Clinico-Pathological Study of Hysterectomy Specimens in Kathmandu Medical College Teaching Hospital

Abstract

Introduction: Uterus is subjected to many non-neoplastic and neoplastic diseases. Hysterectomy is the commonest gynecological surgery done for the management of the pathologies of the female reproductive system. Histopathological examination of hysterectomy specimens is done routinely which has both diagnostic and therapeutic significance.Objective: To study the common pathologies identified in hysterectomy specimens and to correlate them with the clinical findings.Methodology: A cross sectional study was carried out among all the hysterectomy specimens irrespective of primary lesion sent for histopathological examination from January 2016 to December 2017 in Department of Pathology, Kathmandu Medical College Teaching Hospital (KMCTH). Relevant history was taken from the requisition form. Ethical clearance was obtained from the Institutional Review Committee of KMCTH.Results: A total of 198 cases were studied. The most common pathology encountered was leiomyoma (60.0%) followed by adenomyosis (14.0%). Atrophic endometrium was seen in 24.3% cases. Chronic cervicitis was found in most of the cases (96.5%) along with endocervical polyp in 8.1% cases. Leiomyoma was found to be the most common indication for hysterectomy comprising 48.0% followed by abnormal uterine bleeding (24.75%) and utero-vaginal prolapse (18.25%). Hysterectomy was most commonly performed in the age group of 41 - 50 years and total abdominal hysterectomy with bilateral salpingo-oophorectomy was found to be the commonest procedure done comprising 8 0.0%.Conclusion: Leiomyoma was found to be the most common pathology in myometrium and chronic cervicitis in cervix. Abnormal uterine bleeding and vaginal prolapsed were also found to be common. Lesions which can be managed conservatively do need hysterectomy or not, is a matter of great concern. BJHS 2018;3(2)6:423-426.

Hysterectomy and Oophorectomy in Reproductive Age: A Cross-Sectional Study from a Tertiary Care Hospital

“…In the myometrium, other pathologies included adenomyosis in 37 (23.57%) women and adenomyosis in combination with leiomyoma in 37 (23.57%) women. These findings are comparable to studies from Pakistan, India, and Nepal [20,23,25]. An Indian study has reported adenomyosis to be the dominant histopathological finding, followed by leiomyoma, with many cases also exhibiting dual pathologies [26].…”

“…The mean age of women in the reproductive age group was 40.37 (± 5.47) years, whereas, most of the women belonged to the age range of 40-49 years. These findings are comparable to the average age of 41-50 years for women undergoing hysterectomies in developing countries [2,20]. However, as pathology reports were the only source of information and because of a wide standard deviation in the age of women, a bias of differential misclassification could not be excluded.…”

“…Abdominal hysterectomy was performed in 128 (81.53%) women. The proportion of abdominal versus vaginal hysterectomy is similar to other Asian countries such as Nepal (90%) and India (86%) [20][21].…”

Frequency and Spectrum of Non-Malignant Lesions in Abdominal Hysterectomy Specimens

“…16 Study done by Pradhan SB et al, reported; 60% incidence of leiomyoma and 14% incidence of adenomyosis. 15 Study by VV Sreedhar et al observed 20.5% metrorrhagia and post-menopausal bleeding in females. Increased risk of malignancy is associated with architectural complexity and cellular atypia.…”

“…In our study, the most common finding is leiomyoma. The leiomyoma incidence varies from 20.5% to 69% and the adenomyosis incidence varies from 7.5% to 47% in the 5,9,13,14,15 In a study done by Imam et al, incidence of leiomyoma was 29.04% while incidence of adenomyosis was 11.69%. 14 Study done by Baral R et al, revealed leiomyoma incidence as 48.6% and 10.3% incidence of adenomyosis.…”