A prospective study of clinical and histopathological correlation of specimens of hysterectomies

Uterus, a vital reproductive organ is subjected to many benign and malignant diseases. Although many medical and conservative surgical treatment options are available, hysterectomy still remains the most commonly performed major gynaecological operative procedure worldwide. Mostly it is the definitive treatment for many of its indications including abnormal uterine bleeding, like in case of fibroids, adenomyosis, utero-vaginal prolapse, endometriosis and pelvic inflammatory disease. Aims and objectives were to know the indications for hysterectomy and its various complications and to analyse correlation between the clinical indication with their histopathological findings.

This hospital based study was conducted at RNT Medical College, Udaipur. A total of 200 case were included undergoing hysterectomy (any route) for gynecological disease. Surgical specimens were sent for histopathology and reports were analysed and compared with the indications of surgery.

In this study preoperative indication of hysterectomy was leiomyoma (34.50%) followed by utero vaginal prolapse (39.0%) and adenomyosis (12.5%) etc. Common finding of HPR report of specimens of uterus and adnexa are as follows: endometrium- proliferative phase (44.50%), myometrium- leiomyoma (33%), cervix- mild squamous hyperplasia (45%), ovaries- physiological ovarian cyst (25.50%). Pre-operative diagnosis of all cases of study were confirmed on histopathology. There was no major intraoperative complication in study group like bladder, rectum, ureter, visceral organ injuries etc. There was no life-threatening postoperative complication and all patients were discharged in good general condition.

In most cases diagnosis by HPR was similar with our preoperative diagnosis but in few cases HPR diagnosis may differ from preoperative diagnosis. Major complications were negligible, hence now-a-days hysterectomy is considered quite a safe procedure. Metrics

Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD. Cesarean Delivery and Peripartum hysterectomy. In: Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD eds. Williams Obstetrics. 24th edn. USA: Mc Graw Hill Companies; 2014:587. Gupta G, Kotasthane D. Hysterectomy: a clinic- pathological correlation of 500 cases. Internet J Gynecol Obstet. 2009;14(1). Graves EJ. National Centre for Health Statistics, National Hospital Discharge Survey, Annual Summary, 1990. Spencer CP, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynaecol. 1999;106:623-32. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. FIGO Working Group on Menstrual Disorders. Int J Gynaecol Obstet. 2011;113:3-13. Sobande AA, Eskandar M, Archibong El, Damole. Elective hysterectomy: a clinicopathological review from Abha catchment area of Saudi Arabia. West Afr J Med. 2005;24(1):31-5. Sachin AK, Mettler L, Jonat W. Operative spectrum of hysterectomy in a German university hospital. J Obstet Gynecol India. 2006;56(1):59-63. Bukar M, Audu BM, Yahava UR. Hysterectomy for benign gynaecological conditions at Gombe, North eastern Nigeria. NMJ. 2010;51(1):35-8. Rather RG, Gupta Y, Bardhwaj S. Pattern of lesion in Hysterectomy specimens. A prospective study. JK Sci. 2013;15:63-8. Perveen S, Tayyab S. A clinic pathological review of elective abdominal hysterectomy. J Surg Pak. 2008;13:26-9. Miller NF. Hysterectomy: therapeutic necessity or surgical racket? Am J Obstet Gynecol. 1946;51: 804. Mauzy CH, Lock FR, Donnelly JF. The management of fibromyomata uteri. Am J Obstet Gynecol. 1951;61(1):32-40. Johnson CG, Moll Jr CF, Post L. An analysis of 6,891 hysterectomies for benign pelvic disease: With special reference to the safety of routine total abdominal hysterectomy. Am J Obstet Gynecol. 1956;71(3):515-31. Benson RC, Sneeden VD. Adenomyosis: a reappraisal of symptomatology. Am J Obstet Gynecol. 1958;76(5):1044-61. Lazarus J, Locke BZ, Thomas DS. Migration differentials in mental disease: State patterns in first admissions to mental hospitals for all disorders and for schizophrenia, New York, Ohio and California, as of 1950. Milbank Memor Fund Quart. 1963;41(1):25-42. Qamar-ur-Nisa, Habibullah, Shaikh TA, Hemlata, Memon F, Memon Z. Hysterectomies; an audit at Tertiary Care Hospital. Professional Med J. 2011;1:46-50. Shergill SK, Shergill HK, Gupta M, Kaur S. Clinicopathological study of hysterectomies. J Indian Med Assoc. 2002;100(4):238-46. Abdullah LS. Hysterectomy: A clinicopathologic correlation. Bahrain Med Bull. 2006;28(2):1-6. Sajjad M, Iltaf S, Qayyum S. Pathological findings in hysterectomy specimens of patients presenting with menorrhagia in different age groups. Ann Pak Inst Med Sci. 2011;7(3):160-2. Sarfraz R, Sarfraz MA, Kamal F, Afsar A. Pattern of benign morphological myometrial lesions in total abdominal hysterectomy specimens. Biomedica. 2010;26:140-3. Pity IS, Jalal JA, Hassawi BA. Hysterectomy: a clinicopathologic study. Tilsit Med J 2011;17(2):7-16. Ramachandran TS, Sinha R. Subramanium. Correlation between clinic pathological and ultrasonographic findings. J Clin Diagn Res. 2011;5(4):734-40. D'Esopo DA. Hysterectomy when the uterus is grossly normal. Am J Obstet Gynecol. 1962;83(1):113-22. Wesley RH. A clinicopathological review of elective abdominal hysterectomy. Am J Obst. Gyn. 1954;67:293. Lee NC, Dicker RC, Rubin G, Oray HW. Confirmation of preoperative diagnosis for hysterectomy. Am J Obstet Gynaecol. 1984;150(3):283-7. 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. Foster Jr HW. Removal of the normal uterus. South Med J. 1976;69(1):13-5. Curtis WW, Suckow E, Huffman JW. Abdominal complete hysterectomy. Obstet Gynecol Survey. 1950;5(6):910. Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, et al. Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol. 2002;187(6):1561-5. Boukerrou M, Lambaudie E, Narducci F Crepin G, Cosson M. Hysterectomy for benign lesions: what remains for the abdominal route? J Gynecol Obstet Biol Reprod. 2001;30(6):584-9 Martin X, Gjata A, Goltier F, Raudrant D Hysterectomy for a benign lesion: can the vaginal route be used in all cases? J Gynecol Obstet Biol Reprod. 1999;28(2):124-30. Weir WC. Am J Obst. Gyn. 1948;52:218. Vandana P, Khoiwal S. Evaluation of Acceptance, Safety and Expulsion of Postplancental Intrauterine Contraceptive Devices (PPIUCD). IJSR. 2020;9(2):10-11. Mengert WF, Stolt R. Am J Obst Gyn. 1945;49:603. Vaidya PK. Obst. Gyn. India. 1979;29:1222.