Abdominal hysterectomy: analysis of clinico-histopathological correlation in Western Rajasthan, India

Abstract

Background: Hysterectomy is the most common gynecological surgery done in the females worldwide as it provides definitive cure to a wide range of gynecological diseases, both benign and malignant. The indications to perform this major surgery should always be justified and the pathology should be proved histopathologically. Histopathological analysis and review is mandatory to evaluate the appropriateness of the hysterectomy.Methods: A retrospective, longitudinal study was conducted in the Department of Obstetrics and Gynecology, UMAID Hospital, Dr. S.N. M.C. Jodhpur (Raj.) during October 2014 to March 2015.Total 105 cases were studied during this period. The study included all women undergoing planned abdominal hysterectomy. Data was recorded on proformas, including demographic characteristics and clinical features. Hysterectomy specimens were saved in 10% formalin and sent to the Department of Pathology. Histopathology reports were analyzed and compared with the indications of surgery to draw various informative conclusions.Results: Of 105 cases, 55(52.38%) were in the age group of 41 – 50, which comprised the commonest age group undergoing the surgery. Maximum women (95%) those underwent hysterectomy were multiparous. Most common preoperatively clinical diagnosis was leiomyoma uterus which was diagnosed clinically and sonographically in 51(48.57%) cases. On Histopathological examination, the commonest pathology, similar to clinical impression, was found to be Leiomyoma at 50.48% (n = 53). Adenomyosis (21.90%) was detected as Second most common pathology. Histopathological confirmation of pre-operative diagnosis was 89% for malignancy, 96% for fibroids, 100% for adenomyosis, 100% for pelvic inflammatory disease.Conclusions: There was a high correlation when the clinical diagnosis was a fibroid, adenomyosis and ovarian mass. Every hysterectomy specimen should be subjected to histopathological examination because it is mandatory for conforming diagnosis and ensuring optimal management, in particular of malignant disease.

A Clinico-histopathological Correlation of Elective Abdominal Hysterectomy in University Hospital

“…6 In this study, the most common preoperative diagnosis for hysterectomy was leiomyoma uterus found in 105 (51.72%) patients followed by ovarian tumor in 34 (16.75%) patients which were similar to the results reported by Acharya S. 7 Jha R. found that leiomyoma was the indication in 24.9%, ovarian tumor in 14.9%, and DUB in 7.7% of the cases. 10 Similar results were observed in the studies done by Yadav DP, Jaleel R and Naheed K. 2,3,9 In our study, the most common histopathological diagnosis was leiomyoma, found in 87 (42.86%) patients, as similar to other studies. 2,4 Ovarian tumor observed in 35 (17.24%) patients was the next common pathology found in this study whereas adenomyosis was also the next common pathology found in other studies.…”

“…This finding was similar to previous studies. [2][3][4][5][6][7] In the present study, the maximum number of 110 (54.19%) patients was seen with parity 2-3 which was comparable to other studies. 3,8 The most common clinical symptom in this study was menorrhagia found in 67 (33.00%) patients followed by pain abdomen in 62 (30.54%) patients which were similar to the studies done by Jaleel R, Perveen S and Naheed K. 2,6,9 It is well known that hormonal disturbance in the perimenopausal age group, results in symptomatic menstrual changes.…”

“…[2][3][4][5][6][7] In the present study, the maximum number of 110 (54.19%) patients was seen with parity 2-3 which was comparable to other studies. 3,8 The most common clinical symptom in this study was menorrhagia found in 67 (33.00%) patients followed by pain abdomen in 62 (30.54%) patients which were similar to the studies done by Jaleel R, Perveen S and Naheed K. 2,6,9 It is well known that hormonal disturbance in the perimenopausal age group, results in symptomatic menstrual changes. 6 In this study, the most common preoperative diagnosis for hysterectomy was leiomyoma uterus found in 105 (51.72%) patients followed by ovarian tumor in 34 (16.75%) patients which were similar to the results reported by Acharya S. 7 Jha R. found that leiomyoma was the indication in 24.9%, ovarian tumor in 14.9%, and DUB in 7.7% of the cases.…”

“…In the study conducted by Yadav DP et al, AUB was found in 27 (25.71%) patients in which AUB was histopathologically correlated in 2 (7.40%) patients. 3 In our study, the preoperative symptomatic diagnosis of postmenopausal bleeding was made in 5 (2.46%) patients. Only 40% of preoperatively diagnosed postmenopausal bleeding cases were correlated on histopathological diagnosis while the rest were missed preoperatively which included endometrial polyp (40%) and adult granulosa cell tumor (20%).…”

“…2,4,10,11 In this study, the correlation between preoperative diagnosis and histopathological diagnosis was 100.00% in cases of ovarian tumor, complex endometrial atypical hyperplasia, PID, fibroid polyp and chronic cervicitis whereas it was 96.55% in ovarian cyst and 82.86% in leiomyoma, comparable to previous studies. 3,7,10,12 However, double pathologies of leiomyoma and adenomyosis coexisted in 11 patients (10.47%). Adenomyosis was found in 5 patients (4.77%) with preoperative diagnosis of leiomyoma while acute endometritis was found in 1 patient (0.95%) whereas no pathology was identified in 1 patient (0.95%) in histopathological diagnosis.…”