Abstract
HISTOPATHOLOGICAL SPECTRUM OF HYSTERECTOMY SPECIMENS IN TERTIARY CARE HOSPITAL: A PROSPECTIVE STUDY

Dr. Prem Singh, Dr. Archana Ticku and Dr. Gitanjali Jamwal

ABSTRACT

Hysterectomy is the standard method and most regularly performed surgical technique in peri and post menopausal women in U.S.A. In India hysterectomy rate is 6% as compared to western countries where it is 10 -20%.[1] In November 1843, Charles Clay performed the first abdominal hysterectomy in Manchester, England. In 1929, Richardson, MD, performed the first total abdominal hysterectomy. Since early 20th century, hysterectomy is the ultimate treatment of diseases of the pelvic organs such as adenomyosis, fibroid, pelvic inflammatory disease, endometriosis and cancer of the reproductive organs.[2] It is considered as a life saving measure in women with certain type of malignancies and in acute uterine bleeding. It also improves the quality of life for women with definite uterine pathologies such as endometriosis, fibroids, and uterine prolapse. With proper approach of hysterectomy procedure and accurate selection of patients the occurrence rate of morbidity and mortality is low.[3] Pathological evaluation and examination of hysterectomy specimens have diagnostic and great therapeutic importance. Incidence of uterine and adnexal pathologies varies from nation to nation and from region to region within the nation.[4] Uterus, being a vital female reproductive organ is subjected to many benign and malignant diseases. Even though many medical and conservative surgical treatment options are existing, hysterectomy still is the most commonly performed major gynaecological procedure worldwide.[5] A total hysterectomy implies the removal of the uterus and cervix. When bilateral adnexae are removed it is called as hysterectomy with Bilateral Salpingoopherectomy(BSO).Vaginal hysterectomy is performed predominantly for uterine prolapse whereas abdominal hysterectomy with or without salpingoophorectomy for fibroids and menstrual problems.[6] Before laproscopically assisted vaginal hysterectomy (LAVH),75% of hysterectomies performed were total abdominal hysterectomies(TAH) and the rest were total vaginal hysterectomies (VH). Rate of TAH decreased to 39% while that of VH remained the same (29 %) after the introduction of LAVH. In 1990, 73% of all hysterectomies were TAH which dropped to 63% in 1997 whereas the rate of LAVH, which was 0.3% in 1990, increased to 9.9%.[7] Radical hysterectomy is more extensive procedure done for cancers of uterus, cervix where surrounding tissue, upper vagina and the pelvic lymph nodes are dissected.[8] Histopathological examination of uterus and adnexa plays a crucial role in making a correct and exact diagnosis, which has a insightful impact on the management of the patient and also carries therapeutic and legal implications.[9]

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