Analysis of Immunohistochemical Markers (Bcl-2 and Ki-67) Expression in Various Endometrial Lesions among Women Presenting with Abnormal Uterine Bleeding

Abstract

Background: Abnormal uterine bleeding (AUB) has been increasingly reported, with its underlying mechanisms linked to cell proliferation and apoptosis. This study assessed the expression of anti-apoptotic marker (Bcl-2) and proliferative marker Ki-67 in cyclical and abnormal endometrium. Methods: This was a cross-sectional study conducted among women with the clinical history of AUB, adequate clinical details and adequate endometrial specimens received in the form of endometrial curettage and endometrial biopsy. Immunostaining for Bcl – 2 and Ki – 67 markers were done on cyclical and abnormal endometrial lesions followed by scoring based on number of cells and intensity of staining. Results: About 200 specimens were included in this study. On IHC, the Bcl-2 expression was highest in proliferative phase with a mean value of 14.96, followed by endometrial carcinoma (13.71), Disordered proliferative endometrium (DOPE) (12.44) and mean of hyperplastic pattern was 10.04 with the lowest mean score of 3.47 in secretory phase. Ki-67 expression was highest in endometrial carcinoma with a mean value of 15.43, followed by hyperplastic pattern of 14.93, proliferative phase of 14.00 and mean value of DOPE was 10.04. The expression of Ki-67 was significantly decreased in secretory phase with a mean score of 2.67. Conclusion: There was an increased expression of both Bcl-2 and Ki-67 in the proliferative phase while it was minimal in secretory phase in cyclical endometrium. When Bcl-2 and Ki-67 staining were assessed in abnormal endometrium, there was an increased proliferative activity and increased anti-apoptotic activity in disordered proliferative endometrium, hyperplasia and endometrial carcinoma.