Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy?
- 347 Downloads
- 1 Citations
Abstract
Introduction and hypothesis
Vaginal hysterectomy (VH) is a commonly performed procedure for the operative treatment of uterovaginal prolapse (UVP). The reported incidence of unexpected gynecological cancer in cases of VH for UVP ranges between 0.3 and 0.8 %. Aim of the study is to assess the incidence of malignant and premalignant gynecological histopathological findings among women who underwent a VH for UVP and had a normal preoperative workup.
Methods
The histopathology reports of women who underwent VH for the treatment of UVP were retrospectively assessed. All women had a history of normal cervical smear tests and a normal preoperative transvaginal scan. Patients with a history of a premalignant or malignant gynecological pathological condition and women with abnormal uterine bleeding were excluded.
Results
Overall, 14 out of 333 women who underwent VH (4.2 %) were found to have abnormal histopathological findings of the uterus. Among them, there were 9 cases of endometrial hyperplasia of any type (2.7 %), 1 case of cervical cancer (0.3 %), 1 case of cervical intraepithelial neoplasia (CIN) III (0.3 %), and 3 cases of CINI (0.9 %). No cases of endometrial cancer were detected. Among women who underwent salpingo-oophorectomy (n = 86) three simple serous cysts (3.5 %) were found, with no cases of ovarian cancer.
Conclusions
The incidence of unexpected premalignant or malignant gynecological pathological conditions among asymptomatic women who underwent VH, with a history of normal cervical smear tests and normal preoperative TVS, was low but not negligible. This information should be included in the preoperative counseling of women planning to undergo surgery for UVP.
Keywords
Vaginal hysterectomy Uterovaginal prolapse Risk of malignancy Asymptomatic GreekAbbreviations
- AUB
Abnormal uterine bleeding
- BSO
Bilateral salpingo-oophorectomy
- ET
Endometrial thickness
- HGSIL
High=grade squamous intraepithelial lesion
- HRT
Hormone replacement therapy
- LGSIL
Low-grade squamous intraepithelial lesion
- MUS
Midurethral slings
- POP
Pelvic organ prolapse
- PV
Per vaginam
- SERMs
Selective estrogen receptor modulators
- SSF
Sacrospinous fixation
- TVS
Transvaginal scan
- USL
Uterosacral ligament
- UVP
Uterovaginal prolapse
- VALS
Vaginal assisted laparoscopic sacrocolpopexy
- VH
Vaginal hysterectomy
Notes
Conflicts of interest
None.
References
- 1.Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180(2 Part 1):299–305CrossRefPubMedGoogle Scholar
- 2.Grigoriadis T, Athanasiou S, Giannoulis G, Mylona SC, Lourantou D, Antsaklis A (2013) Translation and psychometric evaluation of the Greek short forms of two condition specific quality of life questionnaires for women with pelvic floor disorders: PFDI-20 and PFIQ-7. Int Urogynecol J 24:2131–2144CrossRefPubMedGoogle Scholar
- 3.Renganathan A, Edwards R, Duckett JR (2010) Uterus conserving prolapse surgery–what is the chance of missing a malignancy? Int Urogynecol J 21:819–821CrossRefPubMedGoogle Scholar
- 4.Frick AC, Walters MD, Larkin KS, Barber MD (2010) Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol 202:507PubMedGoogle Scholar
- 5.Wan OY, Cheung RY, Chan SS, Chung TK (2013) Risk of malignancy in women who underwent hysterectomy for uterine prolapse. Aust N Z J Obstet Gynaecol 53:190–196. doi: 10.1111/ajo.12033 CrossRefPubMedGoogle Scholar
- 6.Athanasiou S, Grigoriadis T, Chatzipapas I, Protopapas A, Antsaklis A (2013) The vaginally assisted laparoscopic sacrocolpopexy: a pilot study. Int Urogynecol J 24:839–845CrossRefPubMedGoogle Scholar
- 7.Breijer MC, Peeters JA, Opmeer BC, Clark TJ, Verheijen RH, Mol BW, Timmermans A (2012) Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 40:621–629CrossRefPubMedGoogle Scholar
- 8.Smith-Bindman R, Weiss E, Feldstein V (2004) How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 24:558–565CrossRefPubMedGoogle Scholar
- 9.Mutter GL (2000) Endometrial intraepithelial neoplasia (EIN): will it bring order to chaos? The endometrial collaborative group. Gynecol Oncol 76:287–290CrossRefPubMedGoogle Scholar
- 10.Kurman RJ, Kaminski PF, Norris HJ (1985) The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 56:403–412CrossRefPubMedGoogle Scholar
- 11.Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A et al (2009) Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK collaborative trial of ovarian cancer screening (UKCTOCS). Lancet Oncol 10:327–340CrossRefPubMedGoogle Scholar
- 12.Prat J (2014) FIGO committee on gynecologic oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 124:1–5CrossRefPubMedGoogle Scholar
- 13.Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S et al (2006) Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer 119:1095–1101CrossRefPubMedGoogle Scholar