The Incidence of Histopathologic Diagnosis in Hysterectomy Specimens

Abstract

Objective: This study identified the frequency of clinical indications for hysterectomy and the most common pathologies in hysterectomy specimens. Material and Methods: A total of 361 hysterectomy specimens between October 2007 and October 2009 were retrieved and studied Results: The most common indication for hysterectomy was leiomyoma (31.85 %). Other indications were endometrial hyperplasia (27.14 %), dysfunctional uterine bleeding (18.55 %), uterine prolapse (9.14 %), chronic pelvic pain (7.20 %), adenomiyosis (3.87 %), cervical neoplasia (2.21 %). The most common pathology identified was leiomyoma (40.16 %). Other pathologies included endometrial hyperplasia (38.22 %), adenomyosis (25.48 %), endometrial polyps (8.86 %), CIN 1 (3.32 %), CIN 2 (1.66 %) and atrophic endometrium (3.60 %). In 158 (43.76 %) of hysterectomy specimens combined pathology was identified. The most common combination was leiomyoma and endometrial hyperplasia (38.60%). Other combined pathologies included adenomoysis and endometrial polyps (17.72 %), adenomyosis and leiomyoma (12.65 %), leiomyoma and endometrial polyps (8.22 %). Conclusion: The existence of cervical disorders should be demonstrated when an operation is going to be performed for an endometrial pathology in a pre or postmenopausal woman. Cervix and cervical canal should be examined during endometrial evaluation.

Keywords

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Histerektomi Materyallerinde Histopatolojik Tanıların İnsidansı

Öz

Amaç: Bu çalışmada histerektomi için klinik endikasyonların sıklığı ve histerektomi materyallerindeki en yaygın patolojiler tanımlandı. Gereç ve Yöntem: Ekim 2007 ile Ekim 2009 arasında 361 histerektomi materyali tekrar gözden geçirildi ve patolojik tanılar araştırıldı. Bulgular: Histerektomi için en yaygın klinik endikasyon leiomyoma (% 31.85) idi. Diğer klinik endikasyonlar endometrial hiperplazi (% 27.14), disfonksiyonel uterin kanama (% 18.55), uterus prolapsusu (% 9.14), kronik pelvik ağrı (% 7.20), adenomyozis (% 3.87), servikal neoplazi (% 2.21) idi. En yaygın tanımlanan patoloji leiomyoma (% 40.16) idi. Diğer patolojiler endometrial hiperplazi (% 38.22), adenomyozis (% 25.48), endometrial polipler (% 8.86), CIN 1 ( % 3.32 ), CIN 2 ( % 1.66 ) ve atrofik endometrium (% 3.60) idi. Yüzellisekiz (% 43.76) histerektomi materyalinde kombine patolojiler tanımlandı. En yaygın kombinasyon leiomyoma ve endometrial hiperplazi (% 38.60) idi. Diğer kombine patolojiler adenomyozis ve endometrial polip (% 17.72), adenomyozis ve leiomyoma (% 12.65), leiomyoma ve endometrial polipler (% 8.22) idi. Sonuç: Endometrial patolojiler nedeniyle özellikle premenapozal ve postmenapozal dönemde opere edilecek olgularda servikal neoplazilerin beraber olabileceği unutulmamalıdır. Bu nedenle endometrial örnekleme yaparken endoservikal örneklemeninde yapılması önemlidir.

Anahtar Kelimeler

• Histerektomi, Patoloji, Leioyoma

References

1. Lee NC, Dicker RC, Rubin GL, Ory HW. Confirmation of the preoperative diagnoses for hysterectomy. Am J Obstet Gynecol 1984; 150: 283-287.
2. Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312-322.
3. Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 2009; 280: 529-538.
4. Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus-revisited. Am J Obstet Gynecol 1972; 112: 583-593.
5. K. Jo. Adenomyosis: the pathophysiology of an oestrogen- dependent disease. Best Pract Res Clin Obstet Gynecol 2006; 20: 493-502.
6. Atri M, Reinhold C, Mehio AR, Chapman WB, Bret PM. Adenomyosis: US features with histologic correlation in an in vitro study. Radiology 2000; 215: 783-790.
7. Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: a review.Environ Health Perspect 2003; 111: 1037- 1054.
8. Sherman ME, Mazur MT, Kurman RJ. Benign diseases of the endometrium. In: Kurman RJ, editor. Blaunstein’s pathology of the female genital tract. 5. edition. New York: Springer, 2002; 421–466.

9. Perez-Medina T, Martinez O, Folgueira G, Bjo J. Which endometrial polyps should be resected? J Am Assoc Gynecol Laparosc 1999; 6: 71-74.
10. Reslova T, Tosner J, Resl M, Kugler R, Vavrova I. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133-139.
11. Talukder SI, Haque MA, Hug MH, Alam MO, Roushan A, Noor Z, et al. Histopathological analysis of hysterectomy specimens. Mymensing Med J 2007; 16: 81-84.
12. Bukhari U, Sadiq S. Analysis of the underlying pathological lesions in hysterectomy specimens. Pak J Pathol 2007; 18: 110-112.
13. Verit FF, Artuc H, Kafalı H. The evaluation Of Simple Hysterectomies At Harran University Department Of Obstetrics And Gynecology. Türkiye Klinikleri J Gynecol Obst 2006; 16: 77-81.
14. Sutton GP, Brill L. Malignant papillary lesion of the endometrium. Gynecol Oncol 1987; 27: 294-304.
15. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long term study of 'untreated' hyperplasia in 170 patients. Cancer 1985; 56: 403-412.
16. Tabata T, Yamawaki T, Yabana T, Ida M, Nishimura K, Nose Y. Natural history of endometrial hyperplasia: study of 77 patients. Arch Gynecol Obstet 2001; 265: 85-88.
17. Janicek MF, Rosenshein NB. Invasive endometrial cancer in uteri resected for atypical endometrial hyperplasia. Gynecol Oncol 1994; 52: 373-378.
18. Gönderilme Tarihi: 08.08.2011