Clinicopathological Assessment of Hysterectomy Specimens for Gynaecological Conditions in Maiduguri: A 10 Year Retrospective Review

Abstract

Background: Hysterectomy is the most commonly performed gynaecological surgery throughout the world. Hysterectomies are done for definitive treatment of multiple pathologies of female reproductive organs like fibroids, uterine prolapse, abnormal uterine bleeding, adenomyosis, endometriosis and malignancy of female reproductive organs. A variety of conditions in gynaecological practice like chronic pelvic pain and dysfunctional uterine bleeding require removal of a uterus that may show no gross or microscopic pathology when examined by the pathologist. Clinico-pathological audit of hysterectomies can help us define and improve our standards of diagnosis and justification of the hysterectomies performed.

Objective: To compare the accuracy of various clinical indications and histopathological diagnoses from hysterectomy specimens in Maiduguri.

Materials and methods: A retrospective study of all hysterectomy specimens received in the Department of Pathology, University of Maiduguri Teaching Hospital, Maiduguri over a period of 10 years.

Results: Three hundred and ninety-six (396) hysterectomy specimens were analyzed. Of these, 299 (76%) were received from UMTH. Specimen of hysterectomies were from patients ranging from 20 years to 90 years. Most common age group was 40-49 years with a mean age of 47.2 ± 9.7 years. Among hysterectomies performed, majority were done through the abdominal route 375 (94.7%). The most common type of hysterectomy performed was total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH BSO). Heavy menstrual bleeding seen in 177 (49.7%) of cases was the commonest complaint. The most common benign indication for hysterectomy was uterine fibroid (197 cases) while ovarian cancer (31 cases) was the most common malignant indication. Of the 197 cases of uterine fibroid that was diagnosed preoperatively, histopathological diagnosis of leiomyoma was made in 165 (83.7%) of cases while out of 31 cases of ovarian cancer, 29 (93.5%) was confirmed histologically.

Conclusion: Hysterectomy in this study was commonly done via laparotomy with fibroid as the commonest benign condition while ovarian cancer is the commonest malignant indication and these were histologically confirmed.

keywords: Hysterectomy, Indication, Leiomyoma, Maiduguri, Pathology