Clinicopathological Analysis Of Hysterectomy Specimens - A Retrospective Study At A Tertiary Care Centre In North India

Abstract: The uterus is a hormonally responsive reproductive organ that undergoes a wide range of physiological changes and is susceptible to numerous benign and malignant pathologies. Common benign conditions include abnormal uterine bleeding (AUB), pelvic inflammatory disease (PID), uterine prolapse, adenomyosis, endometriosis, and leiomyomas. Although several treatment modalities exist, hysterectomy remains a prevalent surgical option globally for both benign and malignant condition affecting the female reproductive tract. Histopathological evaluation of hysterectomy specimens is essential for definitive diagnosis and optimal patient management. Aims and Objectives: -The present study aimed to evaluate the various clinical indications for hysterectomy, assess the correlation between preoperative clinical diagnoses and final histopathological findings, and to analyze the spectrum of histomorphological lesions observed in hysterectomy specimens. Materials and Methods: A retrospective analysis of 155 hysterectomy specimens was conducted over one year at the Department of Pathology, Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh. All specimens, including total abdominal and vaginal hysterectomies, were processed and stained with hematoxylin and eosin (H&E) for microscopic evaluation. Histopathological observation from the endometrium, myometrium, cervix, ovaries, and fallopian tubes were documented and correlated with clinical data. Results: Abdominal hysterectomy was the most common performed surgical procedure performed among 155 analyzed cases (83.9%), with the highest incidence in women aged 41–50 years (45.2%). Abnormal uterine bleeding due to leiomyoma (AUB-L) was the most prevalent clinical indication (45.8%), followed by Adenomyosis (AUB-A) in 22.6% of cases. Proliferative endometrium was the predominant endometrial pattern (38.7%), while leiomyoma (44.5%) and adenomyosis (20.6%) were the most frequent myometrial findings. Hyalinization was the most frequent degenerative change observed in leiomyomas (13.6%). Chronic cervicitis was the most frequent incidental cervical finding (51%). Follicular cysts were the most common ovarian lesions (15.6%).2.2% cases each of serous cystadenoma and mucinous cystadenoma were also noted. Malignancies included endometrial carcinoma (1.3%), cervical carcinoma (2.6%), and ovarian carcinomas (2.2% each for serous and mucinous subtypes). A strong clinicopathological correlation was observed in 70–100% of cases. Rare entities such as cellular, epithelioid, lipoleiomyoma, vascular leiomyoma and serous tubular intraepithelial lesion (STIL) were also documented. Conclusion: Hysterectomy remains the cornerstone surgical treatment for various gynecological conditions. Usually there is generally a strong correlation between clinical and histological diagnosis, coexisting or incidental pathologies (chronic cervicitis & adenomyosis) and occult malignancies are often detected only through microscopic evaluation. Therefore, histopathological examination is essential for definitive diagnosis and is crucial for optimal postoperative management.