A clinicopathological study of endometrium in hysterectomy specimens with fibroids

Abstract

Introduction: Hysterectomy is the most common gynaecological surgery performed in the peri menopausal and post menopausal women all over the world. The commonest pathologies in such hysterectomies are uterine fibroids. Many times hysterectomies are also performed for dysfunctional uterine bleeding, in which leiomyomas are commonly noted. When such hysterectomy specimen are grossed and sections studied, co-existing endometrial lesions like hyperplasias, metaplasias, malignancies are usually missed due to the significant presence of leiomyoma. Aim of the Study: The present study intends to unravel all such endometrial pathologies, which would have been missed when there is a co-existing uterine leiomyoma and to categorize these lesions into different groups. Materials and Methods: The study material was obtained from patients who underwent hysterectomy for leiomyoma from December 2011 to August 2013. 200 hysterectomy specimens were included in the study. Tissue bits from representative areas were taken, microscopic sections obtained and histological features studied. Results: Leiomyomas occurred mostly in women aged between 41-50 years and in multiparous women. Menorrhagia was the commonest presentation. Endometrial pattern commonly seen was proliferative phase and hyperplasia. Other patterns like endometrial adenocarcinoma, endometrial polyps and pill endometrium were also encountered. Conclusion: Leiomyomas are estrogen dependent tumours, wherein the endometrium manifests mostly as proliferative phase or hyperplasia suggesting estrogenic prevalence. Findings such as endometrial hyperplasia, polyposis along with distorted, dilated or elongated glands in endometrial curetting could suggest a possibility of uterine leiomyoma. Keywords: Leiomyoma, Hysterectomy, Endometrium, Hyperplasia, Metaplasia, Carcinoma.