Audit of histopathological specimens of laparoscopic hysterectomy at Noble's hospital, IOM

Abstract

Objective: It aimed to determine the incidence of different pathology among the hysterectomy specimens and to correlate that with the clinical picture of patients' presentation. Design: A retrospective study, it is the first audit of histopathological findings of laparoscopic hysterectomy specimens at Noble's Hospital. Methods: It included 101 consequent specimens of laparoscopic hysterectomies done at the department of Obstetrics and Gynaecology, Noble’s hospital between 2017 and 2020. The clinical picture of patients and the histopathological findings of samples were recorded and analysed. The histopathological diagnosis divided the specimens into seven groups, no pathology, adenomyosis, adenomyosis and leiomyoma, leiomyoma, adenomyosis and endometriosis, endometriosis and malignancy. The clinical picture included all types of bleeding as menorrhagia, post coital bleeding, intermenstrual bleeding and perimenopausal bleeding, all types of pain as dyspareunia, dysmenorrhea, lower abdominal pain and colicky pain. Histopathological findings include gross picture and microscopic analysis of endometrium and myometrium as well as the uterine weight. Results: Adenomyosis alone or with other pathology was the commonest finding (54.5%) while adenomyosis as a sole pathology was found in 22.8%. It was significantly higher than figures reported from the UK and worldwide. Incidence of fibroid as a sole pathology or in combination with other pathology was 44.6%, this was compatible with results reported before. The pain was not associated with adenomyosis in this study. The bleeding was the presenting symptom of both adenomyosis and fibroids. Conclusion: The higher incidence of adenomyosis among this specimen and the absence of pain as a presenting symptom may be a genuine finding but most probably indicate the specimen included a larger number of mild and early presentations. It will be useful to do a prospective study of a larger number to correlate the degree of the invasion of the adenomyosis to the myometrium to the clinical picture.