{"paper_id":"3aff3818-6e56-4a22-878c-f7498e018759","body_text":"European Journal of General Medicine150\nClinico-Pathological Assessment of \nHysterectomies in Zaria\nABSTRACT\nAim: To assess and compare accuracy of the clinical indications and \nhistopathological diagnoses from hysterectomy specimens in Zaria.\nMethods: All hysterectomy specimens received in the department \nof Pathology, Ahmadu Bello University Teaching Hospital, Zaria \nfrom January 1995 to December 2005 were analyzed. The speci-\nmens were fixed in formalin, processed in paraffin wax and his-\ntology slides stained with haematoxylin and eosin were studied. \nFrequency of clinical indications were compiled and compared with \nhistopathological diagnoses.\nResults: 317 hysterectomies were analyzed. Of these 288 (90.9%) \nwere associated with salpingo-oophrectomies. Median age of pa-\ntients’ was 45 years and mean age was 44.6 years. Parity of the \nwomen ranged from 0-11 with an average of 4.\nThe clinical indications comprised non-neoplastic- 47 (14.8%) and \nneoplastic-226 (71.3%) causes. The commonest benign neoplastic \nindication was uterine fibroid 196 (61.8%). Malignant neoplastic in-\ndication included cervical cancer 12 (3.8%) and endometrial cancer \n6 (1.9%). Cervical intraepithelial neoplasia (CIN), a preneoplastic \nlesion accounted for 44 (13.9%). Histopathological diagnosis of \nleiomyoma was made in 218 (68.8%), cervical cancer –20 (6.3%) and \nCIN- 49 (15.5%). Incidental pathologies seen included chronic cervi-\ncitis -24, adenomyosis- 13 and cystadenoma – 8. Clinical indications \nin 14 (4.4%) patients were at variance with histological diagnosis. \nConclusion: The clinical indication for hysterectomy and histo -\npathological outcome are comparable in over 90% of cases. The \ncommonest indication and histological finding in our setting is \nleiomyoma. \nKey words: Hysterectomy, Indication, Pathology, Leiomyoma.\nDepartments of Pathology1 and\nObstetrics &Gynaecology2 Ahmadu \nBello University Teaching Hospital,\nShika- Zaria, Nigeria\nEur J Gen Med 2009; 6(3): 150-153\nCorrespondence:\nDr, MOA Soetan Samaila FMCPath\nDepartment of Pathology\nA.B.U.T.H, Zaria, Nigeria.\nPostal code: 810001\nFax no:+23469332271-2\nEmail: mamak97@ yahoo.com\nMobile: +2348035891007\nSamaila Modupeola OA1, Adesiyun AG2, Agunbiade OA2, Mohammed-Duro A2\n\n151\nModupeola et al.\nEuropean Journal of General Medicine\nINTRODUCTION\nWomen world wide suffer from gynaecologic and \nobstetric disorders that require hysterectomy as a \ntreatment option (1-3). This may involve removal of \nthe fallopian tube and ovary depending on clinical \nindication, age and parity of the woman (4). The pro-\ncedure is not well embraced in developing countries, \nin particular Nigeria due to socio cultural reasons (5). \nThus, the clinical indication for the procedure should \nbe justifiable. This study is a comparative assessment \nof the accuracy of clinical indication for hysterec -\ntomy and the histopathological outcome. \nMATERIALS and METHODS\nAll hysterectomy specimens sent to the Department \nof Pathology, Ahmadu Bello University Teaching \nHospital, Zaria over a period of 11 years (1995-2005) \nwere studied. Specimens were received from in- pa-\ntients in the teaching hospital, general, private and \nfederal medical center hospitals within and border-\ning Zaria. These specimens were received in 10% \nformalin and processed in paraffin wax. Histology \nsections stained with haematoxylin and eosin (H&E) \nwere studied. Relevant information on the clinical \nindication, age, parity and duration of symptoms of \npatients were retrieved from accompanying request \ncards. Histopathological diagnoses of these specimens \nwere compared with the clinical indications for the \nprocedure. All hysterectomies without histology re-\nport or where slides or tissue blocks could not be \ntraced were excluded from the study.\nRESULTS\n317 hysterectomies were analysed. Of these 288 \n(90.9%) included a salpingo-oophrectomy. 26 (8.2%) \ncases were from outside the teaching hospital.\nMedian age of patients’ was 45years and mean age \nwas 44.6 years. The peak age for the procedure in \nthese patients was the fifth decade (40-49 years) \n(Table 1).\nParity of the women ranged from 0-11 with an aver-\nage of 4 and duration of symptoms ranged from six \nmonths to three years.\nThe clinical indications comprised non-neoplastic-47 \n(14.8%), pre-neoplastic- 44 (13.9%) and neoplastic-226 \n(71.3%) causes (Table I).\nThe commonest benign neoplastic clinical indication \nwas uterine fibroid 196 (61.8%). Malignant neoplastic \nindication included cervical cancer 12 (3.8%) and en-\ndometrial cancer- 6 (1.9%). \nHistopathological diagnoses were categorized into \nnon-neoplastic- (%), pre-neoplastic- (%) and neoplas -\ntic- (%) (Table 2).\nTable 1. Age groups and clinical indications.\nIndications   Age in  Years \na. Nonneoplastic  20-29 30-39 40-49 50+ Total (%)\nAdenomyosis  0 2 4 0 6 (1.9)\nPelvic pain 0 1 5 0 6 (1.9)\nPolyp 0 0 1 1 2 (0.6)\nUV prolapse 0 0 4 2 6 (1.9)\nVaginal bleeding 0 2 10 3 15 (4.7)\nUterine rupture 0 2 0 0 2 (0.6)\nOvarian cyst 2 3 5 0 10 (3.2)\nSubtotal 2 10 29 6 47 (14.8)\nb. Pre-neoplastic\nDysplasia 0 8 34 2 44 (13.9)\nc. Neoplastic     \nFibroid 0 29 126 41 196 (61.8)\nOvarian tumour 1 1 3 0 5 (1.6)\nCervical cancer 0 2 7 3 12 (3.8)\nEndometrial cancer 0 2 3 1 6 (1.9)\nAdenocarcinoma 0 0 2 2 4 (1.3)\nChoriocarcinoma 0 0 2 1 3 (0.9)\nSubtotal 1 34 143 48 226 (71.3)\nTotal 3 52 206 56 317\n\nHysterectomies in Zaria\nEuropean Journal of General Medicine152\nIncidental pathologies seen included chronic cervi-\ncitis -24, adenomyosis -13, cystadenoma -7 and hy -\ndatidiform mole -3. Clinical indications in 14 (4.4%) \npatients were at variance with histological diagnosis. \nDISCUSSION\nHysterectomy is a major surgical procedure which \ninvolves the total removal of the uterus with or with-\nout the fallopian tubes and ovaries (4). Many women \nin Africa and Nigeria in particular are reluctant to \nundergo this procedure because of the socio-cultural \nattachment to procreation and taboos associated with \nlack of menstruation (5). As such indication for the \nprocedure must be cogent. \nHysterectomy specimens accounted for 1.5% of all \nspecimens received in our department within the \nstudy period. Reports on the incidence of hysterec -\ntomies ranges from 14.3% to 22.7% (1, 2,6-8). The \nlow frequency rate in this review may be related to \nreluctance of our women to part with their uterus.\nAge and parity are factors usually considered before \nhysterectomy is performed in our setting (9). The \npeak age for the procedure was the fifth decade \n(40-49). Estimated age range is 31- 60 years (5,8,10-\n12). The average parity in our study was four with \na range of 0-11. Our finding is comparable with the \n3-9 parity range reported in Ibadan, Western Nigeria \n(10). Twenty- five of the women were nulliparous. \nGyna ecologists practicing in developing countries, in \nparticular Nigeria are usually reluctant to perform \nhysterectomy in young nulliparous females except in \nadvanced malignant diseases, unsuccessful myomec-\ntomy for uterine fibroids and uterine rupture which is \na medical emergency (9,13). In developed countries, \nparity is not a limiting factor (1,2,10).\nThe most frequent clinical indication was uterine \nfibroid, a disease with predilection for black wom-\nen. This correlated well with histologic findings of \nbundles of spindle cells having fairly uniform rod \nshaped nuclei arranged in predominant interlacing \npatterns in a fibrocollagenized stroma. 22 incidental \nleiomyomata were also found in specimens removed \nfor other reasons. Many studies in Nigeria and oth-\ner parts of Africa have documented fibroid as the \nTable 2. Spectrum of histopathological diagnoses.\nHistological diagnosis   Frequency \na. Nonneoplastic Actual  Incidental pathology Total\nChronic cervicitis 8 24 32\nSquamous metaplasia 0 10 10 \nAdenomyosis 6 13 19\nHydatidiform mole 0 3 3\nSubtotal 14 50   64\nb. Preneoplastic   \nCIN 44 5 49\nc. Neoplastic   \nLeiomyoma 196 22 218\nThecoma 1 0 1\nCystadenoma 6 8 14\nMature teratoma 3 0 3\nCystadenocarcinoma 5 0 5\nDysgerminoma 1 0 1\nEmbryonal carcinoma  1 0 1\n Squamous cell carcinoma 18 2 20\nLeiomyosarcoma 4 0 4\nAdenocarcinoma 4 2 6\nChoriocarcinoma 2 1 3\nStromal sarcoma 1 0 1\nGranulosa cell tumour 3 0 3\nSubtotal 245 35 280\nTotal 303 90 393\n\n153\nModupeola et al.\nEuropean Journal of General Medicine\nleading indication for hysterectomy in Black African \nWomen (8-11,13).\nCervical intraepithelial neoplasia (CIN), a pre-neo -\nplastic disease which early detection impacts posi-\ntively on the incidence of cervical cancer was the \nsecond commonest clinically and histologically. Over \n70% of the cases were high grade lesions histologi-\ncally. All the women with CIN as clinical indication \nwere identified from prior cervical smear cytology. \nWe thus, recorded a high degree of correlation with \nsubsequent tissue specimen. Unfortunately, the cervi-\ncal cytology is not widely employed in our setting \ndue to lack of awareness and socioeconomic factors \n(14,15). 5 incidental CIN lesions were recorded.\nVaginal bleeding ranked a poor third in the clinical \nindication. Histology of these cases revealed cervical \nSCC in 6, endometrial cystic hyperplasia in 2, chronic \ncervicitis -5 and CIN- 2. All six SCC were advanced \nstage disease. Patients in our setting more often \npresent late in the course of their disease (14). Of \nthe 143 patients with neoplastic clinical indication, \n11.9% was malignant. 5 of the women with malignant \nclinical indication had previous histological diagnosis.\nIncidental pathological findings ranged from seeming-\nly innocuous chronic cervicitis, squamous metaplasia \nand hydatidiform mole to malignant diseases compris-\ning, squamous cell carcinoma and choriocarcinoma. \nClinical accuracy of 95.6% was observed. Of the 14 \nclinical indications at variance with histology, 12 \n(86%) did not require hysterectomy as the treatment \nof choice.\nIn conclusion, the leading clinical indication for hys-\nterectomy and histological finding was leiomyomata. \nOver 90% of clinical indications compared well with \nhistopathological outcome.\n REFERENCES\n1. Harris WJ. Early complications of abdominal and vag-\ninal hysterectomy (Review). Obstet Gynaecol Survey \n1995;50:795-805.\n2. Bachmann GA. Hysterectomy: A critical review. J \nReprod Med 1990;35:839-62.\n3. Mayonda I. Total or subtotal abdominal hysterec-\ntomy for benign gynaecological disease. Review in \nGynaecological practice 2003;3:26-31.\n4. Campbell S, Monga A. Gynaecology by Ten Teachers. \nCampbell S, Monga A (edrs) ELST 17\nth pg 53.\n5. Ezem BU, Otubu JA. Hysterectomy in the Hausa/fulani \npopulation in Nigeria. Int J Gynecol Obstet 1981;19:145-9.\n6. Carlson KJ. Outcomes of hysterectomy. Clin Obstet \nGymaecol 1997;40:939-46.\n7. Loft A, Anderson TF, Bronnum-Hansen H, Rocpstorff \nC, Madsen M. Early postoperative mortality following \nhysterectomy. A Danish population based study (1977-\n1981). Br J Obstet Gynaecol 1991;98:147-54.\n8. Emembolu JO. Uterine fibromyomata. Presentation and \nmanagement in Northern Nigeria. Int J Gynaecol Obstet \n1987;25:414-6.\n9. Seffah JD, Adanu RMK. Hysterectomy for Uterine \nFibroids in Nullipara at Korle Bu Teaching Hospital, \nGhana. Trop J Obstet Gynaecol 2005;22:125.\n10. Orji EO, Ndububa VI, Ajenifuja KO. Elective \nHysterectomy in Obafemi Awolowo University Teaching \nHospitals Complex, Ile-Ife. Sahel Med J 2002;5:125-8.\n11. Roberts OA, Okunlola MA. Abdominal Hysterectomy for \nBenign Gynaecological Conditions at Ibadan, Nigeria. \nTrop J Obstet Gynaecol 2001;18:19-23.\n12. Mackenzie I.Z. Reducing Hospital Stay after abdominal \nhysterectomy. Br J Obstet Gynaecol 1996;103:175-8.\n13. Onwuhafua PI, Oguntayo A, Adesiyun G, Obineche \nI, Akuse JT. Audit of Hysterectomies in a Group of \nPrivate Hospitals in kaduna City, Northern Nigeria. Trop \nJ Obstet 2005;22:16-20. \n14. Anorlo RI, Banjo AA, Odomelun C, Egagle ME, Abudu \nOO. Cervical cancer screening, level of awareness in \nwomen attending a primary health care facility in \nLagos. Nig Med J 2000;7:25-8.\n15. Ayinde OA, Omigbodun AO. Knowledge, attitude and \npractices related to prevention of cancer of the cer -\nvix among female health workers in Ibadan. J Obstet \nGynaecol 2003;23:59-62.","source_license":"CC0","license_restricted":false}