A retrospective clinico-pathological study of hysterectomy cases in a tertiary care hospital in India – a review of 950 cases.

Abstract

Abstract:Introduction: Hysterectomy is the most commonly performed gynaecological surgery in India as well as in abroad. It is frequently done in myometrial and endometrial pathologies and rarely for other causes. Hysterectomy is definitive management for diseases like fibroid, adenomyosis, dysfunctional bleeding, prolapsed uterus and malignant lesions of uterus and adenexa. We aimed our study to observe incidence of different pathologies of uterus and other reproductive organs in hysterectomy specimens and retrospective correlation between clinical diagnosis and histopathological finding of hysterectomy cases. Materials and Methods: Retrospective data were collected from our routine histopathological laboratory. Detailed history, clinical examination and operative findings and provisional diagnosis of all 950 hysterectomy cases were recorded during study period of 2 years. Histopathological diagnosis was correlated with clinical and preoperative diagnosis. Observations: Abdominal hysterectomy (734 cases, 77.26%) was the most common route of approach during surgery. Common pre-operative diagnoses were fibroid uterus (32%), dysfunctional uterine bleeding (28.95%), uterine prolapsed (22.74%). Other causes included uterine polyps (1.6%), complications of pregnancy (2.74%), ovarian tumours (8.42%), cervical carcinomas (2.97%) etc. Common pathologies on histology were leiomyoma (32%), adenomyosis (20.32%), atrophic endometrium (17.26%) and endometrial pathology (8.95%). Discussion: Our study has been correlated with other studies of India and other south Asian countries. Most common indication of hysterectomy in our study is dysfunctional uterine bleeding (32%) but Gupta et al and Jha R et al found utero-vaginal prolapse as most common indication. Leiomyoma was the most common histology diagnosed in the present series. Clinical diagnosis was possible in 67.57% cases in our study similar to Khan et al (70.51%). Conclusions: Histopathological examination of hysterectomy specimens helps to detect the exact causes and underlined pathology.

Clinicopathological spectrum of hysterectomy specimens in a tertiary care hospital- A review of 826 cases

“…Overall incidence of endometrial carcinoma in hysterectomy specimens was found to be 1.21% which is similar comparable to Subrata et al Overall incidence of ovarian tumors in hysterectomy specimens is 10.4% and benign tumors constituted 66.3% in the present study compared to Subrata et al which reported 8.42% tumors with 63.5% benign tumors [13]. Correlation of clinical diagnosis with the histopathologic diagnosis in the present study showed 94.5% correlation, that was comparable to study by Lee et al (80%), Gupta et al and Gangadharan et al (95%) [10,15,28].…”

“…High percentage of endometrial hyperplasia in the age group may be due to obesity, diabetes and sedentary lifestyle [27]. Incidence of malignancy in the hysterectomy specimens in this study was 7.75% which was comparable to Subrata et al (7.68%) and Gupta et al (4%) [10,13].…”

“…In the present study, AUB and fibroid uterus were the most common clinical indication for hysterectomy followed by prolapse uterus. Previous study done by Priyadarshini et al, showed fibroid uterus, AUB and prolapse as the most common indication for hysterectomy [5,10,13,14,15,21,22]. The histopathological study of the specimens in the present study revealed leiomyoma as the most common single histopathological finding observed in 310 cases.…”

“…25.3% cases had adenomyosis. Pevious studies reported similar findings ie.,leiomyoma and adenomyosis as the most common histopathological finding in their studies [5,10,13,15,16,19]. Khriesat et al reported adenomyosis as the most common finding in hysterectomy specimens with 37%.…”

Frequency and morphology of benign histopathological lesions in total abdominal hysterectomy specimens.

“…9 Hysterectomy may be performed via abdominal or vaginal routes, depending on pathology, indication for undergoing procedure and surgeon's expertise. 8,10 It is considered important that women should be counseled by her health care provider in detail regarding available treatment modalities and alternate treatment options should be informed to involve her in decision making before undergoing such major surgical procedure. 11 Hysterectomy is a major surgical procedure in terms of both morbidity and mortality.…”