Histomorphological analysis of uterine and cervical lesions in hysterectomy specimens at a tertiary care hospital

Authors : Sujatha R, Sujatha R, Jaishree T, Jaishree T, Manjunatha Y. A, Manjunatha Y. A

DOI : 10.18231/2581-3706.2019.0014

Volume : 4

Issue : 1

Year : 2019

Page No : 72-77

Introduction

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Fig. 1: Age distribution of all the hysterectomy specimens.

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Fig. 2: Clinical indications of all the hysterectomies

Table 1: Distribution of case as per the type of hysterectomy

The histomorphological findings were analyzed.

Table 2: Endometrial change seen in all the 155 specimens.

S.no	Endometrial Change	Number of cases
1.	Proliferative Endometrium	83(53.54%)
2.	Secretory Endometrium	10(6.45%)
3.	Atrophic Endometrium	09(5.80%)
4.	Simple Hyperplasia	31(20.0%)
5.	Complex hyperplasia	03(1.93%)
6.	Endometrial Polyp	07(4.51%)
7.	Endometritis	04(2.58%)
8.	Pill endometrium	02(1.29%)
9.	Carcinoma Endometrium	06(3.87%)
	Total	155

In the myometrium, most common finding encountered was Leiomyoma in 66 cases (42.58%) followed by adenomyosis in 35 cases (22.58%). Myometrial hyperplasia was encountered in 2 cases (1.29%). In case of leiomyomas, 2 cases (1.29%) were benign cellular leiomyoma and 7 cases (4.51%) showed degenerative changes. (Table 3)

Table 3: Myometrial lesions seen in all the 155 specimens.

S.no	Myometrial changes	Number of cases
1.	Unremarkable	21(13.54%)
2.	Leiomyoma	66(42.58%)
3.	Adenomyosis	35(22.58%)
4.	Leiomyoma with adenomyosis	26(16.77%)
5.	Monckebergs’ Calcific sclerosis	05(3.22%)
6	Myometrial Hyperplasia	02(1.29%)
	Total	155

The histomorphological study of cervix showed Chronic non specific cervicitis as most common finding seen in 86 cases (55.40%). Granulomatous cervicitis seen in 2 cases (1.20%), polypoidal endocervicitis in 16 cases (10.30%) and microglandular hyperplasia in 03 cases (1.90%). 4 cases (2.50%) of endocervical polyp and 2(1.20%) cases of blue nevus were also encountered. In our study 11 cases (7.00%) of cervical dysplasias and 9 cases (5.80%) of carcinoma cervix were noted. In case of Cervical carcinoma 6 cases were of Squamous cell carcinoma cervix, 1 case of Adenocarcinoma cervix, 1 case of Adenosquamous carcinoma cervix and 1 case was Lymphoepitheilioma like SCC.

Table 4: Histomorphological lesions of cervix.

S.no	Histomorphological Findings	Number of cases
1.	Chronic non specific cervicitis	86(55.40%)
2.	Polypoidal endocervicitis	16(10.30%)
3.	Granulomatous Cervicitis	02(1.20%)
4.	Microglandular hyperplasia	03(1.90%)
5.	Cervical Polyp	04(2.50%)
6	Cervical Fibroid	02(1.20%)
7.	Blue nevus – Cervix	02(1.20%)
8.	Chronic non specific cervicitis with Squamous metaplasia	20(12.90%)
9.	Cervical Dysplasia	11(7.00%)
10	Carcinoma Cervix	09(5.80%)
	Total	155

Rarest and interesting lesions encountered were 1 case of lymphoepithelioma like SCC, 2 cases of Benign Cellular leiomyoma and 2 cases of Blue nevus.

In 21 hysterectomy specimens no pathological findings were encountered.

Discussion

Hysterectomy is the most commonly performed major gynecological surgery throughout the world. It is a successful operation in terms of symptom relief and patient satisfaction and provides definitive cure to many diseases involving uterus as well as adnexa.^[4]

This study was undertaken to analyze and understand the histomorphological spectrum of uterine and cervical lesions in hysterectomy specimens and to determine its correlation with respect to age and clinical diagnosis of the patient.

In our study commonest age group for hysterectomy specimens was 5^th decade, which is in concordance with studies by Patil HA et al,^[5] Ajmera Sachin K et al^[6] and Yogesh Neena et al.^[7]

In our study, the incidence of abdominal hysterectomy was higher than the vaginal as in the studies done by Ajmera Sachin K et al,^[6] Sunita Malik et al^[8] and Ankur gupta et al.^[9]

The present study revealed Menorrhagia as most common indication which was found to be in concordance with studies done by Ticku et al^[10] and Karthikeyan et al.^[11]

Endometrial polyp in this present study was 7 cases (4.51%) which was seen to be in concordance with study conducted by Yogesh Neena et al which was 3.47%.^[7]

In this present study endometrial hyperplasia accounts to 34 cases (21.9%). This finding was found comparable with the studies conducted by Ojeda VJ ^[12]and Ranabhat et al,^[13] which showed 22.3% and 16% cases of endometrial hyperplasia respectively.

In our study endometrial carcinoma was encountered in six cases (3.80%), and mainly found in post menopausal age group presenting with post menopausal bleeding. The study done by Ankur gupta et al^[9] has similar findings.

Among the myometrial lesions, leiomyoma accounts for majority comprising of 66 cases (42.58%), which is in comparison with studies done by Ajmera Sachin K et al^[6]in 170 cases (48.6%) and Stewart and Arti.^[14] Majority of the studies done on the histopathological analysis of hysterectomy specimens so far reveals that uterine fibroids are the most common pathology to be encountered in the uterus.

Adenomyosis (22.58%) was second most common pathology in our present study which was in accordance with study conducted by Sunita malik et al^[8] showing 21%. Adenomyosis is very rare and difficult to diagnose pre operatively as it has no specific clinical symptom of its own. It is usually diagnosed only after hysterectomy by histomorphological examination of the specimen. Around 26 cases (16.77%) in this study revealed the presence of both leiomyoma and adenomyosis.

Non neoplastic diseases of uterine cervix are predominantly inflammatory and are more common. A vast majority of cases with inflammatory pathology had no specific cause and chronic non specific cervicitis being the most common lesion encountered accounting to 55.40% which is in comparable with other studies done by Nwachokor & Forae^[15] and Garewal et al.^[16]

 

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Fig. 3: Complex hyperplasia of Endometrium: Micrograph shows crowded branching and papillary glands seperated by scant stroma. (H & E at 40X).

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Fig. 4: Endometrial Adenocarcinoma: Micrograph shows atypical crowded glands with invasion into the stroma. (H & E at 40X).

Among the myometrial lesions, leiomyoma accounts for majority comprising of 66 cases (42.58%), which is in comparison with studies done by Ajmera Sachin K et al^[6]in 170 cases (48.6%) and Stewart and Arti.^[14] Majority of the studies done on the histopathological analysis of hysterectomy specimens so far reveals that uterine fibroids are the most common pathology to be encountered in the uterus.

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Fig. 5: Granulomatous Cervicitis: Micrograph shows well formed granulomas adjacent to endocervical glands.(H & E at 10x).

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Fig. 6: Poorly differentiated SCC: Mirograph shows squamous cells with high N: C ratio, marked atypia and minimal keratinization. (H & E at 40X).

Adenomyosis (22.58%) was second most common pathology in our present study which was in accordance Intraepithelial neoplasia is a very critical in the the natural history of cervical carcinoma. The importance of detecting and treating patients at this stage is that the progression of intraepithelial neoplasia into carcinoma can be prevented.In this present study cervical dysplasia accounts for 9 cases (5.80%) which is in comparison with Vijaya Gattu et al^[17] and Cervical cancer accounts for 8 cases (5.16%) which is also in concordance with Vijaya Gattu et al.^[17]

Adenomyosis (22.58%) was second most common pathology in our present study which was in accordance with study conducted by Sunita malik et al^[8] showing 21%. Adenomyosis is very rare and difficult to diagnose pre operatively as it has no specific clinical symptom of its own. It is usually diagnosed only after hysterectomy by histomorphological examination of the specimen. Around 26 cases (16.77%) in this study revealed the presence of both leiomyoma and adenomyosis.

Non neoplastic diseases of uterine cervix are predominantly inflammatory and are more common. A vast majority of cases with inflammatory pathology had no specific cause and chronic non specific cervicitis being the most common lesion encountered accounting to 55.40% which is in comparable with other studies done by Nwachokor & Forae^[15] and Garewal et al.^[16]

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Fig. 7: Blue nevus cervix: Micrograph shows wavy dendritic cells arranged in clusters next to endocervical gland. (H & E at 10X).

Uterine cervix is a very unusual site for pigmented melanotic lesions.Blue nevi are infrequent incidental findings encountered in the cervix of hysterectomy specimens from middle aged females. In our study 2 cases (1.20%) of blue nevus cervix was encountered as a incidental finding in the hysterectomy specimen

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Fig. 8: Lymphoepithelioma like SCC: Micrograph shows syncytium of poorly differentiated tumour cells with prominent lymphoplasmacytic infiltrate.(H& E at 10X).

Conclusion

Hysterectomy still remains one of the most common treatment modality worldwide, thereby forming substantial work load in the histopathology department. This present study provides a limelight on the various histomorphological findings of uterus and cervix encountered in hysterectomy specimens at our institution. The histomorphological analysis was found to correlate well with the clinical diagnosis of the patients and quite a few lesions were also encountered completely as pure incidental findings. Hence, it becomes mandatory that every hysterectomy specimen, even if it is grossly appearing to be normal, it should be subjected to exhaustive histomorphological examination so as to ascertain better post operative management and follow up.

Conflict of Interest: None

References

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