{"paper_id":"3b142d26-c3e3-4151-9c61-6b7df4863ab0","body_text":"International Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 12, December 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nHistomorphologic\n \nStudy of Uterine and Cervical \nLesion in Hysterectomy Specimen in the \nDepartment of Pathology and J\nA\n \nGroups of \nHospitals, A Prospective Study\n \n \nDr\n.\n \nMeenakshi Patel\n1\n, Dr\n.\n \nReena Jain\n2\n, \nDr\n.\n \nSudha \nIyengar\n3\n,\n \nDr\n.\n \nSonal Kulshreshtha\n4\n \n \nDepartment of Pathology\n, G.R. Medical College Gwalior (M.P)\n, India\n \n \n \nAbstract\n: \nBackground\n: The female reproductive system is vulnerable to a wide range of benign and malignant disorders. Despite the \navailability of conservative therapies, hysterectomy remains one of the most commonly performed gynecological surgeries world\nwide. \nHistopathologic\nal evaluation of hysterectomy specimens plays a crucial role in identifying underlying lesions, including occult \nmalignancies.\n \nAim\n: To analyze the histomorphological spectrum of uterine and cervical lesions in hysterectomy specimens and\n \ncorrelate \nthem with age and clinical presentation.\n \nMaterials and Methods\n: This prospective study was conducted in the Department of Pathology, \nJA Group of Hospitals, Gajra Raja Medical College, Gwalior, from May 2023 to October 2024. A total of 380 hysterectomy specim\nens \nfulfilling the inclusion criteria were examined. Followi\nng fixation, gross examination, tissue sampling, processing, and H&E staining, \nhistopathological evaluation of uterine and cervical components was performed. Data were analyzed using \nIBM SPSS Statistics v20 and \nJamovi v2.3.28.\n \nResults\n: The highest frequency of hysterectomy was observed in the 41\n–\n50\n-\nyear age group (46.3%). Total hysterectomy \nwith bilateral adnexal removal was the most common procedure (60%). In the endometrium, proliferative phase was the predomina\nnt \npattern (44.7%), wh\nereas premalignant and malignant lesions\n-\nincluding hyperplasia with atypia (5.3%), EIN (1.1%), and endometrial \ncarcinoma (2.9%)\n-\nwere also identified. In the myometrium, leiomyoma (26.6%) and adenomyosis (17.6%) were the most prevalent \nfindings. Cervical evaluation revealed chronic non\n-\nspecific cervicitis as the most common lesion (78.2%); however, CIN/CIS and invasive \ncervical carc\ninoma were detected in 6.3% of cases.\n \nConclusion\n: Histopathological examination of hysterectomy specimens is imperative \nfor detecting clinically significant premalignant and malignant lesions, particularly in perimenopausal women, and is fundame\nntal to \nopt\nimal diagnostic and therapeutic decision\n-\nmaking.\n \n \nKeywords:\n \nHysterectomy, Histomorphology, Uterine, Cervical lesions, Cervical intraepithelial neoplasia (CIN)\n \n \n1.\n \nIntroduction\n \n \nThe female genital system, comprising the uterus, cervix, \novaries, and fallopian tubes, is susceptible to various benign \nand malignant diseases at any age due to hormonal influences, \ncontributing significantly to female mortality and morbidity. \nAlthough me\ndicinal and conservative approaches are \navailable, hysterectomy remains an effective therapeutic \noption for many conditions [1]. Globally, hysterectomy is the \nsecond most common major surgical procedure performed on \nfemales, following cesarean sections [2]\n. It involves the \nremoval of the uterus through either a vaginal or abdominal \napproach [3], a practice that began in the early 1900s. The \ncommonest indications for hysterectomy include \nendometriosis, adenomyosis, uterine fibroids, prolapse, and \ndysfunction\nal or abnormal uterine bleeding [4]. The \nGLOBOCAN 2022 report states that cervical cancer is the \nfourth most common cancer among women worldwide, with \n662,301 new cases reported. Based on 127,526 newly \nreported cases, cervical cancer is identified as the s\necond \nleading cancer among women in India [5]. There was little \nchange in incidence between 2020 and 2022, as seen by the \n123,907 cases reported in India according to the \nGLOBOCAN 2020 projections [6]. Yet, these figures \ndemonstrate the large and ongoing p\nrevalence of cervical \ncancer in the nation, highlighting the need for continued \nefforts in treatment, earlyidentification, and prevention. The \n348,709 cervical cancer\n-\nrelated deaths that have been \ndocumented globally also include 79,906 deaths from India \n[\n5]. A gynecologist performs a hysterectomy, which is the \nsurgical removal of the uterus. In Manchester, England, \nCharles Clay conducted the first subtotal hysterectomy in \n1843, then in 1929, he performed the first complete \nabdominal hysterectomy.[7] Despite the availability of \nalternative treatment options for s\neveral gynecological \nconditions, hysterectomy continues to be one of the most \ncommon gynecological surgeries performed globally. The \nstructure of the uterus, which includes the endometrium and \nmyomet\nrium, experiences dynamic changes across different \nstages of a woman's life.\n \n \n \nThese changes include pathological changes like hyperplasia \nand benign and malignant neoplastic lesions, as well as \nphysiological changes like the menstrual cycle and \npregnancy\n-\nrelated changes. Worldwide, hysterectomy is the \nsecond most common major surgic\nal treatment performed on \nwomen, behind caesarean sections. [8] There aren't any \nnational data available for India. Nonetheless, research has \nbeen done in Haryana.[9] and Ahmedabad.[10] to evaluate \nhysterectomies' prevalence and indications in India. The \nm\najority of the specimens in any hospital's histopathology \ndepartment are from hysterectomy procedures. Surgical \nremoval of the uterus may be performed unilaterally (U/L) or \nbilaterally (B/L) with U/L or B/L salpingo\n-\noophorectomy, \neither preserving or excis\ning the cervix in the case of a \nsupracervical hysterectomy [8]. Abnormal uterine bleeding \n(AUB) of any source, which is defined as bleeding from the \nuterine corpus that is abnormal in regularity, volume, \nfrequency, or duration that occurs outside of pregna\nncy, is the \nmost common reason for a hysterectomy.[11] The objective \nof this study was to analyze the histological results of uterine \nPaper ID: SR251210133424\nDOI: https://dx.doi.org/10.21275/SR251210133424\n766 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 12, December 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nand cervical specimens from hysterectomies submitted to the \npathology department for histopathological examination. The \nstudy aimed to investigate the patterns of lesions in the \nhysterectomy specimens, identify the various clinical \nindications for the proc\nedure, and assess the relationship \nbetween histopathological findings and age groups.\n \n \nAims & Objectives: \nTo study Histomorphology of uterine \nand cervical lesion in hysterectomy specimen. \n \n \nPrimary objective:\n \n \n1)\n \nTo see different histopathological lesions in uterus and \ncervix in hysterectomy specimens. \n \n2)\n \nTo study its correlation with respect to age and clinical \npresentation.         \n \n3)\n \nTo study malignant lesion of cervix and uterus prevalent \nin our region.\n \n \n2.\n \nMaterial & Methodology\n \n \nThe study entitled “to Histomorphologic study of Uterine and \nCervical Lesion in Hysterectomy Specimen” A Prospective \nStudy” was carried out as below:\n \n \nPlace of study:\n \nThe study was designed in the Department of \nPathology, It was carried out in the Department of Pathology \nand JA Groups of Hospitals, Gajra Raja Medical College, \nGwalior Madhya Pradesh. \nPeriod of study\n: The present study \nwas carried out May 2023 to Oct 2024 a period of 18 months.\n \n \nSample size:\n \nBy reference document analysis, titled: From \nthe study of “Sujatha R.et all\n \n(2019)1 Histomorphological \nanalysis of uterine and cervical lesions in hysterectomy \nspecimens at a tertiary care hospital”. The commonest lesion \nencountered was Chronic non\n-\nspecific cervicitis in \n86(55.40%) cases. The formula for calculating sample size: \nA\nt 5% level of significance and 5% absolute error sample size \ncalculated using the formula:  n = Z2\nα/2\nPQ d2, Z\nα/2 = 1.96 \n(at 5% level of significance) calculated sample\n \nsize was 380.\n \n \nInclusion criteria: \nAll hysterectomy specimen submitted in \nhistopathology section of pathology department, G.R. \nMedical College for histopathological examination related to \nUterine and Cervix lesions. \n \n \nExclusion criteria:\n \nHysterectomy specimen with indications \nfor pathologies related to fallopian tubes (tubal ectopic and \ntubal cancer) and ovaries (ovarian cancer) were omitted from \nthe study.\n \n \nStudy Procedure\n: The specimens for this study will be \nselected from hysterectomy cases received in the Department \nof Pathology, Histopathology Section, G.R. Medical College, \nGwalior, referred from the Department of Obstetrics and \nGynaecology. The received hysterectomy sp\necimens \nunderwent immediate fixation in 10% neutral buffered \nformalin. After 24 hours of fixation, the specimens were \nthoroughly examined grossly and then multiple representative \nbits are taken, processed and embedded in paraffin. \nHistological sections, 3\n-\n5 microns thick, were cut, slide\n-\nmounted, and stained with standard H & E stain for \nmicroscopic evaluation. Histomorphological observations of \nthe uterus and cervix lesions were recorded and then analyzed \nin relation to the patients' age and clinical diagn\nosis. \n \n \nEthical Consideration\n: Ethical clearance for the study was \nobtained from the Institutional Ethical Committee of Gajra \nRaja Medical College, Gwalior (M.P.) before starting the \nstudy.\n \n \nInformed Consent:\n \nThe study did not require informed \nconsent because it utilized archived hysterectomy specimens \nreferred from the Department of Obstetrics and Gynaecology, \nwhich were already available in the Department of Pathology. \n \n \nData Analysis\n: The completed questionnaire was sorted and \nentered into Microsoft 2019 excel package, IBM SPSS \nStatistic version 20 and Jamovi version 2.3.28 for analysis.\n \n \n3.\n \nResult\n \n \nThe highest number of hysterectomy cases was observed in \nthe 41\n–\n50year age group (176 cases, 46.3%), followed by the \n31\n–\n40year group (112 cases, 29.5%), The mean patient age \nwas 45.8 years (SD ±8.92). The most common type was total \nhysterectomy with bilate\nral adnexal removal, accounting for \n60% of the cases (n=228). Partial hysterectomies with \nunilateral adnexal removal constituted 24.7% (n=94), while \nthose without adnexal removal made up 15.3% (n=58) of the \nspecimens.\n \n \nTable 1:\n \nDistribution of Uterine and Cervical Specimen on basis of different parameter\n \nParameter\n \nCategory / Finding\n \nNo. of Cases\n \nPercentage (%)\n \nAge Distribution\n \n21\n–\n30 years\n \n12\n \n3.2\n \n31\n–\n40 years\n \n112\n \n29.5\n \n41\n–\n50 years\n \n176\n \n46.3\n \n51\n–\n60 years\n \n55\n \n14.5\n \n>60 years\n \n25\n \n6.6\n \nType of Hysterectomy\n \nPartial (Uterus + Cervix; without adnexa)\n \n58\n \n15.3\n \nPartial (Uterus + Cervix + one\n-\nsided adnexa)\n \n94\n \n24.7\n \nTotal (Uterus + Cervix + bilateral adnexa)\n \n228\n \n60\n \nEndometrial Histopathology\n \nProliferative phase\n \n170\n \n44.7\n \nSecretory phase\n \n65\n \n17.1\n \nSenile endometrium\n \n83\n \n21.8\n \nHyperplasia without atypia\n \n27\n \n7.1\n \nHyperplasia with atypia\n \n20\n \n5.3\n \nEIN (Endometrial intraepithelial neoplasia)\n \n4\n \n1.1\n \nEndometrial carcinoma\n \n11\n \n2.9\n \nMyometrial Histopathology\n \nNo pathology\n \n172\n \n45.3\n \nPaper ID: SR251210133424\nDOI: https://dx.doi.org/10.21275/SR251210133424\n767 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 12, December 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nLeiomyoma\n \n101\n \n26.6\n \nAdenomyosis\n \n67\n \n17.6\n \nLeiomyoma + Adenomyosis\n \n19\n \n5.0\n \nMyometrial hyperplasia\n \n12\n \n3.2\n \nMyometrial invasion by endometrial carcinoma\n \n6\n \n1.6\n \nMonckeberg calcification\n \n3\n \n0.8\n \nCervical Histopathology\n \nChronic non\n-\nspecific cervicitis (CNC)\n \n297\n \n78.2\n \nNabothian cyst\n \n34\n \n8.9\n \n \nGranulomatous cervicitis\n \n14\n \n3.7\n \nSquamous metaplasia with CNC\n \n11\n \n2.9\n \nCervical dysplasia / CIN\n \n6\n \n1.6\n \nCarcinoma cervix in situ\n \n7\n \n1.8\n \nCarcinoma cervix\n \n11\n \n2.9\n \n \nThe histopathological evaluation of myometrial lesions \nspecimens showed that 172 cases (45.3%) had no detectable \npathology. Among the pathological findings, leiomyoma was \nthe most common lesion, identified in 101 cases (26.6%), \nfollowed by adenomyosis in 6\n7 cases (17.6%). A combination \nof leiomyoma with adenomyosis was seen in 19 cases (5.0%). \nLess frequently observed findings included myometrial \nhyperplasia in 12 cases (3.2%), myometrial invasion by \nendometrial carcinoma in 6 cases (1.6%), and Monckeberg \nc\nalcification in 3 cases (0.8%). \nC\nervical lesions showed that \nchronic non\n-\nspecific cervicitis (CNC) was the most common \nfinding, seen in 297 cases (78.2%). Nabothian cysts were \nnoted in 34 cases (8.9%), followed by granulomatous \ncervicitis in 14 cases (3.7%). Ca Cervix 11(2.9%) and \nsquamou\ns metaplasia with CNC 11(2.9%), while cervical \ndysplasia/CIN 6 (1.6%) and carcinoma cervix in situ(CIS) \nwere identified in 7 cases (1.8%).\n \n \n \nFig\nure \n1\n:\n \nShowing endometrial hyperplasia without atypia\n \n \n \nFigure \n2\n:\n \nCarcinoma cervix in situ (CIS)\n \n \n4.\n \nDiscussion\n \n \nIn the present histomorphological\n \nstudy of 380 hysterectomy \nspecimens, observation and analysis were performed and the \nresults were compared with studies from India and abroad. \nThe highest number of cases was found in the 41\n–\n50\n-\nyear age \ngroup (46.3%), followed by 31\n–\n40 years (29.5%). Fewe\nr \ncases were noted among 51\n–\n60 years (14.5%) and >60 years \n(6.6%), while the lowest incidence occurred in 21\n–\n30 years \n(3.2%). The mean patient age was 45.8 ± 8.92 years. Similar \nage distribution was reported by Sujatha R et al. (2019) and \nKolur A et al. (2\n019), whereas Khalid H et al. (2022) noted \npeak incidence in the 51\n–\n60\n-\nyear group.\n \n \nTotal hysterectomy with bilateral adnexal removal was the \nmost common surgical procedure in our study (60%), \nfollowed by partial hysterectomy with unilateral adnexal \nremoval (24.7%) and without adnexa (15.3%). Comparable \ntrends were seen in studies by Kish\nore M et al. (2024), Kharat \nVarsha et al. (2023) and Dolon M.F. et al. (2021), showing \nabdominal hysterectomy as the most frequent approach.\n \n \nRegarding endometrial pathology, proliferative phase was the \npredominant finding (44.7%), followed by senile \nendometrium (21.8%) and secretory phase (17.1%). \nHyperplasia without atypia (7.1%), hyperplasia with atypia \n(5.3%), EIN (1.1%) and endometrial carc\ninoma (2.9%) were \nalso noted. These results correlate with studies by Kishore M \net al. (2024), Kharat Varsha et al. (2023) and Sujatha R et al. \nPaper ID: SR251210133424\nDOI: https://dx.doi.org/10.21275/SR251210133424\n768 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 12, December 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n(2019), all of which also showed proliferative endometrium \nas the most common pattern.\n \n \nMyometrial lesions were dominated by leiomyoma (26.6%) \nand adenomyosis (17.6%), consistent with findings by Kolur \nA et al. (2019) and Sujatha R et al. (2019). Cervical pathology \nrevealed chronic nonspecific cervicitis as the most frequent \nlesion (78.2%), f\nollowed by Nabothian cysts (8.9%) and \ngranulomatous cervicitis (3.7%), correlating well with studies \nby Shrivastava K et al. (2024) and Harshal A. Patil et al. \n(2015). Although most cervical lesions were benign, a small \nproportion showed premalignant and m\nalignant changes, \nemphasizing the importance of histopathological evaluation.\n \n \n5.\n \nConclusion\n \n \nThis prospective histopathological study of 380 hysterectomy \nspecimens conducted at the Department of Pathology, JA \nGroup of Hospitals, Gajra Raja Medical College, Gwalior, \ndemonstrates that hysterectomy is most frequently performed \nin the perimenopausal a\nge group, particularly among women \naged 41\n–\n50 years. Total hysterectomy was the predominant \nsurgical procedure, reflecting a preference for comprehensive \nmanagement in this age group.\n \n \nEndometrial evaluation showed that although physiological \npatterns such as the proliferative phase were common, a \nconsiderable proportion of cases exhibited premalignant and \nmalignant lesions, including hyperplasia and endometrial \ncarcinoma, emphasizing th\ne importance of routine \nhistopathological examination. Myometrial analysis revealed \nleiomyoma and adenomyosis as the most frequent benign \npathologies, while the detection of myometrial invasion by \nendometrial carcinoma, though uncommon, highlights the \nneed\n \nfor meticulous microscopic assessment. Cervical study \nshowed chronic non\n-\nspecific cervicitis as the most common \nlesion; however, premalignant and malignant changes \nincluding CIN, CIS, and invasive carcinoma were also \nidentified in a notable subset, reinfo\nrcing the role of \nhistopathology in early cancer detection.\n \n \n6.\n \nRecommendations\n \n \n1)\n \nRoutine histopathological examination of all \nhysterectomy specimens is essential.\n \n2)\n \nPerimenopausal women (41\n–\n50 years) should undergo \nregular gynecological screening.\n \n3)\n \nEarly evaluation of abnormal uterine bleeding is crucial \nfor timely detection of endometrial lesions.\n \n4)\n \nPromote Pap smear, HPV testing, and HPV vaccination \nfor cervical cancer prevention.\n \n5)\n \nStrengthen coordinated management between \ngynecologists\n, pathologists, and oncologists for optimal \npatient care.\n \n \nAcknowledgement\n: \nWe sincer\nely thank the \ndepartment of \nobstetrics and gynaecology\n \nand department of \nPathology, \nG.R. Medical College, Gwalior\n, for their \ncontinuous support \nand guid\nance throughout\n \nthe study.\n \n \n \n \nConflict\ns\n \nof interest:\n \nthe authors no conflict of interest.\n \n \n \nReferences\n \n \n[1]\n \nRather GR, Gupta Y , Bardhwaj S. Patterns of lesions in \nhysterectomy specimens: a prospective study. JK \nscience. 2013;15(2):63. \n \n[2]\n \nKrentel H, Wilde RLD. Laparoscopic supracervical \nhysterectomy with in\n-\nbag morcellation in very large \nuterus. Case reports in medicine. 2017;2017. \n \n[3]\n \nDonnez O, Jadoul P, Squifflet J, et al. A series of 3190 \nlaparoscopic hysterectomies for benign disease from \n1990 to 2006: evaluation of complications compared \nwith vaginal and abdominal procedures. BJOG. 2009 \nMar; 116 (4): 492\n-\n500. doi: 10. 1111/j. 1471\n-\n \n0528. \n2008. 01966. x. Epub 2008 Nov 11. Cunningham, F. G., \nLeveno, K. J., Bloom, S. L., Dashe, J. S., Hoffman, B. \nL., Casey, B. M., & Spong, C. Y . (2018). 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Sch J App Med \nSci 2014;2(6G):3320\n-\n3323.\n \n[12]\n \nSujatha R et.al\n \n(2019). Histomorphological analysis of \nuterine and cervical lesions in hysterectomy specimens \nat a tertiary care hospital, DOI: 10.18231/2581\n-\n3706.2019.0014 \n \n[13]\n \nKhalid H. et.al (2022). Pattern of Uterine and Cervical \nLesions Marked on Histopathological Examination of \nHysterectomy Specimens, DOI: \nhttps://doi.org/10.53350/pjmhs221610997. \n \n[14]\n \nKolur A et.al (2019). Clinicopathological Analysis of \nHysterectomy Specimens. Print ISSN: 2456\n-\n9887, \nOnline ISSN: 2456\n-\n1487 \n \nPaper ID: SR251210133424\nDOI: https://dx.doi.org/10.21275/SR251210133424\n769 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 12, December 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n[15]\n \nDolon M.F. et\n \nal.\n \n(2021). Histopathological Report of \nHysterectomy Specimens in a Tertiary Care \n10.36349/easms.\n \n2021.v04i03.003 \n \n[16]\n \nKharat Varsha et.al\n \n(2023). Hospital, Research Article \nDOI: Histopathological Spectrum of Lesions of \nHysterectomy Specimens in Tertiary Care Hospital: \nTwo Year Retrospective Study, doi: \n10.59218/makrjms.2023.12.385.390\n \n[17]\n \nShrivastava K et al.\n \n(2024). Histopathological spectrum \nof uterine lesions in hysterectomy specimens of patients \nwith abnormal uterine bleeding. PISSN 2349\n-\n3240 | \neISSN 2349\n-\n3259\n \n[18]\n \nHarshal A. Patil et al.\n \n(2015) Histopathological Findings \nin Uterus and Cervix of Hysterectomy Specimens. DOI: \n10.15306/mvpjms/2015/v2i1/58635.\n \nPaper ID: SR251210133424\nDOI: https://dx.doi.org/10.21275/SR251210133424\n770","source_license":"CC0","license_restricted":false}