[ Ana Sayfa | Editörler | Danışma Kurulu | Dergi Hakkında | İçindekiler | Arşiv | Yayın Arama | Yazarlara Bilgi | E-Posta ]
Fırat Üniversitesi Sağlık Bilimleri Tıp Dergisi
2018, Cilt 32, Sayı 3, Sayfa(lar) 143-146
[ Özet ] [ PDF ] [ Benzer Makaleler ] [ Yazara E-Posta ] [ Editöre E-Posta ]
1815 Histerektomi Materyalinin Klinikopatolojik Olarak Değerlendirilmesi
Özgür İLHAN ÇELİK
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Medical Pathology, Muğla, TURKEY
Anahtar Kelimeler: Histerektomi, anormal uterin kanama, uterin hastalıklar, jinekolojik maligniteler
Özet
Amaç: Histerektomi, kadınlara en sık uygulanan cerrahi prosedürlerden biridir. Bu çalışmanın amacı, histerektomi materyallerinde tanı almış hastalıkların dağılımını değerlendirmektir.

Gereç ve Yöntem: Herhangi bir nedenle histerektomi yapılmış olan 1815 kadın hasta retrospektif şekilde klinikopatolojik olarak değerlendirildi.

Bulgular: Ortalama histerektomi geçirme yaşı 48.94 idi. Histerektominin önde gelen nedeni ve patolojik tanısı %47.82 oranında leiomyoma idi. İkinci önde gelen neden ve histopatolojik tanı prolapsus uteri idi (%24.63) ve üçüncü sırada tanı konan adenomyozis (%12.84) ise, başta leiomyomlar olmak üzere genellikle diğer hastalıklarla birliktelik gösteren bir durumdu. Endometriyum, myometriyum, serviks, vajina, tuba uterina ve over malign tümörlerinin sayıları daha az olsa da; kadınların hayatlarını kısaltan en tehlikeli jinekolojik hastalıklardı. Bu nedenle, hastalara daha iyi sağkalım sağlamak için erkenden uygun tedaviye başlamak amacıyla bu tümörleri mümkün olduğunca erken teşhis etmek çok önemlidir.

Sonuç: Sonuç olarak, Anormal uterin kanama, pelvik ağrı gibi belirtilerin nedenleri jinekolojik karsinomlar açısından ayrıntılı olarak araştırılmalı ve özellikle serviks karsinomlarının erken teşhisi için doğurganlık dönemindeki her kadına Servikovajinal Papanicalaou Smear tarama testi uygulanmalıdır.

  • Başa Dön
  • Özet
  • Giriş
  • Materyal ve Metot
  • Bulgular
  • Tartışma
  • Kaynaklar
  • Giriş
    Hysterectomy is one of the most frequent surgical procedures of women. The prevalence of it changes by race, development of the countries and the geographic location (4%-40%) 1,2. Education level, age at first birth, gravity, parity, the number of alive children, the number of miscarriages and other risk factors like genetic tendency to malignancies (Lynch Sendrom) have been found to be associated with the risk of hysterectomy 3,4. The indication of hysterectomy varieses between the regions. However the leading indication is leiomyoma 5-7. The other indications are abnormal uterine bleeding (AUB) 8, endometriosis, adenomyosis 9-11, endometrial, cervical, tubal, ovarian benign and malignant masses 12-16.

    In this study we have searched the diversity of the diagnosis of the hysterectomy materials in order to present the most frequent diseases of the uterus that require surgery.

  • Başa Dön
  • Özet
  • Giriş
  • Materyal ve Metot
  • Bulgular
  • Tartışma
  • Kaynaklar
  • Materyal ve Metot
    We analyzed 1815 female patients retrospectively who underwent hysterectomy because of any reason and histopathologically evaluated at the pathology laboratory between the beginning of 2012 to the end of 2017 in this study. Clinicopathological parameters of the patients were obtained from the hospital automation system. The histopathologic diagnosis were evaluated and the distribution of the lesions were determined.

    This Project was evaluated by Hospital Research and Publication Ethics Committee and it was approved in terms of scientific researches and patient ethics.

    In statistical analysis of data, mean and standard deviation for continuous variables and percentages for categorical variables were used. Descriptive statistics and categorical variables were given as frequencies (percentages).

  • Başa Dön
  • Özet
  • Giriş
  • Materyal ve Metot
  • Bulgular
  • Tartışma
  • Kaynaklar
  • Bulgular
    The mean age of 1815 patients included in the study was 48.94. The minimum age was 30; the reason of hysterectomy by this patient was leiomyoma. The maximum age was 85; the reason of hysterectomy by this patient was endometrial carcinoma. The distribution of the lesions diagnosed in the patients listed in Table 1.


    Büyütmek İçin Tıklayın
    Table 1: The results of the diagnostic evaluation of hysterectomy materials.

  • Başa Dön
  • Özet
  • Giriş
  • Materyal ve Metot
  • Bulgular
  • Tartışma
  • Kaynaklar
  • Tartışma
    AUB is the most common symptom of gynecological conditions, which is defined as any type of bleeding in which the duration, frequency or amount is excessive for a woman. It is generally an indicator of possible uterine disease 8,17. Previous studies have shown that the prevalence of AUB varies in different populations (between 10% and 30%) (18, 19). It frequently enforces medical intervention in order to improve the comfort of the patient's life 20,21. In the AUB conditions that do not respond to medical or small surgical treatments, the last choice is hysterectomy. These patients have either structural diseases like benign/ malignant situations (40%) or dysfunctional uterine bleeding (DUB) in the absence of demonstrable structural or organic abnormalities (60%). Most of the DUB patients can be treated medically, rarely hysterectomy is needed to be applied (0.05%-0.09%). In our study 14 patients (0.77%) underwent hysterectomy because of the DUB in parallel with the literature 1,17-22.

    The leading reason of hysterectomy was presented as leiomyomas (or fibroids in other words) in the literature 1-7,23. Pavone et al. declared that leiomyomas accounted for 40%-60% of all the hysterectomies, this was compatible with our results (47.82%). There were also subtypes of the leiomyomas diagnosed as seperately from the usual leiomyomas accounting 3.64%. Total rate is also compatible with the Pavone et al’s results. Also we have found 2 leiomyosarcomas and 2 stromal sarcomas in 4 patients which were presumed leiomyomas (0.22%) in paralel with the study of Ruengkhachorn et al (0.2%) 24. This means masses that seem like leiomyomas must be closely monitored and carefully managed.

    The second leading reason of hysterectomy was prolapsus uteri (24.63%) paralel to the literature 25,26. These patients were generally older than 50 years old.

    Adenomyozis seemed to be the third common diagnosis with a rate of 12.84%. However in most of these patients, the diagnosis of the adenomyozis was not the only disease alone in hysterectomies. It was mostly diagnosed together with leiomyomas. This means leiomyomas and adenomyozis often coexist in the same uterus with a prevalence ranging from 15% to 57% 10,11,27.

    Another group of lesions that was composed of benign lesions (endometrial/endocervical polyps, Hyperplasias without atypia, Paratubal Cysts, Simple Cysts of ovary- follicular cysts, surface epithelial inclusion cysts, cystic corpus luteum-, Endometriosis) generally do not require hysterectomy but encountered as an accompanying disease by tumors (especially leiomyoma), adenomyosis and prolapsus uteri. They were diagnosed in 28.87% of the hysterectomies 28. The next small group was composed of premalignant lesions (Endometrial hyperplasia with atypia, LSIL, HSIL,GIN) with a ratio of 1.49% and benign tumors of the ovary (fibroma, fibrothecoma, serous/ seromucinous/ mucinous cystadenomas, Benign Brenner tumor, mature teratoma) with a ratio of 6.61%.

    The last group was the most important group as it was composed of borderline tumors (serous and seromucinous borderline tumors: 0.22%) and the malignant tumors (Endometrial endometrioid/serous carcinomas, ovarian fibrosarcoma, serous/mucinous carcinoma, clear cell carcinoma, granulosa cell tumor, brenner tumor, endometrioid carcinoma and metastasis of colonic carcinoma to ovary, cervical squamous/ adeno carcinomas, vaginal squamous/clear cell carcinomas and tubal serous carcinoma: 4.90%). These malignant tumors were the cases with the highest indication for hysterectomy 13-16,29,30. Fortunately malignancies occupy a very small group; however they are the most dangerous diseases that shorten the lives of the patients. So it is very important to diagnose these tumors as early as possible in order to begin the appropriate treatment quickly to provide the patients better survivals. As a result the reasons of the symptoms like AUB, pelvic pain must be researched in details for gynecological carcinomas and the cervical screening test with the cervicovaginal papanicalaou smear test must be applied to every women in fertility period for early diagnosis of cervical carcinomas.

  • Başa Dön
  • Özet
  • Giriş
  • Materyal ve Metot
  • Bulgular
  • Tartışma
  • Kaynaklar
  • Kaynaklar

    1) Liu F, Pan Y, Liang Y, et al. The epidemiological profile of hysterectomy in rural Chinese women: A population-based study. BMJ open 2017; 7: e015351.

    2) Barghouti FF, Yasein NA, Jaber RM, et al. Prevalence and risk factors of urinary incontinence among jordanian women: impact on their life. Health Care Women Int 2013; 34: 1015-1023.

    3) Desai S, Campbell OM, Sinha T, et al. Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India. Health Policy Plan 2017; 32: 68-78.

    4) Stang A, Kluttig A, Moebus S, et al. Educational level, prevalence of hysterectomy, and age at amenorrhoea: a cross-sectional analysis of 9536 women from six population-based cohort studies in Germany. BMC Womens Health 2014; 14: 10.

    5) Garry R. The future of hysterectomy. BJOG 2005; 112: 133-139.

    6) Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit 2008; 14: 24-31.

    7) DeCherney AH, Bachmann G, Isaacson K, et al. Postoperative fatigue negatively impacts the daily lives of patients recovering from hysterectomy. Obstet Gynecol 2002; 99: 51-57.

    8) Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age. A cross-sectional study. Medicine 2018; 97: e11457.

    9) Morassutto C, Monasta L, Ricci G, Barbone F, Ronfani L. Incidence and estimated prevalence of endometriosis and adenomyosis in Northeast Italy: A data linkage study. PLoS ONE 2016; 11: e0154227.

    10) Ates S, Ozcan P, Aydin S, Karaca N. Differences in clinical characteristics for the determination of adenomyosis coexisting with leiomyomas. Obstet Gynaecol Res 2016; 42: 307-312.

    11) Struble J, Reid S, Bedaiwy MA. Adenomyosis: A clinical review of a challenging gynecologic condition. J Minim Invasive Gynecol 2016; 23: 164-185.

    12) Cho HW, Koo YJ, Hong JH, Lee JK. Clinical indications for hysteroscopic removal of uterine masses: Time, age atdiagnosis and mass size. J Obstet Gynaecol 2017; 43: 1751-1757.

    13) Yamagami W, Nagase S, Takahashi F, et al. Clinical statistics of gynecologic cancers in Japan. J Gynecol Oncol 2017; 28: e32.

    14) Rauh-Hain JA, Melamed A, Schaps D, et al. Racial and ethnic disparities over time in the treatment and mortality of women with gynecological malignancies. Gynecol Oncol 2018; 149: 4-11.

    15) Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clİn 2018; 68: 284-296.

    16) Plagens-Rotman K, Chmaj-Wierzchowska K, Pięta B, Bojar I. Modifiable lifestyle factors and ovarian cancer incidence in women. Ann Agric Environ Med 2018; 25: 36-40.

    17) Munro MG, Critchley HO, Fraser IS. The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding. Semin Reprod Med 2011; 29: 391-399.

    18) Kazemijaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, et al. A population-based study of the prevalence of abnormal uterine bleeding and its related factors among Iranian reproductive-age women: An updated data. Arch Iran Med 2017; 20: 558-563.

    19) Liu Z, Doan QV, Blumenthal P, et al. A systematic review evaluating health-related quality of life, work impairment, and health care costs and utilization in abnormal uterine bleeding. Value Health 2007; 10: 173-182.

    20) Matteson KA, Raker CA, Clark MA, et al. Abnormal uterine bleeding, health status, and usual source of medical care: analyses using the Medical Expenditures Panel Survey. J Womens Health (Larchmt) 2013; 22: 959-965.

    21) Cote I, Jacobs P, Cummings D. Work loss associated with increased menstrual loss in the United States. Obstet Gynecol 2002; 100: 683-687.

    22) Munro MG, Dickersin K, Clark MA, et al. The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding: Summary of an Agency for Health Research and Quality-sponsored randomized trial of endometrial ablation versus hysterectomy for women with heavy menstrual bleeding. Menopause 2011; 18: 445-452.

    23) Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and risk factors of uterine fibroids. Best Pract Res Cl Ob 2018; 46: 3-11.

    24) Ruengkhachorn I, Phithakwatchara N, Nawapun K, Hanamornroongruang S. Undiagnosed uterine sarcomas ıdentified during surgery for presumed leiomyoma at a National Tertiary Hospital in Thailand: A 10-year review. Int J Gynecol Cancer 2017; 27: 973-978.

    25) Gerten KA, Markland AD, Lloyd LK, Richter HE. Prolapse and incontinence surgery in older women. J Urol 2008; 179: 2111-2118.

    26) Handa VL, Garret E, Hendrix SDO, Gold E. Progression and remission of pelvic organ prolapse: A longitudinal study of menopausal women. Am J Obstet Gynecol 2004; 190: 27-32.

    27) Weiss G, Maseelall P, Schott LL, et al. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women’s Health Across the Nation (SWAN). Fertil Steril 2009; 91: 201-206.

    28) Kurman RJ, Carcangiu ML, Herrington CS, Young RH. WHO classification of tumours of female reproductive organs. 4th Edition, Lyon: IARC, 2014.

    29) Genç M, Çenç B, Korkut B, Turan A, Kurt S. Postmenopozal dönemde overin granüloza hücreli tümörü: Olgu sunumu ve literatürün gözden geçirilmesi. Fırat Üniversitesi Sağlık Bilimleri Tıp Dergisi 2012; 26: 93-96.

    30) Nayar R, Wilbur DC. The Pap test and Bethesda 2014. Cancer Cytopathol 2015; 123: 271-281.

  • Başa Dön
  • Özet
  • Giriş
  • Materyal ve Metot
  • Bulgular
  • Tartışma
  • Kaynaklar
  • [ Başa Dön ] [ Özet ] [ PDF ] [ Benzer Makaleler ] [ Yazara E-Posta ] [ Editöre E-Posta ]
    [ Ana Sayfa | Editörler | Danışma Kurulu | Dergi Hakkında | İçindekiler | Arşiv | Yayın Arama | Yazarlara Bilgi | E-Posta ]