Revisiting indication for hysterectomy according to PALM-COEIN classification and its correlation with histopathological examination reports

Vazeer Bhavya Shanmukhi, M. Vijaya Sree
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2023 · vol. 12(7) , pp. 2145–2150 · doi:10.18203/2320-1770.ijrcog20231925 · W4382357943
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study compared preoperative clinical diagnoses for hysterectomy with histopathological findings in 50 patients, finding leiomyoma to be the most common clinical diagnosis but noting discrepancies with HPE results.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-14 · read from full text ⓘ

This prospective study (Dec 2020–Dec 2022) examined 50 patients undergoing abdominal hysterectomy in whom preoperative clinical diagnosis and ultrasonography-based indication for surgery were correlated with histopathological examination (HPE) of the removed specimens. Most patients’ clinical diagnosis was leiomyoma (42%, 21/50), and among those, HPE showed discrepancies in 4 cases, including adenomyosis in 2 cases and unremarkable myometrium in 2 cases. The paper reports other common histopathologies such as leiomyoma in myometrium, chronic papillary endocervicitis, hydrosalpinx, and simple serous ovarian cysts, while explicitly excluding patients with frank malignancy and uterine prolapse. This paper is centrally about endometriosis and/or adenomyosis only through adenomyosis detection as part of clinico-histopathological correlation in hysterectomy specimens, making it directly relevant to adenomyosis.

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Abstract

Background: Hysterectomy is most common major gynaecological surgery. AUB is commonest indication for hysterectomy. Hysterectomy is done when medical/minimally invasive treatment methods fail. It provides permanent relief of symptoms and patient satisfaction. Aim of this study was to correlate the clinical preoperative diagnosis and histopathological findings of cases which needed abdominal hysterectomy. Methods: This prospective study was conducted in Department of OBG at Mamata general hospital, Khammam, during December 2020 to December 2022. The patients were diagnosed based on history, clinical examination and ultrasonography reports. Patients with frank malignancies and uterine prolapse were excluded. Hysterectomy was done wherever it is indicated and the specimens were sent for histopathological examination (HPE). HPE reports were correlated with preoperative indication for hysterectomy. Results: In this study 50 patients who underwent abdominal hysterectomy were studied. Data was recorded in terms of demographics, clinical features, indications of the hysterectomy and histopathological findings. It was observed that, most common clinical diagnosis was leiomyoma [21 women (42%)]. Among these 21 women, histopathological findings of 4 women were different (adenomyosis in 2 cases and unremarkable myometrium in 2 cases). Leiomyoma in myometrium, chronic papillary endocervicitis in cervix, hydrosalpinx in fallopian tubes and simple serous cysts in ovaries were the commonest histopathology noted. Conclusions: Hysterectomy is most widely performed major gynaecological operation and histopathology is mandatory for confirming diagnosis and management. With the improvement in the different treatment options for AUB, hysterectomy in benign disease should only be done when all the other conservative options fail.
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Background

Hysterectomy is most common major gynaecological surgery. AUB is commonest indication for hysterectomy. Hysterectomy is done when medical/minimally invasive treatment methods fail. It provides permanent relief of symptoms and patient satisfaction. Aim of this study was to correlate the clinical preoperative diagnosis and histopathological findings of cases which needed abdominal hysterectomy.

Methods

This prospective study was conducted in Department of OBG at Mamata general hospital, Khammam, during December 2020 to December 2022. The patients were diagnosed based on history, clinical examination and ultrasonography reports. Patients with frank malignancies and uterine prolapse were excluded. Hysterectomy was done wherever it is indicated and the specimens were sent for histopathological examination (HPE). HPE reports were correlated with preoperative indication for hysterectomy.

Results

In this study 50 patients who underwent abdominal hysterectomy were studied. Data was recorded in terms of demographics, clinical features, indications of the hysterectomy and histopathological findings. It was observed that, most common clinical diagnosis was leiomyoma [21 women (42%)]. Among these 21 women, histopathological findings of 4 women were different (adenomyosis in 2 cases and unremarkable myometrium in 2 cases). Leiomyoma in myometrium, chronic papillary endocervicitis in cervix, hydrosalpinx in fallopian tubes and simple serous cysts in ovaries were the commonest histopathology noted.

Conclusions

Hysterectomy is most widely performed major gynaecological operation and histopathology is mandatory for confirming diagnosis and management. With the improvement in the different treatment options for AUB, hysterectomy in benign disease should only be done when all the other conservative options fail. Metrics

References

Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in United States. Ame J Obstet Gynaecol. 1982;144:841-48. Nausheen F, Iqbal J, Bhatti FA, Khan AT, Sheikh S. Hysterectomy: the patient’s perspective. Ann Gyne. 2004;10(4):339-41. Pathak DR, Agarwal S, Tiwari P, Kumar G. To study the clinical and histopathological findings on hysterectomy. Euro J Mole Clin Med. 2022;9(6):299-304. Olsson JH, Ellstrom M, Hahlin M. A randomized prospective trial comparing laparoscopic and abdominal hysterectomy. Brit J Obstet Gynaecol. 1996;103(4):345-50. Dicker RC, Scally MJ, Greenspan JR, Layde PM, Ory HW, Maze JM, et al. Hysterectomy among women of reproductive age: trends in the United States, 1970-1978. JAMA. 1982;248(3):323-7. Khan R, Sultana H. How does histopathology correlate with clinical and operative findings in abdominal hysterectomy? J Armed Forces Med Coll. 2010;6(2):17-20. Verma D, Singh P, Kulshrestha R. Analysis of histopathological examination of the hysterectomy specimens in a north Indian teaching institute. Int J Res Med Sci. 2016;4(11):4753-8. Arya TS, Bhushan S. Histopathological analysis of uterus and appendages following total abdominal hysterectomy. MedPulse-Inter J Gynaecol. 2017;3(1):54-6. Sultana SN, Sony AA, Pervin M, Hamid MA. Clinico-histopathological correlation of abdominal hysterectomy. Int J Reprod Contra Obstet Gynecol. 2022;11:2337-41. Kasinathan A, Nagulapally H. A retrospective study on indications and histopathological analysis of non-oncological hysterectomies in a tertiary care hospital. Int J Reprod Contra Obstet Gynecol. 2020;9(12):5050-4. iwana KK, Nibhoria S, Monga T, Phutela R. Histopathological audit of 373 nononcological hysterectomies in a teaching hospital. Pathol Res Internat. 2014;2014:1-5. Gupta G, Kotasthane DS, Kotasthane VD. Hysterectomy: a clinico-pathological correlation of 500 cases. Int J Gynaecol Obstet. 2010;14(1):1-5. Frances Jr H. Abdominal myomectomy as a treatment for symptomatic uterine fibrois. Obsteretic and gynaecology clinics North America. 1995; 22(4):781-9. Abraham R. Uterine fibroid. Manual of clinical problems in obstetrics and gynaecology. 4th ed. 1994;227-229.

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