Clinicopathological Analysis Of Hysterectomy Specimens - A Retrospective Study At A Tertiary Care Centre In North India

Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1098 International Journal of Medical and Pharmaceutical Research Online ISSN-2958-3683 | Print ISSN-2958-3675 Frequency: Bi-Monthly Website: https://ijmpr.in/ Research Article Clinicopathological Analysis Of Hysterectomy Specimens - A Retrospective Study At A Tertiary Care Centre In North India Dr. Kiran1, Dr. Nupur Kaushik1, Dr. Pawni Prabhat1, Dr. Khalda Nasreen2 1Assistant Professor. Department of Pathology, Rama Medical College Hospital & Research Centre, Hapur, UP 2Professor & HOD. Department of Pathology, Rama Medical College Hospital & Research Centre, Hapur, UP A B S T R A C T Corresponding Author: Dr. Kiran Assistant Professor. Department of Pathology. Rama Medical College Hospital & Research Centre, Hapur, UP Received: 09-08-2025 Accepted: 14-09-2025 Available online: 05-10-2025 Copyright© International Journal of Medical and Pharmaceutical Research Abstract: The uterus is a hormonally responsive reproductive organ that undergoes a wide range of physiological changes and is susceptible to numerous benign and malignant pathologies. Common benign conditions include abnormal uterine bleeding (AUB), pelvic inflammatory disease (PID), uterine prolapse, adenomyosis, endometriosis, and leiomyomas. Although several treatment modalities exist, hysterectomy remains a prevalent surgical option globally for both benign and malignant condition affecting the female reproductive tract. Histopathological evaluation of hysterectomy specimens is essential for definitive diagnosis and optimal patient management. Aims and Objectives: -The present study aimed to evaluate the various clinical indications for hysterectomy, assess the correlation between preoperative clinical diagnoses and final histopathological findings, and to analyze the spectrum of histomorphological lesions observed in hysterectomy specimens. Materials and Methods: A retrospective analysis of 155 hysterectomy specimens was conducted over one year at the Department of Pathology, Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh. All specimens, including total abdominal and vaginal hysterectomies, were processed and stained with hematoxylin and eosin (H&E) for microscopic evaluation. Histopathological observation from the endometrium, myometrium, cervix, ovaries, and fallopian tubes were documented and correlated with clinical data. Results: Abdominal hysterectomy was the most common performed surgical procedure performed among 155 analyzed cases (83.9%), with the highest incidence in women aged 41–50 years (45.2%). Abnormal uterine bleeding due to leiomyoma (AUB-L) was the most prevalent clinical indication (45.8%), followed by Adenomyosis (AUB-A) in 22.6% of cases. Proliferative endometrium was the predominant endometrial pattern (38.7%), while leiomyoma (44.5%) and adenomyosis (20.6%) were the most frequent myometrial findings. Hyalinization was the most frequent degenerative change observed in leiomyomas (13.6%). Chronic cervicitis was the most frequent incidental cervical finding (51%). Follicular cysts were the most common ovarian lesions (15.6%).2.2% cases each of serous cystadenoma and mucinous cystadenoma were also noted. Malignancies included endometrial carcinoma (1.3%), cervical carcinoma (2.6%), and ovarian carcinomas (2.2% each for serous and mucinous subtypes). A strong clinicopathological correlation was observed in 70–100% of cases. Rare entities such as cellular, epithelioid, lipoleiomyoma, vascular leiomyoma and serous tubular intraepithelial lesion (STIL) were also documented. Conclusion: Hysterectomy remains the cornerstone surgical treatment for various gynecological conditions. Usually there is generally a strong correlation between clinical and histological diagnosis, coexisting or incidental pathologies (chronic cervicitis & adenomyosis) and occult malignancies are often detected only through microscopic evaluation. Therefore, histopathological examination is essential for definitive diagnosis and is crucial for optimal postoperative management. Keywords: Hysterectomy, Endometrium, Myometrium, Cervix, Histopathological correlation. Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1099 INTRODUCTION The female genital tract comprises the uterine corpus and cervix, with the corpus further divided into the endometrium and myometrium.[1] The uterus, a crucial hormone-responsive reproductive organ, is prone to various benign and malignant pathologies.[2] Under hormonal regulation, the endometrial lining undergoes cyclical shedding. Lesions affecting the uterine corpus and cervix are among the most frequent reasons for gynecological consultation.[3] These conditions are predominantly observed in middle-aged and elderly women. Common clinical manifestations include abdominal pain, abnormal uterine bleeding (AUB), postmenopausal bleeding, vaginal discharge, and the presence of a pelvic mass or uterine prolapse. Although conservative medical and hormonal therapies are often employed initially, hysterectomy continues to be a widely adopted definitive treatment in cases where other options prove ineffective. Hysterectomy involves the surgical removal of the uterus and cervix, sometimes also including unilateral or bilateral related organs like ovaries or fallopian tubes. The first subtotal hysterectomy was performed by Charles Clay in Manchester, England, in 1843, while the first total abdominal hysterectomy was conducted in 1929.[4]. This procedure can be carried out via abdominal, vaginal, or laparoscopic approaches, with or without salpingooophorectomy. Laparoscopic methods are increasingly preferred due to their minimally invasive nature, faster recovery, and better cosmetic outcomes. Menstrual irregularities and heavy bleeding account for approximately 25%–33% of gynecological outpatient visits. AUB, defined as any abnormal variation in the frequency, regularity, volume, or duration of menstrual bleeding, is a significant health concern.[5]. It affects 14%–25% of women in the reproductive age group, with prevalence rising to 50% in perimenopausal women.[6] In India, the reported prevalence of AUB is around 17.9%, often leading to complications such as severe anemia that may necessitate surgical intervention.[7] The most frequent indication for hysterectomy is AUB, commonly associated with uterine pathologies such as prolapse, leiomyoma, adenomyosis, and endometriosis.[8] To classify AUB based on etiology, the PALM–COEIN system categorizes the causes of AUB:PALM refers to structural causes like Polyp, Adenomyosis, Leiomyoma, Malignancy and Hyperplasia; COEIN refers to non-structural causes such as Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified.[9] AIMS AND OBJECTIVE The study aims to evaluate the spectrum of histomorphological lesions observed in hysterectomy specimens. Additionally, the study seeks to correlate these findings with the patient’s age and their respective clinical presentations, enhancing diagnostic accuracy and improve clinicopathological understanding of uterine pathology in a tertiary care setting. MATERIALS AND METHODS This one year retrospective observational study was conducted in the Department of Pathology at Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh included 155 hysterectomy specimens, obtained for various gynecological indications. All specimens were received in the histopathology laboratory, properly labeled, and immediately fixed in 10% buffered formalin at a 1:10 specimen-to-fixative volume ratio. After adequate fixation for 8–10 hours, a thorough gross examination of each specimen was performed. Representative tissue sections were taken from the cervix, endometrium, myometrium, ovaries, and fallopian tubes. The tissues underwent processing using standard histological techniques, including embedding and sectioning at 2–5 µm thickness. The resulting sections were stained with hematoxylin and eosin (H&E) and examined microscopically. Histopathological findings from cervix, endometrium, myometrium, ovaries and fallopian tubes of every hysterectomy specimen were noted and subsequently correlated with the patients clinical presentation and age. Inclusion Criteria • All hysterectomy specimen (total and subtotal) regardless of whether they included bilateral or unilateral salpingo-oophorectomy, were included in the study. Exclusion Criteria • Specimens from patients with a preoperative confirmed diagnosis of malignancy. • Endometrial and cervical biopsy samples (i.e.,specimens other than complete hysterectomy specimens) We analyzed all 155 hysterectomy specimens and findings were summarized in the following tables are based on the observations made histopathologically. The highest incidence was shown in the 41–50 years age group (70 cases, 45.2%), followed by the 31–40 years group (52 cases, 33.5%) (Figure-1) Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1100 Figure 1: Age –wise distribution of hysterectomy specimen (N=155) The most common indication was AUB due to Leiomyoma (71 cases, 45.8%), followed by adenomyosis (35 cases, 22.6%), utero-vaginal prolapse (20 cases, 12.9%) and ovarian cystic lesions/tumor (13 cases, 8.4%) . Other indications included endometrial polyps (9 cases, 5.8%) and endometrial malignancy/hyperplasia accounting for 7 cases (4.5%) (Table 1). Table.1 Clinical Indication of hysterectomy (N=155) S.N Indication Number of cases Percentage (%) 1. AUB-Leiomyoma 71 45.8% 2. AUB-Adenomyosis 35 22.6% 3. AUB-Endometrial polyp 9 5.8% 4. AUB-Endometrial hyperplasia/Malignancy 7 4.5% 5. Utero-vaginal prolapse 20 12.9% 6. Ovarian cyst /Tumor 13 8.4% Total 155 100% The most common procedure performed was total abdominal hysterectomy with adnexal preservation (65 case, 41.9%). This was followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy, ( 50 cases 32.3%) (Figure-2) Figure 2: Distribution of Hysterectomy cases The most prevalent histopathological pattern of the endometrium was the proliferative phase, identified in 60 cases (38.7%), followed by atrophic endometrium in 37 cases (23.9%). Other findings included the secretory phase in 21 cases 0 10 20 30 40 50 60 70 80 21-30 years 31-40 years41-50 years51-60 years61-70 years 71-80 years Incidence of age No of cases 16.1% 41.9% .32.3% 9.7% Types of Hysterectomy Vaginal hysterectomy TAH with preservation of both tubes and ovaries TAH with bilateral salpingooophorectomy(BSO) TAH with unilateral salpingooophorectomy(USO) Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1101 (13.5%), disordered proliferative endometrium in 19 cases (12.2%), endometrial polyps in 7 cases (4.5%), and pill endometrium in 3 cases (1.9%). Less frequent findings included hyperplastic changes specifically simple hyperplasia (0.7%) and complex hyperplasia with atypia (1.3%). Endometrial stromal nodule and Low grade Endometrial stromal sarcoma were each found in one cases. Endometrial adenocarcinoma was identified in two cases (1.3%) (Table 2) (Figures-3,4 &5 ) Table-2. Distribution of histopathological findings in endometrium (N=155) S.N Histopathological findings Number of cases Percentage (%) 1. Proliferative Endometrium 60 38.7% 2. Secretory Endometrium 21 13.5% 3. Disorderd proliferative Endometrium 19 12.2% 4. Atrophic Endometrium 37 23.8% 5. Endometrial Polyp 07 4.5% 6. Endometritis 01 0.7% 7. Pill Endometrium 03 1.9% 8. Endometrial stromal nodule 01 0.7% 9. Low grade Endometrial stromal sarcoma 01 0.7% 10. Simple Hyperplasia 01 0.7% 11. Complex Hyperplasia 02 1.3% 12. Carcinoma Endometrium 02 1.3% Total 155 100% (a) (b) Fig.3 (a) Endometrium. Endometrioid adenocarcinoma showing complex and papillary arrangement of glands (b) A higher magnification photomicrograph showing nuclear pleomorphism and hyperchromasia in glands. H&E,4X H&E,40X (a) (b) H&E,10X H&E,40X Fig.4 (a)Endometrium. Endometrial stromal nodule showing well demarcated tumor-myometerial interface (b) A higher magnification photomicrograph showing proliferation of bland endometrial stromal cells around small arterioles. Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1102 Leiomyoma was the most frequent myometrial pathology identified in 69 cases (44.5%).Adenomyosis was observed in 32 cases (20.6%), while 20 cases (12.9%) presented with both leiomyoma and adenomyosis.. The remaining 34 cases (22%) exhibited no significant pathological changes.(Table-3)(Figure-6) Table 3: Distribution of histopathological findings in myometrium (N=155) S.N Histopathological findings Number of cases Percentage (%) 1. Leiomyoma 69 44.5% 2. Adenomyosis 32 20.6% 3. Leiomyoma+ Adenomyosis 20 12.9% 4. Unremarkable 34 22% Total 155 100% (c) Fig.5 (a,b)Endometrium. Low grade endometrial stromal sarcoma-Irregular islands of neoplastic stromal cells invading the myometrium in tongue like pattern.(c) ) A higher magnification photomicrograph showing proliferations of endometrial stromal cells with minimal nuclear atypia. Fig.6 (a) Myometrium. Leiomyoma-Intersecting bundles (fascicles) of spindle shaped cells.(b) A higher magnification photomicrograph showing spindle cells have oval to cigar shaped bland nuclei. (b) H&E,10X H&E,40X (b) (a) H&E,4X H&E,10X H&E,40X (a) Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1103 Site Distribution of Leiomyoma: The most frequent location was intramural (92 cases,59.4%), followed by subserosal (52 cases, 33.5%) (Table.4) Table.4 Site Distribution of Leiomyoma S.N Site wise distribution of leiomyoma Number of cases Percentage (%) 1. Intramural 92 59.4% 2. Submucosal 11 7.1% 3. Subserosal 52 33.5% Total 155 100% Pathological changes in leiomyomas: 120 cases of typical leiomyomas (77.4%), followed by degenerative changes in 31 cases (20%) and four variants of leiomyoma (2.6%) (Figure-7) Figure 7:Various pathological changes in leiomyoma Degenerative changes: were observed in 20% of leiomyomas, with hyalinization being most common (13.6%). (Figure-8) Unusual variants: identified included cellular, epithelioid, lipoleiomyoma, and vascular leiomyoma—each comprising 0.65% of cases.(Figure -9) 77.4% 20% 2.6% Typical Degenerative changes Variants (a) (b) (c) Fig.8 Myometrium with secondary changes . (a) Hyaline changes with lipoleiomyoma (b) A higher magnification photomicrograph showing hyaline changes with calcification (c) Myxoid Leiomyoma – smooth muscle cells separated by myxoid matrix. H&E,40X H&E,10X H&E,10X Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1104 Age-wise analysis revealed a predominance of leiomyomas and adenomyosis in the 41–50 year age group (55% and 53.9%, respectively). (Table-5) Table 5: Age -wise distribution of Leiomyoma & Adenomyosis S.N Age group Leiomyoma (N=89) Adenomyosis (N=52) Number of cases Percentage (%) Number of cases Percentage (%) 1. 21-30 01 1.2% 00 00.00% 2. 31-40 26 29.2% 13 25% 3. 41-50 49 55% 28 53.9% 4. 51-60 11 12.4% 10 19.2% 5. 61-70 02 2.2% 01 1.9% 6. 71-80 00 00.00% 00 00.00% Chronic cervicitis constituted the predominant cervical pathology, diagnosed in 79 cases (51%). Other findings included chronic cervicitis with nabothian follicle in 42 cases (27%), and squamous metaplasia in 24 cases (15.5%). Cervical polyps and dysplasia each accounting for (1.3%), four cases of carcinoma (2.6%) were also diagnosed. Rare lesions included cervical leiomyoma (1.3%).(Table-6 (Figures-10&11) Table-6 Distribution of histopathological findings in cervix (N = 155) S.N Histopathological findings Number of cases Percentage (%) 1. Chronic cervicitis 79 51% 2. Chronic cervicitis with nabothian follicle 42 27% 3. Chronic cervicitis with squamous metaplasia 24 15.5% 4. Cervical polyp 02 1.3% 5. Cervical leiomyoma 02 1.3% 6. Cervical dysplasia 02 1.3% 7. Cervical cancer 04 2.6% Total 155 100% (a) (b) Fig.9 (a) Myometrium .Epithelioid leiomyomaA higher magnification photomicrograph showing round or polyglonal cells with eosinophilic cytoplasm in nested or trabecular pattern. (b) Myometrium. Cellular leiomyomaA higher magnification photomicrograph showing Increased cellularity with scant cytoplasm. H&E,40X H&E,40X Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1105 (a) (b) H&E,10X H&E,10X Fig. 10 (a) Cervix. HSIL -Shows full thickness nuclear atypia and lack of maturation (b) Cervix. Cervical leiomyoma –Spindle-shaped smooth muscle cells arranged in intersecting bundles or fascicles. Fig.11(a) Cervix. Well differentiated Squamous cell carcinoma-Showing abundant keratinization of epithelium and minimal nuclear pleomorphism. (b) Cervix. Endocervical adenocarcinoma– Tumor shows variable sized closely packed glands floating in abundant mucin (c,d)) Cervix. Adenocarcinoma-Irregular, angulated or cribriform glands. (e) Cervix. Adenocarcinoma -A higher magnification photomicrograph showing glands lined by stratified nuclei. H&E,10X H&E,10X H&E,10X H&E,40X (d) (c) (a) (b) (e) H&E,4X Dr. Kiran et al. Clinicopathological Analysis of Hysterectomy Specimens - A Retrospective Study at a tertiary care centre in North India . Int. J Med. Pharm. Res., 6 (5): 1098‐1109, 2025 1106 Among the 90 cases where ovaries were available for examination, 52 cases (57.8%) showed no pathological changes. Non-neoplastic lesions were identified in 25 cases (27%), predominantly follicular cysts (15.6%) followed by luteal cysts (8.9%). Neoplastic lesions comprised 13 cases included serous cystadenoma (5.6%), mucinous cystadenoma (2.2%), teratoma (2.2%), and malignant tumors such as serous and mucinous cystadenocarcinomas (each 2.2%).(Table-8) Table-7 Distribution of histopathological findings in ovary (N = 90) S.N Histopathological findings Number of cases Percentage (%) 1. Follicular cyst 14 15.6% 2. Luteal cyst 8 8.9% 3. Endometeriosis 3 3.3% 4. Serous cystadenoma 5 5.6% 5. Serous carcinoma 2 2.2% 6. Mucinous cystadenoma 2 2.2% 7. Mucinous carcinoma 2 2.2% 8. Teratoma 2 2.2% 9. Unremarkable 52 57.8% Total 90 100% Among 90 fallopian tube specimens, the majority (87.7%) exhibited normal histology. Nonneoplastic lesions included salpingitis (3.3%) and paratubal cysts (7.8%).One case (1.1%) of focal serous tubal intraepithelial lesion (STIL) is also found in present study.It is a rare pathological finding in the fallopian tubes, characterized by epithelial stratification, loss of polarity, mild nuclear atypia, and papillary architecture. (Table-8) Table-8 Distribution of histopathological findings in fallopian tube (N = 90). S.N Histopathological findings Number of cases Percentage (%) 1. Salpingitis 3 3.3% 2. Paratubal cyst 7 7.8% 3. Serous tubular intraepilthelial lesion (STIL) 1 1.1% 4. Unremarkable 79 87.7% Total 90 100% (a) H&E,40X Fig. 11 (a) Ovary. Serous carcinoma -A higher magnification photomicrograph showing tumors cells arranged in glands and sheets, having large vesicular nuclei (b ) Ovary. Mucinous carcinoma - Crowded glands and cyst with complex irregular infoldings and protrusions into the surrounding stroma. (c) Ovary. Mucinous carcinoma -A higher magnification photomicrograph showing gland lined by pseudostratified columnar epithelium with intracellular mucin. H&E,10X H&E,40X (b) (c)