Histopathological Evaluation of Myometrial Lesions of the Uterus in Nnewi Teaching Hospital: (Five‑Year Retrospective Study)

Abstract

Introduction: A 5‑year retrospective study to evaluate the lesions of myometrium (both nonneoplastic and neoplastic) in the hysterectomy
and myomectomy specimens received in our institution.

Aim: This research will serve as a baseline study of different myometrial lesions in the histopathology department of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. This is the first of such a study since the institution of the department. The study will also highlight myometrial lesions in relation to the age and mode of presentations as well as histopathological features.

Methodology: The pathology report forms in the histopathology department NAUTH, Nnewi, were retrieved, and relevant information was extracted. Atotal of 290 cases of myometrial lesions were obtained within the study period, of which 283 cases that fulfilled the inclusion criteria were analyzed. The processed tissues and the slides stained with regular histochemical stain (hematoxylin and eosin) technique in this 5‑year study period were reviewed by the above researchers using multi‑headed microscope (®CARL ZEISS).

Results: The myometrial lesions observed include leiomyoma, leiomyomata, leiomyosarcoma, leiomyoma coexisting with adenomyosis, adenomyosis, invasive carcinosarcoma, and hemorrhagic necrosis following uterine rupture. The age range at the presentation was between 10
and 80 years. The mean age for leiomyoma was 39.24 ± 8.41 standard deviation (SD), whereas the mean age for adenomyosis was 43 ± 9.86 SD.
Leiomyoma was the most common myometrial lesion with a frequency of 93.9% (266 cases) and show degenerative changes in 139 cases (52.%)
Followed by coexisting leiomyoma with adenomyosis which had a frequency of 3.9% (11 cases). Atotal of 184 leiomyoma cases with a frequency
of 69.2% occur in multiple nodules. Adenomyosis alone had a frequency of 3.18% (9 cases). Therefore, the total number of adenomyosis in
this research was 20 cases. Menorrhagia was the most common clinical symptoms with a frequency of 31.4% (82 cases). Leiomyosarcoma
had a frequency of 1.77% (5 cases), whereas the least represented were hemorrhagic necrosis and invasive carcinosarcoma with frequencies
of 2 (0.8%) and 1 (0.4%), respectively.

Conclusion: (1) Leiomyoma is the most common myometrial lesions and tends to coexist in a few cases with adenomyosis while majority of them show degenerative changes. (2) Menorrhagia is the most common presenting symptoms of myometrial lesions while the histologic examination is the only tool to differentiate these myometrial lesions with similar clinical symptoms.

Keywords: Adenomyosis, invasive carcinosarcoma, leiomyoma, leiomyosarcoma, menorrhagia