Clinicohistopathological Correlation in Diagnosis and Incidence of Occult Carcinoma in Hysterectomy Specimens in a University College Hospital in Nigeria

Abstract

Hysterectomy terminates a woman's reproductive life. Its indication should be devoid of misdiagnosis. Our objective is to determine the correlation in clinical and histopathological diagnoses and incidence of occult carcinoma in hysterectomy specimens. This was a ten-year retrospective review of hysterectomies done January 1, 1999 through December 31, 2008 at the University of Benin Teaching Hospital, Benin City, Nigeria. There were 3,965 gynecological surgeries. Hysterectomies were 498 (12.6%), 49.8 per year or 125.6 per 1000 gynecological surgeries. Uterine fibroids (71.6%) and cervical cancer (50.0%) were respectively the commonest benign and malignant conditions.Women with carcinoma were significantly older P<0.000 and had higher parity, P<0.02. Clinico-histopathological diagnoses were 100%- correlated for carcinoma and 99.2% for benign diseases with 0.8% occult cancers (P < 0.03). Many of the patients with occult cancer lost to follow-up. The study highlighted good correlation in clinico-histopathological diagnoses of benign and neoplastic diseases but abnormal cervical cytology and adenomyosis were significant risk-factors for misdiagnosis of occult cancer and uterine fibroids respectively. We advocate pre-hysterectomy cervical screening and endometrial biopsy to reduce the incidence of undiagnosed gynecological malignancies. The use of efficient patient-recall system will enhance patients' follow-up and optimize management. Early diagnosis of ovarian neoplasm may still remain a challenge.

Key words: Hysterectomy, Specimen, Clinico-histopathology, misdiagnoses, Occult-carcinoma