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

  • Dr. Ronald J Bosco Assistant Professor, Department of Pathology, Trichy SRM medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
  • Dr. Sarada V Professor, Department of Pathology, Trichy SRM medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
Keywords: Hysterectomy, AUB, Endometrial Hyperplasia, Leiomyoma

Abstract

Introduction: Hysterectomy is one of the most common surgeries performed for common gynaecological indications, but less frequently done for tumors of female genital tract. Abnormal uterine bleeding (AUB) is one of the most common indications for hysterectomy. Histopathology is essential to confirm these common causes, but also helps to identify rare causes and to rule out malignancy. This study aims to anaylse the age pattern, clinical indications, clinicopathological correlation of hysterectomy cases along with distribution, causes and histopathological pattern of endometrial lesions in AUB.

Material and Methods: The present study is a retrospective study done at Trichy SRM medical college hospital with hysterectomies done between January 2018 to November 2019 been included in the study. Clinical and Histopathological details were recorded, analysed and compared.

Results: Of the 826 cases, Total abdominal hysterectomy was the most common surgery. The age varied from 21 to 85 with fourth decade as the most common age. Fibroid uterus and AUB were the most common clinical indication.Histopathology revealed leiomyoma as the most common diagnosis. About 95.5% cases correlated with clinical diagnosis. Of the 258 AUB cases, 100 had pure endometrial pathology and 31 cases showed combined endometrial and other pathologies. Totally 76 cases of endometrial hyperplasia were identified and 65 presented with AUB. About 11.6% AUB patients had malignancy and endometrial carcinomacomprised of 3.9% cases.

Conclusion: Histopathological evaluation is essential to substantiate the clinical findings, identify missed pathologies, establishing a definitive etiology thereby aiding effective treatment of the pathology.

Downloads

Download data is not yet available.

References

Sutton C. Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol.1997;11(1):1-22. doi: https://doi.org/10.1016/s0950-3552(97)80047-8.

Nausheen F, Iqbal J, Bhatti FA, Khan AT, Sheikh S. Hysterectomy: The patient’s perspective . Annals Gynecol.2004;10(4):339-341. doi: https://doi.org/10.21649/akemu.v10i4.1220

Prasad DR, Nair NV. Retrospective analysis of elective hysterectomy cases in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2018;7(9):3714-3717. doi: http://dx.doi.org/10.18203/2320-1770.ijrcog20183782.

Wu JM, Wechter ME, Geller EJ. .Hysterectomy rates in the United States 2003. Obstet Gynecol.2007;100(5):1091-1095. doi: https://doi.org/10.1097/01.AOG.0000285997.38553.4b.

Kishwar N, Abid H, Riasat A. Clinico-pathological study of hysterectomy at Pak Red Crescent medical and dental college.JIIMC.2018;13(2).

Veena S Naik, Jyoti D Rege, Kusum D Jashnavi. Pathology of genital tract in post menopausal bleeding, Dept of Pathology, T.N.Medical college and BYL nairch. Hospital, Mumbai, Bombay Hosp J, 1996.

Cote I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol.2003;188(2):343-348. doi: https://doi.org/10.1067/mob.2003.92.

Rimza ME. Dysfunctional uterine bleeding. Pediatr Rev.2002;23(7):227-233. doi: https://doi.org/10.1542/pir.23-7-227.

Thompson JD. Hysterectomy.In:Thompson JD, Rock JA, eds. Te Linde’s Operative Gynecology.7th ed. JB Lippincott Company, Philadelphia,1992.663-738.

Gupta G, Kotasthane D, Kotasthane V. Hysterectomy: A clinic-pathological correlation of 500 cases. Int J Gynec and Obstet.2010;14(1).

Singh A, Arora AK. Why hysterectomy rates are lower in India? Ind J Commun Med.2008;33(3):196-197. doi: https://dx.doi.org/10.4103%2F0970-0218.42065.

Kovac Sr. Hysterectomy outcomes in patients with similar indications. Obstet Gynecol.2000;95(6 pt 1):787-793. doi: https://doi.org/10.1016/s0029-7844(99)00641-9.

Subrata P, Srabani C,Anuradha S et al. A retrospective clinico-pathological study of hysterectomy cases in a tertiary care hospital in India- A review of 950 cases. Bang J Med Sci.2018;17(1):88-92. doi: https://doi.org/10.3329/bjms.v17i1.35287.

Gousia RR, Yudhir G, Subash B. Patterns of lesions in hysterectomy specimen: a prospective study. JK Sci.2013;15(2).

Gangadharan V, Prasanthi C. Hysterectomy- a clinicopathological correlation in a rural setting. Indian J Bas App Med Res. 2016;5(2):8-15.

Mishra B, Bhol SK. Study of clinical and pathological correlation of AUB patients undergoing hysterectomy. MedPulse – Int J Gynaecol. 2017; 3(1):13-18

Toma A, Hopman WM, Gorwill RH. Hysterectomy at a Canadian tertiary care facility:results of a 1 year retrospective review. BMC Women’s health.2004;4-10. doi: https://doi.org/10.1186/1472-6874-4-10.

Leung PL. An audit on hysterectomy for benign diseases in public hospitals in Hong Kong. HK Med J.2007;13(3):187-193.

Mandal SK. Clinico-pathological correlation of hysterectomy specimen for abnormal uterine bleeding in perimenopausal women. J Med Sci Clinic Res.2017;5(1). doi: https://dx.doi.org/10.18535/jmscr/v5i1.125.

Jha R, Pant AD, Jha A, Adhikari RC, Sayami G.. Histopathological analysis of hysterectomy specimens. J Nepal Med Assoc.2006;45(163):283-290.

Priyadarshini Ph,Gomathi E. Clinicopathological study of uterine leiomyomas in hysterectomy specimens: A retrospective study. Int J Adv Res. 2018;6(2):571-576. doi: http://dx.doi.org/10.21474/IJAR01/6474.

Shergill SK,Shergill HK,Gupta M et al. Clinicopathological study of hysterectomies. J Indian Med Assoc.2002;100(4):238-239.

Sajitha K,Shetty KP,Jayaprakash S et al. Study of histopathological patterns of endometrium in abnormal uterine bleeding. CHRISMED J Health Res.2014;1(2):76-81.

Khreisat B, Al- Rawabdeh S, Duqoum W. Adenomyosis: Frequency of hysterectomy in histopathological specimens at two Jordanian military hospitals. JRMS.2011;18(2):76-79.

Sajjad M, Iltaf S, Qayyun S. Pathological findings in hysterectomy specimens of patients presenting with menorrhagia in different age groups. Am Pak Inst Med Sci.2011;7:160-162.

Baak JP, Mutter GL. EIN and WHO 94. J Clin Pathol. 2005;58:1-6. doi: https://doi.org/10.1136/jcp.2004.021071.

Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynecol India. 2011;61(4):426-430. doi: https://dx.doi.org/10.1007%2Fs13224-011-0047-2.

Lee NC, Dicker RC, Rubin GL, Ory HW. Confirmation of pre-operative diagnosis for hysterectomy. Am J Obstet Gynecol.1984;150(3):283-287. doi: https://doi.org/10.1016/s0002-9378(84)90366-1.

Mitali M, Pratima M. Clinico-pathological evaluation of abnormal uterine bleeding. J Health Res Rev. 2015;2(2):45-59. doi: https://doi.org/10.4103/2394-2010.160904.

Albers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Phys. 2004;69:1915-1926.

Talukdar B, Mahela S. Abnormal uterine bleeding in perimenopausal women: Correlation with sonographic findings and histopathological examination of hysterectomy specimen. J Mid- Life Health. 2016;7(2):73-77. doi: https://doi.org/10.4103/0976-7800.185336

Muzaffar M, Akhtar KA, Yasmin S, Mahmood-Ur-Rehman, Iqbal W, Khan MA. Menstrual irregularities with excessive blood loss: A clinicopathological correlation. J Pak Med Assoc. 2005;55(11):486-489.

Bhosle A, Fonseca A. Evaluation and histopathological correlation of Abnormal uterine bleeding in perimenopausal women. Bombay Hosp J.2010;52(1):69-72.

Khan S, Hameed S, Umber A. Histopathological pattern of endometrium on diagnostic D and C in patients with abnormal uterine bleeding. Annals.2011;17(2):166-170. doi: https://doi.org/10.21649/akemu.v17i2.293.

Goldstein SR. Menorrhagia and abnormal bleeding before the menopause. Best Pract Res Clin Obstet Gynecol.2004;18(1):59-69. doi: https://doi.org/10.1016/j.bpobgyn.2003.10.003.

McCluggage WG. My approach to the interpretation of endometrial biopsies and curettings. J Clin Pathol. 2006;59(8):801-812. doi: https://doi.org/10.1136/jcp.2005.029702.

Emons G, Beckmann MW, Schmidt D, Mallmann P; Uterus commission of the Gynecological Oncology Working Group (AGO). New WHO Classification of Endometrial Hyperplasias. Geburtshilfe Frauenheilkd. 2015;75(2):135–136. doi: https://doi.org/10.1055/s-0034-1396256.

Mazur MT, Kurman RJ. Normal endometrium and infertility evaluation. In: Mazur MT, Kurman RJ,eds. Diagnosis of endometrial biopsy and curettings: A practical approach. 2nd ed. New York: Springer Verlag; 2005.p.7-33.

CITATION
DOI: 10.17511/jopm.2020.i01.08
Published: 2020-01-30
How to Cite
J Bosco, R., & V, S. (2020). Clinicopathological spectrum of hysterectomy specimens in a tertiary care hospital- A review of 826 cases. Tropical Journal of Pathology and Microbiology, 6(1), 50-57. https://doi.org/10.17511/jopm.2020.i01.08
Section
Original Article