Histerektomi Materyallerinde Histopatolojik Tanıların Değerlendirilmesi

Year 2016, Volume: 6 Issue: 2, 87 - 91, 19.10.2016

Çiğdem Kunt İşgüder , Hatice Yılmaz Doğru , Asker Zeki Özsoy , Bülent Çakmak , İlhan Bahri Delibaş , Akgül Arıcı Fazlı Demirtürk

https://doi.org/10.16899/ctd.65609

Abstract

Amaç: Bu çalışmanın amacı; benign endikasyonlarla yapılan histerektomilerin preoperatif klinik endikasyonlarının ve postoperatif histopatolojik tanılarının değerlendirilmesidir.

Gereç ve Yöntem: Mart 2013-Mayıs 2015 tarihleri arasında Gaziosmanpaşa Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde benign endikasyonlarla histerektomi uygulanan 170 hastanın klinik özellikleri ve postoperatif histopatolojik tanı raporları retrospektif olarak değerlendirildi.

Bulgular: Hastaların yaş ortalaması 50.48±7.50 (min:38, max:74) idi. En sık histerektomi endikasyonu 77 olgu (%45.3) ile leiomyoma idi. Daha sonra sırası ile disfonksiyonel uterin kanama 50 (%29.49) ve endometrial hiperplazi 22 (%12.9) olarak tespit edildi. Diğer klinik endikasyonlar  uterus prolapsus 17 (%10), kronik pelvik ağrı 2 (%1.2) ve adenomyozis 2 (%1.2) idi. Histerektomi materyallerinin histopatolojik raporlarının değerlendirilmesi sonucunda, en yaygın patoloji leiomyoma 87olguda (%51.2), takiben adenomyozis 35 olguda (% 20.5) ve endometrial hiperplazi 31 (18.3) saptandı. Endometrial polip 10 olguda (%5.9) ve 7 olguda (%4.1) ise atrofik endometrium mevcuttu. 44 histerektomi materyalinde kombine patoloji tanımlandı. %50 oranında leiomyoma ve endometrial hiperplazi en yaygın kombibasyon olarak tespit edildi. Ayrıca histerektomi materyallerinin serviks incelemelerinde %64.7 ‘sinde kronik servisit olduğu gözlendi.

Sonuç: 4. ve 5. dekatta açıklanamayan menometroraji, sekonder dismenore ve kronik pelvik ağrı ile başvuran hastaların tanısında ve tedavileri planlanırken mutlaka adenomyozis akla gelmelidir. Leiomyama ve endometrial hiperplazilerin yüksek oranda birlikteliğinden dolayı leiomyoma tanısıyla histerektomi planlanan olgularda menometroraji de mevcut ise endometrial örnekleme yapılmasının gerekli olduğu görülmektedir.

 

Keywords

Histerektomi, histerektomi endikasyonları, patoloji

The Evaluation Of Histopathological Diagnosis In Hysterectomy Materials

Abstract

-The aim of this study is to assess the preoperative clinic indications and postoperative histopathological diagnosis of hysterectomies with benign indications.Materilas and Methods- Clinical features and reports of postoperative histopathological diagnosis of 170 patients, whose underwent hysterectomy with benign indications in Gaziosmanpasa University Medical Faculty Department of Obstetrics and Gynecology, were retrospectively evaluated.Results- The mean age of the patients was 50.48±7.50 (min-38, max-74). Leiomyoma with 77 case (E.3) was the most hysterectomy indicated disease. Thereafter, dysfunctional uterine bleeding in 50 ().49), and endometrial hyperplasia 22 (%12.9) were detected. The other clinical indications were uterine prolapse in 17 patients (%10), chronic pelvic pain in 2 (%1.2) and adenomyosis in 2 (%1.2). The results of histopathological reports belong to hysterectomy materials indicated that leiomyoma was the most common pathological finding with 87 cases (Q.2), subsequently adenomyosis in 35 cases (% 20.5) and endometrial hyperplasia in 31 (18.3) was detected. Endometrial polyp was found in 10 cases (%5.9) and atrophic endometrium in 7 cases (%4.1). Combined pathology was defined in 44 hysteterctomy materials. Leiomyoma and endometrial hyperplasia were detected as the most common combination with a ratio of P. In addition, chronic cervicitis was seen in d.7 of cervical examinations of hysterectomy materials. Conclusion- Adenomyosis should be kept in mind while planning the diagnosis and treatment of patients whose admitted with compliants of menometrorrhagia, seconder dysmenorrhea and chronic pelvic pain in 4th and 5th decade. Endometrial sampling caused by the co-existence of leiomyoma and endometrial hyperplasia must be necessary in hysterectomy planned cases for leiomyoma those already have menometrorrhagia-

Keywords

hysterectomy, hysterectomy indications, pathology.

References

• Pokras R. Hysterectomy, past, present and future. Stat Bull Metrop Insur Co 1989; 70(4)12-21.
• Benrubi GI. History of hysterectomy. J Fla Med Assoc 1988; 75: 533-8
• Davies A, Magos A. Indications and alternatives to hysterectomy. Bailliere’s Clin Obstet and Gynaecol 1997; 11(1): 61- 75.
• Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Pe- terson HB. Hysterectomy in the United States, 1988- 1990. Obstet Gynecol 1994;83(4):549-55.
• Coulter A, Bradlow J, Agass M, Martin-Bates C, Tulloch A. Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records. Br J Obstet Gynaecol 1991; 98(8): 789-96.
• Rock JA, Jones HW III, Histerektomi, In: Te Linde’s Op- eratif Jinekoloji 9. Basım, Çeviri Editörü: Erol Tavmer- gen, İzmir Güven Kitabevi 2005: Bölüm 31, Sayfa 731- 755.
• Vessey MP, Villard-Mackintosh L, McPherson K, Coul- ter A, Yeats D. The epidemiology of hysterectomy: find-ings in a large cohort study. Br J Obstet Gynecol 1992; 99(5): 402-7.
• Sandberg SI, Barnes BA, Weinstein MC, Braun P. Elec- tive hysterectomy. Benefits, risks, and costs. Medical Care. 1985;23(9):1067-85.
• Eisinger SH1, Meldrum S, Fiscella K, le Roux HD, Gu- zick DS. Low-dose mifepristone for uterine leiomyo- mata. Obstet Gynecol. 2003 Feb;101(2):243-50.
• Lepine LA, Hillis SD, Marchbanks PA, et al. Hysterec- tomy surveillance- United States 1980-1997. MMWR 1997; 46(4): 1-15.
• Dinçgez B, Coşkun Eİ, Ayanoğlu YT. Kliniğimizde ger- çekleştirilen histerektomi olgularının değerlendirilme- si. Şişli Etfal Hastanesi Tıp Bülteni 2011; 45(2): 35-8.
• Ojeda VJ. The pathology of hysterectomy specimens. Z Med J 1979; 89(631): 169-71.
• İsaoğlu Ü, Yılmaz M, Delibaş İ, et al. The Evaluation of Histopathologic Diagnosis in Specimens of Hysterec- tomy Abant Med J 2013; 2(2):91-94
• Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4(4): 312-322.
• Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 2009; 280(4): 529-38.
• Arif A, Jamal S, Mubarik A, Zubair A, Ghori UK. Study of adenomyosis in different decades of life: An expe- rience at army medical college, Rawalpindi-Pakistan. Pak J Pathol 2007; 18: 75-78.
• Lee NC, Dicker RC, Rubin GL, Ory HW. Confirmation of the preoperative diagnoses for hysterectomy. Am J Obstet Gynecol 1984; 150(3): 283-7.
• Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyen-dec- ker G. Adenomyosis in endometriosis prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 2005; 20(8): 2309-16.
• Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long term study of ‘untre- ated’ hyperplasia in 170 patients. Cancer 1985; 5682): 403–12.
• Terakawa N, Kigawa J, Taketani Y,et al. The behavior of endometrial hyper-plasia: a prospective study. Endo- metrial Hyperplasia Study Group. J Obstet Gynaecol Res 1997; 23(3): 223–30
• Sherman ME, Mazur MT, Kurman RJ. Benign dise- ases of the endometrium. In: Kurman RJ, editor. Blaunstein’s pathology of the female genital tract. 5. edition. New York: Springer, 2002; 421–466.
• Perez-Medina T, Martinez O, Folgueira G, Bjo J. Which endometrial polyps should be resected? J Am Assoc Gynecol Laparosc 1999; 6(1): 71-74.
• Reslova T, Tosner J, Resl M, Kugler R, Vavrova I. En- dometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262(3-4): 133-9.
• Talukder SI, Haque MA, Hug MH, Alam MO, Roush- an A, Noor Z, Nahar K. Histopathological analysis of hysterec-tomy specimens. Mymensing Med J 2007; 16(1): 81-4.
• Shegill SK, Shergill HK. Clinicopathological study of hysterectomies. J Indian Med Assoc 2002; 100(4): 238-9.