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Uterin Prolapsusu Olan Hastalarda Preoperatif ve Postoperatif Endometriyal / Uterin Histopatoloji Sonuçlarının Değerlendirilmesi

Year 2020, Volume: 17 Issue: 1, 266 - 268, 31.03.2020

Abstract

Amaç: Bu çalışmanın amacı, preoperatif ve postoperatif endometrial histopatolojik bulguları karşılaştırmak ve endometrial kalınlığı 5 mm'nin altında olan ve POP için vajinal histerektomi yapılan asemptomatik kadınlarda beklenmeyen maligniteleri tespit etmektir.
Gereç ve Yöntemler: Bu retrospektif kesitsel çalışmaya Ocak 2010 - Aralık 2016 arasında toplam kırk sekiz kadın hasta dahil edildi. Tüm hastalara ameliyat öncesi Pap Smear ve endometrial biyopsi yapıldı. Ayrıca tüm hastaların endometrial duvar kalınlığı preoperatif olarak ultrasonografi ile değerlendirildi. Pelvik organ prolapsusu nedeniyle opere edilen 48 vajinal histerektomi hastasının histopatolojik verileri analiz edildi.
Bulgular: Preoperatif endometrial biyopsi sonuçları sırasıyla % 70.8 ve% 29.2 oranında atrofik endometriyum ve proliferatif endometriyum olarak gözlemlendi. Postoperatif histopatolojik sonuçlar sırasıyla % 60,4, % 14,6 ve % 25 oranlarında endometrial kistik atrofi, proliferatif endometriyum ve endometrial polip olarak bulundu. Ayrıca, histerektomi sonrası sırasıyla % 37,5 ve % 16,7 oranında leyomiyom ve adenomiyoz saptandı.
Sonuç: Sonuçlarımız, endometrial örneklemenin endometrial kalınlığın 5 mm'den az olması durumunda asemptomatik uterovaginal prolapsus hastaları için öncelikle gerekli olmadığını gösterdi. Bu şartlara sahip hastalarda, ameliyat öncesi endometrial kalınlığın transvajinal ultrason ile değerlendirilmesi yeterli olacağı sonucuna varılmıştır.

References

  • 1. Faraj R, Broome J. Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature. J Med Case Rep 2009;3:99.
  • 2. Detollenaere RJ, den Boon J, Stekelenburg J, Alhafidh AH, Hakvoort RA, Vierhout ME, van Eijndhoven HW. Treatment of uterine prolapse stage 2 or higher: a randomized multicenter trial comparing sacrospinous fixation with vaginal hysterectomy (SAVE U trial). BMC Womens Health 2011;11:4.
  • 3. Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 1972;15:1048-54.
  • 4. Woodman PJ, Swift SE, O’Boyle AL, Valley MT, Bland DR, Kahn MA, Schaffer JI. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:340-5.
  • 5. Grigoriadis T, Valla A, Zacharakis D, Protopapas A, Athanasiou S. Vagina hysterectomy for utero vaginal prolapse: what is the incidence of concurrent gynecological malignancy? Int Urogynecol J. 2015;26:421–5.
  • 6. Litwińska E, Nowak M, Kolasa-Zwierzchowska D, Nowińska-Serwach A, Władziński J, Szpakowski A, Wilczyński, J.R, Stetkiewicz, T. Vaginal hysterectomy vs. laparoscopically assisted vaginal hysterectomy in women with symptomatic uterine leiomyomas: a retrospective study. Prz Menopauzalny 2014;13:242–6.
  • 7. Fialkow MF, Newton KM, Lentz GM, Weiss NS. Life time risk of surgical management or pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:437–40.
  • 8. Lousquy R, Costa P, Delmas V, Haab F. Update on the epidemiology of genital prolapse. Prog Urol 2009;19:907-15.
  • 9. Mingels MJJM, Geels YP, Pijnenborg JMA, van der Wurff AA, van Tilborg AAG, van Ham MAPC, Massuger LFAG, Bulten J. Histopathologic assessment of the entire endometrium in asymptomatic women. Hum Pathol 2013;44:2293-01.
  • 10. Dreisler E, Poulsen LG, Antonsen SL, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Pérez-López FR, Simoncini T, Tremollieres F, Rees M, Ulrich LG. EMAS clinicalguide: Asessment of the endometrium in peri and postmenopausal women. Maturitas 2013;75:181-90.
  • 11. Renganathan A, Edwards R, Duckett JR. Uterus conserving prolapsed surgery-what is the chance of missing a malignancy? Int Urogynecol J 2010;21:819–21.
  • 12. Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol 2010;202:e1–e4.
  • 13. Wan OY, Cheung RY, Chan SS, Chung TK. Risk of malignancy in women who underwent hysterectomy for uterine prolapse. Aust N Z J Obstet Gynaecol 2013;53:190–6.
  • 14. Mutter GL. Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The endometrial collaborative group. Gynecol Oncol 2000;76:287–90.
  • 15. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in post-menopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 2004;24:558–65.
  • 16. Gupta JK, Chien PF, Voit D. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta analysis. Acta Obstet Gynecol Scand 2002; 81: 799-16.
  • 17. Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003;188: 401-8.
  • 18. Wilailak S, Jirapinyo M, Theppisai U. Transvaginal Doppler sonography: is there a role for this modality in the evaluation of women with postmenopausal bleeding? Maturitas 2005; 50: 111-6.
  • 19. Elbiaa AA, Abdelazim IA, Farghali MM, Hussain M, Omu AE. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Prz Menopauzalny 2015;14(3):188-91.
  • 20. Bohoussou E, Adjoussou SA, Letouzey V, Fatton B, de Tayrac R. Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?. J Gynecol Obstet Biol Reprod (Paris) 2014;43:40-5.
  • 21. Min-Jeong Kim, Jİn-Ju Kim, Sun Mie Kim. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci 2016;59(3):192-200.

Evaluation of Preoperative and Postoperative Endometrial/Uterine Histopathology Results in Patients with Uterine Prolapse

Year 2020, Volume: 17 Issue: 1, 266 - 268, 31.03.2020

Abstract

Aim: The aim of the study was to compare the preoperative and postoperative endometrial histopathologic findings and to detect the unexpected malignancies among the asymptomatic women with endometrial thickness below 5 mm, who underwent vaginal hysterectomy for POP.
Material and Methods: A total of forty-eight female patients between January 2010 and December 2016 were included in this retrospective cross-sectional study. Pap Smear and endometrial biopsy were performed to all patients before surgery. Also, the endometrial wall thickness of all patients was evaluated by ultrasonography preoperatively. The histopathological data of 48 vaginal hysterectomy patients operated for pelvic organ prolapse were analyzed.
Results: The preoperative endometrial biopsy results were observed as atrophic endometrium and proliferative endometrium in 70.8% and 29.2% rates, respectively. The postoperative histopathologic results were found as endometrial cystic atrophy, proliferative endometrium and endometrial polyp in 60.4%, 14% and 25% rates, respectively. In addition, leiomyoma and adenomyosis were determined after hysterectomy in 37.5% and 16.7%, respectively.
Conclusion: Our results showed that endometrial sampling is not primarily necessary for asymptomatic uterovaginal prolapse patients if endometrial thickness is less than 5mm. It has been concluded that preoperative evaluation of endometrial thickness by transvaginal ultrasound would be sufficient in patients with these conditions.

References

  • 1. Faraj R, Broome J. Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature. J Med Case Rep 2009;3:99.
  • 2. Detollenaere RJ, den Boon J, Stekelenburg J, Alhafidh AH, Hakvoort RA, Vierhout ME, van Eijndhoven HW. Treatment of uterine prolapse stage 2 or higher: a randomized multicenter trial comparing sacrospinous fixation with vaginal hysterectomy (SAVE U trial). BMC Womens Health 2011;11:4.
  • 3. Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 1972;15:1048-54.
  • 4. Woodman PJ, Swift SE, O’Boyle AL, Valley MT, Bland DR, Kahn MA, Schaffer JI. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:340-5.
  • 5. Grigoriadis T, Valla A, Zacharakis D, Protopapas A, Athanasiou S. Vagina hysterectomy for utero vaginal prolapse: what is the incidence of concurrent gynecological malignancy? Int Urogynecol J. 2015;26:421–5.
  • 6. Litwińska E, Nowak M, Kolasa-Zwierzchowska D, Nowińska-Serwach A, Władziński J, Szpakowski A, Wilczyński, J.R, Stetkiewicz, T. Vaginal hysterectomy vs. laparoscopically assisted vaginal hysterectomy in women with symptomatic uterine leiomyomas: a retrospective study. Prz Menopauzalny 2014;13:242–6.
  • 7. Fialkow MF, Newton KM, Lentz GM, Weiss NS. Life time risk of surgical management or pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:437–40.
  • 8. Lousquy R, Costa P, Delmas V, Haab F. Update on the epidemiology of genital prolapse. Prog Urol 2009;19:907-15.
  • 9. Mingels MJJM, Geels YP, Pijnenborg JMA, van der Wurff AA, van Tilborg AAG, van Ham MAPC, Massuger LFAG, Bulten J. Histopathologic assessment of the entire endometrium in asymptomatic women. Hum Pathol 2013;44:2293-01.
  • 10. Dreisler E, Poulsen LG, Antonsen SL, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Pérez-López FR, Simoncini T, Tremollieres F, Rees M, Ulrich LG. EMAS clinicalguide: Asessment of the endometrium in peri and postmenopausal women. Maturitas 2013;75:181-90.
  • 11. Renganathan A, Edwards R, Duckett JR. Uterus conserving prolapsed surgery-what is the chance of missing a malignancy? Int Urogynecol J 2010;21:819–21.
  • 12. Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol 2010;202:e1–e4.
  • 13. Wan OY, Cheung RY, Chan SS, Chung TK. Risk of malignancy in women who underwent hysterectomy for uterine prolapse. Aust N Z J Obstet Gynaecol 2013;53:190–6.
  • 14. Mutter GL. Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The endometrial collaborative group. Gynecol Oncol 2000;76:287–90.
  • 15. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in post-menopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 2004;24:558–65.
  • 16. Gupta JK, Chien PF, Voit D. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta analysis. Acta Obstet Gynecol Scand 2002; 81: 799-16.
  • 17. Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003;188: 401-8.
  • 18. Wilailak S, Jirapinyo M, Theppisai U. Transvaginal Doppler sonography: is there a role for this modality in the evaluation of women with postmenopausal bleeding? Maturitas 2005; 50: 111-6.
  • 19. Elbiaa AA, Abdelazim IA, Farghali MM, Hussain M, Omu AE. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Prz Menopauzalny 2015;14(3):188-91.
  • 20. Bohoussou E, Adjoussou SA, Letouzey V, Fatton B, de Tayrac R. Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?. J Gynecol Obstet Biol Reprod (Paris) 2014;43:40-5.
  • 21. Min-Jeong Kim, Jİn-Ju Kim, Sun Mie Kim. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci 2016;59(3):192-200.
There are 21 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Sema Baki 0000-0001-5321-0739

Özlem Koşar Can 0000-0001-7101-4838

Burcu Yılmaz 0000-0003-2322-1255

Vehbi Tokgöz

Publication Date March 31, 2020
Submission Date January 2, 2020
Acceptance Date February 21, 2020
Published in Issue Year 2020 Volume: 17 Issue: 1

Cite

Vancouver Baki S, Can ÖK, Yılmaz B, Tokgöz V. Evaluation of Preoperative and Postoperative Endometrial/Uterine Histopathology Results in Patients with Uterine Prolapse. JGON. 2020;17(1):266-8.