Histopathological analysis of gynaecological hysterectomy specimens at a tertiary care hospital in southern Nigeria

Abstract

Background: Hysterectomy is the most common major gynaecological surgery in the world. It effectively treats many gynaecological conditions. Several studies have described the pathological findings in hysterectomy specimens and investigated the relationship between preoperative clinical diagnosis and pathological diagnosis, but none have been carried out at the study centre. Objectives: To determine the indications for hysterectomy, identify the patterns of pathologies in hysterectomy specimens and their correlation with pre-operative clinical diagnosis at the University of Port Harcourt Teaching Hospital. Material and Methods: This retrospective study included 202 women who had non-oncological hysterectomy at the Gynaecology unit of the University of Port Harcourt Teaching Hospital between January 1, 2011, and December 31, 2016. The study included all types of hysterectomies, such as vaginal and total abdominal hysterectomies, as well as unilateral/bilateral salpingectomy/salpingo-oophorectomy. Hysterectomy for gynaecological cancer and pregnancy complications were not considered. The information was gathered from the patients' theatre records, histopathology reports, and case notes and entered into a predesigned proforma. The data set included socio-demographic characteristics, clinical presentation, type of hysterectomy, clinical diagnosis, and pathological lesions. The statistical analysis was performed using SPSS version 25, with a p-value of 0.05 set as the level of significance. Results: Of The 202 cases studied, the most common age group that underwent hysterectomy was 35 and 44 years 94 (46.5%). The most common type of hysterectomy was total abdominal hysterectomy 165 (84.6%). The commonest clinical indications for hysterectomy were leiomyoma 135 (66.8%), followed by adenomyosis 17 (8.4%). The most common findings identified by histopathology were proliferative endometrium 78 (38.6%) in endometrium, leiomyoma 135 (66.8%), in myometrium, chronic cervicitis 7 (3.5%) in cervix, and follicular cysts 15 (40.6%) in ovaries. Histopathological confirmation of preoperative diagnosis was 88.6% for cervical pathology. Majority of the cases pre-operatively diagnosed as Dysfunctional uterine bleeding (DUB) were found to have adenomyosis, endometrial polyp, secretory endometrium, or disordered proliferative endometrium. Conclusion:The most common pathologies found were proliferative endometrium in endometrium, leiomyoma in myometrium, chronic cervicitis in cervix, and chronic salpingitis in fallopian tubes. In most cases, histopathologic analysis confirmed the clinical diagnosis.