Online ISSN: 2515-8260

Keywords : Hysterectomy


To study the clinical and histopathological findings on hysterectomy

Dr Razia Siddiqui, Dr Shruti Agarwal, Dr Priyanka Tiwari, Dr Girish Kumar Pathak

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 299-304

Background: Hysterectomyare mostlycommon performed in the gynecological procedure for clinical problem in its treatments includes fibroids, prolapse, adenomyosis, endometriosos. Hysterectomy is performed worldwide in women at 30- 55 years of age. Aim and objectives to indicate the diagnosis to performed hysterectomy in patients and complications associated undergoing hysterectomy.
Methods: Total 255 patients undergone hysterectomy in the hospital was studied and analysed it clinical indications of surgery and complication of it, surgical specimens were sent for histopathology and report.
Results: The study shows thathysterectomy was performed in the major diagnosis of uterine prolapse (33.50%), leiomyoma (45.50%), adenomyosis (12.50%) while the report specimens also showed it. The diagnosis before the hysterectomy was confirmed by histopathology. There was no major complications were observed in the patients undergoing hysterectomy as this procedure is widely used for gynecological problems.
Conclusions: The study shows the data of patients’ trends of the hysterectomy and diagnosis that leads to perform hysterectomy was analyzed by histopathological finding in the patients. Complications were negligible in the hysterectomy and safe procedure

A Retrospective assessment of the histo-morphological diversity of various lesions of the uterus, cervix and adnexa

Dr. Vani H Patel, Dr. Maulik K Mehariya, Dr. Vishal S Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 90-95

Aim: To study the histo-morphological diversity of various lesions of the uterus, cervix and adnexa.
Materials and Methods: A Retrospective Histopathological study of 609 cases of nonneoplastic and neoplastic lesions of hysterectomy specimens was conducted in Department of Pathology, over the period from June 2015- May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Atrophic changes were seen in 13.46% cases. Endometrial hyperplasia was seen in 26 cases. Among the neoplastic lesions 2.46% cases were endometrial polyps with only 3 cases of malignancy forming 0.49%. Among the histologic types of lesions of myometrium, majority were Leiomyoma (27.59%). Leiomyoma and Adenomyosis were seen in 55 cases (9.04%). Adenomyosis was seen in 22.00%. Chronic cervicitis was seen in 36.07% cases and chronic cystic cervicitis in 6.21% of cases. Nabothian cyst were seen in 124 cases (20.80%). 19.80% cases showed Squamous metaplasia. Out of 188 Ovarian lesions, 167 (88.83%) were non-neoplastic lesions and 21 (11.17%) were neoplastic lesions. Fallopian tube pathology included chronic salpingitis in 2 cases, paratubal cyst in 07 cases. 69.4% of cases show unremarkable fallopian tubes.
Conclusion: The present study provides awareness into the wide range of histopathological patterns of lesions in uterus and cervix in hysterectomy specimens. It aids to appropriate management in the postoperative period.

HISTOMORPHOLOGICAL SPECTRUM OF ENDOMETRIAL AND CERVICAL LESIONS FOLLOWING CURETTAGE AND BIOPSY- A RETROSPECTIVE STUDY

Rashmikumari T. R, Priyanka Prasad Arvind, Astha Srivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2121-2128

Background: Abnormal uterine bleeding (AUB) is the most common clinical presentation in premenopausal and postmenopausal period which could be due to either endometrial or cervical lesions. Early detection of precursor lesions and exclusion of malignancy is a diagnostic challenge for pathologists. Many studies were done on either endometrium or cervix alone, hence we took this study to evaluate both simultaneously before the hysterectomy. Objectives: To profile the histomorphological spectrum of endometrium and cervical lesions on curettage and biopsy concurrently before hysterectomy and correlation with hysterectomy specimens wherever available.
Materials and Methods: The present study was conducted on 153 cases of endometrial curetting’s and cervical biopsies received from Department of Gynaecology to Department of Pathology, RIMS, Raichur during a period of February 2020 to January 2022. Histopathology slides were retrieved from the archives of Department of Pathology. New slides were made from Paraffin embedded blocks wherever necessary and stained with Haematoxylin and Eosin. Histopathological examination of the hysterectomy specimens was conducted wherever available.
Results: Majority of the patients were in third decade of life with mean age of 41.3 years (P<0.0001) and the commonest clinical indication was AUB ((P<0.0001). Majority of the endometrium showed cyclical changes in both endometrial curettage and in hysterectomy specimens which showed a perfect positive coefficient correlation of 0.92 (P value = 0.028). Similarly, the cervical biopsy and cervix findings in hysterectomy specimen showed a highly significant P < 0.0001. The commonest histomorphological lesion in cervix was non-specific chronic cervicitis (NSCC).
Conclusion: Abnormal uterine bleeding is a major gynaecological problem in perimenopausal and post-menopausal women. It could be due to either endometrial / cervical lesions hence if it is evaluated simultaneously with a minimally invasive procedure as our study so that unnecessary radical surgeries can be avoided and medical/ conservative treatment could be offered.

A PROSPECTIVE STUDY OF ENDOMETRIUM IN LEIOMYOMA UTERUS

Manasa R, Jyostnalatha P, Dr. Manikanta Veesam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2656-2662

Background: Leiomyoma (fibroid) is the commonest neoplasm accounting for 75% of benign tumours affecting women in reproductive age group. They are dependent upon the steroid hormones for their growth and maintenance. As the endometrium and leiomyoma (fibroid), are both steroid hormone dependent, we studied the corresponding histological changes in endometrium in cases of uterine leiomyoma.
Materials and Methods: The study included 100 hysterectomy cases where leiomyoma/leiomyomas were present. Brief clinical history regarding age, clinical presentation, parity was obtained. The specimens were fixed in 10% formalin; tissue bits from representative areas were taken and stained with Haematoxylin and Eosin.
Results: The commonest age group was 4th decade (54%). The commonest clinical presentation or chief complaint in current study is menorrhagia (46% cases). Majority of the women in the study were multiparous (89%) and the most common type of leiomyoma encountered in the study, based on location, was intramural type (62% cases). Proliferative pattern of endometrium (62%) is the most common pattern associated with leiomyomatous uteri in this study.
Conclusion: Uterine fibroids (leiomyomas) are the most common benign gynecological tumors in women of reproductive age globally. Endometrium and leiomyoma (fibroid), are both dependent on steroid hormones for the growth and maintenance. Histopathological diagnosis is the mainstay to identify the uterine leiomyoma, though some amount of clue may be obtained from the endometrial curettings.

A retrospective assessment to determine the incidence and indication for hysterectomy in tertiary care facility

Dr. Vani H Patel, Dr. Maulik K Mehariya, Dr. Vishal S Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2232-2236

Aim: to study the incidence and indication for hysterectomy in the study population.
Materials and Methods: A Retrospective study was conducted in Department of Pathology, over the period from June 2015-May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Out of total 10230 histopathological specimens received at department of Pathology from June 2015 to May 2017, hysterectomy specimens were 609 accounting for of total specimen received. Hysterectomy specimens were received from a wide range of age groups varying from 15 years to 81 years. The average age for undergoing hysterectomy was 43.05 years. Majority of cases (44.01%) were from the 5th decade followed by 4th decade (36.95%). Among the 609 cases, the major clinical diagnosis for which hysterectomy was performed included DUB (32.35%), Fibroid (29.39%) and Prolapse (16.09%). 6 Hysterectomies were performed for malignant lesions (Carcinoma of cervix, Endometrial carcinoma and Ovarian malignancy) and 24 Obstetrics Hysterectomies were done.
Conclusion: Maximum numbers of patients were from the 5th decade followed by 4th decade. DUB, Fibroid and Uterine Prolapse were the major clinical diagnosis before Hysterectomy was done.

Histopathological correlation of hysterectomy specimens with clinical and other investigational findings

Dr. Killol Nathubhai Desai, Dr. Vidya Satapara, Dr. Alpeshkumar Maheshbhai Maru, Dr. Harshid L. Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1040-1048

Context: Hysterectomy is the surgical removal of the uterus and is the most common major
gynaecological surgical procedure performed worldwide.
Aims: To study the incidence and distribution of various types of pathologies in the
hysterectomy specimens in the population studied.
Methods and Material: A total of 500 cases were studied. The study material was obtained
from patients’ hospitals that underwent hysterectomy and also specimens sent from nearby
private or government
Results: Among various significant pathologies, benign accounted for 95.7% of lesions while
malignant for 4.3% of lesions. Among benign lesions, adenomyosis was commonest with 203
(136 isolated + 67 with leiomyoma) cases and it was most common in 41-50 years age group.
Leiomyoma was next common with 183 (116 isolated + 67 with adenomyosis) cases and it
was also most common in 41-50 years age group. 67 (13.4%) cases had both leiomyoma and
adenomyosis. CIN1 or LSIL accounted for 15 cases, serous cystadenoma of ovary for 12
cases, endometrial polyp for 12 cases, mature cystic teratoma of ovary for 8 cases,
endocervical polyp for 9 cases, cervical leiomyoma for 6 cases, mucinous cystadenoma for 3
cases, placenta accreta for 3 cases, simple endometrial hyperplasia without atypia for 2 cases,
infected decidua for 2 cases, CIN2/CIN3 or HSIL for 2 cases, adult granulosa cell tumour for
2 cases, endometriosis of ovary for 2 cases, broad ligament leiomyoma for 2 cases, acute
salpingitis for 1 case, endometriosis of fallopian tube for 1 case, complete hydatidiform mole
for 1 case, invasive hydatidiform mole for 1 case and adenomatoid tumour of myometrium
for 1 case. Among malignant lesions, carcinoma of cervix was commonest with 11 cases,
followed by carcinoma of ovary with 7 cases and carcinoma of endometrium with 3 cases.

To study the efficacy and safety between use of BICLAMP (bipolar coagulation forceps) in vaginal hysterectomy and conventional vaginal hysterectomy: A prospective study at tertiary care center, Maharashtra

Dr. Neha Chandraprakash Agrawal, Dr. Priyanka Kunal Purohit, Dr. Gaurav Kumar J Desai and Dr. Chintan M Upadhyay

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 784-790

Background: Bipolar vessel sealing systems (BVSS) are accepted to be safe and efficacious
with possible advantages over conventional methods, namely fewer requirement of postoperative
analgesics, less blood loss, shorter operative time and minimum hospital stay.
Objectives: To compare the efficacy and safety between use of BiClamp (Bipolar
Coagulation Forceps) in Vaginal Hysterectomy and Conventional Vaginal Hysterectomy.
Materials and Methods: This prospective study was done among 80 cases indicating
hysterectomy for benign diseases admitted in OBGY unit were selected randomly out of
which 40 cases underwent Conventional Vaginal Hysterectomy and 40 cases underwent
BiClamp Vaginal Hysterectomy at department of obstetrics & Gynecology in Government
medical college and hospital, Latur during November 2012 to September 2014.
Results: Mean duration of hospital stay required for participants of cases and control group
was 2.6 days and 4.2 days respectively (p<0.05). Mean duration of operation of cases and
control group participants was 70.9 min and 75.5 min respectively (p<0.05). Mean blood loss
during operation noted among the cases and control group participants was 90.1 ml and 115.9
ml respectively (p<0.05). During operation, three suture material required in in 0.0%
participants of cases group and 82.5% of control group respectively (p<0.05). Post- op
complications like fever, bladder injury, bowel injury & hemorrhage noted only in
participants of control group.
Conclusion: BiClamp Vaginal Hysterectomy post-operative pain was less, intraoperative
blood loss was less, operative time was significantly shorter, duration of hospital stay was
less and BiClamp Vaginal Hysterectomy was more Cost effective than the Conventional
Vaginal Hysterectomy

STUDY OF FIBROID UTERUS

DR VIJAY Y KALYANKAR,2.DR BHAKTI VIJAY KALYANKAR, DR SRINIVAS N GADAPPA, DR REVATI RAMESHWAR GHAYAL, DR MEGHA CHAUHAN, DR SHIVANGI S VERMA .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4974-4980

INTRODUCTION-uterine fibroids are common tumor of uterus, seen in reproductive age group. Fibroids during pregnancy produce special challenges during labour. Small fibroids with minimal symptoms treated with medical management, while large, multiple fibroids with pressure symptoms require surgical management. Fibroids during pregnancy produces special challenges during labour.
AIMS & OBJECTIVES –To study and analyse the Risk factors associated withfibroids, Clinical features according to different type offibroid, Different types of management of fibroid.
METHODOLOGY- fibroid cases were diagnosed clinically and with ultrasonography. Details of clinical examination findings, investigations and treatment modalities used were noted. Difficulties during surgery and methods to overcome were studied.
Histopathology details of specimen and other associated findings were studied.
RESULTS- Fibroids are Commonly seen in reproductive age group showing 45.5% cases. Majority cases are multipara seen in 79.35% cases and 5.14% cases are pregnant patients with fibroid. Intramural fibroid was seen in 60% and presented with menorrhagia (73%) and dysmenorrhea (50.5%). Fibroids presented with menstrual symptoms were seen in 96.15% cases. 61.7% cases underwent surgical management in that Total Abdominal Hysterectomy alone constitute 76.19%. neglected fibroids were common in rural areas making surgical management more common.
CONCLUSIONS- Pre-operative adequate preparations with general build-up for anesthesia and surgery, imaging studies, ureteric stenting where-ever required, use of GNRH analogues and following the principles of Fibroid surgery, made successful surgeries with no surgical morbidity and mortality. Caesarean section is common mode of delivery in fibroids in pregnancy with no complications.

Realities Of Time. Chronic Gender Inflammation And Pelvic Pain

Sitora Amirovna Tilyavova; Gulchehra Samatovna Karimova

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 2754-2766

One of the most pressing problems in modern gynecology is the problem of chronic inflammation of the appendages. Every obstetrician-gynecologist has to deal with a complaint of pain in the lower abdomen in women every day. About 39% of women experience pelvic pain caused by inflammation of the uterine appendages periodically, while 12% of patients experience pain for at least 5 days every month, and another 12% suffer from persistent pelvic pain [2]. Chronic pelvic pain occupies a special place among the variety of clinical manifestations of gynecological diseases and is considered by most researchers as one of the leading symptoms of inflammatory diseases of the pelvic organs: chronic salpingitis and oophoritis, pelvic peritoneal adhesions, chronic endometritis. However, the presence of a "routine" gynecological pathology cannot always explain the development of pain in the lower pelvis. Pelvic pain is an indication in 12% of all hysterectomies. For this reason, the aim of our study was to optimize the treatment of chronic inflammatory diseases of the uterine appendages to improve the quality of life and prevention of pelvic pain. The object of the study was 100 women with chronic salpingoophoritis complicated by pelvic pain, who were divided into three groups according to the method of treatment. During the study, we used, along with general clinical research methods and examination for sexually transmitted infections, special research methods, such as: studying the intensity of pain on the VAS scale, bacterioscopic and bacteriological examination of vaginal contents, ultrasound scanning and Doppler studies, estradiol, progesterone, testosterone, FSH, LH, DHEAS-S, TSH, prolactin and cortisol in the blood serum, the content of prostaglandins F2α, E2 and growth factors in the serum. In addition, the level of immunoglobulin A (IgA), the concentration of the main cytokines (IL 1β, IL6) in the blood serum were determined. The resulting material was subjected to automated statistical processing. After the examination, the patients received the necessary treatment, which included antibiotic-anti-inflammatory therapy (ceftriaxone, doxycycline, metronidazole), 20 procedures of pharmaco-physiotherapeutic intravaginal electrotherapy with the drug Glutoxim in an amount of 1 ml of 1% solution, intravaginal ultrasound therapy, synbiotic Bifiten. Based on the results of the data, the effectiveness of the use of the developed pharmaco-physiotherapeutic method (91%) was proved in comparison with intravaginal ultrasound therapy (74%) and, especially, drug therapy (40%).