Histopathology diagnosis in women who underwent a hysterectomy for a benign condition

To study the correlation between the preoperative clinical diagnosis and the final histopathology of hysterectomy specimens.

This is a retrospective study by the authors of all cases who underwent a hysterectomy over a 2- year period (2008-2009). All hysterectomies performed for malignant indication were excluded.

During the 2- year study period there were a total of 137 cases eligible for analysis. 107 patients had hysterectomy alone and 30 patients had hysterectomy with salpingo-oophorectomy. The abdominal route was used in 122 cases (89%) and the vaginal one in 15 patients (11%). The mean age at the time of hysterectomy was 49.1 years (range 35-76 years). Heavy menstrual loss was the most common indication for hysterectomy accounting for 39% of the cases. The rest of the indications included, fibroids, abdominal pain, postmenopausal bleeding, uterine prolapse and others. The histopathology of the endometrium prior to hysterectomy was reported in 68% of the cases and the most common finding was an endometrium with signs of hormonal imbalance. In the final histopathology reports of the hysterectomy specimens, fibroid was the most common finding reported in 36.5% of the cases. Adenomyosis was reported in 28% of the cases, endometrial hyperplasia in 12%, no specific pathology in 10% and malignancy in 5%.

Hysterectomy will remain a common gynecological operation in both developing and developed countries. The clinical and the pathological correlation are poor, when abdominal pain or dysfunctional uterine bleeding (DUB) was the preoperative clinical diagnosis. However, there was a very high correlation when the clinical diagnosis was a fibroid. All hysterectomy specimens should be sent for histopathology regardless of the preoperative histopathology of the endometrium.