Patterns of Lesions in Hysterectomy Specimens in a Tertiary Care Hospital

Abstract

Introduction: Hysterectomy is one of the most common gynaecological procedures performed all over the world. The most frequent indications for hysterectomy are fibroids, abnormal uterine bleeding uterovaginal prolapse and endometriosis. The objective of this study was to present the histopathological patterns of various uterine and adnexal pathologies in the hysterectomy specimens and also to correlate its pre-operative clinical diagnosis with histopathology.
 Methods: This is a two-year descriptive study of hysterectomy specimens carried out in the Department of Pathology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Data of all the hysterectomy specimens collected during this period was analyzed. 
 Results: Out of the 533 cases, fibroid was the most common indication for hysterectomy that was seen in 229 (42.94%) cases followed by uterovaginal prolapse in 101 (18.93%) cases. Leiomyoma was the most common pathology reported in 250 (46.90%) hysterectomy specimens, followed by ovarian tumours in 95 (17.82%) cases. In 17.82% (95/533) cases, no pathology was seen. Overall, the pre-operative indications in 533 cases of hysterectomy were histopathologically verifiable in 487 (91.37%) cases.
 Conclusions: Though the histopathological examination correlates well with the pre-operative clinical diagnosis, a number of lesions were also encountered as pure incidental findings. Hence, it is mandatory that every hysterectomy specimen should be subjected to histopathological examination so as to ensure better post-operative management.
 Keywords: adenomyosis; hysterectomy; leiomyoma; tumour; uterovaginal prolapse.

Clinico-Pathological Correlation of Morphological Lesions in Hysterectomy Specimens - A 3-Year Study in a Medical College Hospital

“…Since early 20 th century, hysterectomy is a definitive treatment of pelvic pathology including fibroid, abnormal uterine bleeding, chronic pelvic pain, endometriosis, adenomyosis, uterine prolapse, pelvic inflammatory disease and genital malignancies 10. In the present study, most (39.8%) women were in the age group of 41-50 years of age, similar to studies done by Vaidya S et al11 (45.63%) and Rather et al 12 (47.27%). The mean age in our study was 45.54 years, similar to the studies done by Rahat Sarfaraz et al 13 (44.58 years) and Vaidya S et al 11 (46.98%).…”

“…Similarly, a higher percentage has been reported in other studies. 1,4,9,10,11,12 The most common type of hysterectomy was simple hysterectomy (50%), followed by TAH with BSO in our study. However, in studies done by Rather et al 12 and Vaidya et al 11 , TAH with BSO was the most common type of operative procedure.…”

“…12 However, some authors. 11,17 have reported a higher incidence of ovarian neoplasms. The difference could be explained by our larger sample size.…”

“…4 In our study, abnormal uterine bleeding was the most common clinical presentation (47.9%), similar to Rather. 12 et al and Saleh et al 11 Hysterectomy can be done by abdominal, vaginal and laparoscopic approaches of which abdominal approach is the most preferred all over the world. All the hysterectomies were done by abdominal approach in our study.…”

“…Among the neoplasms, serous cyst adenoma was the most common diagnosis similar to various other studies. 11 Fallopian tubes are complex structures that represent more than conduits from ovary to endometrial cavity. The significance of pathologic changes in fallopian tubes is related to the possible effect on fertility, exceptions being a few rare tubal neoplasms which may be life threatening.…”