Author(s): M. S. Siddegowda1, Jasneet Kaur Sandhu2, Sundaram Shivakumar3
BACKGROUND Hysterectomy is the most common procedure done for definitive treatment of abnormal uterine bleeding. However, advent of effective medical and conservative treatment modalities is now posing a question mark on justification of hysterectomy, thus advocating compulsory histopathological assessment to rationalise the need for hysterectomy procedures. AIM This study was done for identification of lesions of uterus and adnexa in routine hysterectomy specimens performed for various gynaecologic indications and correlation with the preoperative indications. METHODOLOGY A retrospective audit was done including hysterectomy specimens referred for gynaecologic indications to the Department of Pathology of a teaching hospital over a period of three years (May 2012- April 2015). All specimens were evaluated for clinical details and the frequency of various gross and microscopic endometrial, myometrial, cervical and adnexal changes. RESULTS During the study period, 826 hysterectomy specimens were received with most being simple hysterectomy specimens and the most common presenting symptom being menstrual irregularities (55.3%). Most of the women were in the age group of 31-50 years (75.5%). The most common preoperative indication in women less than 50 years of age was uterine fibroid and in women more than 50 years of age was prolapse. In the endometrium, most cases displayed proliferative phase (54.1%) and the most common pathological changes were endometrial polyp (9 cases) and simple hyperplasia (8 cases) followed by 2 cases of endometrial carcinoma, single case each of EIN and metastatic squamous cell carcinoma of cervix. In the myometrium, most common lesion was leiomyoma (40.4%). In the cervix, chronic cervicitis was most commonly observed. Fallopian tube was unremarkable in most cases (91.3%) and most ovarian specimens showed physiological changes (87.1%). The most common incidental finding was adenomyosis (20.7%).
CONCLUSION Correlation of preoperative diagnosis to histopathological evaluation is essential for confirmation as well as identification of incidental findings that play a key role in morbidity of the patient. Adenomyosis still remains a clinical challenge elusive to preoperative diagnosis and thus, needs to be kept in mind by both clinician and pathologist for better patient management.