Hysterectomy: a clinicopathologic correlation

ABSTRACT

To study the most common pathologies identified in hysterectomy specimens and to correlate the findings with the clinical indications. Department of Pathology, King A. Aziz Medical City, Jeddah. All hysterectomy specimens in the period between January 2000 and December 2003 were retrieved and studied for the following variables the primary clinical indication, the pathological diagnosis, the mode of surgery [abdominal versus vaginal] and the patient age. The total number of hysterectomy specimens received was 179. The patient's age ranged between 23-90 years with an average age of 49 years old. The most common clinical indication for hysterectomy was present and previous malignancies 50 [27.9%] including cases of therapeutic and follow up hysterectomies for gynecologic malignancies followed by uterine leiomyoma 44 [24.5%]. Other clinical indications included dysfunctional uterine bleeding 29 [16.2%], uterine prolapse 15 [8.3%], endometrial polyps 10 [5.5%], adenomyosis 5 [2.7%] and endometrial hyperplasia 6 [3.3%]. Emergency hysterectomy for post partum hemorrhage and placenta accreta 15 [8.3%]. Abdominal hysterectomy was the preferred approach [85.4%] for cases other than uterovaginal prolapse. The vaginal route was used in 13.4% of cases and two cases underwent laparoscopic hysterectomy. The most common pathology identified was leiomyoma 62 [34%], followed by adenomyosis in 33 [18.4%] and endometrial polyp in 24 [13.4%]. Changes consistent with uterovaginal prolapse accounted for 15 [8.3%]. Other less frequent pathologies identified included disordered proliferative endometrium, endometritis and simple hyperplasia, which was present in 12 [6.75]. The pathologic examination confirmed the clinical diagnosis in all cases of leiomyomas, adenomyosis and endometrial polyps. This study confirms previous international published data that benign pathologies are more common in hysterectomy specimens than their malignant counterparts and that the most common pathology identified in hysterectomy specimens is leiomyoma. The clinical and pathological correlation is 100% in cases of leiomyoma, adenomyosis and endometrial polyps