Is it worth preserving the uterus? unanticipated pathology in hysterectomy for pelvic organ prolapse (POP)

Background: In recent years concept of uterine conservation has been increasing at the time of surgical management of pelvic organ prolapse (POP). This study was intended to assess the risk of premalignant and malignant uterine/endometrial, and cervical pathology at the time of hysterectomy-based POP procedures, to better understand the risks of uterine conservation in the surgical treatment of POP in Indian setup.Methods: Patients who had undergone vaginal hysterectomy for POP in last five years were identified by medical record tracking using ICD-9 codes. Case records then were reviewed to collect patient characteristics and the final histopathological diagnosis of the hysterectomy specimen. Cases with premalignant or malignant uterine/endometrial or cervical pathology recognized prior to surgery were excluded.Results: A total of 573 women who underwent vaginal hysterectomy and pelvic floor repair for the sole indication of POP were included. On analyzing the histopathological diagnosis of the specimen obtained during surgery in 57.1% of cases the findings were consistent with the changes seen in cases of POP. Only 5.9 % of cases had cervical or endometrial pathologies who would have required treatment/follow up in future if the uterus was left in situ.Conclusions: The risk of missing a malignant and premalignant cervical or uterine pathology in women presenting with uterine prolapse is low if appropriate preoperative workup has been done. Uterine preservation in surgical management of POP could be considered an option

Establishing patterns on hysteroscopy in abnormal uterine bleeding (AUB)

Introduction: Pattern recognition of various phases of normal endometrium and endometrial pathologies during hysteroscopy has many advantages. It would help to triage women with AUB, so as to be selective with biopsies and curettages. Recognition of normal variant or benign lesion would reduce burden to the pathologist by decreasing the number of unnecessary sampling. It will also decreases anxiety of the patient as the report/prognostication can be instant in many cases. Material and methods: This prospective, double blind, correlation study was carried out in the teaching hospital with a sample population of 70 women presenting with AUB who underwent hysteroscopy and endometrial sampling. We identified patterns of endometrium which can used to predict six endometrial pathologies which were later correlated with the final histological diagnosis. Results: There was good correlation between hysteroscopic patterns and histopathology report, 33% of starry sky appearance correlated with atrophic endometrium, 87% of tongue shaped projections correlated with endometrial polyp, 44.4% of pebble stone appearance correlated with myomatous polyp, 50% of polypoidal pattern correlated with endometrial hyperplasia. 100% correlation was seen in strawberry appearance, pattern for secretory endometrium and cerebroid appearance which was pattern designated to endometrial carcinoma. Conclusion: Hysteroscopic pattern recognition is a useful concept to triage women who require sampling for histopathological diagnosis. Keywords: Abnormal uterine bleeding, Histopathology, Hysteroscopy, Pattern recognitio