result obtained aids in establishing the alterations in the female endometrium.
- Treatment :It is important, however, to pay attention to the degree of hyperplasia and the presence of atypical cells since the treatment approach may vary. In the menopausal state, hormonal ablation with progestin is recommended as a line of treatment to manage the menstrual cycle and facilitate the sloughing off of the hyperplastic endometrial tissue in benign endometrial hyperplasia without atypia (Sung & Abramovitz, 2020). If atypical hyperplasia is found, then a course of treatment that is escalated, including a hysterectomy, might be needed to decrease the chances of the development of endometrial cancer.
- Education: This concept map indicates that Mrs. Parker should be educated on the importance of early treatment for endometrial hyperplasia to avoid the development of endometrial cancer (Makker et al., 2021). She should informed about its purpose in treating the disease and understand that there might be unwanted repercussions. Special attention should be paid to the need for proper recommendations for follow-up exams and compliance with the chosen course of treatment.
- Follow-Up: It is necessary to observe the dynamics of the treatment outcomes and the reduction of endometrial hyperplasia during routine follow-up visits (Concin et al., 2021). To assess the resolution of hyperplastic changes, Mrs. Parker should be advised to undergo endometrial biopsies or ultrasounds at some interval of time. In case of the worst or continuation of symptoms, one may be required to undergo other tests and changes to the management plan.
References
Concin, N., Matias-Guiu, X., Vergote, I., Cibula, D., Mirza, M. R., Marnitz, S., Ledermann, J., Bosse, T., Chargari, C., Fagotti, A., Fotopoulou, C., Martin, A. G., Lax, S., Lorusso, D., Marth, C., Morice, P., Nout, R. A., O’Donnell, D., Querleu, D., & Raspollini, M. R. (2021). ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Gynecologic Cancer, 31(1). https://doi.org/10.1136/ijgc-2020-002230
Makker, V., MacKay, H., Ray-Coquard, I., Levine, D. A., Westin, S. N., Aoki, D., & Oaknin, A. (2021). Endometrial cancer. Nature Reviews Disease Primers, 7(1). https://doi.org/10.1038/s41572-021-00324-8
Nees, L. K., Heublein, S., Steinmacher, S., Juhasz-Böss, I., Brucker, S., Tempfer, C. B., & Wallwiener, M. (2022). Endometrial hyperplasia is a risk factor for endometrial cancer. Archives of Gynecology and Obstetrics, 306(2), 407–421. https://doi.org/10.1007/s00404-021-06380-5
Smolarz, B., Szyłło, K., & Romanowicz, H. (2021). Endometriosis: Epidemiology, classification, pathogenesis, treatment and genetics (Review of Literature). International Journal of Molecular Sciences, 22(19), 10554. https://doi.org/10.3390/ijms221910554
Sung, S., & Abramovitz, A. (2020). Postmenopausal bleeding. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562188/
Will, A. J., & Sanchack, K. E. (2020). Endometrial biopsy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541135/
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Question 
Hello please create an essay: Below are the essay elements: I will attach a sample Aquifer Essay so you have an idea.
Essay Elements:
• One to three pages of scholarly writing in paragraph format, not counting the title page or reference page. PLEASE MAKE SURE THAT YOU ONLY HAVE 3 PAGES, NO MOREL NO LESS
• Brief introduction of the case
• Identification of the main diagnosis with supporting rationale. THE MAIN DIAGNOSIS HERE IS MENOPAUSE. PLEASE PUT THE ICD-10 CODE.
• Identification of at least two additional differential diagnoses with a brief rationale for why these were ruled out (Choose only two on the differential diagnosis I put below
• Diagnostic plan with supporting rationale or references
• A specific treatment plan supported by recent clinical guidelines
• Please refer to the rubric for point value and requirements. In general, these elements must be covered as per the rubric.
Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness
DETAILS AND SUMMARY OF THE PATIENT
Mrs. Parker is a 55-year-old postmenopausal female who presents to an ambulatory family medicine office with two weeks of vaginal bleeding. She has a past medical history of hypertension, hypothyroidism, and obesity and has been on continuous hormone therapy for two years. During her workup for abnormal postmenopausal uterine bleeding, a pelvic exam, Papanicolaou (Pap) test, uterine ultrasound, and endometrial biopsy are performed, which confirm a final diagnosis of endometrial proliferation. Differential diagnosis includes endometrial cancer and hyperplasia. Simultaneous with the evaluation of abnormal uterine bleeding, the patient also receives counseling regarding the prevention of osteoporosis and treatment of perimenopausal symptoms.
Differential diagnosis: (PLEASE CHOOSE ONLY TWO DIFFERENTIALS TO PUT IN THE ESSAY)
• Cervical polyp
• endometrial hyperplasia
• hormone-producing ovarian tumor
• endometrial cancer
• proliferative endometrium
• physiologic uterine bleeding
Final diagnosis: Menopause
PLEASE FOLLOW THE ESSAY OUTLINE BELOW
Aquifer Essay Title
The introduction should be a paragraph that provides a brief overview of the case and main diagnosis with rationale and supporting evidence. You do not need to discuss pathophysiology or summarize the entire case. The entire paper should be between one and three pages long.
Differential Diagnoses
This section will be the differential diagnosis. Explain why it is a differential and not the main diagnosis. For Final Diagnosis. Explain why it is the main diagnosis. Please put the ICD-10 code