Comparison of clinical indications and postoperative histopathological diagnoses of hysterectomy specimens with benign preliminary diagnoses
Zehra Bozdag, Omer Faruk Dizibuyuk, Neslihan Bayramoglu Tepe
Gaziantep University Faculty of Medicine, Department of Pathology, Gaziantep, Turkey
Aim: Hysterectomy specimens constitute a large section of routine pathology practice as hysterectomy operations widely performed all over the world to manage benign gynecological disorders by the gynecologists. In this study, we aimed to evaluate hysterectomy specimens obtained due to benign preliminary diagnoses by comparing them with regard to clinical indications and postoperative histopathological diagnoses.
Material and Methods: Nine hundred and forty-seven cases who underwent hysterectomy at Gaziantep University Medical Faculty Hospital between January 2012 and December 2016 were retrospectively re-evaluated with regard to clinical indications and postoperative histopathologic diagnoses.
Results: Leiomyoma was the most common hysterectomy indication and accounted for 34.1% (n:323). Other indications in descending order of prevalence were as follows; abnormal uterine bleeding (n:290, 30.6%), endometrial hyperplasia (n:113, 11.9%), uterine prolapse (n:107, 11.3%), adenomyosis (n:75, 7.9%) and abnormal placentation (n:39, 4.1%).
According to the final histopathological results of the hysterectomy specimens, leiomyomas (n:325, 34.3%) were the most common postoperative diagnosis followed by adenomyosis (n:150, 15.8%) and endometrial hyperplasia (n:113, 11.9%). Abnormal placentation was found in 39 cases (4.1%). Squamous intraepithelial lesions of the uterine cervix were found in 39 cases (4.1%), endometrial adenocarcinomas in 10 cases (0.9%), smooth muscle tumor with uncertain malignant potential, leiomyosarcoma and granulosa cell tumor in one patient each (0.09%).
We found more than one pathology in 280 cases. The most common pathology was leiomyomas coexisting with adenomyosis (n:170, 17.9%), while others included leiomyoma coexisting with endometrial polyp (n:56, 5.9%), and leiomyoma coexisting with endometrial polyp and adenomyosis (n:54, 5.7%).
Conclusion: Incidental detection of conditions such as cervical squamous intraepithelial lesions and endometrial adenocarcinomas in hysterectomy materials obtained for benign preliminary diagnoses support the importance of cervical screening test and endometrial sampling as routine processes in preoperative surgical examinations. This also stresses the importance of macroscopic examination and increased sampling in suspicious cases for pathologists.