Correlation Between Histopathological Findings and Clinical Indications in Hysterectomy Cases

Abstract

Hysterectomy is one of the most common gynecological surgeries carried out globally, second only to cesarean section. It is indicated for a wide range of benign and malignant conditions; however, discrepancies often exist between the clinical indications for hysterectomy and the final histopathological findings. This study aimed to assess the correlation between clinical indications and histopathological findings in hysterectomy specimens. A retrospective observational study was conducted over one year at the Obstetrics and Gynecology Department, Al-Bayda Medical Center. A total of 168 female patients aged ≥18 years who underwent hysterectomy for gynecological indications were included. Clinical data, preoperative investigations, and histopathological reports were collected from medical records. Specimens were analyzed using standard histopathological techniques, and findings were compared with preoperative clinical diagnoses. The majority of hysterectomies were performed in women aged 41–50 years (57.1%). Multiparous women constituted the largest group, with 49% having two prior deliveries. Heavy menstrual bleeding was the most frequent presenting symptom (50%). Leiomyoma was the most common clinical diagnosis (52.4%), followed by adenomyosis (12.5%). Histopathological analysis revealed leiomyoma in 31.5% of cases, leiomyoma with adenomyosis in 13.7%, and adenomyosis alone in 10.7%. Malignancies were identified in 10.7% of specimens, including endometrial (7.7%) and cervical carcinoma (3%). A notable discrepancy was observed between clinical and histopathological diagnoses; for example, only 60.2% of clinically suspected leiomyomas were confirmed histologically, and several cases of clinically benign conditions revealed underlying malignancies. The study highlights a considerable gap between clinical diagnoses and histopathological findings in hysterectomy cases. While leiomyomas remain the leading indication, histopathology frequently uncovers additional or alternative pathologies, including malignancies. These findings emphasize the indispensable role of histopathological evaluation in confirming diagnoses, guiding patient management, and preventing misdiagnosis. Strengthening preoperative diagnostic protocols through improved imaging and routine endometrial sampling may reduce discrepancies and optimize treatment decisions